Sensorimotor Psychotherapy Interventions for Trauma and Attachment 9780393706130, 9780393708509

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The Norton Series on Interpersonal Neurobiology Louis Cozolino, PhD, Series Editor Allan N. Schore, PhD, Series Editor (2007–2014) Daniel J. Siegel, MD, Founding Editor The field of mental health is in a tremendously exciting period of growth and conceptual reorganization. Independent findings from a variety of scientific endeavors are converging in an interdisciplinary view of the mind and mental well-being. An interpersonal neurobiology of human development enables us to understand that the structure and function of the mind and brain are shaped by experiences, especially those involving emotional relationships. The Norton Series on Interpersonal Neurobiology provides cutting-edge, multidisciplinary views that further our understanding of the complex neurobiology of the human mind. By drawing on a wide range of traditionally independent fields of research—such as neurobiology, genetics, memory, attachment, complex systems, anthropology, and evolutionary psychology— these texts offer mental health professionals a review and synthesis of scientific findings often inaccessible to clinicians. The books advance our understanding of human experience by finding the unity of knowledge, or consilience, that emerges with the translation of findings from numerous domains of study into a common language and conceptual framework. The series integrates the best of modern science with the healing art of psychotherapy.

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Sensorimotor Psychotherapy INTERVENTIONS FOR TRAUMA AND ATTACHMENT

Pat Ogden Janina Fisher ILLUSTRATORS

Deborah Del Hierro Anthony Del Hierro

W.W. NORTON & COMPANY New York • London A Norton Professional Book

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For Ron Kurtz (1934-2011), best friend and most influential mentor, who dramatically changed the course of my life and my work. Without a doubt, the finest education I ever received was sitting in on psychotherapy sessions with Ron and his clients in the 1970s. In all my experience over the last four decades, I was never again to witness anything comparable to the magic and power of his clinical work. Ron’s pioneering legacy and the funloving, generous, compassionate presence he so fully embodied are with me always. ∼ Pat Ogden

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Contents Introduction SECTION ONE Getting Started CHAPTER 1 CHAPTER 2 CHAPTER 3

Essential Principles Orientation for Therapists Orientation for Clients SECTION TWO

CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER

Basic Concepts and Skills

4 The Wisdom of the Body, Lost and Found 5 The Language of the Body: Procedural Learning 6 Pay Attention: The Orienting Response 7 Mindfulness of the Present Moment 8 Directed Mindfulness and Neuroplasticity 9 The Triune Brain and Information Processing 10 Exploring Body Sensation 11 Neuroception and the Window of Tolerance 12 Three Phases of Therapy SECTION THREE Phase 1: Developing Resources

CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER

13 14 15 16 17 18 19 20

Appreciating Your Strengths: Survival and Creative Resources Taking Inventory: Categories of Resources Somatic Resources Grounding Yourself Core Alignment: Working with Posture Using Your Breath A Somatic Sense of Boundaries Developing Missing Resources SECTION FOUR Phase 2: Addressing Memory

CHAPTER 21 Implicit Memory and Your Resource Repertoire 5

CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER

22 23 24 25 26 27

Reconstructing Memory: Finding Resources in a Painful Past Dual Awareness of Past and Present Sliver of Memory Restoring Empowering Action Recalibrating Your Nervous System: Sensorimotor Sequencing Emotions and Animal Defenses SECTION FIVE Phase 3: Moving Forward

CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER

28 29 30 31 32 33 34 35

The Legacy of Attachment Beliefs and the Body Making Sense of Emotions Moving through the World: How We Walk Boundary Styles in Relationships Connecting with Others: Proximity-Seeking Actions Play, Pleasure, and Positive Emotions Challenging Your Window of Tolerance Afterword Glossary References Index

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Introduction The body’s intelligence is largely an untapped resource in psychotherapy. Few educational programs in clinical psychology or counseling emphasize how to draw on the wisdom of the body to support therapeutic change, leaving therapists mostly dependent on a client’s verbal narrative. Yet the story told by the “somatic narrative”—gesture, posture, prosody, facial expressions, eye gaze, and movement —is arguably more significant than the story told by the words. This nonverbal language reflects and sustains implicit processes shaped in the brain and body even before the acquisition of language. Somatic expressions communicate meanings and expectations that not only influence the manner in which content is explicitly expressed but can also essentially determine the content itself. To omit the body as a target of therapeutic action is, to my way of thinking, an unfortunate oversight that deprives clients of a much-needed avenue of self-knowledge and change. Yet, when Norton asked me to write a workbook to go along with Trauma and the Body: A Sensorimotor Approach to Psychotherapy (Ogden, Minton, & Pain, 2006), I was hesitant. The prospect of publishing such a book, which I initially envisioned as a series of exercises to be performed in solitude, contradicted my firm belief in the relationship between client and therapist as the single most important element in clinical practice. Since our brains and bodies develop and change in a relational context, I was concerned that it would be misleading and irresponsible to suggest that workbook exercises performed in solitude could be efficacious. I also feared that readers would try to adapt their needs and process to a workbook, whereas treatment should always be adapted to the individual. On the other hand, psychoeducation about the role of the body in reflecting and sustaining unresolved trauma, attachment disorders, and other relational difficulties has always been an integral component of my own clinical practice of Sensorimotor Psychotherapy. And, experiential worksheets, often designed in collaboration with my clients to help them reconnect with the body and change their posture and movement, have been essential in reaching therapeutic goals. It seemed a pity not to share these ideas and exercises with others. Gradually a solution came to me. A workbook could be written for therapists and their clients, designed to be explored within the context of the therapeutic relationship. It could be both psychoeducational and experiential, and therapists and clients together could determine the best way to use the material, adapting and 7

adjusting it to the unique needs of each client and the dynamics of the dyad. Suddenly, doors opened, possibilities expanded, and this book was born. In writing it, I am counting on the therapeutic relationship to provide the context through which the role of the body in treating trauma and attachment deficits is explored. It is also essential to understand that this material is in no way intended as a standalone treatment or manualized approach. The selected concepts and interventions from Sensorimotor Psychotherapy introduced in this book, which by no means represent the full spectrum of what Sensorimotor Psychotherapy has to offer, are designed as an adjunct to, and in support of, other methods of treatment. With a primary emphasis on the therapeutic relationship and on adjusting these ideas and interventions to the needs of each client, I expect and hope that including the body in the therapy process will become viable for therapists and their clients. However, it is important to emphasize that this book is not intended to teach the practice of Sensorimotor Psychotherapy or to provide comprehensive instruction in this approach. It is meant to introduce some foundational concepts of this method that clients can explore experientially through worksheets and exercises under the guidance of their therapist. Therapists who wish to learn Sensorimotor Psychotherapy can enroll in the comprehensive trainings in this method that are offered throughout the world by the Sensorimotor Psychotherapy Institute. Although Sensorimotor Psychotherapy incorporates body-oriented interventions common to other somatic psychology approaches, the Sensorimotor Psychotherapy Institute, founded in 1981, has developed its own unique method of somatic psychology theory and practice informed by interpersonal neurobiology, neuroscience, trauma and attachment research. Often referred to as a “bodyoriented talking therapy,” Sensorimotor Psychotherapy blends theory and technique from cognitive, affective, and psychodynamic therapy with straightforward somatic interventions, such as helping clients to become aware of their bodies, to track their bodily sensations, and to implement physical actions that promote empowerment and competency. Within the context of an attachment-focused therapy, Sensorimotor Psychotherapy teaches clinicians to become interested in how the body carries the legacy of trauma and attachment inadequacies and in how to help clients change this legacy through somatic awareness and movement. Therapists and clients alike discover that the natural intelligence of the body can be tapped as a fundamental resource in clinical practice. Clients are taught to observe the relationship between the body, beliefs, and emotions, noticing how a self-representation uttered in a here-and-now therapy moment, such as, “I’m not good enough,” both affects and is reflected in patterns of sensation, posture, gesture, breath, gait, autonomic arousal, and movement. The interventions described herein actively incorporate the body, seeking to change the habits of physical action and posture that keep clients stuck in the past, and to support a more unified approach to treatment. 8

Sensorimotor Psychotherapy: Interventions for Trauma and Attachment explores selected concepts and techniques from Sensorimotor Psychotherapy in a way that traditionally trained therapists will find immediately applicable to their clinical practice. The book will be useful for psychotherapists of a variety of persuasions: psychologists, psychiatrists, social workers, counselors, and marriage and family therapists. Some of the material may also be valuable for psychiatric nurses, occupational therapists, rehabilitation therapists, crisis workers, victim advocates, disaster workers, and body therapists, as well as for graduate students and interns entering the field of mental health. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment begins with a section that presents foundational premises and orients therapists and clients to the book and how to use it. The remainder of the book consists of relatively short chapters, each one designed to educate the reader about a particular topic relevant to clinical work. A glossary of terms is provided at the end of the book. Every chapter is accompanied by a several worksheets that are designed to help clients integrate the material. Each chapter is preceded by a guide for therapists that describes the main purpose of the chapter, identifies which clients might benefit most from it, offers tips for integrating the material into clinical practice, introduces the chapter’s worksheets, and suggests possibilities for adapting these interventions with dissociative clients. Readers are encouraged to familiarize themselves with the contents of this book and select and explore those chapters, interventions, and worksheets that are most useful and appropriate for their profession and with their specific clientele.

SECTION ONE:

Getting Started

The chapters in the first section offer important background information for the topic chapters and worksheets that follow. All three chapters in this section are intended for therapists to read in preparation for utilizing the rest of the book with clients. Chapter 3 is required reading for clients before embarking on the topic chapters. CHAPTER 1, “Essential Principles” provides an overview of the underlying theory that influences the practice of Sensorimotor Psychotherapy. This chapter discusses how physical patterns reflect and sustain trauma and attachment deficits and explores the concepts of attachment, trauma, and dissociation, emphasizing the importance of the therapeutic relationship and therapeutic enactments. It also describes Sensorimotor Psychotherapy’s “embedded relational mindfulness™,” an application of mindful awareness that takes place within the relationship, rather than in solitude (Ogden in pressa). CHAPTER 2, “Orientation for Therapists,” offers general guidelines and tips 9

for how to use the subsequent topic chapters with clients. Several subjects are explored, including the structure of the remainder of the book, psychoeducation, and how to use the worksheets; adapting the material for dissociative clients; and developing a degree of ease with body-oriented interventions. CHAPTER 3, “Orientation for Clients,” is written specifically for clients. It explains why this material should be explored collaboratively under the guidance of a therapist and how to use the subsequent chapters within the context of therapy. It outlines the structure of the book, defines relevant terms, discusses how to make use of the concepts and worksheets, and offers special recommendations to those with dissociative disorders. Therapists should require that clients read this chapter prior to working with the rest of the book.

SECTION TWO:

Basic Concepts and Skills

The first of four sections that comprise topic chapters and experiential worksheets, this section provides an overview of the role of the brain, body, and nervous system in trauma and attachment issues and explores how to begin changing outdated patterns through mindfulness and understanding. The final chapter in this section orients the reader to the structure of the remainder of the book. CHAPTER 4, “Wisdom of the Body, Lost and Found,” discusses why many clients feel disconnected from the body, have developed a negative attitude toward it, or experience body sensations as scary, meaningless, or confusing. This first topic chapter helps make sense of these feelings and viewpoints, and clarifies the innate knowledge held in the body. This foundation of understanding opens up lines of communication for therapist and client to discuss apprehensions about working with the body and inspires appreciation for its wisdom. CHAPTER 5, “The Language of the Body: Procedural Learning,” describes how to translate the language of the body by understanding habits of posture, gesture, and movement as intelligent adaptations to past experiences. It clarifies how these procedurally learned physical habits reflect and sustain outdated survival and coping strategies and underscores the value of changing these patterns to help resolve the negative impact of the past. CHAPTER 6, “Pay Attention: The Orienting Response,” explains the orienting response and the effects of adverse experiences on it. At any given moment, we are inundated with a myriad of sensory stimuli. Which stimuli we automatically attend to, or orient toward, and which we filter out, are, in part, shaped by our trauma and attachment histories. In this chapter clients learn to understand their automatic orienting habits and practice changing them. CHAPTER 7, “Mindfulness of the Present Moment,” teaches mindfulness skills for noticing internal experience, as distinguished from orienting toward external 10

stimuli that was elucidated in the previous chapter. Sensorimotor Psychotherapy’s approach to mindfulness is explained and distinguished from other mindfulness practices. Clients learn to focus on the present moment internal experience of their body sensations, movements, perceptions, emotions, and cognitions, rather than on the past or the future. CHAPTER 8, “Directed Mindfulness and Neuroplasticity,” refines the mindfulness skills learned in the previous chapter by teaching clients to deliberately direct their mindful awareness toward specific selected elements of internal experience. This kind of focused attention is thought to capitalize on the brain’s capacity for neuroplasticity by creating new experiences. CHAPTER 9, “The Triune Brain and Information Processing,” explores the possible effects of experience on the functioning of the three areas that comprise the triune brain (MacLean 1985)—neocortex, mammalian, and reptilian, which roughly correspond to cognitive, emotional, and sensorimotor (or body) processing. Learning about these “brains” can help clients better understand why they think, feel, and act as they do and support integration among these three levels of information processing. CHAPTER 10, “Exploring Body Sensation,” builds on the previous chapter to further distinguish cognitive, emotional, and sensorimotor processing. This chapter teaches clients to become mindful of body sensations that are usually processed automatically, a skill that can facilitate understanding of internal states and promote regulation. Clients will begin to develop a vocabulary to describe physical sensations, as distinguished from vocabulary that describes emotions and thoughts. CHAPTER 11, “Neuroception and the Window of Tolerance,” explains Porges’s concept of “neuroception” as a function of the autonomic nervous system’s capacity to detect environmental features that are safe, dangerous, or life-threatening (cf, Porges). Clients learn how faulty neuroception develops, and how reminders of past threat cause a neuroception of danger even when the current environment is safe. Siegel’s (1999) concept of the window of tolerance, a zone of regulated autonomic arousal in which information can be processed and integrated, is introduced. Dysregulated arousal is described as instinctively activated, rather than as a sign of weakness or deficit. CHAPTER 12, “Three Phases of Therapy,” adapts Janet’s (1898) phaseoriented treatment to provide an overview of the three phases described in this book: Phase 1: Developing resources; Phase 2: Memory: integrating the past; and Phase 3: Attachment and beyond: moving forward. Each phase has its own challenges, goals, interventions, and acquisition of skill. Together, these three phrases provide an overall structure for establishing immediate and long-term therapeutic goals. This chapter also orients the reader to the rest of the book, which is divided according to these three phases.

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SECTION THREE:

Phase 1—Developing Resources

This section spells out how to identify, embody, and make use of a variety of personal resources that often go unappreciated and teaches clients how to develop new resources, particularly somatic ones. CHAPTER 13, “Appreciating Your Strengths: Survival and Creative Resources,” guides clients to acknowledge the strengths that they already possess. Learning to validate these resources is a potent step in this first phase of therapy because doing so can increase self esteem, promote regulation of arousal and challenge perceptions of personal inadequacy. This chapter defines resources, reframes many symptoms, difficulties, and coping strategies as survival resources, and helps clients acknowledge and embody their creative resources. CHAPTER 14, “Taking Inventory: Categories of Resources,” explores a variety of classifications of resources for the purpose of broadening clients’ appreciation of the wide range of resources available to them. Clients learn to recognize internal and external resources in each of the categories that they have already developed and explore ways to embody these resources. CHAPTER 15, “Somatic Resources,” introduces clients to how their own movements and gestures can be sources of stabilization, comfort, and competency. By identifying and practicing the somatic resources they already possess and learning new ones, such as centering and containment, clients build confidence in the role of physical action in supporting well-being and regulating difficult emotions, sensations, and impulses. CHAPTER 16, “Grounding Yourself,” describes grounding as a felt sense of connection to the ground through the foundational support of the legs and feet. This chapter explains grounding as an essential somatic resource that underlies many psychological capacities. It contrasts being ungrounded, which can contribute to feeling unfocused and unsupported, with being overgrounded, which can contribute to feeling stuck and sluggish. Clients learn and practice a variety of somatic resources to support being grounded. CHAPTER 17, “Core Alignment: Working with Posture,” describes the function of the spine and surrounding muscles, highlighting the important role that posture plays in how we feel about ourselves, others, and the world around us. Clients are encouraged to develop a connection to their physical core and practice a more aligned posture, which in turn supports their psychological core and a positive sense of self. CHAPTER 18, “Using Your Breath,” explains the mechanics of breathing, including how breathing patterns can either exacerbate stress and dysregulation or reduce stress and support regulation. Clients discover their own breathing habits, explore how different breathing habits affect arousal and well-being, and identify ways of breathing that are resourcing for them. 12

CHAPTER 19, “A Somatic Sense of Boundaries,” clarifies the importance of a physically felt sense of boundaries. The difference between physical and internal boundaries is defined, and childhood experiences that influence the felt sense of boundaries are explored. Clients learn to mindfully sense the physical indicators of their needs, preferences, opinions, and limits and how to make their words congruent with their body language to communicate clear boundaries. CHAPTER 20, “Developing Missing Resources,” focuses on helping clients identify resources, particularly somatic resources, that are weak, underused, undeveloped, or missing altogether. Building on Chapter 14, “Taking Inventory: Categories of Resources,” it also guides clients to discover and practice new internal and external resources for each category.

SECTION FOUR:

Phase 2: Addressing Memories

Traditional talk therapy models often emphasize the need to create a coherent verbal narrative of the past. In contrast, this section elucidates a bottom-up approach to memory that emphasizes reorganizing the impact of the past on the body rather than formulating a verbal description about what happened. CHAPTER 21, “Implicit Memory and Your Resource Repertoire,” teaches clients about the nature of implicit memory and why neither avoiding memories nor reliving them is the best option. Clients learn to identify their implicit memories and to develop a repertoire of resources that they can call upon as they continue the memory work of this section. CHAPTER 22, “Reconstructing Memory: Finding Resources in a Painful Past,” teaches clients to identify and embody the resources that they used before, during, and after adverse events. Because clients often discover resources they have not remembered before, a new experience and a more positive association to the memory of the event is created. Deliberately focusing on remembering these new elements is thought to alter the way memory is stored in the brain. CHAPTER 23, “Dual Awareness of Past and Present,” describes how dual awareness—the ability to both remain connected to the here and now and simultaneously reexperience a distressing internal state, similar to the one that occurred during the original event—is an essential skill for successfully processing the effects of the past. Instead of detaching from or reliving memories, clients learn dual awareness skills to mindfully explore the impact of state-specific memories on their experience of the present moment. CHAPTER 24, “Sliver of Memory,” describes how to carefully select small moments of memory, and to explore these moments in the context of therapy. Dual awareness is then used to address the effects of recalling these moments on the clients’ internal experience. The impact of remembering a particular sliver of 13

memory should be strong enough that the unintegrated effects of the memory are experienced and processed, but not so intense that clients become unduly dysregulated and cannot integrate what they experience. CHAPTER 25, “Restoring Empowering Action,” explains how faulty neuroception leads to dysregulated animal defenses, and how these defenses can be recognized, processed, and integrated on a body level. Animal defenses are often impervious to both verbal attempts at resolution and to working with their emotional components, but they do respond to body-based interventions. Clients will learn to recognize somatic signs of various animal defenses and practice new, empowering actions. CHAPTER 26, “Recalibrating Your Nervous System: Sensorimotor Sequencing,” directly addresses the strong energies of hyperarousal associated with traumatic memory by teaching clients to put aside trauma-based emotions, thoughts, and content and to focus instead on the body. Clients learn to direct their mindful attention exclusively to the involuntary physical sensations and movements associated with hyperarousal until their arousal returns to the window of tolerance. CHAPTER 27, “Emotions and Animal Defenses,” discusses trauma-related emotions that support the particular function of each animal defense. Clients learn to recognize the signs of these emotions and why expressing them does not typically resolve them. Instead, they can be regulated and completed through physical action and awareness of sensation, approaches taught in the previous two chapters.

SECTION FIVE:

Phase 3: Moving Forward

This final section explores the impact of personal history on current life and relationships, and how this history manifests in procedural patterns, emotional biases, and cognitive distortions. Clients explore new actions to challenge the limiting legacy of the past, expand on the positive elements of their history, increase their capacity for relationships, and widen their windows of tolerance. CHAPTER 28, “Legacy of Attachment,” continues to explore how early caregiving has conditioned clients’ relational capacity. Even “good-enough” parenting leaves a child with needs or desires that go unmet or partially met, imparting a legacy of procedural habits that significantly impacts later relationships. In this chapter, clients learn to recognize the physical patterns that contribute to both dissatisfying and satisfying relationships. CHAPTER 29, “Beliefs and the Body,” addresses basic core beliefs about self, others, and the world that are shaped by early attachment and trauma. Clients learn how their limiting beliefs are both reflected and sustained by physical habits. They practice how to utilize somatic interventions to change these physical habits and update their beliefs, constructing new meanings more fitting to their current reality. 14

CHAPTER 30, “Making Sense of Emotions,” teaches clients how early attachment relationships affect their current emotional biases and how these biases are reflected in the body. Within the context of the therapeutic relationship, clients learn to recognize the attachment-related emotions that keep them stuck in the past and explore reconnecting with and expressing emotions they have disavowed. CHAPTER 31, “Moving through the World: How We Walk,” draws attention to patterns of locomotion so that clients can discover how the way they carry their bodies as they walk affects them. They explore different gaits and the feelings and beliefs that accompany each style of walking. Increasing awareness of their own style of walking and how it pertains to their personal history helps clients choose an intervention to modify the way they walk in a small way to support their therapeutic goals. CHAPTER 32, “Boundary Styles in Relationships,” builds upon Chapter 19, “A Somatic Sense of Boundaries,” to focus on boundary styles in relational contexts. Clients learn about four boundary styles that are formed in the context of attachment, distinguish the somatic and psychological traits of these styles, and discover the physical habits of each one. By assessing their own boundary styles and exploring different ways of setting boundaries with others, clients develop healthier relational boundaries. CHAPTER 33, “Connecting with Others: Proximity-Seeking Actions,” explains how childhood proximity-seeking actions are learned and modified to be used in adult relationships. If proximity-seeking actions are frightening, undeveloped, uncomfortable, or avoided, then initiating contact with others, making friends, and sustaining relationships is impaired. This chapter helps clients discover their habitual proximity-seeking actions and practice those that support satisfying relationships. CHAPTER 34, “Positive Emotions, Pleasure, and Play,” focuses on how to increase the capacity for good feelings and experiences, which are often constrained by a childhood marked by trauma or the disappointments and hurts of attachment. Clients first become aware of physical patterns that hinder their ability to experience emotions, pleasure, and playful states. These good feelings become more accessible as clients explore both high and low arousal, positive emotions, and practice playful movements. CHAPTER 35, “Challenging Your Window of Tolerance,” the final chapter, explores the interplay of human drives for both novelty and safety. Clients learn how to widen their windows of tolerance by experimenting with appropriate risktaking activities that challenge their comfort zone and their current capabilities. They are encouraged to seek new adventures, pursue a greater variety of activities, go beyond their “norm” to deepen relationships, and develop areas of life that they may have neglected. 15

Afternote A book such as this cannot do justice to the unique magic of what goes on between therapist and client in clinical practice. The felt sense of one another that is the essence of all relationships, including author–reader and therapist–client, eludes the confines of verbal description. It is what transpires within the relationship that is at the core of transformation in any psychotherapeutic approach. The profound work of therapy that has to do with expanding affect array, negotiating enactments, and the interactive repair of attachment failures can be alluded to, but cannot be adequately depicted in a practical book like this one. It is also difficult, if not impossible, to fathom the emotional depths of therapy through reading about concepts or interventions. All of this requires right-brain to right-brain communication (cf. Schore, 1994), an ineffable quality of connectedness that is not learned from the written word or technique. Thus, your capacity for empathic attunement, interactive repair, negotiating enactments, and generally being fully “in” the relationship with your client are all essential to carry the work of this book forward in a way that honors and responds to the inimitable magic of what goes on between the two of you. What this book can provide is a selection of concepts, interventions, and worksheets that can help you create a deeper level of embodied connectedness with your clients so that change can take place more easily in the hidden recesses of the self. And since those recesses are not accessible to purely verbal work, because they exist below and beside cognitive awareness or linguistic formulation, interventions that work directly with the body can greatly enhance your effectiveness as a therapist. The intimacy of your journey with your client will be heightened by thoughtful attention not only to the verbal exchange, but also to what is being spoken beneath the words, through the body.

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SECTION ONE

Getting Started

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CHAPTER 1

Essential Principles The body speaks clearly to those who know how to listen. Nonverbal expressions visibly reveal what words cannot describe: the “speechless terror” (van der Kolk, 1996, p. 517) of trauma and the legacy of early or forgotten dynamics with attachment figures. The multifaceted language of the body depicts a lifetime of joys, sorrows, and challenges, revealed in patterns of tension, movement, gesture, posture, breath, rhythm, prosody, facial expression, sensation, physiological arousal, gait, and other action sequences. The implicit, automatic physical habits that developed in a context of trauma and attachment inadequacy, can constrain our capacity to make new meaning and respond flexibly to the here and now, often turning the future into a version of the past. Schore (2011) asserts that it is the brain’s right hemisphere, responsible for implicit emotional and body processing, that dominates human behavior. Since explicit verbal language cannot fully describe these implicit processes, it follows that a therapist’s exclusive reliance on the “talking cure” might limit clinical efficacy. A “paradigm shift” is indicated in psychotherapy (and is taking place in many schools of thought) that takes into account the dominance of nonverbal, bodybased, implicit processes over verbal, linguistic, explicit processes (Kurtz, 1990; Ogden, Minton, & Pain, 2006; van der Kolk, 2006; Schore & Schore, 2008; Schore, 2011). Therapeutic action is conceptualized not only as interpreting and attending to the client’s narrative and emotions but also as participating in and attending to the communications that occur beneath the words in a body-to-body tête-à-tête. The purpose of this book is to elucidate the language of the body, per se, as a vehicle for understanding human behavior and as a target of therapeutic action. This chapter provides an overview of underlying foundational concepts and perspectives for the reader to keep in mind as we begin this journey together.

Meaning-Making, Prediction, and Action Every waking moment, our brains and bodies assimilate a myriad of sensory stimulation from the environment, as well as images, thoughts, emotions, body sensations, and movements from our internal state. In a millisecond, through 18

operations so complex that they elude the full understanding of even the most brilliant minds, our brains compare this wealth of current data to memories of past experience. The most critical purpose of this comparison is to predict the next moment with sufficient accuracy so that we can make an adaptive physical action (Llinas, 2001). What we expect to happen in the very next instant determines the immediate action we make, whether it is reaching out to another person or for an object, such as a cup of tea. Our predictions of what will happen next are predicated upon the sense we make of what is occurring in the present. Making meaning and predicting the immediate future of a relational interaction begin long before the acquisition of language and are evident in the behavior of infants. Beebe (2006) asserts: Early interaction patterns are represented pre-symbolically, through the procedural organization of action sequences. Predictability and expectancy is a key organizing principle of the infant’s brain. Infants form expectancies of how . . . interactions go whether they are positive or negative, and these expectancies set a trajectory for development (which can nevertheless transform). (p. 160)

These trajectories are evident in Tronick’s (2007) Still Face experiments, in which a mother is instructed to play with her infant, but then, on cue, to stop responding. When her lack of response continues past a few moments, “the infants disengage, look away, become sad and engage in self-organized regulatory behaviors such as thumb sucking to maintain their coherence and complexity and to avoid dissipation of . . . their state of consciousness. . . . There is meaning and certitude made by and expressed in his or her posture, actions and affects” (Tronick, 2006, pp. 16–17). Sometimes in the Still Face experiment, the infant desperately seeks proximity with eyes, arms, vocalizations, and even the whole body, only to cease such actions, falling silent and slumping in the highchair, when the mother does not respond. One of the films shows an infant pulling his mother’s hair, eliciting a fleeting expressing of anger from her. The infant responds by lifting his arms in front of his face in a gesture that appears protective, apparently interpreting the mother’s angry expression as threatening. The mother’s anger is momentary, and she swiftly seeks to repair the rupture in their connection, making every effort to reengage and play with her infant. Eventually he lowers his arms, relaxes his body, and smiles—his body now reflecting a different meaning. However, negative interactions or nonresponsiveness recur frequently, without adequate repair, the infants’ reciprocal actions and postures gradually become persistent procedural tendencies that continue long after environmental conditions have changed, restricting future meaning-making, expectations and predictions. Early experiences are remembered “as a series of unconscious expectations” (Cortina & Liotti, 2007, p. 205). These expectations are all the more potent and influential precisely because the experiences that shaped them are not available for reflection and revision. When we do not remember what happened, the memories remain unchanged yet continue to shape subsymbolic processes that “operate in 19

sensory, motoric and somatic systems, as sounds, smells, feelings of many different sorts” (Bucci, 2011, p. 210). These processes influence not only the developing brain and the way in which movements are executed, but also the structure of the body itself. Form is determined by function; repeated executions of particular movements, such as hunching the shoulders in fear, shape the body’s structure over time. In 1937, Todd observed, “For every thought supported by feeling, there is a muscle change . . . man’s whole body records his emotional thinking” (p. 1). Engrained physical habits of posture, gesture, expression, and gait can be thought of as “statement[s] of . . . psychobiological history” (Smith, 1985, p. 70), as windows into our past. The overarching purpose of making meaning and predicting the future is to assure that the immediate actions we make will preserve our survival. But “surviving” is not the same as “living.” Bromberg (2011) clarifies: Through their anticipatory protective system, people are able to more or less survive. But many are also more or less unable to live because full involvement in ongoing life is drained of meaning by the affective residue of developmental trauma that in adulthood serves as a perpetual reminder that stability of self cannot be taken for granted and requires that life be managed with vigilance rather than lived with spontaneity. (p. 276)

People come to therapy because they want to move beyond surviving, but to do so, the restrictive predictions that are rooted in the past must be revised to fit current reality. This endeavor is a complicated, constantly fluctuating process involving a host of intricate operations, including physical action sequences, that participate in making predictions. The body’s language itself is richly nuanced, mysterious, and multifaceted. It interfaces with a multitude of systems that together comprise the complex momentto-moment process of making meaning and forecasting the future. Tronick (2009) states: “Meanings include anything from the linguistic, symbolic, abstract realms, which we easily think of as forms of meaning, to the bodily, physiologic, behavioral and emotional structures and processes, which we find more difficult to conceptualize as forms, acts, or actualizations of meaning” (p. 88). The body and how it makes meaning is one piece of the puzzle. Because therapy is largely “dependent upon pre-linguistic forms of communication and intersubjectivity,” (Beebe, 2014, p. 29), exploring the body can enrich and inspire your clinical practice. But keep in mind that the nonverbal indicators continually interface with numerous other forms of meaning-making and prediction, implicit and explicit, dyadic and individual, in a complicated intertwining that remains somewhat of a mystery. Nevertheless, illuminating clues that shed a bit of light on this mystery can be found in the enduring physical patterns that reflect one’s history of trauma and attachment.

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Trauma, Attachment, and the Body The movement, posture, and physiology of the body adapt automatically, without our conscious intent, to assure survival and maximize available resources. When a child’s attachment figures are “good enough” (Winecott, 1958), meaning-making, predictions, and action sequences “remain to some extent fluid and flexible throughout life; the nature of the consequences that are anticipated for a given action will change as the context of interaction changes and with development of the individual’s powers” (Bucci, 2011, p. 6). Thus, as our brains compare current information with past data, there is the possibility of an “upgrading” (Llinas, 2001, p. 38) of meaning and of expectations of the immediate future. However, schemas become more and more rigid in increasingly less functional environments, impeding new learning (Bucci, 2011). The legacy of trauma and attachment inadequacies, with their consequential neuropsychological deficits, constrains new meanings and obstructs upgrading the forecast. Brains are conservative in taking the risk that certain actions might be “safe” or gratifying when they were once “dangerous” or elicited a negative response from others. The lack of upgrading, of course, serves survival functions (better to mistake a stick for a snake than a snake for a stick) but can also thwart adaptive action in favor of what has worked in past circumstances. Forecasts that have become fixed and certain actions that have become limited begin to reinforce each other. For example, if proximity-seeking behaviors such as reaching out and making eye contact were consistently responded to in a misattuned or negative manner, we will eventually begin to predict that there will be unpleasant consequences if we seek proximity. Then, we may literally stop reaching out to others and avoid making eye contact. In turn, others may not notice our desire to connect and thus fail to respond in an attuned manner, confirming our predictions. If standing upright with our heads held high brought unwanted attention, abuse, or shame, we learn to slump or keep our heads down in a nonassertive posture. Such a posture in and of itself reflects and sustains the early learning, restricting upgrading of meanings and predictions. Physical actions such as these continue long after circumstances have changed, even when they are ill-suited for current situations and relationships. The predictions that shaped these actions are not challenged, or if they are, the physical habits that reflect and sustain the out-dated predictions often inhibit their full transformation. Such actions, along with their meanings and predictions, stem from trauma or attachment inadequacies and failures, or a combination of the two. Although the legacies of trauma and attachment are inextricably entwined, they can be distinguished in their etiology and for the purpose of clinical understanding (Ogden, 2009). Unresolved trauma can be conceptualized as deriving from overwhelming experiences that cannot be integrated. Trauma inevitably elicits instinctive survival 21

mechanisms of hyper- or hypoarousal and subcortical animal defenses. Attachment issues arise from experiences with others, especially early attachment figures (the person[s] who looked after us as children, to whom we were emotionally bonded) that cause emotional distress but do not evoke extreme autonomic dysregulation. Relational trauma involves interactions with others that are experienced as threatening and do stimulate dysregulated arousal and animal defense. Although trauma and attachment experiences are interconnected and cannot be teased apart in actuality, recognizing the primary indicators of each helps clinicians prioritize their interventions. These clinical choices become paramount in an integrative therapy approach.

The Legacy of Attachment The “social engagement system,” mediated by the ventral parasympathetic branch of the vagus nerve, fosters interaction with the environment (Porges, 1995, 2001, 2004, 2005, 2008, 2009, 2011). This system does not depend on the peripheral movement of the arms and legs, but on the regulation of the muscles of the face and head, through neural pathways that link the brain stem with the cortex (Porges, 2011). It is available to the full-term infant whose ability to engage relies on facial expressions, sounds, gaze, and the like, rather than on gross motor movement. Underpinning attachment, the social engagement system is evident as a baby vocalizes, cries, grimaces, smiles, gazes, or coos—all behaviors that promote interactions with the others (Porges, 2004, 2005). This system effectively provides a great degree of flexibility in relational communication. Porges (2005) clarifies: The social engagement system has a control component in the cortex (i.e., upper motor neurons) that regulates brainstem nuclei (i.e., lower motor neurons) to control eyelid opening (e.g., looking) facial muscles (e.g., emotional expression), middle ear muscles (e.g., extracting human voice from background noise), muscle of mastication (e.g., ingestion), laryngeal and pharyngeal muscles (e.g., prosody), and head tilting and turning muscles (e.g., social gesture and orientation). (p. 35)

This neural regulation of facial muscles and vocalization serves to increase proximity with caregivers, securing the survival and well-being of the infant. The social engagement system is further developed throughout childhood in face-toface, brain-to-brain, body-to-body nonverbal communications with others who effectively regulate the child’s autonomic and emotional arousal. With sufficient care, children acquire generally positive expectations of interactions with others and become increasingly effective at nonverbal signaling, engaging, and responding to others (Brazelton, 1989; Schore, 1994; Siegel, 1999; Stern, 1985; Tronick, 2007). Porges (2004, 2011) coined the word neuroception to describe a neural process, outside the realm of awareness, that is neurobiologically programmed to 22

detect features in the environment, including behavioral cues from others, that indicate degrees of safety, danger, and threat. This term is distinguished from perception, which requires cognitive awareness of input from sensory systems. When safety is neurocepted, the social engagement system is strengthened. Social behavior requires the inhibition of the areas of the brain that organize defensive strategies, and such inhibition is appropriate only in contexts that are safe (Porges, 2011). All human beings require enough safety in the growing-up years to develop an effective social engagement system in order to build attachment and affiliative relationships (Porges, 2004, 2005, 2009, 2011). Attachment formation and social engagement build upon one another. Socially engaged interactions of attunement and mutual pleasure strengthen attachment bonds and future capacity for affiliation (Porges, 2004, 2005, 2009, 2011), and a secure attachment with sufficient interactive repair develops a healthy social engagement system. In the context of secure attachment, the child attains a greater capacity for autoregulation, even in early childhood (Schore, 1994), and develops a social engagement system that effectively facilitates interactive regulation and proximityseeking behavior. The neuroception of safety is reflected both in the inhibition of defense systems and in activation of behavior flexibility that enables adaptive contact with others: reaching out, grasping, eye contact, holding on, letting go, pulling toward, and pushing away. This early learning in the context of attachment facilitates not only relational capacities (Schore, 1994; 2006; Fosha, Siegel, & Solomon, 2009), including action sequences such as reaching out for help or for contact with others, but also autoregulatory strategies supported by the body, such as grounding, full breathing, or an aligned posture (Ogden et al., 2006). Childhood attachment patterns—secure, insecure-avoidant, insecureambivalent, and disorganized-disoriented—are characterized by certain kinds of difficulties that are reflected and sustained by particular action sequences (Ainsworth, Belbar, Waters, & Wall, 1978). It is important to note that even securely attached clients come to therapy with troubles rooted in mildly unsatisfactory (in comparison with insecure attachment) experiences such as inadequate attention from parents who were “too busy,” slightly harsh, somewhat inconsistent, insensitive, or fault-finding, or whose acceptance and approval was predicated on performance, such as earning top grades in school. These dynamics might have caused a degree of emotional distress, but were not so severe as to result in an insecure attachment. Imperfect yet still secure attachment fosters “affective competence,” which includes “being able to feel and process emotions for optimal functioning while maintaining the integrity of self and the safetyproviding relationship” (Fosha, 2000, p. 42). Nevertheless, even in the best of families in which attachment figures have provided good-enough regulation and interactive repair, certain emotional responses and somatic patterns are favored over others. 23

All children will instinctively adjust their inner needs and behavioral responses to parental demands and preferences, learning early on what is expected in relationships. Parental expectations inevitably leave a young child with two (nonconscious) choices: One, to remain “safe” and win approval of attachment figures by meeting their expectations, or two, risk “danger” in the form of ejection, criticism, disappointment, or worse by failing to meet expectations (Porges, personal communication, September 13, 2013). When possible, living up to expectations would be the best choice because doing so usually reduces the presence and frequency of the behavioral features in the attachment figure that cause children to instinctively neurocept danger. Thus survival, security, and social engagement are preserved when meeting parental expectations allows the child to neurocept safety. The body will both reflect and sustain efforts to meet the expectations of attachment figures. For example, a client whose parents preferred compliance over assertion, might abandon standing proudly upright with a straightforward gaze into the eyes of another for a slightly slumped posture and more hesitant gaze. She was willing to acquiesce in order to “stay safe,” that is, not rejected, in her family. In turn, the slumped posture helped her maintain a compliant attitude, which would not be supported by an erect, proud posture. On the other hand, a client who was expected to perform well and be assertive and stoic unconsciously lifted her chin and stood tall with her shoulders back in efforts to fulfill these expectations. Her emotions were biased toward frustration and anger as a way to “fit into” and thus stay safe in her particular family, leaving more vulnerable emotions such as sadness, hurt, and disappointment unacknowledged and unresolved. These physical and emotional patterns limit the range of affect and behavior, but do not necessarily indicate insecure attachment histories. Clients with insecure–avoidant attachment histories characteristically shun situations and relationships that stimulate attachment needs. Simple proximityseeking actions, such as reaching out or making eye contact, may feel uncomfortable, awkward, or even dysregulating. Distancing actions, such as pushing-away motions or avoiding eye contact, may feel more comfortable (Ogden et al., 2006). Most clients who have developed avoidant or distancing patterns have low overall autonomic arousal levels and depend upon autoregulation (Cozolinno, 2002; Schore, 2003a) to self-regulate, typically finding it easier to withdraw under stress than to take action that would promote interactions with others (Cozolino, 2002). Emotional expression tends to be minimal (Cassidy & Shaver, 1999); overregulation reduces the experience of both positive and negative affects. Such clients usually find it difficult to shift out of low arousal states and modulate high arousal (Schore, 2003a). In contrast, those with insecure–ambivalent histories are inclined to maximize attachment needs, fear abandonment, and sustain higher overall arousal. 24

Preoccupied with the availability of attachment figures, these individuals tend toward enmeshment, clinging behavior, and increased affective and bodily agitation at the threat of separation from attachment figures, including the therapist. Usually quite comfortable with proximity-seeking actions, such clients desire closeness and may find it more difficult to tolerate distance in relationships. Pushing-away and letting-go actions are less comfortable than clinging, grasping, and reaching-out actions. People with insecure–ambivalent attachment histories tend to have a sympathetically dominant nervous system (Cozolino, 2002; Schore, 2003a) with a low threshold of arousal and concurrent difficulty maintaining arousal within a window of tolerance.

The Legacy of Trauma When caregivers consistently fail to ensure a child’s safety and protection, arousal fluctuates in extremes of hyperarousal to hypoarousal, and the social engagement system is unable to function optimally. The child’s ability to regulate arousal and communicate via eye contact, facial expression, and verbalization, or to respond affably to overtures from others, fails to develop adequately. Traumatized clients typically have a compromised social engagement system and thus cannot accurately neurocept safety even in nonthreatening environments (Sahar, Shalev, & Porges, 2001). Many traumatized clients have developed “faulty” neuroception—that is, “an inability to detect accurately whether the environment is safe or another person is trustworthy” (Porges, 2011, p. 17). Animal defensive systems are instinctively catalyzed under dangerous or lifethreatening conditions of all kinds. Under threat, the sympathetic nervous system releases adrenaline to stimulate the heart to pump harder, to increase respiration and provide muscles with the oxygen and energy needed to fuel the animal defenses. All the senses become hyperalert. An infant’s first instinct is to cry out, called the “separation cry” (Panksepp, 1998; van der Kolk, 1987). “attachment cry” (Steele, van der Hart, & Nijenhuis 2005), or simply “cry-for-help,” designed to secure the nearness of attachment figures for help and protection. A freeze defense, described as “alert immobility” (Misslin 2008, p. 58) is characterized by high arousal coupled with a complete cessation of movement except for respiration and movement of the eyes. Additional animal defenses that mobilize the body to flee or fight become available as the infant’s motor capacities mature, But when no one else is available to help, when fighting back or running away is impossible or would only make the trauma worse, the body becomes numb, collapsed, and immobilized, enabled by the dorsal vagal branch of the parasympathetic nervous system that supports the defense of feigning death or shutdown. When the attachment figure is also a threat to the child, two systems with 25

conflicting goals are activated simultaneously or sequentially: the attachment system, whose goal is to seek proximity, and the defense systems, whose goal is to protect. In these contexts, the social engagement system is profoundly compromised and its development interrupted by threatening conditions. This intolerable conflict between the need for attachment and the need for defense with the same caregiver results in the disorganized–disoriented attachment pattern (Main & Solomon, 1986). A contradictory set of behaviors ensues to support the different goals of the animal defense systems and of the attachment system (Lyons-Ruth & Jacobvitz, 1999; Main & Morgan, 1996; Steele, van der Hart, & Nijenhuis, 2001; van der Hart, Nijenhuis, & Steele, 2006). When the attachment system is stimulated by hunger, discomfort, or threat, the child instinctively seeks proximity to attachment figures. But during proximity with a person who is threatening, the defensive subsystems of flight, fight, freeze, or feigned death/shut down behaviors are mobilized. The cry for help is truncated because the person whom the child would turn to is the threat. Children who suffer attachment trauma fall into the dissociative–disorganized category and are generally unable to effectively auto- or interactively regulate, having experienced extremes of low arousal (as in neglect) and high arousal (as in abuse) that tend to endure over time (Schore, 2009b). In the context of chronic danger, patterns of high sympathetic dominance are apt to become established, along with elevated heart rate, higher cortisol levels, and easily activated alarm responses. Children must be hypervigilantly prepared and on guard to avoid danger yet primed to quickly activate a dorsal vagal feigned death state in the face of inescapable threat. In the context of neglect, instead of increased sympathetic nervous system tone, increased dorsal vagal tone, decreased heart rate, and shutdown (Schore, 2001a) may become chronic, reflecting both the lack of stimulation in the environment and the need to be unobtrusive. These initially adaptive responses to immediate danger turn into inflexible and pervasive procedural tendencies when trauma is unresolved. Once these actions have been procedurally encoded, individuals are left with regulatory deficits and “suffer both from generalized hyperarousal [and hypoarousal] and from physiological emergency reactions to specific reminders” (van der Kolk, 1994, p. 254). Traumatized clients often experience rapid, dramatic, exhausting, and confusing shifts of intense emotional states, from dysregulated fear, anger, or even elation, to despair, helplessness, shame, or flat affect. They may continue to feel frozen, numb, tense, or constantly ready to fight or flee. They may be hyperalert, overly sensitive to sounds or movements and easily startled by unfamiliar stimuli. Or they may underreact to stimuli, feel distant from their experience and their bodies, or even feel dead inside. From both traumatic and nontraumatic interactions with attachment figures, children form internal working models (Bowlby, 1969/1982, 1973, 1988), 26

comprising representations of self, other, and relationships. Helping them understand the environment and predict the potential results of their actions, working models are encoded in procedural memory and become nonconscious strategies of affect regulation (Schore, 1994) and relational interaction. Far from being static, these models, with their inherent meanings, forecasts, and physical patterns, are affected by every subsequent experience in an ongoing spiral of development. Whether shaped by trauma, attachment, or both, working models and their procedural patterns of behavior reflect the adaptability of brain and body. Habitual postures, expressions, movements, and autonomic responses to the environment echo predictions about what is to come based on the repeated experiences of the past. Decades after the events, clients exhibit physical patterns that reflect and sustain their histories. These patterns have become default behaviors over other actions that would be more adaptive in current contexts.

Dissociation and the Complexity of the Self Whether secure, insecure, or traumatic, early attachment dynamics are the beginning templates for children’s developing cognition, affect array, regulatory ability, and physical patterns (the way they move, hold the body, and engage particular gestures, postures, facial expressions, and so forth). Attachment is complicated. Children can develop different kinds of attachments to different people, and their working models of others and themselves can be complex and contradictory, even with the same person. Bowlby (1969/1982) asserts: It is not uncommon for an individual to operate, simultaneously, with two (or more) working models of his attachment figure(s) and two (or more) working models of himself. When multiple models of a single figure are operative, they are likely to differ in regard to their origin, their dominance, and the extent to which the subject is aware of them. (p. 205)

Thus, the self is not a fixed “thing” but an emergent, associative process “arising out of a hard-wired disposition to relate to another” (Wilkinson, 2006, p. 155). Different self-states or “parts” may hold different working models with relatively fixed meaning-making and conflicting expectations of the future that are not integrated. The gamut of childhood circumstances—from secure attachment to disorganized–disoriented attachment to severe, prolonged attachment trauma (which also includes disorganized–disoriented attachment)—engenders different degrees of integrative failure, conceptualized as occurring on a continuum. Mild differences in self-states that everyone experiences are at one end. Integrative failure increases along the continuum, with trauma-related dissociation existing more toward the other end. Profound integrative failure is at the most extreme, manifesting as two or more dissociative parts, each with its own sense of self, often involving amnesia or lack of awareness for some emotions, thoughts, actions, and 27

memories. As Wilkinson (2006) asserts, to understand the parts of the self that have experienced relational trauma “the key will be stored in the implicit, emotional, amygdaloidal memory of the right hemisphere, known only through ways of being, feeling, and behaving” (p. 158). Although the differences that occur along this continuum are not fully understood, this section attempts to elucidate how self-states occur even in the most secure environments and differentiate them from trauma-related dissociative parts, recognizing that the boundaries between the two are indistinct. Bromberg’s (2011) work is a good starting point because he describes how all attachment figures, due to their own histories and human imperfections, engender self-states in their children: A person’s core self—the self that is shaped by early attachment patterns—is defined by who the parental object both perceives him to be and denies him to be. That is, through relating to their child as though he is “such and such” and ignoring other aspects of him as if they don’t exist, the parents “disconfirm” the relational existence of those aspects of the child’s self that they perceptually dissociate. . . . The main point is that “disconfirmation” . . . is relationally nonnegotiable. (p. 57)

That is, the failure of parents to recognize aspects of their children results in children’s own disconfirmation of those very same aspects that attachment figures discounted. Consequently, children form two (or more) working models of a single attachment figure, one relating to the confirmation of certain aspects of themselves and another relating to the disconfirmation of other aspects. They also form two or more working models of themselves. Keep in mind that this disconfirmation is not a conscious, thought-out process but implicitly lived through patterns of thought, movement, meaning-making, and expectation. Each part of the self “holds a relatively non-negotiable affective “truth” that is supported by its self-selected array of “evidence” designed to bolster its own insulated version of reality” (Bromberg, 2012, p. 15). The part that is disconfirmed becomes a “not-me” selfstate, because its truth, history, and working models are incompatible with those of the individual and his or her self-identity. This disconfirmation itself occurs on a continuum from mild to severe. All parents, due to human frailty and the legacy of their own unresolved past, disconfirm aspects of their children, often unwittingly. Most parents, if they knew they were doing so and understood the negative effects it might have on their children, would probably attempt to change their behavior. For example, a young man who seemed to have had a very secure attachment history told that “it was expected” that he be a high school football star, following in his father’s and grandfather’s footsteps. The part of him that wanted to be a dancer remained disconfirmed until, as an adult, he decided to take hip-hop lessons. When he finally told his parents of his love of dance, they told him they would have been happy to send him to dance classes “if we had only known.” However, in traumatogenic environments, disconfirmation is profound. One client, severely abused, 28

experienced a profound disconfirmation not only of her physical and emotional needs but also of her self, resulting in working models of herself as “bad” and her father as “dangerous.” At the same time, because her father had at times comforted her when she was hurt, another part of her formed a working model of him as supportive. Years later, our adult clients struggle to reconcile their various self-states, often without understanding the origin or nature of their internal conflicts. For example, a client might identify as a confident, independent adult and reject (as her parent[s] did) a needy self-state in which she yearns to be taken care of. Typically, these selfstates do not communicate well with one another, each holding contradictory working models of the self and of others. As Bromberg (2012) confirms, “The felt otherness between one’s own states becomes an alien ‘thing’ to be managed because it can no longer be contained as negotiable internal conflict that is mediated by self-other wholeness” (p. 274). Clients thus are often unable to hold the differing “truths” of different self-states in their minds at the same time, so needs may remain unacknowledged or be overridden. Eventually, because no part of the self will completely disappear, the part of the self that has been disconfirmed will find a voice in ways that may be indirect, demanding, confusing, painful or harmful. Nontraumatized, securely attached clients dealing with attachment issues will experience self-states that are less sequestered and have permeable boundaries, but are in a degree of conflict nevertheless. A creative, spontaneous self-state that wants to play and have fun may struggle against a structured, nose-to-thegrindstone, ambitious self-state; parts of the client focused on pleasing others may clash with parts that want to do what the client pleases. These struggles tend to be organized around conflict between the familiarity of habitual relational knowing and self-knowing versus more adaptive or creative ways of being in relationship and in the world. Trauma-related dissociation is markedly different, both experientially and neurobiologically, from the internal conflicts between parts of the self that hold different working models in nontraumatized clients. For traumatized individuals, the inability to hold these different self-states in mind simultaneously is much more profound. On a neurobiological level trauma-related dissociation is based on simultaneous activation of both defense and attachment drives, as discussed in the previous section, “The Legacy of Trauma.” It can be further conceptualized as an integrative failure of neurobiologically organized responses to threat reflecting two general types of psychobiological systems: the animal defense systems stimulated by danger and life threat, and the daily life systems stimulated by nonthreatening environmental demands (van der Hart et al., 2006, Ogden et al., 2006). These systems are called action systems because when one of them is aroused, particular 29

phsyical actions—along with thoughts and emotions—are galvanized to meet the goals of that system. Disorganized–disoriented attachment, strongly correlated with ongoing dissociation (Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997), is often described as the arousal of two different systems. To review: The animal defenses—subcortical survival instincts that organize around the neuroception of danger and life threat—include the cry for help, designed to elicit help and protection; mobilizing defenses of fight or flight that organize overt action; and immobilizing defenses of freeze and feigned death that engender a lack of physical action. The daily life systems, on the other hand, comprise several subsystems that require a degree of safety, and thus the social engagement system to fulfill their goals. These systems stimulate us to form close attachment relationships, explore, play, participate in social relationships, regulate energy, reproduce, and care for others (Bowlby, 1969/1982; Cassidy & Shaver, 1999; Fanselow & Lester, 1988; Lichtenberg, 1990; Lichtenberg & Kindler, 1994; Marvin & Britner, 1999; Ogden et al., 2006; Panksepp, 1998; van der Hart et al., 2006). The goals of the defensive system—to defend and protect—conflict with the goals of daily life systems—to engage with other people and the environment. Each category of system stimulates contradictory neurobiological states, including contradictory emotions, thoughts, physical actions, and senses of self. Responding to the arousal of daily life systems—such as the needs of one’s children, the demands of work, or the sexual needs of one’s partner—requires neurocepting safety and keeping the emotions, thoughts, and defensive responses associated with past trauma at bay. The internal experience of traumatized individuals affected by conflicts between these two systems of defense and of daily life is often confusing and sometimes overwhelming. When trying to carry on with daily life priorities, these individuals may be unable to inhibit defensive subsystems in safe environments. Continuing to neurocept danger, they often experience intrusive fears and phobias, waves of shame and despair, impulses to desperately seek help, fight, flee, freeze, or shut down, that sabotage their efforts to function. To the extent that these alternations between daily life and animal defensive action systems are repetitive and persistent, clients will experience ongoing failure of integration and increased compartmentalization. As Steele, van der Hart, and Nijenhuis (2005) state: [The] action systems of daily life and those of defense . . . naturally tend to mutually inhibit each other. For example, one does not stay focused on cleaning the house or reading when imminent danger is perceived; instead one becomes hypervigilant and prepares for defense. Then, when danger has passed, one should naturally return to normal activities rather than continuing to be in a defensive mode. Integration between these two types of action systems will more likely fail during or following traumatic stress. (p. 17)

The phrase “part of the self” is used as a metaphor to describe the failure of systems to integrate in such a way that an individual has more than one sense of self 30

with accompanying thoughts, emotions, physical tendencies, and behaviors. These parts can act in parallel with the client or can act outside the client’s awareness, resulting in amnesia (Steele, van der Hart, & Nijenhuis, 2004). Bowlby (1973) states: The behaviour to which the activation of one behavioural system leads may be highly compatible with the behaviour to which activation of another system leads; or it may be highly incompatible with it; or some parts of one maybe compatible with some parts of the other, whilst other parts of each are incompatible with each other. (p. 97)

One or more action system mediates each dissociative part, and each part engages in thoughts, emotions, and actions to meet the goals of that system that may be outside the control or awareness of other parts. In trauma-related dissociation, each has its own first-person perspective, or its own sense of self, which is different from the other part(s) (Nijenhuis & van der Hart, 2011). The person does not have different selves, but rather the parts have different senses of self that exist within the whole (Steele & van der Hart, 2013). These parts are not completely separated or split—a common misconception. Dissociative systems are complex with various parts having at least some permeable boundaries with overlapping basic functions and goals of which the client may or may not be aware. No matter whether parts emerge from one end of the continuum (nontraumatic situations of relatively mild disconfirmation of aspects of the self) or from the other end (severe, prolonged abuse by attachment figures and profound disconfirmation), a sense of “not me” is experienced. At the former end of the continuum, the selfstates usually tend to be more ego-syntonic. However, with traumatic dissociation, jarring intrusions of not-me parts occur, sometimes along with lapses in awareness of what happens when other parts are active. It appears that trauma-related dissociation can be distinguished from the self-states that occur in nontraumatogenic environments by the following: the presence of disorganized– disoriented attachment; the presence of dissociative symptoms (especially those implying activity of parts, such as hearing voices, amnesia for behaviors in the present, and so forth); and a first-person sense of self in the dissociative parts, even if rudimentary (Kathy Steele, personal communication, June 17, 2013). Without understanding trauma-related dissociation, therapists might perceive the client to be ambivalent, resistant, chronically relapsing, or identified with a “false self,” (Winnicott, 1960) rather than to be internally conflicted between action systems of daily life and animal defenses, or between parts of the self that were confirmed by attachment figures and parts that were denied. The formation of parts occurs as a protective and even survival mechanism, but especially in its more extreme forms, the formation of parts comes with a cost: The price of this protection is to plunder future personality development of its resiliency and render it into a fiercely protected constellation of relatively unbridgeable self-states [or parts] each rigidly holding its own truth and its own reality “on call,,” ready to come “on stage” as needed, but immune to the

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potentially valuable input from other aspects of self. (Bromberg, 2006, p. 33)

With an understanding of dissociation as unintegrated self-states or parts of the self, therapists can better appreciate the struggles that occur in the clients’ treatment and even as a result of therapy, and recognize the valuable function of each part. With this knowledge base, the signs and symptoms related to clients’ self-states or parts can be understood as communications about what had been required to ensure their survival or well-being. As conflicts between the goals of various action systems are recognized, the hard work towards integration then has a better chance of being successful.

Nonverbal Indicators Bowlby (1969/1982) asserted: Much of the work of treating an emotionally disturbed person can be regarded as consisting, first, of detecting the existence of influential models of which the client may be partially or completely unaware, and, second of inviting the client to examine the models disclosed and to consider whether they continue to be valid. (p. 205)

In Sensorimotor Psychotherapy, visible and tangible nonverbal behaviors that tell their own inimitable stories of working models are ongoing sources of implicit and explicit exploration in the therapy hour. Kurtz (2010) recommended that psychotherapists be on the lookout for particular nonverbal cues, or “indicators,” that are “a piece of behavior or an element of style or anything that suggests . . . a connection to character, early memories, or particular [unconscious] emotions.” Especially important are indicators that reflect and sustain predictions that are “protective, over-generalized and outmoded” (p. 110). Not every nonverbal cue is an indicator. For example, reaching for a cup of tea or brushing one’s hair out of the eyes is not usually an indicator. Behaviors that are indicators help therapists “[formulate] hypotheses about the client: what kind of implicit beliefs are being expressed and what kind of early life situations might have called for such patterns and beliefs” (Kurtz, 2010, p. 127). Different parts of the self exhibit different physical indicators. Verbal and nonverbal communications might contradict each other and conceal aspects of internal experience as well as reveal them. A client may say that she feels fine while her lips purse, she looks away, and a furrow appears on her brow; another smiles as she talks about her disappointment. A childishly needy part of a client might collapse helplessly, while the part that challenges his employees to perform displays a very different stance. A client who reaches out to shake hands but looks away or leans backwards may be exhibiting signs of dissociative parts of the self through conflicting simultaneous movements. Contradictory behaviors might also be 32

intended to tone down a verbal message. One client tilted her head and smiled disarmingly as she described how she was not benefiting from therapy. Indicators that register consciously for therapist or client can be explored explicitly, along with the associated affect, even while the content they represent remains unconscious. Grigsby and Stevens (2000) have suggested that recognizing such indicators and disrupting automatic behaviors hold more promise clinically than conversing about the history that shaped them: “Talking about old events . . . or discussing ideas and information with a patient . . . may at best be indirect means of perturbing those behaviors in which people routinely engage” (p. 361). They recommend that therapists try to “observe, rather than interpret, what takes place, and repeatedly call attention to it. This in itself tends to disrupt the automaticity with which procedural learning ordinarily is expressed” (p. 325). Once specific indicators are observed and named, explicit exploration of them can provide a direct avenue to discovering and changing the corresponding working models. The theoretical models described in this chapter can guide these observations of habitual patterns, steering the therapist to look for indicators connected to attachment interactions and unresolved trauma. Nonverbal indicators reminiscent of early attachment interactions are evident in physical expressions of working through movements, postures, gestures, prosody, and facial expressions. Indicators reflecting unresolved trauma include hyperarousal (e.g.: tension, rapid heart rate, trembling, wide eyes) and hypoarousal (e.g.: vacant expression, flaccid muscles, collapse of posture), terror, panic, or rage, impulsive or dulled reactions, and other signs of faulty neuroception and animal defenses. Any of these indicators can occur simultaneously or sequentially to reveal conflicts between self-states and parts. In the therapy hour, the therapist helps clients to bring the experience of these indicators into the present moment in order to “activate those deep subcortical recesses of our subconscious mind where affect resides, trauma has been stored, and preverbal, implicit attachment templates have been laid down” (Lapides, 2010, p. 9). In this way, nonverbal memory and associated affect can be felt, regulated, and explored explicitly even when there are no declarative memories or explicit content clearly connected to these implicit patterns. The therapist takes on the dual task of attending to the client’s somatic narrative along with the verbal narrative. The verbal narrative can be interesting and informative, and this explicit exchange helps create safety, understanding, and empathic connection between therapist and client. Although clients can only verbally express elements of their history and inner dilemmas that are in their conscious awareness, the manner in which the narrative is expressed reveals a history that is often not conscious. Bringing these indicators to awareness enables implicit phenomena, and the historical dynamics they represent, to become a part of the explicit exchange. By drawing attention to the body’s participation in the verbal narrative (e.g., “It looks like your shoulders tense when you speak of your father”), 33

the automaticity of both the verbal narrative and the physical reactions are interrupted so that they can be mindfully explored. This approach represents a shift in paradigm from “talking about” the issues to engaging mindful awareness of the evoked indicators as they manifest in the present moment.

Embedded Relational Mindfulness Clients come to therapy not to change what happened, which is impossible, but to change the effects of the past as they impinge on the present. Rather than deal with the actual events, clients . . . need to deal with the internal residues of the past. Neurobiologically speaking, they need to activate the medial prefrontal cortex, insula and anterior cingulate by learning to tolerate orienting and focusing their attention on their internal experience, while interweaving and conjoining cognitive, emotional and sensorimotor elements of their traumatic [and attachment] experience. (van der Kolk, 2009, p. 462)

Mindfulness helps facilitate this task by teaching clients to orient and focus awareness on the effects of past events as they emerge in the present moment (Kurtz 1990; Ogden et al 2006). Mindfulness is commonly described as a solitary, silent, non-verbal, internal activity, and is usually taught as such. It requires an inner receptivity to whatever arises in the mind’s eye, as a “quality of attention which notices without choosing, without preference” (Goldstein & Kornfield, 1987, p. 19). Mindfulness can be taught as an internal concentration practice (focusing on breath, a mantra, or body sensation) or as an external concentration practice focusing on a particular stimulus (such as a candle), or as a skill-building practice such as found in dialectical behavior therapy (DBT; Linehan, 1993) and mindfulness-based cognitive therapy (Segal, Williams, & Teasdale, 2002). The “embedded relational mindfulness” of Sensorimotor Psychotherapy also focuses attention on internal processes; however, it is markedly different from these common solitary, silent practices because it is a shared, here-and-now relational and verbal activity that occurs between therapist and client within the relationship. Sensorimotor Psychotherapy’s application of mindfulness in clinical practice is based on the work of Ron Kurtz (1990). Rather than being taught through structured exercises or an internal practice that excludes the therapist, embedded relational mindfulness is integrated with, and embedded within, what transpires moment to moment between therapist and client. Therapists guide clients to notice selected elements of their internal present experience, and also to verbally report what they notice as the experience is taking place. Through this process, both therapist and client are mindful of the ebb and flow of the client’s present moment experience. It’s as if clients take the therapist with them into their inner world by describing their experience verbally as it unfolds rather than describing it after the immediacy 34

of the moment passes. Mindfulness becomes an intimate relational call and response, encouraged by a slowed pace of mutual discovery and collaborative curiosity about the components of clients’ present moment experience rather than the fast pace of conversation. Critical to this process is the therapist’s purposeful influence on clients to attend to specific elements of their internal experience. Instead of allowing clients’ attention to drift randomly toward whatever emotions, memories, thoughts movements or sensations they might be drawn to, therapists purposefully use “directed mindfulness” to guide the patient’s awareness toward particular elements of internal experience. Unrestricted mindfulness toward any and all elements can activate disturbing intrusions and overwhelming arousal for people with PTSD and thus is often met with dismay, judgment, self-criticism and further dysregulation. Clients with non-traumatic attachment issues as well often find themselves going over and over the same problems without resolution, being drawn to familiar elements of internal experiences rather than to something new. To support therapeutic goals, mindfulness is directed by the therapist, who carefully and firmly guides the patient’s mindful attention toward particular elements of internal experience thought to support therapeutic goals (Ogden 2007; 2009). If the goal is to develop confidence, mindfulness might be directed toward the length and alignment of the spine. If it is to delve into sadness, mindfulness might be directed or toward a dejected downward turn of the head. If an internal image of past trauma or an external traumatic reminder such as the sound of a siren causes hyperarousal, mindfulness might be directed to the sensation in the legs to promote grounding rather than to the internally generated image because grounding supports regulation. Thus, mindfulness is “an active search process, a purposeful seeking in the field of awareness” (Siegel 2010, p. 108). Mindfulness itself is “motivated by curiosity” (Kurtz, 1990, p. 111) and thus “allow[s] difficult thoughts and feelings [and images, body sensations, and movements] simply to be there . . . to adopt toward them a more ‘welcome‘ than a ‘need to solve’ stance” (Segal et al., 2002, p. 55). The mutual curiosity of embedded relational mindfulness naturally decreases anxiety and resistance and opens the mind beyond the limits of what it already knows. The therapist’s ability to help clients become curiously mindful of their internal experience, rather than identify with it, leads to new learning (see Chapter 2, “Orientation for Therapists” for a description of therapeutic skills for mindfulness). Clients shift from being caught up in the story to being interested in discovering their internal experience. “No one is ever there for me” becomes “I experience a shield of tension in my chest, and I have the thought, ‘No one is ever there for me,’ and then I feel sadness come up.” Both client and therapist become interested in how these elements of present-moment experience change through continued mindful exploration within the relationship. Unpredictability is expected and welcomed, often resulting in 35

“safe surprises” from which a new reality is co-constructed within the relationship (Bromberg, 2006). It is essential that the client’s sense of safety in the relationship increases overall through the use of embedded relational mindfulness, which can be a challenge when exploring painful traumatic and attachment issues. In order for therapy to take place, clients must be able to neurocept safety sufficiently to engage with the therapist. However, clients might be unable, based on prior conditioning, to accurately neurocept whether the environment is safe or another person is trustworthy (Sahar et al., 2001), especially as traumatic material or attachment failures are stimulated in therapy, whether deliberately or inadvertently. If trauma is stimulated, clients might implicitly neurocept danger, which activates the brain’s fear circuitry to stimulate animal defenses of cry-for-help, fight, flight, freeze, or shutdown. At these times, social engagement is often compromised and must be reestablished. If attachment issues are stimulated, clients might also implicitly neurocept danger and either adjust their responses to further push away the not-me parts that were disconfirmed by their caregivers in order to try to stay “safe” in the therapeutic relationship, or experience strong negative feelings and reactions toward the therapist that interfere with social engagement. Using embedded relational mindfulness, the therapist must simultaneously accompany clients into the painful present-moment reexperiencing of the past, facilitate enough safety of the here and now so that therapy can continue, interactively repair after a mismatch, and relationally negotiate therapeutic enactments. This concurrent evocation of trauma-related dysregulation and attachment-related disconfirmations, hurts, and social engagement can result in a depth of intimacy in the relationship that exceeds that which ensues from conversation alone. The therapeutic encounter often becomes more deeply resonant emotionally and the intersubjective moment becomes more palpable. However, for this to occur, attitudes and interventions that support embedded relational mindfulness must be privileged over ordinary conversation and discussion (Kurtz, 1990; Ogden et al., 2006) and over solitary mindfulness practices.

Mindful Therapeutic Experiments Therapeutic experiments (Kurtz, 1990; Ogden et al, 2006) directly disrupt what has been learned procedurally and shed light on how trauma and attachment wounds are recapitulated in the present moment. Experiments include simple verbal actions (e.g., saying “no”) and physical actions (e.g., reaching out, making eye contact, pushing away) that challenge conditioned responses, or engaging a habitual response in order to discover more about it (e.g., exaggerating a tension pattern, or purposely avoiding eye contact). When explored in mindfulness, these experiments 36

yield discoveries that are “unforced, automatic, and spontaneous” (Kurtz, 1990, p. 69), increasing the client’s sense of the experiment’s impact and validity. There are no “right” or “wrong” responses to these experiments; they are conducted to find out “what happens” within the relationship and internally for the client—what thoughts, emotions, sensations, images, and so on, emerge. Experimenting with habits of movement, posture, and gesture can change the implicit communication to others and also to the self. Our sense of self is determined both by the story we tell ourselves verbally and by the story we tell ourselves nonverbally through these physical habits. For example, if one’s posture is habitually curved forward and slumped instead of upright, it conveys implicit meaning not only to others but also to the individual. The slumped posture itself might diminish self-esteem and contribute to, if not induce, feelings of shame, helplessness, or inadequacy associated with the past. Exaggerating this posture slightly can stimulate associations that then could be directly shared and worked through in therapy. Or, a more aligned posture could be explored, along with all the emotions, thoughts, memories, and relational dynamics that would then spontaneously ensue. In this process, the posture, gesture, movements and expressions of the body favorably start to change, which in and of itself can alter the implicit communications to others and to the self. These interventions go beyond simple body awareness questions such as, “What do you notice in your body?” or “How do you experience that in your body?” In Sensorimotor Psychotherapy, body awareness is only the beginning. The point is to help clients address and change procedural learning—how information is processed on a bodily level—which requires that the movements, gestures, and postures that reflect and sustain one’s history are addressed in such a way that they start to change spontaneously. The Sensorimotor Psychotherapist will guide the client’s awareness toward particular elements of bodily experience, and then either follow these elements until they spontaneously change, or initiate a specific action that causes somatic patterns rooted in the past to reorganize. A chronically puffedup chest that communicates a need to keep one’s distance or create safety by intimidating others begins to relax and open. A habit of lowering the head and crouching of body posture that signal compliance changes into a lifted head and upright posture. A dysregulated nervous system recalibrates so that arousal remains at a tolerable level. It is important to be aware that simple experiments can elicit a variety of selfstates or dissociative parts that may be “inhospitable and even adversarial, sequestered from one another as islands of truth, each functioning as an insulated version of reality that protectively defines what is ‘me’ at a given moment and forcing other self states that are inharmonious with its truth to become ‘not-me’” (Bromberg, 2011, p. 69-70). Like new words, new actions such as reaching out can be viewed as antagonistic by certain parts of the self whose reality and purpose are 37

challenged by such proximity-seeking behaviors. Physical actions can be laden with trauma-related emotions of terror and rage that accompany animal defenses or with strong attachment-related emotions, such as resentment, fear, anger, or disappointment, that were not regulated by the attachment figures in childhood. One part of the self might have vowed never to reach out again, lest no one respond. Or, a part may live in terror that reaching out will bring abuse, as it did in the past. Processing these actions and the associated emotions can increase the ease of transitions between states, encourage communication and integration among parts, change the way information is processed somatically, and support a more integrated sense of self. The spontaneous, open-ended quality of therapeutic experiments reflects a larger theoretical principle of the unique, unchartered territory of what transpires within each individual therapeutic dyad. Although the experiments conducted in therapy are, in principle, “techniques,” they are neither generic nor manualized. The inspiration to conduct a particular experiment emerges naturally and unexpectedly as therapist and client subjectively experience each other. Philip Bromberg states that most characteristically he does not “plan” in advance what to do or say in the therapy hour, but rather “finds himself” doing or saying certain things that arise spontaneously from within the relationship (personal communication, December 21, 2010). His words and actions are not premeditated or generic techniques, but rather are emerging responses to what transpires in the here and now between himself and his patient. Similarly, in my own work, somatic interventions and the way they are implemented, and even which indicators I am drawn to notice from all that my client presents, are emerging responses to what transpires in the here and now between my client and me. It takes training, experience, and practice for the therapist to “know” which nonverbal cues are meaningful indicators. and which are not, and how to implement a therapeutic experiment in the therapy hour. This knowing is not cognitive; rather the therapist finds him- or herself being drawn to a particular indicator or to trying a particular experiment, often without knowing why, and only later discovers the connection to implicit trauma or attachment failure. The interventions are the spontaneous outcome of the affective and somatic responsiveness to the experience of what is taking place within the relationship that is not processed cognitively but is known implicitly.

The Therapeutic Relationship: Safety and Risk Schore (2009a) writes: “At the most fundamental level, the work of psychotherapy is not defined by what the therapist explicitly, objectively does for the patient, or says to the patient. Rather the key mechanism is how to implicitly and subjectively 38

be with the patient” (p. 41). The way of being with the client is thus paramount, and therapeutic change occurs within this context. The starting place of therapy is to create enough safety within the relationship that clients can embark upon the oftenfrightening journey of self-discovery. Kurtz (2010) described beautifully how he created connection: “My first impulse is to find something to love [in the client], something to be inspired by, something heroic, something recognizable as the gift and burden of the human condition, the pain and grace that’s there to find in everyone you meet.” This attitude of generosity implicitly acknowledges the dignity of the human spirit, setting the stage with respect and appreciation so that therapy can commence. Safety is created primarily through implicit body-to-body affective communication, rather than through words. As Bowlby asserted over 40 years ago, “With attachment theory in mind, a therapist will convey, largely by non-verbal means, his respect and sympathy for his patient’s desires for love and care from her relatives, her anxiety, anger and perhaps despair at her wishes having been frustrated and/or denigrated” (1980, p. 180, emphasis added). The therapist tracks the client’s nonverbal indicators, assesses dysregulated arousal, and adjusts the pace and process of therapy accordingly to stimulate the social engagement system and help the client feel safe. Acting as an “auxiliary cortex” (Diamond, Balvin, & Diamond, 1963), the therapist becomes an interactive “affect regulator of the patient’s dysregulated states in order to provide a growth-facilitating environment for the patient’s immature affect-regulating structures” (Schore, 2001b, p. 264). Keep in mind that if arousal greatly exceeds the regulatory boundaries of the window of tolerance, experience cannot be integrated. Effective interactive psychobiological regulation requires paying more attention to how the relationship and the interventions affect autonomic arousal than to the content of the client’s verbal narrative. Along with responding to what is spoken, the therapist responds, often nonconsciously, to nonverbal signals that suggest a shift from regulated to dysregulated arousal or loss of social engagement. As these indicators of dysregulation are noted, therapists use their social engagement systems to regulate when clients cannot do so for themselves. Therapists thereby help clients regain social engagement, remain aware of the here and now, and mindfully notice elements of internal experience that support regulation. The therapist is “interacting at another level, an experience-near subjective level” that implicitly processes moment-to-moment socioemotional information at levels beneath awareness (Schore, 2003b, p. 52). A meaningful nonverbal conversation between therapist and client transpires as each implicitly emits and receives significant indicators. ‘Encoding’—giving off non-verbal signals about feelings, thoughts and needs—goes hand in hand with ‘decoding’—detecting the other person’s non-verbal signals of the same and perceiving them accurately 39

(Schachner, Shaver, & Mikulincer, 2005). The moment-to-moment physical movements and adjustments are visible reflections of this nonconscious dialogue. Each party implicitly interprets the other’s cues and responds with his or her own nonverbal behaviors: leaning forward, averting or holding gaze, tightening, relaxing, a deep breath or a holding of the breath—the possibilities are endless. Beebe (2014) notes, “ Our ability to sense and not to inhibit our own bodily arousal, attention patterns, affective reactions, orientation shifts, and touch patterns is key (p. 143). Although as therapists, we can learn to become aware of and understand our own nonverbal participation, our responses should not be controlled lest dyadic regulation becomes contrived or impaired. This nonverbal communication “feeds [the therapist’s] ability to process [the] patient’s emotions in the implicit mode” (Beebe, 2014, p. 77). The nature of the ensuing bodily states from this ultra-rapid, implicit dialogue is intersubjective—we have a “feeling” or “know in our gut” certain things that we find difficult to articulate. These intuitions are, at least in part, a product of the unconscious encoding and decoding of indicators of chronic procedural habits as well as the time-limited nonverbal cues that regulate the relationship, moment by moment. A childlike hanging of the head or pout of the lower lip might be a momentary plea for care or empathy, or a chronic habit leftover from a childhood of neglect. Tensing around the eyes might convey a message of suspicion that could reflect a chronic distrust of others or a response of confusion or misattunement in the presentmoment interaction. The movement, gesture, and posture of a client deeply affect that of the therapist, and vice versa, eliciting corresponding actions in the other in an ongoing, body-to-body call and response (Ogden, in press, 2013, 2011). Montgomery (2013) notes that “the more the affect management style that characterizes a client’s typical way of dealing with emotions needs to be changed and ‘rewired’ neurobiologically, the more at least an experience of emotional attunement or bonding should occur with the clinician” (p. 34). This attunement is engendered not only via somatic signals but also prosody and the manner in which language is used (as opposed to the content itself). In the therapeutic relationship, “right-brain to right-brain prosodic communications . . . act as an essential vehicle of implicit communications. . . . The right hemisphere is important in the processing of the ‘music’ behind our words” (Schore & Schore, 2008, p. 14). Matching prosody—timbre, volume, pace—to resonate with the client is necessary to join and connect. From there, the therapist might up- or downregulate the client as needed to support therapeutic goals. Kurtz (1990) taught his students to speak in the simplest language possible to facilitate access to a child state of conciousness, and early memories. Lapides (2010) has commented that it is necessary to “keep sentences simple as [left-hemisphere verbal] processing is impaired at elevated levels of arousal and to rely on [right-hemisphere] non-verbal means to connect with [hyperaroused patients]” (p. 9). The affective, nonconscious, nonverbal dance 40

shapes what happens within the relationship without conscious thought or intent. It is the essence of therapy, redefining psychotherapy as the “affect communicating cure” rather than the “talking cure” (Schore & Schore, 2008). What occurs within the therapeutic dyad will be strongly influenced by the therapist’s window of tolerance as much as by the client’s (Siegel, 1999; Schore, 2003a, 2009). The therapist’s window is a “critical factor determining the range, types, and intensities of emotions that are explored or disavowed in the transference– countertransference relationship and the therapeutic alliance” (Schore, 2009, p. 130). The two windows together determine what can be explicitly and implicitly addressed and how it is addressed. Therapists who have a sufficiently wide window will be able to not only establish safety in the alliance, but challenge clients to expand their windows. Whereas safety is essential for clients to begin therapy, therapists also have a responsibility to help clients expand their capacities by challenging their regulatory abilities in the face of strong emotion or autonomic dysregulation. If clients’ emotional and physiological arousal consistently remains in the middle of a window of tolerance (e.g., at levels typical of low fear and anxiety states), they cannot expand their capacities because they are not in contact with disturbing residue of traumatic or affect-laden attachment experiences in the here and now of the therapy hour. However, if arousal greatly exceeds the regulatory boundaries (Schore, 2009a) of the window of tolerance at either the low or the high end, experience cannot be integrated. To work successfully at the regulatory boundaries, clients must be able to simultaneously detect safety while experiencing some element of dysregulated affect, which thereby foster an expansion of the window itself. Bromberg (2006) points out that the atmosphere of the therapeutic relationship must be “safe but not too safe.” See Figure 1.1 for an illustration of this concept and working on the edge at the regulatory boundaries of the window of tolerance.

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FIGURE 1.1

Once the client’s arousal has reached the beyond edges of the window of tolerance, it is imperative to avoid stimulating additional emotional or physiological arousal by continuing to execute physical actions or implement other interventions that cause further dysregulation. The therapist and client must continuously evaluate the client’s capacity to process at the regulatory boundaries of the window to assure that arousal is high enough to expand the window but not so high as to sacrifice integration.

Two Clinical Journeys Therapy is always a dance of safety and risk, not only for clients but also for therapists. Clients are challenged as they address the legacy of trauma and attachment, and similarly, therapists are challenged by the residue of their own histories that emerges unbidden and often unawares. The dance between therapist and client engages the therapist’s unconscious interpretations and somatic and affective reactions, communicated to him- or herself and the client beneath the words, and vice versa. Because these reactions occur below the surface of awareness, they do not lend themselves to straightforward discussion or reflection. The ensuing implicit relational encounters can turn into to collusions, collisions, and therapeutic enactments that “represent re-expressions in real time of early forming right brain automatic survival mechanisms. More specifically, enactments are dialogically [and somatically] re-created in right brain-to-right brain transference–countertransference communications, interactions occurring between the patient’s relational unconscious and the therapist’s relational unconscious” (Schore, 2011, p. 158). Both parties are often working at the regulatory boundaries 42

of their own windows of tolerance with content that eludes conscious understanding but is reminiscent of early contexts where relational attunement was absent and repair was not forthcoming. As the therapist’s unsymbolized implicit processes interact with those of the client, unexpected relational encounters can ensue that can be distressing for therapist and client alike. No therapist seeks out such conflicts, but they happen in spite of attempts to prevent them. Bromberg (2011) asserts that “there is no way to avoid these clashes of subjectivity without stifling the emergence [in both therapist and client] of dissociated self-states that need to find a voice” (p. 57). Therefore, therapeutic action must include participating in and navigating what is enacted beneath the words, a negotiation that “can either result in retraumatization, if it’s not properly processed at the intimate edge between client and therapist, or it can lead to a better resolution and integration on a higher level” (Stark, 2009). Like misattunements that are then repaired, these collisions can be reworked in a more powerful and substantial manner through processing an enactment than if the enactment had not occurred. Therapy can be conceptualized as comprising two simultaneous clinical journeys that therapist and client embark upon together, one explicit and conscious and one implicit and unconscious (Ogden, 2013). The explicit journey pertains to the conscious aspects of the relationship between therapist and client and of the therapeutic process, often supported by theory and technique on the therapist’s side. On the explicit journey, the therapist intends to “develop the skill of seeing [the] internal world, and being able to shape it toward integrative functioning” (Siegel, 2010c, p. 223). Therapeutic methods, meant to be learned and then set aside and not usually considered explicitly in the therapy hour, nevertheless guide interventions that emerge spontaneously within the dyad but can be justified and explained, if desired. Therapists can reflect upon the explicit journey, even as it is unfolding, and make adjustments in presence or technique. In comparison, the implicit journey is unconscious or only partially conscious and difficult to articulate because it pertains to what happens when the internal world cannot be seen or understood but is enacted unawares. Taking place beneath the words, both client and therapist might have a sense of something being “off” between them in a vaguely familiar way. Therapists may be explicitly aware that their efforts keep leading to session outcomes that were neither intended nor desired. The therapist’s conscious wish not to trigger the client’s shame or anger, for example, might repeatedly lead to that very outcome, leaving the therapist feeling baffled and incompetent and the client feeling misunderstood or worse. What neither therapist nor client realizes is that another conversation is occurring beneath their words, a body-to-body interchange between the implicit parts of client and therapist that is not intended, typically reflecting past encounters where disconfirmations have occurred, or relational negotiations have failed. It can be a 43

tumultuous journey with many crises, collisions, collusions, and enactments that, if not negotiated within the relationship, can sabotage the therapy or cause a chronic therapeutic impasse. Therapists often initially perceive a therapeutic impasse as having to do only with the clients’ history, failing to understand that the enactment is mutually created. They occur in the realm where interactive regulation had been absent, dissatisfying, or hurtful for each of them. In a replay of the earlier disconfirmation, what each person needs from the other is not provided in the therapy hour, thus proving again that the need is invalid and will not be met. The two histories collide in a hand-inglove enactment. Both therapist and client implicitly re-experience the shame of having such “illegitimate” needs, reminiscent of what they had felt as children. The enactment will continue to escalate us long as the therapist believes that the discord pertains only to the client. Therapists are challenged to “wake up” (Bromberg 2006) and realize that the enactment has to do with their own history as well as their clients’. This realization usually occurs without reflection, through a stroke of intuition—the result of “direct knowing that seeps into conscious awareness without the conscious mediation of logic or rational process” (Boucouvalas 1997, p. 7; in Schore 2011, p. 13). What is called for in navigating an enactment is not technique, interpretation, or explanation, which typically only adds to the enactment. The therapist and client need to delve together into what is taking place between them and mutually negotiate the enactment, allowing the meaning between them to be discovered through their interaction. As Schore (2011) states, “....the therapist’s moment-tomoment navigation through these heightened affective moments [occurs] not by left brain explicit secondary process cognition but right brain implicit primary process affectively driven clinical intuition” (p. 1). It is essential to understand that enactments are not “mistakes” but are nonconscious strivings for a higher level of growth and organization and their negotiations are a function of the developing and emerging relationship. The processing of each person’s implicit self(s) within the relationship provides the raw material for new experiences, new actions, and new meanings for both parties. This intersubjective process of joining and co-creation cannot be defined, identified or predicted ahead of time, because it occurs within the context of what transpires unexpectedly within the dyad. This negotiation is “all about developing the capacity of patient and [therapist] to move from experiencing the other as an object to control or be controlled by to being able to play with each other” (Bromberg 2011, p. 18). Fundamentally, the implicit journey holds the potential for deeper therapeutic change and growth. It is the unformulated, unconscious impact of therapist and client on one another, including the influences of past childhood histories of both parties, that often catalyzes the real healing power of clinical work. 44

All good therapy explores the messy territory of negotiating the inescapable implicit enactments that sizzle beneath the surface while explicit communications are taking place. A relational, attachment-focused therapy is a healing process not because therapists are “treating trauma and attachment” but because they are “helping to restore belief in the existence of enduring human relatedness. The process of enactment accomplishes this especially powerfully because it generates a here-and-now reality that is created by both people in which endangered attachment becomes reparable right in the room” (Philip Bromberg, personal communication, March 19, 2013). The relational negotiation of an attachment requires a creative leap into the unknown in which the outcome is unpredictable and uncharted for both parties. As Tronick (2003) states: “Co-creativity implies neither a set of steps nor an end state. Rather, it implies that when two individuals mutually engage in a communicative exchange, how they will be together, their dynamics and direction are unknown and only emerge from their mutual regulation” (p. 476). Explicit and implicit realms are both essential avenues of therapeutic exploration. Language, verbal meaning-making, and verbal exchange with others affect implicit processes, and vice versa. As Tronick (2009) emphasizes: “Adult and children make meaning in the explicit and use language to make meaning. Words, insights, and cognitions in awareness are elements in an individual’s state of consciousness. Working on changing a patient’s explicit sense of their place in the world CAN produce change” (p. 103). That said, although language and explicit exchange are obviously indispensable in clinical practice, the wordless but potent implicit dialogue between therapist and client is critical to the change process. Emotional and somatic experience comes alive in therapy as we both consciously and unconsciously respond to explicit and implicit cues in our clients and ourselves. When we experiment with new actions to challenge outdated procedural learning, we can address implicit processing, including enactments, both explicitly through the use of words and also implicitly at a level at which words are not available and sometimes not needed for therapeutic change to occur. To navigate this journey, both parties need to muster a spirit of adventure to leap into the unknown waters of interpersonal relatedness and the underbelly of the self. In Sensorimotor Psychotherapy, they also need to cultivate a sustained faith that together they can discover how to draw on the intelligence of the body to move on from the past and reorganize consciousness at a higher level.

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CHAPTER 2

Orientation for Therapists In Sensorimotor Psychotherapy clients’ physical habits afford potent inroads into troubled histories during which interactive negotiations had been unsatisfactory, painful, or traumatic. Gestures, postures, sensations, and movements become targets of intervention and agents of change. But often neither clients nor their therapists understand the original wisdom of these physical habits, nor how to explore and change them. To capitalize on the body in therapy calls for a shift in emphasis from conversation to mindful exploration; from a sole focus on emotions and thoughts to the inclusion of body sensation, posture, and movements; from discussing new possibilities to experimenting with new actions. Unless you have already been trained in Sensorimotor Psychotherapy or other body-oriented approaches, you will first learn about a somatic way of working through the material in this book. If you have developed your own unique style and habits over years of clinical practice, especially if you use primarily a “talk therapy” approach, introducing Sensorimotor Psychotherapy interventions into your work might feel awkward or even a bit de-skilling at first. Working somatically may at times even go against the grain of some aspects of your previous training and accustomed methodology. You might feel ill at ease asking clients to be aware of their bodies, change their posture, or explore physical action. You may be uncomfortable demonstrating movements yourself. This chapter provides some basic practical guidelines and tips to support your ease and skill as you begin to put into practice the Sensorimotor Psychotherapy interventions described in this book. Keep in mind that you must always adapt treatment to your own capacities and comfort level, to the needs of each client, and to what emerges in the moment within the therapist–client dyad. Therefore you are encouraged to explore this book collaboratively with your clients in a way that works for both of you. As stated in the “Introduction,” the material in this book should not be implemented as a standalone treatment or as a manualized approach. The concepts and worksheets should be incorporated into whatever methodology you already know and implement in your clinical practice. You might be concerned that clients who are dysregulated, destabilized, bodyphobic, low functioning, or otherwise challenged will be unable to benefit from this material. However, none of these difficulties has to prevent a client’s use of this 46

book because the material can and should be modified to suit the particular needs of each client. Similarly, age, brain injury, learning disabilities, or developmental delays are also not necessarily contraindications for utilizing the book but rather signs that the material may need to be modified in some way—simplified, demonstrated instead of verbalized, or its introduction titrated.

Structure of the Book Following this chapter is an orientation written directly to clients that emphasizes working collaboratively with you, their therapist, to learn the concepts and complete the worksheets in the subsequent chapters. The “Orientation for Clients” also offers parameters about pacing, safety and risk, dissociation and dissociative disorders, and adapting the material to accommodate clients with various diagnosis and difficulties. We strongly recommend that you review that chapter yourself, require your clients to read it before embarking on the topic chapters, and discuss its contents together in session. Because some of the terminology used in this volume, such as “arousal” and “dysregulation,” will be new or perhaps confusing to clients, a glossary is provided at the end of the book. Including the glossary terms in your psychoeducation with your clients as you go through the topic chapters and worksheets to make sure they understand them, and repeating definitions as necessary, will be essential to your clients’ comprehension and success. The remainder of the book comprises four sections, each containing several chapters organized around a specific topic (refer to the “Introduction” for an overview of the sections and their topics). Before using a chapter with your client, you should study it yourself until you understand the concepts. Discussing the terms used in the chapter with your clients before asking them to read it, and referring back to the glossary, will make it easier for them to understand the material. Thoroughly familiarizing yourself with each worksheet and completing it yourself before introducing it to your client will help you learn from the “inside out” and assure that you understand the purpose of the worksheet. Then you can more easily communicate and model the skills necessary to complete each worksheet assignment to your client. You should also study the therapists’ guide that precedes each chapter, which explains the major purpose of the chapter, clarifies which types of clients might benefit, and describes how to use the worksheets with clients. Each guide also gives some suggestions for how to adapt the chapter material for use with dissociative clients—essential reading if you plan to use this material with this population. Though loosely intended to build on one another in sequence, the topic chapters can be approached in many ways. They can be introduced to your clients in order 47

or out of sequence, as appropriate for their therapeutic process. You might incorporate one chapter and its worksheets every week or two into the ongoing therapy, or you may leave longer gaps between assignments. You might familiarize yourself with the various chapters and select specific chapters to work with when you think their contents would be useful to a client. In a short-term treatment with a limited number of sessions, you may need to pick and choose a few relevant chapters and focus on those during the time you have. In any case, you will want to become acquainted with the concepts of the chapters and their worksheets so that you can select ones to incorporate into your practice to the best advantage for each client.

Implementing the Material This material is designed to benefit both traumatized and nontraumatized clients with varying degrees of integrative capacity and ability to self-regulate. Numerous examples are woven through the chapters that illustrate a variety of clinical situations and client problems. Some of the examples illustrate how severely traumatized individuals have made use of the material, whereas others clarify how nontraumatized individuals have incorporated the concepts and exercises. Most clients will recognize themselves in some of the clinical examples but find other examples irrelevant to their issues. As you explore the different examples together, you can provide both empathetic support and psychoeducation about how the effects of trauma and attachment manifest in many forms and drive symptoms with differing degrees of severity. The key to successfully implementing this material is to prioritize appropriate challenges, that is, challenges big enough to help clients take some risks but small enough that they can ultimately master them. Appropriate challenges will be very different for clients suffering from posttraumatic stress disorder (PTSD) and those who are not. Clients with intellectual or physical impairments, as well as child, adolescent, and older or elderly clients, all require interventions tailored to their specific needs. You must adapt your approach accordingly. With some clients, you might discuss what you learned from a chapter after you have read it yourself rather than assign it to them to read. With others, you might suggest that they read the chapter outside of sessions, complete the worksheets, and then discuss what they discovered with you in a subsequent session. Or, you might find that reading a chapter, or parts of a chapter, aloud together in session, then pausing after each main idea to discuss the concepts and elucidate their specific relevance for that client, works best for some. The worksheets accompanying each topic chapter are designed for specific kinds of issues and to build specific skills. They require varying degrees of self48

regulation and integrative capacity for their successful completion. It was a quandary to decide whether to include worksheets that encourage clients to delve into their more painful emotions, to “sit with their feelings” rather than regulating or resourcing them. However, several worksheets are included in the sections on Phase 2 and Phase 3 intended to help clients experience and express attachmentrelated emotions. Those worksheets in particular should be completed under your guidance. Since some worksheets are more challenging and evocative, and others are more regulating, you will need to select those that are appropriate for each client’s integrative capacity and where he or she is in treatment, skipping some worksheets and focusing on others. If your client’s ability to self-regulate is high, it will not be necessary for you to use all the worksheets about regulating dysregulated arousal. However, if your client is prone to dysregulation, you might avoid the worksheets that revisit the deep emotional pain of early attachment inadequacies, or at least wait until more stabilization is achieved before you use them. Encouraging clients to do more if they are able, or less as needed, as well as using the therapeutic relationship in an attuned fashion to help clients challenge themselves without loss of social engagement and the ability to feel safe. To reiterate, it will be helpful for you to complete the worksheets yourself to gain firsthand experience that will guide you in predicting which ones are best to appropriately challenge your clients. You and your client can determine which worksheets, if any, should be filled out between sessions and reviewed together at the next meeting, and which ones should be completed in session. For dissociative, dysregulated, or low functioning clients, it will be necessary to go over most if not all of the worksheets together to provide the titration and regulation that will support the integration of the material. Higher-functioning clients might benefit from completing the worksheets that are primarily psychoeducational between appointments, and sharing them with you at the next session. The worksheets that require mindful reflection on the presentmoment effects of the past or simply on here-and-now awareness of thoughts, emotions, and the body are most effective if they are guided by you in session with your client, and then filled out together. Those that have to do with attachmentrelated emotions are challenging and evocative, and should be completed together in session for all clients so that you can guide them through the steps described in the worksheet. In any case, the worksheets should provide a jumping-off point for reflection and be reviewed and discussed together after they are completed. They are meant to develop curiosity and confidence in the body’s wisdom, and support new learning and integration, rather than to be regarded as assignments clients “should” complete. Feel free to modify your approach to the chapters and the worksheets so that they are effective in meeting these goals. Keeping in mind the importance of collaboration, you may find it helpful to ask some of your clients how they prefer to 49

use the chapter and worksheets. They may want to read the chapter outside of therapy or during the therapy hour or they may prefer that you both read it between sessions. They may want to take time to discuss the chapter in session. Perhaps they prefer to just move immediately into the worksheets. The two of you can discuss together the pros and cons of completing the worksheets in session or between session and decide the best way to proceed. Despite your careful and collaborative presentation of the material, some clients may not choose to read the chapters or complete the worksheets, or they may be unable to do so. Rather than being disturbed by such apparent obstacles, you can be curious to discover together what the difficulty might be and how to prevent it from compromising the client’s use of the book. Maybe your client was not ready for a particular worksheet or chapter, and you need to save it for a later date or use the contents as a discussion point rather than as an assignment. Perhaps your client is not interested in working somatically, does not understand how it could help him or her, or did not reap any benefit from completing the worksheets. Your client may find a particular worksheet (or homework, in general) triggering, unappealing, a waste of time, or be unable to process the information it contains. Some clients who have feelings of anxiety or reluctance about doing “homework” might find it more agreeable if they complete the worksheets in session with your help. For those who suffer from a language-based learning disability, such as dyslexia, the very format of the book can be anxiety producing, and these clients may avoid the material or experience anticipatory feelings of failure or shame. It can be helpful for you to anticipate any such obstacles, discuss clients’ concerns openly to mitigate apprehensions, and discover together the best way to use the material. And, for some clients, it might work best if you yourself read the chapters, complete the worksheets, and then integrate the concepts into the therapy in an organic way that fits with their presentation, week to week, without their working directly with the book themselves. The chapters and worksheets are based on the principle of neuroplastic change that requires repetition for new neural networks to be set in place. Thus, they are intended to be explored more than once to facilitate lasting benefits. You will find that various chapters and worksheets have different meanings and relevance to clients at different times in their lives or in their work with you, so they may be repeated over the course of therapy. It will be helpful for you to refer back to them often in sessions to reinforce new learning. You may find that some worksheets seem to duplicate each other, and that concepts are repeated in subsequent chapters. Keep in mind that the book has been deliberately designed to be somewhat repetitive in order to facilitate neuroplastic change.

Dislike or Phobia of the Body 50

If your clients insist, “I don’t like my body,” you have an opportunity to explore how their dislike of the body came about, often as a learned, adaptive response to trauma, adverse experience, familial expectations or cultural pressures. Clients’ shame or aversion to the body is understandable in the context of trauma and is usually addressed best at first by appreciating how their dislike or phobia helped them to survive what happened to them. If the word body itself is a trigger for clients, as it sometimes is for those with severe trauma in their history, you might substitute different language, such as experience, or movement for the word body. The first topic chapter, “Wisdom of the Body, Lost and Found,” elucidates attitudes toward the body, and it might be useful for the two of you to read that chapter or parts of it together with your client, as a jumping-off point for discussion. The second topic chapter on the language of the body can also bring dislikes or phobias of the body to the surface. Your client’s reaction to these chapters will help you frame the subsequent chapters to fit your client’s relationship to his or her body. A small subset of clients might be fiercely wedded to their fear, hatred, or avoidance of anything having to do with the body. In Sensorimotor Psychotherapy, we encourage working with and around that “resistance,” understanding it as a learned attitude often having to do with being violated, rather than treating it as a problem. You might capitalize on these moments as an opportunity to convey your respect for their boundary. When clients say, “No, I don’t want to go there—I am not doing this,” you might shift the focus to their ability to strongly state their preference. Validating clients’ preferences and boundaries conveys respect of their right to choose, which might not have been honored when they were children. You can encourage them to notice the clear “no” reactions as a boundary or defense, something active and empowering they perhaps could not do when younger or when powerless (cf. Chapters 19, “A Somatic Sense of Boundaries” and 32, “Boundary Styles in Relationships”).

Psychoeducation Psychoeducation helps clients become informed collaborators so that the material in this book will be more easily and successfully integrated into their treatment. Used as needed during sessions, psychoeducation can help clients understand their reactions to the material and how work with the body might support them in reaching their treatment goals. Your clients have come to therapy with certain needs and objectives, and when you use psychoeducation to elucidate how working with a particular chapter topic might help them meet their goals, they are more likely to be receptive to this material. For example, if a client reports, “I’m having panic attacks and I can’t sleep—I just want to get more sleep,” you might suggest 51

something like this: “Maybe we could work with becoming more grounded, because if you can feel your legs and learn how to let your energy settle, your nervous system will calm down and you will probably have an easier time going to sleep. Why don’t we explore the chapter on grounding [Chapter 16, “Grounding Yourself”] together?” Similarly, when working with relational issues such as the inability to generate a support system, you might respond by saying, “It makes sense that you stopped reaching out to others when you were little because you were really on your own. But now, even though you want more connection, it’s still hard for you to reach out and connect with others. If we work with the chapter about actions that everyone uses to connect to others [Chapter 33, “Connecting with Others: Proximity-Seeking Actions”], like eye contact and reaching out, we might be able to help you meet your goal of developing a support system for yourself.” Psychoeducation about the benefits of working somatically should be balanced with assuring clients that they are always in control of what goes on in the session. Some clients may be apprehensive that somatic interventions will require that they do something physical or move in a way that makes them uncomfortable. They can often be set at ease when you assure them that they are in charge of whether they want to work with the body, how they work with the body, and when they want to work with the body, and that no intervention you might suggest is ever mandatory. Additionally, some clients may assume that touch or hands-on bodywork will be used. Explaining that Sensorimotor Psychotherapy is a body-oriented talking therapy, very different from massage and other body therapies, and that touch is not necessary to benefit from this book, will clarify this misconception. It is important to remember to give just the amount of information clients need in a particular moment to make use of a specific chapter’s concept or intervention. The simpler the language and the more concrete your presentation of the concept, the more likely that clients can absorb the information. The intention is to pique their curiosity and win their cooperation so that they are able to make use of this material in your therapy with them. Psychoeducation should help clients make connections between the distressing issues they bring to therapy and the possibility of relief or resolution offered by a Sensorimotor Psychotherapy interventions.

Using Your Body to Demonstrate When verbal psychoeducation is accompanied by demonstration, visual representations, or modeling, clients can more easily comprehend, retain and use what we offer. They become more comfortable executing the actions themselves when you show them what you mean by using your own body. For example, with the client who is suffering from panic, you might demonstrate in the following way: 52

“When we feel panic, our energy is high, our bodies are tense and mobilized upward, and we often are a little shaky (therapist demonstrates shaky arms and body with elevated shoulders, shallow chest breathing, constricted diaphragm, wide eyes). Our energy needs to quiet down so we can relax. How about if we work with grounding to help everything settle so that you can calm down (therapist demonstrates relaxing the shoulders and eye muscles, slowing the voice, pace, and breathing, quieting the shaking, and letting energy settle downward)?” As you speak, you are demonstrating what panic looks and feels like physically and then showing the client what grounding and settling down looks and feels like physically. The same principle of demonstrating posture and movement holds true for addressing attachment related beliefs. You can “take on” or illustrate a negative belief, such as “I have to always work hard to be accepted,” in your own body (e.g., demonstrate a tense, high-energy, mobilized “ready-for-action” body that avoids eye contact) that supports the particular belief. Then, you can show how a different physical organization might support a different belief, such as “I can relax and people still accept me,” by relaxing your muscles, breathing more fully, and making more eye contact. Your client is much more likely to understand how the body itself reflects and sustains beliefs. Using your own body in this way conveys the psychoeducation point you want to make faster and more clearly than merely conversation. It effectively communicates ways the body might participate in the client’s difficulty, and conveys hope that working somatically will help resolve the difficulty. And your willingness and ability to use your own body in this way enhances a collaborative atmosphere. Demonstrations such as these activate the client’s mirror neuron system, optimizing his or her readiness to perform the same actions you execute. As clients observe you demonstrating a movement, such as relaxing your shoulders or reaching out, motor neurons in their brains fire as if they were executing the same action, essentially “rehearsing” the action themselves (Rizzolatti & Craighero, 2004; Rizzolatti, Fadiga, Gallese, & Fogassi, 1996). It is helpful to capitalize on mirror neurons by using your own body to model certain actions in order to prime your clients to execute those same actions in the service of supporting therapeutic goals.

Attitude and Positive Reinforcement Making the process of exploring the body an effortful, stressful, or negative experience is detrimental to building confidence in the body as a target of therapeutic intervention. Therefore, how you introduce attending to the body is critical. Tuning into the body requires a quiet spaciousness and a sense that this is a 53

perfectly natural activity for both of you to be doing. If your voice is soft, gentle, and slow, indicating an abundance of time to sense the body, or filled with wonder and curiosity to suggest that this will be an interesting adventure, the more likely it will be that clients can quiet their minds and sense their own bodies better. Noticing and reinforcing how clients are already able to connect with the body —rather than how disconnected from it they are—fortifies their confidence and stimulates enthusiasm for further somatic exploration. Using encouragement or praise lets clients know that their descriptions of their posture, movement, or sensation have value. Such positive reinforcement as ”You’re doing fine” or “It’s wonderful that you can actually feel and describe that tension—some people don’t have that awareness,” communicates that you are noticing and valuing their capacity to sense the body and describe what they sense and encourages them to increase their focus on somatic experience.

Embedded Relational Mindfulness Skills Most therapists are accustomed to following clients’ narratives, hearing their stories and discussing their problems. However, a different focus will be needed to work with the material to come. We are interested in chronic patterns of internal organization as well as how thoughts, emotions, sensation and movements fluctuate during the therapy hour (cf. Chapter 1, “Essential Principles”). These particular elements of internal experience are the targets of exploration in the chapters and worksheets. You will find that the topic chapters and worksheets emphasize teaching clients to be aware of internal experience and share with you what they become aware of as they experience it. Sensorimotor Psychotherapy employs a specific set of therapeutic skills influenced by Kurtz (1992) to help clients become aware of these patterns and fluctuations and to share them with you. The embedded relational mindfulness skills described below will aid you in facilitating a shared awareness of clients’ here and now experience. The first skill is noticing, or tracking, changes in clients’ posture, movement and expression. These changes will reveal elements of their internal experience that clients are not verbalizing. When they tighten, pull back, lean forward, round their shoulders, or sit perfectly still, they are communicating meaningful information about what is going on internally as they talk with you. Clients may report internally generated images, smells, tastes, or sounds or beliefs (such as “I can’t get support” or “It’s my fault”) and their bodies will participate in what they are saying— perhaps in a slump of the posture, a frown, or a downward glance. Emotions will be evident through moist eyes, facial expression, change in voice tone, or a downward glance. You can track how various elements of experience go together. For example, a client’s utterance of “It’s my fault,” may be expressed as she talks 54

about seeing her father’s unwelcoming face when she turned to him for comfort, and at the same time, her posture slumps, her face blanches, and her eyes tear up. These elements of present moment experience often remain unnoticed by clients until you direct attention to them by naming what you track. Simple verbal “contact” statements that verbalize present moment experience, such as, “As you see your father’s face, it looks like your posture slumps”, or “You seem sad right now,” bring your client’s attention to these elements as they are occurring. To teach mindfulness, it is essential to track and contact present moment experience because mindful awareness can only take place in the present moment (cf Chapter 7, “Mindfulness of the Present Moment”). If you only verbalize your understanding of the narrative, clients will assume that it is the narrative, rather than present moment experience, that is of interest. After bringing clients’ attention to their present experience by naming it, the two of you can collaborate to select or “frame” what to explore through directing mindful attention (cf. Chapter 8, “Directed Mindfulness and Neuroplasticity”). For example, if you want to explore the client’s posture, you might say, “Let’s find out more about the slump in your spine that happens when you talk about your father.” If the client is curious about his or her posture and agrees to explore it, then the two of you can begin to explore the posture through directed mindfulness questions. It’s important that deciding what to frame is a collaborative decision between you and your client—that you both agree on what to explore. After you track, contact, and frame, you can use mindfulness questions to specifically guide your client’s awareness. At this point, there is a shift from conversation to mindfulness that signifies a clear break from the narrative to mindful awareness of internal experience. Clients’ awareness turns inward instead of being focused outward as you ask them directly to be aware of internal experience. Questions like the following clearly direct the client’s attention inward to find out more about what you have framed together: “As you sense that slump in your spine, happens internally . . . what else do you notice?” Additional questions that direct mindful attention toward specific elements of internal experience could be, “What changes in your body?” or “What emotion seems to go with it?” or “What images emerge as you sense this slump in your spine?” Embedded relational mindfulness skills include requiring clients to answer these questions in the moment while they are mindfully aware of internal experience. Otherwise, the focus of the therapy returns to having a conversation rather than mindful exploration. Chapter 7, “Mindfulness and the Present Moment” will provide a clear map of the building blocks of present experience that will assist you as you explore directed mindfulness together in Chapter 8, “Directed Mindfulness and Neuroplasticity.” These interventions of tracking, contacting present experience, framing, and asking mindfulness questions are consistently implemented throughout a Sensorimotor Psychotherapy session and will serve you 55

well as you explore the topic chapters and worksheets with your clients.

Addressing Trauma-Related Dissociation Trauma-related dissociative compartmentalization often goes unrecognized in treatment because it has traditionally been equated only with diagnoses of dissociative identity disorder (DID) rather than acknowledged as a common posttraumatic complication. Although delineating a treatment model for dissociative disorders is beyond the scope of this book, Chapters 1, “Essential Principles” and 3, “Orientation for Clients”, include information on trauma-related dissociation. In addition, each chapter’s therapists’ guide contains a section entitled “Adapting this Material for Dissociative Clients” that considers how to best use the chapter’s concepts and worksheets with this population. As stated in the previous chapter, clients’ alternation between being dysregulated by traumatic reminders and trying to avoid them in order to participate in daily life is characteristic of a dissociative compartmentalization that reflects different adaptive priorities. The goals of the defensive system—to defend and protect—conflict with the goals of daily life systems—to engage with other people and the environment. If you track for such different priorities in your clients, you may notice that at times, your client is focused on stability, work, or family, and the wish to grow and resolve the issues that bring him or her to therapy. You may also notice that these goals are thwarted when traumatic reminders activate strong (and sometimes contradictory) defensive responses. At those times, your client might suddenly become frozen with fear or mute, want to run out of your office or terminate therapy, or first become furious and then drop into helplessness and hopelessness. Obviously, such internal conflicts will affect how your client responds to this book. For example, a client may initially express a wish to use this material but then have difficulty following through. As you continue with the book, that same client, though clearly benefiting from its use, might suddenly become ambivalent or even hostile about using the worksheets, or decide that he or she is “too stupid” and will not possibly be able to understand the concepts. Or, the gains achieved from a chapter are soon completely forgotten or cannot be sustained over time. The client who seems to be tolerating working with the body quite well might suddenly become triggered and overwhelmed and not want to continue. These types of strong or sudden shifts in mood, perspective, or belief are often interpreted as ambivalence or resistance but may instead reflect the activity of dissociative parts that have conflicting goals and priorities. Since many clients interpret these internal struggles as reinforcement of labels such as “crazy” or “borderline,” providing psychoeducation about internal parts 56

and dissociation is usually reassuring rather than alarming to them, especially if they understand the conflicts between the different priorities and functions of various parts. To reiterate, it is recommended that you both read the section in Chapter 3, “Orientation for Clients” on dissociation and discuss its contents together. With a base of shared knowledge, you might then explore how you can collaboratively acknowledge the adaptive priorities, functions, and goals of each part and help increase communication between and among them. Internal coherence and collaboration are always goals in therapy, whether clients have trauma-related dissociatively compartmentalized parts, not-me selfstates, or simply mixed emotions. Clients who struggle with dissociative parts in conflict often find it hard to imagine how internal collaboration will be helpful and tend instead to want their parts “gone.” This phobic reaction toward parts of the self requires therapists to hold the clarity that no part of the body or mind can, or should, be eliminated. When you can help your clients understand that, after trauma, they might experience such alternations between parts of themselves that want to engage in daily life and defensive parts that live in “trauma time” (van der Hart, 2012) as if they were still in danger, they can better understand and work with the conflicts between different parts of the self. The key to increasing their awareness is drawing their attention to the two “sides” (parts fixated in trauma and parts engaged in daily life) so they are more likely to recognize when their reactions are connected to different internal parts and, most importantly, become curious rather than confused by them. Your comfort with the idea that dissociative compartmentalization is a normal phenomenon after trauma, especially following prolonged childhood trauma, and that these changes in mood, perspective, and behavior represent identifiable parts of the self and instinctive adaptive drives associated with them is crucial to your clients’ understanding and ability to integrate those parts. Appreciation of the internal complexity goes hand in hand with the clarity that clients have one mind and one body: The parts are not separate individuals, even in clients with DID, but instead are always part of a whole system that is more than the sum of its parts.

Conclusion Tracking your clients’ responses to each intervention, making small adjustments, noticing their next response, and shaping your next intervention accordingly are essential throughout the therapy process and throughout your exploration of this book. When our therapeutic efforts are “effective,” it means not only that our clients have gained a new understanding or experience of themselves but also that they have integrated this learning so that it continues to deepen and grow in them. We can integrate past and present, insight and emotion, perceptions and facts, self57

states or parts of the self, and, perhaps most critical for our purposes, mind and body. When we work from the “bottom up,” small changes in movement or posture, with repetition and intention, can eventually lead to big changes. Just as we have confidence that a baby’s first tentative steps will one day become coordinated, confident movements, your and your clients’ willingness to work with how the body learns and how that learning builds on itself will yield meaningful rewards.

58

CHAPTER 3

Orientation for Clients Moving on after difficult events such as trauma or hurtful experiences with the people who raised us is not easy, especially when those experiences have conditioned us to view the world as threatening or ourselves as inadequate. Even in a good therapy with a skilled therapist, it can sometimes be challenging to find relief or resolution and we may end up feeling discouraged or stuck in our patterns. Since you are reading this book, you are probably interested in learning new tools to transform old patterns. The body’s movement, posture, and sensation can provide a missing link that can help you tap into that innate drive in all living things to heal, adapt, and develop new capacities. This volume is intended to guide you and your therapist to draw upon the natural intelligence of the body to lessen the distress and increase the satisfaction you might experience in your life today. The purpose of this chapter is to orient you to the structure of the book, how to use it, and to clarify a few underlying concepts and terms that will help you work together with your therapist to use the chapters that follow to your best advantage.

Attachment and Trauma There are many reasons you may be reading this book. Perhaps you simply wish to discover more about your body and learn its language, or you may experience difficulties for which you seek help. Some of you may feel that life is good, but have a vague sense that something is missing. Maybe you feel stable in your life, but not able to relax with others or be fully yourself. You may have achieved what you always wanted but have a nagging feeling that there must be more to life. You may long for more joy, enthusiasm, or connection in your life. Perhaps you are bothered by troublesome relational patterns, low self-esteem, or a lack of success and gratification in your work life. Or you may be plagued by boredom or emptiness that leaves you feeling less than fully alive. Perhaps you go through your days feeling numb and flat or you may experience feeling of out of control, or may be struggling with flashbacks, nightmares, painful or disconcerting sensations, anxiety, or intrusive emotions such as terror, rage, panic, shame, or despair. You may feel overwhelmed or otherwise unable to cope with normal daily life 59

challenges. The problems above stem from either our attachment history or past trauma or a combination of the two. “Attachment” is a term used to describe the strong emotional connection we feel with certain people that endures over time—in other words, we become “attached” to them. The people to whom we are attached are called “attachment figures.” In childhood, our primary attachment figures are our caregivers, often our parents, who are attached to us, too. Attachment relationships also include anyone else with whom we form an emotional bond, such as siblings, grandparents, or friends, and as we grow up, romantic partners and significant others. These relationships bring us great joy but some of them can also be difficult. Our early experiences with attachment figures provide the initial template for all subsequent relationships by instilling in us ways of relating to the world, others, and ourselves. Some of these ways will be constructive for future relationships, but some will not. Although this template does change with experience, we often find ourselves somehow repeating the relational hurts and patterns of the past. In adulthood, the habits that hold us back from engaging fully in our lives and with others may have their roots in past attachment relationships. Trauma refers to any threatening, overwhelming experiences that we cannot integrate. Sometimes our attachment figures are the source of danger, creating a conflict between wanting to turn to them for support, as we do with all attachment figures, and needing to protect ourselves from them. Relational trauma can also be perpetrated by strangers. Rape, bullying, hate crimes, and physical or sexual abuse are also examples of relational trauma. Some traumas, such as accidents or disasters, do not involve other people, but are still traumatic. Trauma can be a single event (e.g., an accident, rape, crime, or disaster) or repeated events. Trauma can also be a chronic condition (e.g., child abuse and neglect, combat, ongoing violence, death camps). When trauma occurs repeatedly early in life, especially if there was no safe person to turn to, or if it was perpetrated by an attachment figure, the effects can be difficult to resolve. It is important to note that any experience that is stressful enough to leave us feeling helpless, frightened, overwhelmed, or profoundly unsafe is considered a trauma. After such experiences, we are often left with a diminished sense of security with others and in the world, and a sense of feeling unsafe inside our own skin. This book addresses the effects of both trauma and attachment wounds. Both kinds of wounds almost always occur in situations in which protection and comfort were not available to us, or were not sufficient to prevent enduring negative repercussions. We rely on the felt experience of the connection with other people to heal from these wounds. Thus, the work of this book should be a collaborative effort between you and your therapist. Working together with your therapist will provide you with the relational support that might have been absent or inadequate in the distressing situations of the past, as well as the skilled guidance of a trained 60

professional.

Structure of the Book Each of the short chapters that follow explores a particular topic relevant to both trauma and attachment. They are structured to help you discover, step by step, how your body can be an asset in transforming the wounds left by trauma and attachment. You might want to look over the first chapter of the book, the “Introduction,” for an overview and brief description of the topic chapters. Since some of the words used in the chapters, like “attachment,” can be unfamiliar or unclear, a glossary is included at the end of the book. It might be useful for you to look over those words as you begin this book and refer to the glossary as you go through the material to come. A guide for your therapist precedes each topic chapter. These guides further explain each chapter’s purpose and suggest different options for integrating the ideas and worksheets into therapy in a way that will work best for you. You may find the guides helpful to read as well. But use your own judgment; it is not necessary for you to read the guides to benefit from the chapters. To help you apply the ideas in a personal way using your own experience, worksheets are provided after each chapter. Through the worksheets, you can apply the concepts discussed in the chapters through exploring the movement, posture, and sensation of your own body. Each worksheet can and should be used more than once. You will find that they have different meanings and relevance at different times in your life and in your therapy. You will also find that some worksheets that accompany later chapters are very similar to ones from previous chapters. This is not a mistake, but a purposeful opportunity to reinforce previously learned skills and support lasting change through repetition.

Using the Chapters and Worksheets There is no “right” way to use the chapters and worksheets. However, as stated, exploring the material with your therapist rather than in solitude is strongly advised. You and your therapist should tailor the use of this material specifically to your needs so that you can work together to meet your therapeutic goals. Because this book is meant to be helpful for people with a broad range of difficulties and diagnoses, some of the chapters or worksheets may not be relevant to your own particular needs. Some may be too challenging to be useful, while others may not be challenging enough. If you feel overwhelmed by your emotions, for example, you should put off the material that is designed to help you express painful emotions and 61

focus on the chapters that will help you regulate them. On the other hand, if you do not need help regulating your emotions, you may find chapters that help you express them to be more useful. Based on your particular set of difficulties, strengths, capacities and goals, you and your therapist can decide together which chapters are best for you to work with at any given time, how fast or slow to go, when to take time to integrate what you have learned or experienced, and when to forge ahead to the next chapter and the next challenge. In each chapter, you will find examples that illustrate how people who have suffered from trauma have made use of the concepts and exercises, and examples that illustrate how people who have suffered from attachment wounds but are not traumatized have used the material. Some of the examples will speak to you, but others may be hard to relate to. Just as with every other aspect of this book, you should take advantage of what you can learn from the examples that resonate with you, inspire you, or encourage you, and feel free to skim over or skip whatever feels not useful or relevant. You and your therapist can decide how much of the work to do together in session, and how much, if any, you should do independently. You may decide to read the chapter together during the therapy hour, discussing the concepts and how they apply to your experience as they come up. Likewise, you and your therapist may decide that completing the worksheets under your therapist’s guidance during the session would be the most helpful. Or, the two of you may decide that you would benefit more from reading a chapter and completing the worksheets outside of therapy, especially if you need time alone to ponder the assignments. If you do decide to work independently, then it will be important to bring your completed worksheet(s) to the next session and to discuss together what you discovered.

Safety and Risk Healing from the past requires a delicate balance of safety and risk. This material, and therapy itself, will inevitably evoke memories, strong emotions, body responses, and survival defenses that can temporarily exacerbate your symptoms, discomfort, or feelings of distress. Without reactivating the old memories and habits and our reactions to them, we cannot resolve the past. However, we need a certain degree of safety to heal from the past, and if we reactivate memories to the point that we are reliving what happened, safety is sacrificed, and we are repeating the past instead of resolving it. As you and your therapist work with this book, it is important to be attentive to the signals inside of you that tell you how fast or how slow to go. You will notice that throughout the book, you are repeatedly reminded to notice when you feel unsafe or experience dysregulated (i.e., too much or too little) arousal. In common 62

vernacular, “arousal” often refers to sexual arousal, but in this book the term is used to refer to the level of activation in the autonomic nervous systems. Our arousal level fluctuates throughout the day within a window of tolerance from being high when we’re excited to low when we are very relaxed. When our arousal is in a zone that is optimal for well being and social interaction, it is “regulated” within a “window of tolerance” (Siegel 1999). The following figure illustrates these three arousal zones—hyperarousal, hypoarousal, and optimal arousal

The material in this book will challenge you to take risks to explore uncomfortable territory and try something new that expands the boundaries of what feels comfortable, easy, or familiar for you. Often these challenges will take your arousal to the edges of your window of tolerance. But if your arousal goes too far beyond your window of tolerance at either extreme (too much or too little), then it is difficult to integrate our experience or new learning. You might feel too unsafe or dysregulated. You will learn apply skills to regulate your arousal with your therapist at these times so you can restore a sense of safety and mastery. Each time you work to bring your arousal into a window of tolerance when it is too high or too low, get in touch with body sensations, challenge yourself to address disturbing emotions, change your posture or ways of moving that are more suited to the present than the past, or address something you have been afraid to deal with, you are making progress. Taking real and lasting steps toward healing requires not only creating safety but also taking appropriate risks. When needed, your therapist will be able to help you identify signs of going too fast and practice the skills you are learning to regulate your arousal and help it return to a window of tolerance. He or she will also be able to help you identify signs of going too slowly, and challenge you at these times to reactivate the painful residue of the past sufficiently so that you can experience and resolve those patterns. However, you are the one who knows best how you are feeling and how 63

the work is going for you. If you feel centered and grounded and able to tolerate strong emotion without becoming unduly distressed or unable to function fully in your life, then you might move more quickly through the material and make good use of the more challenging chapters and worksheets. If, at any time, you find that your distress or symptoms are worsening or becoming unmanageable, that your emotions are too intense, or that you are not functioning well in your life, speak up. It could be a sign that you are moving too fast and may need to pace your work so that it is more tolerable. If so, you can focus on the chapters and worksheets that will help you stabilize your arousal. Needing to slow down and taking your time is not a problem. In fact, going more slowly can be just as useful (and sometimes even more useful) as moving quickly and ambitiously. As you, with your therapist, alternately push yourself just a little beyond your comfort zone and then use these new body-oriented skills to regulate and return to safety if you are triggered, challenge yourself again a little bit more, then regulate once more, you will find your capacities gradually expanding. You and your therapist together can explore finding just the right balance between safety and risk that will allow you to challenge yourself enough to grow and change, but not so much or so fast that you cannot absorb your new experiences.

Misunderstandings and Repair As in any relationship, difficulties can occur between you and your therapist. These can be moments of misunderstanding, misattunements, or times when each of you triggers or is upset by the other. For all of us, these situations can be uncomfortable and challenging, and for anyone who has experienced relational trauma or rejection, criticism and unresolved conflict in early attachment relationships, these dynamics can cause strong reactions. Using the perspective and skills you will be learning, you and your therapist can be curious about these ruptures in your connection and the reactions they trigger, noticing together what happened and what reactions or memories were stimulated. Doing so can help you both understand the impact of the past on the present moment because often these difficulties have to do with old patterns. When the two of you experience a misunderstanding or rupture in your connection, you have the chance to talk about the conflict together and create a new ending to an old story. Negotiating a misunderstanding within the therapeutic relationship provide the person-to-person repair that might have been lacking in the interpersonal ruptures of your past. Often, more can be accomplished through working these conflicts out together than if they had never occurred.

Trauma-Related Dissociation 64

If you have experienced significant trauma or have been diagnosed with a dissociative disorder, it is especially important to proceed slowly with this book, under the consistent guidance of your therapist. And to help you work best with this material it can be useful to understand a little about dissociation. In the aftermath of trauma, change, challenge, and reminders of the past can unexpectedly trigger hyper- or hypo arousal. You may lose time, meaning that you may have little awareness about what happened to you for a period of time. You may experience dramatically different bodily, emotional, and cognitive states. In dissociative disorders, these states can become “parts” of the self, and each part can function outside of your control or awareness some of the time. The language of “parts” is not intended to imply an actual division of the personality into discrete, separate physical entities, but to describe the sometimes dramatically different ways of thinking, feeling, and acting that can change rapidly and are often in conflict. One moment you might think, feel, and act one way, and the next moment you might experience very different thoughts, feelings, and actions. These moments can be really upsetting and confusing, especially without an understanding that such shifts might reflect different internal parts that were formed to help deal with trauma. Generally, dissociative parts of the personality fall into two categories. One category includes part(s) that live in trauma time, and remain ready to defend and protect by fighting, running away, or, if these are not possible, by freezing or shutting down. These defenses come up even when there is no current danger. The function of this category of parts is to protect us. When something triggers a defensive part, your orientation in the present moment disappears, at least to a degree. You may feel threatened, even in the midst of safe and supportive circumstances, and react in ways that might appear irrational to others, or even yourself, because a part of you is reacting to everyday life as if you were still in danger. The second category includes part(s) that try to get on with normal life by responding to the needs of family members, the demands of work or school, or sexual needs and desires. This part usually tries to avoid situations that might be triggering in order to feel safe enough to remain focused on daily life tasks. Every internal part has an important purpose to fulfill, and these functions are often clash. Defensive parts conflict with other parts that want to engage with the world and try to get on with life. One part may want to go to the movies with your family, but another part wants to avoid any potential danger out in the world by staying home. One part may try to protect you by flying into a rage while another tries to protect you by hiding. If you experience trauma-related dissociation, different parts of you can have dramatically different reactions to the chapters and exercises in this book. Once you understand that it is normal to experience profound conflicts between dissociative parts, you can begin to understand the material in 65

this book through the perspective and purpose of different parts of the self.

Adapting the Material The material in this book can be modified to accommodate readers with all kinds of difficulties, including dissociative disorders. When dissociative parts have different reactions and viewpoints, you may fill out one worksheet several times, or even read parts of a chapter again, from the perspective of various internal parts. You may elicit the help of a more stable or stronger part of you to support an unstable part to work with the material. With the window of tolerance as your guide, you and your therapist can find ways to work with movement, posture and sensation that will facilitate regulation and integration of parts. Or, you can decide together what chapters and worksheets are likely to dysregulate you, or parts of you, and put them aside for a later time to focus on those that can help you meet your immediate goals. Understanding the functions of different internal parts will help you better understand why, for example, one part of you, in trying to protect you, might be upset by an exercise in which you practice saying “no” because this part remembers that saying “no” would have brought more abuse your way in the past. But another part of you might be fed up with not saying “no” and want you to be more assertive now that the danger is over. Or, you may notice times when you (or parts of you) feel motivated to do the reading, complete homework assignments, and work on improving the quality of your life. But you may also encounter times when you (or parts of you) feel negative, frightened, overwhelmed, helpless, or even hostile toward the material. These contradictory, shifting reactions to the material in the book can be viewed as useful information about these parts and their role in your survival and adaptation. Then you can help the different internal parts discover ways to communicate and understand each other and find common ground from which they can work together. The chapters and worksheets can also be adapted for people with physical disabilities, learning disabilities, or with behavioral disorders such as ADHD that can make reading and writing difficult. Those of you with physical handicaps may think that a book about the body is inaccessible, however the exercises can be modified in ways to be constructive and useful for you. Those of you with dyslexia or another learning disability can also adapt the material to your needs. For example, you might prefer that your therapist reads chapter material aloud and that you answer the worksheet questions verbally rather than write. Together with your therapist, you can determine how to approach the chapters and worksheets so that they will be the most beneficial for you, adapt them to your particular learning style and situation, and make choices about what to skip or save for later. 66

The risks of wide swings in mood and arousal is greater for those of you who have recently been suicidal or diagnosed with active and severe anxiety, depression, bipolar disorder, or psychosis; are very recently sober, abstinent, or battling self-harm or addictive impulses; or those of you who have been struggling to function or recently hospitalized. If any of these cautions apply to you, you will want to discuss your concerns with your therapist, and you will also need to consistently call on the guidance of your therapist to help you manage these challenges. You and your therapist should carefully pace the work and be sure to have a plan and support system for managing any feelings and impulses that may arise in response to this material. Remember that attempting to tackle the material in this book without professional support could result in a relapse of symptoms, and whatever healing efforts you have achieved could suffer a setback.

Conclusion Healing is an ongoing, organic process, not a single “big bang” moment. When we are physically injured, healing happens by degrees as the body fights infection and then grows new skin cells that gradually become stronger and finally integrate with the skin around the injured area. Healing from traumatic or early relational injuries happens in just the same way. As you work with the material to come you will see that a tremendous emphasis in placed on repetition of anything new that positively changes your internal or relational experience and on integration of body experience with thoughts and emotions. Although it takes patience to repeat new skills until they become second nature, and it takes courage to risk trying something new, you will be rewarded with a newfound confidence in your body as a resource and a deeper level of embodied connection with yourself and others.

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SECTION TWO

Basic Concepts and Skills

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CHAPTER 4

The Wisdom of the Body Lost and Found THERAPISTS’ GUIDE TO CHAPTER 4

Purpose of this Chapter By clarifying what the phrase “wisdom of the body” means, this chapter establishes basic attitudes toward the body that underlie Sensorimotor Psychotherapy. Highlighting the body’s intelligence can build your clients’ confidence in drawing upon their physical movement and sensation to mend the wounds left by trauma and attachment. However, their appreciation of this intelligence is often restricted by a lack of knowledge or awareness, by disconnection from, or by their rejection of the body. If they learned to avoid, fear, override, ignore, dislike, or even hate their bodies, they will most likely come up against obstacles and resistance to working somatically. This chapter explains how such attitudes, along with many presenting symptoms and problems, are rooted in instinctive, healthy responses to unsafe, unstable, or unsupportive early environments, but become problematic because they persist after circumstances have changed.

Clients Who Might Benefit This first topic chapter is an important introduction for most clients because it spells out the rationale for focusing on the body’s wisdom, setting the tone for the remainder of the book. In particular, clients who are confused by their physical symptoms may find it helpful to read the brief descriptions of how trauma and attachment affect the body’s movement and physiology. Those who feel betrayed by, fearful of, disappointed in, or angry with their bodies will find explanations for why they might have developed these attitudes, learn to understand their adaptive functions, and through this understanding, begin to cultivate more salubrious attitudes. Clients for whom disconnection from the body has been pervasive and 69

resulted in unforeseen consequences, such as self-harm or accidents, might begin to understand that reconnection with the body and its wisdom can help them heal from the past. At the other end of the spectrum, those who are already connected to their bodies and who draw on their bodies as sources of enjoyment, competency, or pride will find that this material validates and deepens their appreciation of the body’s intelligence. Clients who are not traumatized but have yet to tap into the body’s wisdom will discover a new avenue of personal exploration.

Suggestions for Clinical Use Your own grasp of the concept, wisdom of the body, and your curiosity about how it is reflected in your clients’ physical adaptations to trauma and attachment experiences are essential to successfully integrating this material into your clinical practice. The origins of clients’ phobias, shame, disconnection, dislike, avoidance, or hatred of the body usually lie in these past experiences. With many clients your first task will be to help them discover these attitudes and reframe them as attempts to ensure survival or win the acceptance of their parents or other attachment figures. If your clients are uncomfortable with the idea that the body is a source of wisdom, acknowledging this discomfort and validating any disconnection from the body as possible adaptation to trauma or attachment inadequacies can spark more willingness on their part to consider the body as an avenue of exploration in therapy. With some clients, especially those who are phobic of the body, you may want to go over the first few paragraphs of the chapter together to assess their reaction and hopefully help them begin to appreciate the innate intelligence of a body that they might have rejected. It may be helpful to use session time to review the section “Our Bodies Adapt to Trauma and Attachment” together to initiate a discussion about how your client’s body has adapted to events of the past. Clients who have not been traumatized may have become disconnected from the body in order to dampen emotions that were not acceptable or welcome in the family or to otherwise meet the expectations of attachment figures. Affirming their wisdom in prioritizing attachment and acceptance by inhibiting those emotions can be helpful. Such clients may need your reassurance and support to alleviate apprehension and to begin to reconnect with the body in order to eventually be able to experience and deal with the emotions they have avoided in a way that helps them resolve the past (see Chapter 30, “Making Sense of Emotions”). Sharing your personal discoveries about the intelligence of your own body can sometimes deepen clients’ confidence in this concept and help combat their uneasiness, confusion, fears, or phobias. If you are a meditator, you might describe how bringing awareness to your breath or body sensations has helped you calm 70

your mind and emotions. If you have a somatic discipline, such as yoga, martial arts, a workout program, dance form, or sport, you might disclose how these disciplines can provide an outlet for tension, reduce stress, trigger the “feel good” endorphins, alleviate lethargy or depression, help manage frustration or anger, or instill a sense of mastery. You might question your clients about how their own physical activities have helped them cope with challenges or experience pleasure, validating how they have already drawn on the wisdom of their bodies.

Introduction to the Worksheets As discussed in Chapter 1, your choices about how to use the worksheets and which ones to omit are guided by what would best “speak” to each of your clients or be easiest for them to integrate. This beginning set of worksheets can guide you in that regard and provide an initial platform by which to assess your clients’ connection to, emotional attitude toward, and capacity to explore the body. The first worksheet, EXPLORING YOUR RELATIONSHIP TO THE BODY, provides an opportunity for clients to become interested in, curious about, and assess their various attitudes toward the body. It is a good starting place for most clients. This worksheet can stimulate discussion about any views of the body that clients might find surprising or concerning. You can use what you learn from clients’ responses to the items in the worksheets to adjust your approach to how you might subsequently incorporate the body in your work together. Clients can be encouraged to draw on what they discovered from this first exercise as they fill out the next few worksheets. FEARS AND HOPES, the next worksheet, will bring to light both the hopes clients have about how working with the body might help them and the fears they experience or anticipate will come up. For clients who are unable to identify or express any hopes, it may be more helpful to first complete the LETTER TO YOUR BODY worksheet in order to articulate both the ways their bodies have disappointed them or let them down, and their gratitude for how their bodies have supported them through the years. Clients who are apprehensive about discussing their relationship to their body directly with you may find that doing so in writing is easier. Perhaps they may be willing to share their letter with you after they write it. The ATTITUDES AND ACTIONS worksheet helps clients identify and articulate their attitudes about their bodies—what they like and dislike—and think about how these attitudes are reflected in how they care for their bodies. If your client has a tendency to generalize (e.g., “I hate my body—I like nothing about it”), then this worksheet should be completed in session so that you can help him or her become curious about the specific beliefs, feelings, and perceptions that are connected to the dislikes, as well as uncover any elements the client likes but may 71

not have considered. The final worksheet, THE BODY’S SIGNALS, sheds light on ways in which clients may or may not listen to the body’s signals. Ultimately, this understanding can foster their ability to pay more attention to the body’s signals and to take more effective action in response. Clients will benefit from your prompts to discern the more subtle signals of the body.

Adapting this Material for Dissociative Clients The dysregulation that accompanies a dissociative disorder can alienate our clients from their bodies; involuntary shaking, trembling, overwhelming emotions and sensations, impulses to action, numbing, and shutting down can make the body a frightening place. When we acknowledge and empathize with the client’s fear while communicating that these disturbing experiences are bodily reflections of traumatic memory, the phobic response to such experiences often lessens, bit by bit, on its own. Because dissociative compartmentalization is often characterized by polarization, internal conflict, and amnestic barriers, clients with a dissociative disorder may alternate between parts that are adamant in their refusal to connect to the body, or even acknowledge that there is a body at all, and other parts that acknowledge the body, at least to some degree. Some parts of the client may be terrified or intensely ashamed of the body, or want to do it harm, as though it belonged to someone else. It is important to understand that dissociation can hide dysregulation, so these clients can appear deceptively regulated. For example, a therapist can be working with one part that seems to tolerate exploring the intelligence of the body, but other parts quickly become overwhelmed. Thus it is important to include different parts in your exploration, discovering how various parts respond to the chapter and to each worksheet and finding common ground among them. When you validate all parts of the client for their survival functions, you might also discover additional positive feelings and thoughts about the wisdom of the body. Clients might then become more receptive to questions such as, “Are there any parts that have used the body as a resource? How have they done that? And how has it helped?” Through such exploration, clients can begin to understand that dissociative parts, such as body phobic parts or parts that deny the existence of the body, have important functions, and those functions involve somatic intelligence.

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CHAPTER 4 The Wisdom of the Body, Lost and Found Every moment, little miracles are taking place inside our bodies that require no conscious attention and usually go unnoticed. Injuries are repaired, harmful germs are fought off, food is transformed into energy, and new cells are created. Homeostasis is maintained as our bodies automatically correct imbalances. For example, our internal thermostat assures that we maintain a steady temperature: When we are too hot, we sweat to cool our bodies and when we are too cold, we shiver to warm up. Our brains compare current perceptions with memories of the past, producing complex bodily signals that guide our actions without any need to think about them, so that we can safely move about the world. For example, in response to immediate input from our senses, we instinctively walk around an obstacle to avoid tripping, or we depress the gas pedal or brake and turn the steering wheel to safely drive a car. Right now, as you read this book, a myriad of wondrous brain and body activities are taking place. Your breath is bringing oxygen to your lungs where it can be absorbed into the bloodstream . . . your heart is pumping blood carrying nourishment to all your cells . . . your muscles are working together in synchrony so that you can hold this book in your hands and turn the pages . . . your brain is decoding and interpreting the markings on this page to make sense and meaning as your eyes are working together to read these words. The speed, complexity, and magnitude of processing that takes place in our brains and bodies so that we can engage in normal daily activities like reading or driving a car is astounding, yet most of us take such evidence of the inherent wisdom of our bodies for granted. When we are able to recognize this wisdom, we can experience the body as a living, ever-changing source of intelligence, information, and energy that provides ongoing support for our physical and mental functioning. However, for many of us our bodies have been objects of criticism, disappointment, frustration, unwanted attention, abuse, or injury. When that is the case, we are likely to lose confidence in the innate intelligence of our own bodies, and then it can be difficult to feel at home in our bodies. This chapter describes how trauma and early attachment experiences affect the body and introduces ways to regain an appreciation for the natural intelligence of your body.

Our Bodies Adapt to Trauma and Attachment 74

A powerful indication of the wisdom of the body is that its movement, posture, and physiology will adapt to our surrounding circumstances, without our conscious intent, to assure our survival and maximize our well-being. For example, if our parents or other attachment figures (people to whom we form an enduring emotional bond) expected us to be modest and not draw attention to ourselves, we might slump and keep our bodies small so that we gain their approval without even noticing what we are doing. If our parents taught us to be tough and assertive, we might unconsciously puff up our chests or maintain unflinching eye contact so that they accept us. We wisely stop reaching out if no one is there to reach back; we cease making eye contact if we see disapproval or rejection in our parents’ eyes. Through these physical habits, our bodies automatically reflect and sustain the ways we learned to adjust our inner needs to the demands and expectations of the people important to us. Trauma stimulates another kind of bodily intelligence in the form of intense physical survival responses designed to protect us from harm. The sympathetic nervous system releases adrenaline to stimulate the heart to pump harder and to increase respiration, providing our muscles with the oxygen and energy needed to get help, to fight, or to escape. All our senses become hyperalert. But if we cannot successfully get help, fight back, or run away, as is usually the case in childhood trauma, our bodies wisely try to protect us by freezing, immobilizing, becoming numb, and shutting down. All of these innate responses to trauma are natural and essential to our survival. For many of us, what were initially adaptive responses to danger and to attachment inadequacies continue long after conditions have changed, causing the same physical reactions now that we experienced then. If we suffered trauma, we may continue to feel frozen, numb, or tense on a daily basis, or we may be constantly seeking help, or be ready to fight or flee. We may be overly sensitive to sounds or movements and easily startled by unfamiliar stimuli. Or we may underreact to stimuli, feel distant from our bodies, or experience a sense of deadness. As adults, we probably still embody the postural and movement habits that helped to maximize what our environments and the people in them could offer us. But often we do not understand the original wisdom of these physical reactions and do not realize that being aware of and changing them can help us to move beyond the confines of the past.

Feelings about the Body Trauma and attachment influence how we feel about our bodies. If we were not held safely, treated kindly, or given sufficient support, we may feel ashamed, disgusted, repulsed, or angry toward our bodies. Jane was told over and over by 75

her abuser what a pretty girl she was, and she came to associate being pretty and feminine with unwanted attention and sexual abuse. She also felt betrayed by her body’s instinctive pleasurable responses during the abuse. She gradually grew to reject her body, her femininity, and her natural sexuality. She found herself gaining weight in an attempt to make herself less attractive, further fueling her dislike of her body. Peter was ashamed of his body for different reasons; he blamed his body for not being strong enough to beat the other boys at arm wrestling contests. His father teased him for being “weak,” and Peter felt his body had let him down because he was not physically strong enough to win his father’s approval. Annette, whose family placed great importance on physical appearance, rejected her body because she did not believe she was attractive or thin enough. When she looked in the mirror, she saw an ugly, overweight reflection although this was not true in reality. Others might feel critical of or let down by their bodies due to illnesses, disabilities, or because their sexual or athletic performance does not match their ideal. We often expect too much from our bodies, unrealistically wanting them to be “perfect” in terms of looks, health, or performance, without understanding these pressures as a result of the demands placed on us by our parents, teachers, coaches, peers, or those who abused us long ago.

Disconnecting from the Body The emotional pain of feeling hurt by people important to us, as well as physical pain, such as that incurred in trauma, is “felt” in the body. Emotional pain may manifest physically as tightness in the throat, increased heart rate, or achiness in the chest, for example. When the sensations of physical and emotional pain are unpleasant or overwhelming, we may disconnect from them so as not to experience the hurt. A disconnection from the body can be healthy and helpful at the time of trauma and emotional stress because it allows us to distance ourselves from a painful situation while actually remaining physically present. This disconnection can be a helpful resource in distressing circumstances. However, over time, we may learn to disconnect in anticipation of hurt and discomfort, not just when such situations actually occur. Instead of being a temporary solution to adversity, disconnection from the body then becomes the new norm. When we are not connected to our bodies, we may view them as a problem—as something to be ignored or overridden or, conversely, as something to be worked on, fixed, or repaired. We may disregard the tension we feel, ignore the discomfort of an injury, push ourselves beyond our limits, or fail to notice the feelings of wellbeing in our bodies. We can become so disconnected from our bodies that we do 76

not take care of them. We might discount the signals of bodily needs such as those indicating hunger, thirst, or fatigue and fail to take care of the body through proper diet, sleep, and exercise. We may even disregard physical symptoms that should require a doctor’s attention, or we might abuse our bodies with long hours at work, sleep deprivation, food, drugs, compulsive exercise, or self-harm. When we ignore, discount, or override the communications from the body, we lose the opportunity to get in touch with its innate wisdom. Instead, we may try to rely on our minds rather than draw upon our natural somatic intelligence in the here and now. Though problem-solving abilities and insight can be of some help, the cost of the self-protective mechanisms we have developed in the face of adverse experiences is often that we lose touch with the potential for healing and growth that can be found through listening to our bodies.

Reconnecting with the Body Initially, reconnecting with the body can be frightening, frustrating, anxiety producing, or even overwhelming, and it is not something that can always be accomplished quickly. Apprehension that reconnecting with the body will cause us to become aware of unpleasant or painful physical sensations or trigger distressing memories or emotions may daunt us. We may doubt that reconnecting with the body can be beneficial in helping us live full and productive lives. Patience is our best resource. Rather than trying to force ourselves to change, we can gently work toward understanding and accepting all aspects of the body, especially those aspects we have disowned or avoided. Awareness and understanding, slowly over time, lead to acceptance and can provide a vital resource for changing old, outdated patterns and behaviors. The more we learn about the wisdom of our bodies, the better we will be able to draw upon this intelligence to resolve the issues of the past. From a basic understanding that the body not only holds adaptations to past trauma and relational experiences, but also the capacity to heal them, we can learn to work with the body as an ally in moving beyond our past conditioning. We can learn ways of reconnecting to the body to unleash a natural healing process that will help resolve psychological wounds and foster a new level of embodied connection to ourselves and to others. The worksheets that follow will help you discover your relationship with your body and explore how you respond to its signals. Understanding how you relate to your body is an important first step in cultivating an appreciation for its wisdom and using that innate intelligence to help heal the wounds left by trauma and attachment inadequacies.

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The Wisdom of the Body, Lost and Found EXPLORING YOUR RELATIONSHIP TO THE B ODY Purpose: To become aware of some of the feelings, views, and attitudes you have about your body as a first step in learning to appreciate the wisdom of the body. Directions: Rate the following statements by circling either strongly disagree, disagree, neutral, agree, or strongly agree. I feel that I am connected to my body.

strongly disagree • disagree • neutral • agree • agree • strongly agree

I view my body as a problem.

strongly disagree • disagree • neutral • agree • strongly agree

I ignore my body.

strongly disagree • disagree • neutral • agree • strongly agree

I override my body by “powering through.”

Strongly disagree • disagree • neutral • agree • strongly agree

I feel that my body supports me.

strongly disagree • disagree • neutral • agree • strongly agree

I am content with they way I look.

strongly disagree • disagree • neutral • agree • strongly agree

I am disappointed in my physical strength.

strongly disagree • disagree • neutral • agree • strongly agree

I am happy about my weight.

strongly disagree • disagree • neutral • agree • strongly agree

I can count on my body.

strongly disagree • disagree • neutral • agree • strongly agree

I feel comfortable in my body.

strongly disagree • disagree • 79

neutral • agree • strongly agree I notice bodily signals such as pain or hunger.

strongly disagree • disagree • neutral • agree • strongly agree

I push myself beyond my limits.

strongly disagree • disagree • neutral • agree • strongly agree

I don’t notice pleasant bodily signals.

strongly disagree • disagree • neutral • agree • strongly agree

I am only aware of my body when I don’t feel well or my body is injured or in pain.

strongly disagree • disagree • neutral • agree • strongly agree

I am ashamed of my body.

strongly disagree • disagree • neutral • agree • strongly agree

I use my body to do things I enjoy: hiking, running, working out, yoga.

strongly disagree • disagree • neutral • agree • strongly agree

Reflect on what you learned about how you view your body from this assessment and consider if any of your responses were surprising or concerning to you. Discuss what you learned with your therapist.

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The Wisdom of the Body, Lost and Found F EARS AND HOPES Purpose: To identify some of the fears and hopes youmight have about increasing your connection with your body. Directions: In the empty boxes underneath “Fears,” describe any fears, anxieties, or apprehensions you may have about connecting with your body. In the empty boxes underneath “Hopes,” describe what you hope to experience or learn through connecting with your body.

Fears Examples: • Reconnecting with my body will feel unpleasant or cause anxiety. • I won’t be able to reconnect with my body. • I’ll start having painful memories. • I’ll dislike what I find.

Hopes Examples: • I want to experience more well-being, motivation, or energy. • I want to develop better physical habits, and feel comfortable in my body. • I want to feel better about my body and connect better with myself.

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The Wisdom of the Body, Lost andFound A LETTER TO YOUR B ODY Purpose: To identify both disappointments in and appreciations for your body with regard to different periods of your life.

Directions: Draft a letter to your body in which you express your disappointments about the ways you feel it has let you down, failed you, or held you back. Also express your gratitude for the ways it has supported or protected you, or helped you heal, learn things, or enjoy yourself. Think about your earliest memories and describe the disappointments and appreciations you felt at that time, and then progress chronologically through your history up to the present moment in your adult life. After writing this letter you can decide if you want to share it with your therapist or if you want to keep it as a personal communication between you and your body.

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The Wisdom of the Body, Lost andFound ATTITUDES AND ACTIONS Purpose: To identify what you like and dislike about your body and how you treat your body. Directions: As you think about your relationship with your body, try to pinpoint what you like and dislike, and describe in the first section below. Then think about the ways that you treat your body and describe in the second section below. When you are finished, answer the questions at the bottom of the page.

How do you feel about your body? List what you like about your body.

List what you dislike about your body.

How do you treat your body? List ways you respect and take care of List ways you don’t respect or take care your body. of your body.

Reflect on the connection between how you feel about your body and how you treat your body. Which attitudes and actions promote your well-being and which might you want to change? What first steps might you take toward that change?

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The Wisdom of the Body, Lost andFound THE B ODY’S SIGNALS Purpose: To identify bodily signals such as hunger, thirst, or fatigue that indicate physical need as well as signals such as tension, gut feelings, or a change in breathing that indicate other kinds of needs, and to describe the effects of when you listened to those signals and when you did not. Directions: Think about the times you have listened to and ignored your body’s signals. Then, answer the prompts below. 1. In the box below, describe a signal from your body that you have listened to and how you responded to the signal. (e.g., The signal was tension in my neck and shoulders from a stressful day at work, and I took a warm bath to help me relax.) 2. In the box below, describe the effect of listening to your body. How did your body feel after you listened to the signal? How did you feel about yourself? (e.g., My body felt so relaxed after the bath, and I was in a good mood. I felt good about taking care of myself and doing something to relieve the tension.) 3. In the box below, describe a signal from your body that you have ignored or overridden. (e.g., When my roommate asked me to watch T.V., I felt my body tensing up, and I looked away. I was tired and yawning, but I stayed up late to watch T.V. anyway.) 4. In the box below, describe the effect of overriding the signal. How did your body feel after you ignored or overrode the signal? How did you feel about yourself? (e.g., I was upset with myself when I stayed up late because I was tired and crabby the next day. I couldn’t focus at work and my coworker got irritated with me. I had to fight to stay alert.) 5. Which signals do you typically listen to, and how do you think you learned to listen to those signals? 6. Which signals do you typically ignore or override, and how do you think you learned to not listen to those signals? 88

7. How can you listen better to your body’s signals and respond more effectively to what your body is telling you?

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CHAPTER 5

The Language of the Body Procedural Learning THERAPISTS’ GUIDE TO CHAPTER 5

Purpose of this Chapter This chapter continues to explore the language of the body to further your and your clients’ understanding about how habits of posture, movement, and gesture can become viable avenues of exploration in therapy. Building upon the previous chapter, this one addresses more precisely how these physical habits reflect adaptations to past circumstances and how they influence the quality of current experience. A slump in the spine might tell the story of a need for compliance in the past, while implicitly diminishing self-esteem and propagating feelings of shame, helplessness, or incompetence in the present. Tension across the shoulders and a pulling in of the stomach muscles might tell the story of a need to protect oneself from bullying in childhood, while evoking feelings of wariness and the belief that others can’t be trusted in current safe environments. Helping clients to identify and understand such habits as procedural learning that reflects intelligent adaptation to past situations, and to recognize the value of changing these patterns to promote well-being in the present, are primary goals of this chapter.

Clients Who Might Benefit This material will be valuable to clients whose chronic patterns of tension, posture, and movement reflect and sustain outdated survival and coping strategies. When clients’ habitual postures and movements directly relate to their presenting problems and contribute to their inability to accomplish their goals, the language of the body is a useful avenue of exploration. For example, clients might recognize that tension in the jaw contributes to bouts of anger, that shoulders hiked up to the ears reflect and sustain fear states, or that avoidance of eye contact interferes with 90

the relational connection they desire. Clients who experience dissatisfying relationships may glean helpful insights about the physical actions and postures that reflect their “implicit relational knowing” (Lyons-Ruth, 1998), identifying those that were welcomed and those that were rejected by attachment figures of the past.

Suggestions for Clinical Use Rather than furthering a mindset of shaming and blaming themselves for their behavior, the language of procedural learning helps describe, without bias, how clients’ current behavior is influenced by the physical habits they learned to help them adapt to the circumstances of the past. Discovering the meaning of procedural patterns and understanding the story told by the body through translating its language can provide information and validation that might ease their selfjudgment. And when clients cannot remember what happened in words, discovering how their procedural learning is an embodied record of the past often alleviates the pressure to construct a verbal narrative. To introduce clients to the importance and scope of procedural learning, the concept can first be illustrated with simple, everyday examples, such as how procedural learning enables us to get from place to place, tie our shoes, ride bicycles, or use our cell phones and computers. From this basic framework, more complex kinds of procedural learning that relate to adaptations to past circumstances become more easily understandable, such as how we learned physical habits to best protect ourselves, win the acceptance of attachment figures, and otherwise adapt to the environment. Exploring the role that procedural learning plays in your clients’ symptoms and problems can help boost their confidence in the wisdom of the body. However, some clients may feel judged or criticized when you bring attention to their habits of posture and movement. Conveying concepts by providing anonymous examples, using your own posture and movement to demonstrate, or appropriately disclosing aspects of your own procedural learning can help set them at ease. Maintaining a playful, curious, exploratory atmosphere will also be helpful. Referencing studies that highlight the influence of posture and expressions on the quality of one’s experience may be useful for some clients who need “proof” that the body influences their well-being. Dijkstra, Kaschak, and Zwann (2006) showed that subjects who embodied a particular posture were inclined to recall memories and emotions in which that posture had been operational. Schnall and Laird (2003) found a correlation between the practice of postures and facial expressions related to sadness, anger, and joy and a tendency to recall past events that contained a similar emotional valence as that of the one they had rehearsed, even though they were no longer practicing the posture. These studies can be shared 91

with clients to highlight the potential benefit that addressing procedural learning might have on promoting therapeutic change. It is important that you help your clients understand that the physical habits and symptoms that were developed as adaptations to extreme or stressful conditions can be unlearned, and that new responses better suited to current reality can be practiced. It took many repetitions to create procedural patterns when they were young, and now it will simply take many repetitions of new actions to create new patterns.

Introduction to the Worksheets The first worksheet, BODY READING, is meant to elicit your clients’ curiosity about how the body conveys personal history and deepen their understanding of the relationship between physical patterns, emotions, and beliefs. Clients may be able recognize their own patterns in the body images on the worksheet, setting the stage for challenging and modifying their own procedural learning. GETTING TO KNOW THE BODY’S LANGUAGE refines clients’ ability to translate the body’s language by guiding them to notice the procedural learning of people they see in a public place. Because these first two worksheets direct clients to notice the bodies of others rather than notice their own bodies, they should be relatively accessible to those who are reluctant or frightened to notice their own procedural learning. Your own enthusiasm and interest in procedural learning will be important to encourage a curiosity and wonder about the language of the body in your clients, preparing them to notice and reflect on their own procedural learning. GOOD TIMES, BAD TIMES, & YOUR BODY helps clients contrast their physical reactions, such as tension or a change in breathing, when they remember two very different situations. Clients will need your prompting to take the time to sense their body’s reactions to recalling each of these situations. You can encourage their awareness by providing a menu of possibilities, such as “Maybe you notice a change in your breathing, or tension or relaxation somewhere in your body. Or maybe your posture slumps a little, or your chin lifts.” Naming what you notice (e.g.: “As you remember that good time it looks like your shoulders relax and you seem to sit a little taller.”) can also bring their attention to how their body changes with remembering each situation. The worksheet will also help build skills for translating the language of the body by exploring how the different physical responses they discovered contribute to how they feel. CONTRADICTIONS BETWEEN MIND AND BODY helps clients identify inconsistencies between procedural leaning and mental knowing, or between what the body knows and what the mind knows, and learn how physical patterns can stimulate emotions connected to the past, rather than the present. Your clients’ responses to this worksheet will be 92

particularly useful to you later in therapy when you can revisit the worksheet to determine what new actions can be practiced to help reconcile thoughts and procedural learning that are at odds.

Adapting this Material for Dissociative Clients In dissociative disorders, different procedural tendencies are held by different parts of the self. Some parts may have developed a slumped posture, rounded shoulders, and loss of muscle tone that might be connected with compliance and shutdown. Other parts might demonstrate tension in the arms, hypervigilance, and clenched fists that indicate a readiness for aggression. Still others might exhibit physical tension, hiked shoulders, and lack of free movement characteristic of freezing. Although clients may or may not initially be able to recall narrative memories held by different dissociative parts, their bodies will tell the story, and their symptoms will be, to some extent, sustained by the procedural learning of each dissociative part. Taking the time to observe the physical manifestations of various parts of the client as they emerge, fostering curiosity about them, and discussing the procedural learning of each part will help clients recognize the physical indicators of internal parts. Because particular indicators can herald the emergence of a particular part, this awareness can help prevent switching and provide opportunities for communication between parts, thus supporting integration. With dysregulated and dissociative clients, you will need to rely even more on repetition to facilitate assimilation of new learning. The more fragmented or activated the client, the more you will need to call attention repeatedly to the procedural learning of various parts of the self. By doing so, the potential of absorbing the new information about the language of the body in a way that is useful and meaningful is increased.

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CHAPTER 5 The Language of the Body: Procedural Learning We remember the past not only in words, images, and stories, but also through chronic habits of tension, movement, and posture. Our bodies continually respond to what happens to us, how others treat us, and how we feel inside. When, as children, we feel safe, our bodies relax and we might snuggle, run, jump, or play, but when we feel scared, our bodies tighten up and we cry and seek out someone to comfort us. If no one is available to soothe or protect us, we sometimes give up and our bodies might “go limp.” If we are scared often enough, the tension or the limpness turns into an enduring physical habit. It takes a long time, but eventually the body’s repeated reactions become automatic, long-lasting patterns that carry the memory of a past that our minds may have forgotten, dissociated, or suppressed. We may not recognize our physical habits as ways of remembering because the body does not speak in words. Instead it speaks the nonverbal language of visceral sensations, posture, tightening or relaxing, movements, gestures, facial expression, changes in levels of autonomic arousal, heartbeat, breath, even physical symptoms. This chapter focuses on the habits of tension, posture, movement, and gesture that we develop over time. When we translate the nonverbal language of these elements into words, we glean insights into behaviors that contribute to difficulties in our current lives and discover new avenues for changing outdated patterns.

Procedural Learning Our memory system for automatically performing certain skills, behaviors, and survival strategies is called procedural memory. A simple way to understand what this term means is to imagine tying your shoes. Once you learned how to tie them at a young age, you no longer had to think about how to do it; you just tied your shoes. When we repeat a movement, a sequence of movements, a posture, tension, or gesture over and over, it becomes habitual. We “remember” how to do it automatically, without thinking about it—the procedure has been thoroughly learned. Procedural memory is different from recalling the events of the past with words. Our procedural memory is recorded in our habitual posture, gestures, how we carry ourselves, movements, and tension patterns and has stories to tell that we can only hear by becoming aware of the language of the body.

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The Effects of Trauma and Attachment on Procedural Learning Ella’s body expressed her history of abuse in ways that words could not. When she thought about her childhood, her shoulders hunched up in fear, and her arms tensed with anger. A poet, she had written eloquently about the abuse, describing in vivid language the disjointed bits she remembered about what had happened to her. Although Ella had explored her trauma and attachment history in talk therapy and in a weekly women’s group, the tension was still there. Her mind told her to put the past behind her, but her body told her that she was not “finished.” Her hunched shoulders reflected how frightened she had been as a child. The tension of her arms spoke of what her body had wanted to do but couldn’t—fight back and protect herself from her father. Ella did not understand that tension is a precursor to action, and chronic tension often tells the story of actions we wanted to make in the past but could not execute. Until she learned to translate the language of her body, she was unaware that the tension in her arms represented the impulse to protect herself that she had held back to avoid making her father mad and the abuse worse. When we experience trauma, it is natural to want to run away or defend ourselves, but often these actions are unsuccessful in keeping us safe. Children cannot run away from their home to escape abuse, and fighting back is most often ineffective and might even risk the making abuse more severe. Ella’s abuser, her father, was stronger than she, and even as a small child, Ella “knew” instinctively that fighting back would have only made him angry and violent. Additionally, her primary attachment figure, her mother, prized politeness and manners and considered expressions of anger to be “crass.” So Ella learned that the best way to please her mother and secure her acceptance, as well as minimize her father’s abuse was to be compliant, quiet, only speak when spoken to, and try not to be noticed. She formed physical patterns that helped her accomplish this: hunching her shoulders up in fear, holding back her anger with the tension in her arms, keeping her eyes down to avoid eye contact, and trying to make herself smaller as she moved through the house. As Ella said to her therapist, “I don’t get angry—I get small. I don’t want to make waves.” Before she was old enough to understand why, her body had learned to keep her as safe as possible and maximize her mother’s care and affection. Ella’s pattern of responding provided her with two very different types of safety: making herself “small” not only minimized the damage of her father’s abuse but also helped her win the acceptance and approval of her mother. Our early attachment with our parents forms the beginning blueprints for the way we learn to move and hold our bodies throughout life. For example, if you grow up with parents who value high achievement and encourage you to “try 96

harder” at everything you undertake, your habitual posture, gesture, and movement will reflect this influence. If this value is held above other values, such as one that communicates “You are loved for yourself, not for what you do,” your body might become tight, mobilized to “work harder” or “try harder,” and your chin might be lifted in an attitude of determination. You might become resolved to find the energy to keep going even if you are tired, and thus override the signals from your body telling you to take a break. These tension patterns, gestures, postures, and movements, when repeated throughout your childhood, become procedurally learned habits that endure into adulthood. Conversely, if you grow up in an environment where trying hard is discouraged or where everything you achieve is undervalued, ignored, or dismissed, you might develop a sunken chest, limp arms, and shallow breath. Your body will reflect the childhood experience of not feeling confident and of “giving up.” As an adult, these habits might make it difficult to mobilize consistent energy or sufficient selfconfidence to complete a difficult task. Although such patterns form because they are initially adaptive, later, when conditions have changed, the procedural learning remains in operation, whether appropriate to your current reality or not. For example, even when we know intellectually that we are now safe, as Ella knew, our procedural learning—now an unconscious automatic habit—can repeatedly warn us that the painful past experience is about to happen again. Procedural learning is based on unconscious presumptions that the future will be the same as the past. The procedurally-learned habits that allow us to effortlessly drive a car depend on the expectation that ways of maneuvering the car will have the same effects as they always have. In this case, the unconscious presumptions, and the corresponding procedural habits are helpful. But some procedurally learned habits interfere with new responses to current life and take precedence over actions that might be more pleasurable or more adaptive. Ella came to therapy because she wanted to get married, but when she thought of marriage, the hunching of her shoulders increased. Even though her conscious mind said one thing (“I want a husband, and it’s safe now to be close”), her body remembered the past when it was not safe to be close to her father. Decades after her childhood was over, Ella’s body unconsciously predicted that if she hunched her shoulders, held back her anger, kept herself small, and tried to please others, she might be safe and accepted. Although Ella desperately longed for a mate, her hunched shoulders, avoidance of eye contact, and fear of being seen prohibited the receptivity and trust she needed to pursue an intimate relationship. Like Ella, our bodies also remember and act from what has worked in the past rather than what might be adaptive to our current situations and relationships. It becomes difficult to move on from the past when our bodies automatically react as if the past were our present reality—like Ella, whose body froze whenever she thought of going out on a date. Before she could fully realize that she was now 97

safe, Ella needed to become aware of the language of her body, both the tension in her shoulders and the anger that it had held back all these years, and how she kept herself small and avoided eye contact. She needed to be able to “hear” the story her body was telling her. As Ella began to listen to the tension in her body, she realized that it held the somatic memory of what had happened to her. The tension in Ella’s arms told her what she had wanted to do but couldn’t: to protect herself by pushing her father away! As Ella realized it would only have made the trauma worse if she had tried to defend herself in the past, she gained a new appreciation for her body’s wisdom that had curtailed those potentially harmful actions. And Ella was also able to change the physical pattern of downcast eye gaze and careful, prim movements that she had developed to please her mother. Together, she and her therapist practiced making eye contact and spontaneous, big movements that countered her habit of staying small until these new behaviors grew increasingly comfortable. Her hunched shoulders gradually relaxed and her body began to feel “freed” of its prison. Through practice, Ella changed her procedurally learned habits. The verbal narrative and our interpretations of what happened are only half the story of any experience. The worksheets that follow will teach you that your body also has a story to tell, one that intertwines with your thoughts and emotions. You may not have heard this story if you learned to disconnect, push away, or ignore your body. But even if your body has become a stranger to you (or even an enemy), you can begin to translate its language. Our self-discovery process comes alive in a new way when we start to understand not only the verbal story of who we are and what happened to us, but also the story the body’s procedural learning has to tell.

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The Language of the Body B ODY READING Purpose: To practice “reading” the body to better understand the language of the body. Directions: Look at each of the five people and notice the differences in their bodies. For each picture describe: • What you notice about the body (e.g., chin is up, feet wide apart). • What the body might convey to others (e.g., “I’m not open,” “I’m standing firm”). • What the person might be feeling (e.g., isolated, hurt, confident). • What childhood experiences might have led to that pattern in the body (e.g., maybe it wasn’t safe to be vulnerable or open, maybe he had to be tough or he got hurt). Remember, there is no “right” answer. Just write down your first impressions! 1.

a. What do you notice about the body? b. What might this body convey to others? c. What might she be feeling? d. What kinds of childhood experiences might have led to this pattern?

2.

a. What do you notice about the body? b. What might this body convey to others? c. What might he be feeling? d. What kinds of childhood experiences might have led to this pattern?

a. What do you notice about the body? 100

3.

b. What might this body convey to others? c. What might she be feeling? d. What kinds of childhood experiences might have led to this pattern?

4.

a. What do you notice about the body? b. What might this body convey to others? c. What might he be feeling? d. What kinds of childhood experiences might have led to this pattern?

5.

a. What do you notice about the body? b. What might this body convey to others? c. What might he be feeling? d. What kinds of childhood experiences might have led to this pattern?

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The Language of the Body GETTING TO K NOW THE B ODY’S LANGUAGE Purpose: To notice the body language of others and reflect on your own interpretations of the postures, movements, and expressions you notice. Directions: Take a walk, stroll in a park, go shopping, visit a library or a museum —anywhere that you can observe other people—and record your observations below. You can also observe the body language you see on television or in movies.

What You Notice 1. What physical elements attract your attention? What do you notice about people’s bodies? (e.g., The way they walk, their facial expressions, eyes or smiles, the energy in their movements, postures, or the shapes of bodies.)

Translating the Body’s Language 2. What do the bodies of the people you notice seem to convey about them? (e.g., The man who has soft eyes and a warm smile, and moves slowly and comfortably seems gentle and welcoming. The girl who has a lively walk and a lot of spontaneous movement seems to be fun-loving and joyful. The woman who has a straight, upright posture, a purposeful walk, and looks straight ahead seems confident but not very joyful.)

Perceptions 3. Think about the people in your life—friends, family, coworkers. Describe any perceptions you might have based on their body language. (e.g., When my husband slouches and does not make eye contact, I think he is worried. When 103

my boss clenches his jaw, I perceive that he is angry.)

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The Language of the Body GOOD TIMES, B AD TIMES, & YOUR B ODY Purpose: To discover what happens in your body when you think about a “good” memory in contrast to a “bad” memory. Directions: Take a few minutes to select a memory of a good time and one of a bad time and then follow the prompts below.

A GOOD TIME 1. In the picture frame, describe a memory of a good time or good moment in the recent past (e.g., going to a party, watching or participating in a favorite sport, hanging with friends, going to a concert, petting a dog, or going to the gym). 2. As you recall that moment, write down how your body responds. (e.g., My shoulders relax, and I take a deep breath; I feel energized, and I sit up straighter; my chest lifts; I square my shoulders.)

A BAD TIME 3. Describe a memory of a bad time or bad moment in the recent past in the picture frame. (e.g., A fight with someone; feeling frustrated with your kids’ misbehavior; getting lost on the way to a special event; or being laughed at or criticized.) 4. As you recall that moment, write down how your body responds. (e.g., My jaw tenses; my spine slumps; I tighten up; my shoulders lift; my arms tense up.)

5. Consider the two memories above. How does your physical reaction to each memory contribute to how you feel about yourself? (e.g., When I relax and take a deep breath, I feel confident and playful; When my jaw tenses, I hold my breath, and I feel angry, but I think I don’t have a right to say anything.) 106

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The Language of the Body CONTRADICTIONS B ETWEEN MIND AND B ODY Purpose: To understand how you may be affected by procedurally learned patterns of the body that contradict your thoughts. Directions: Read the examples below and then think about things that your mind knows but that your body’s procedural learning seems to contradict. Record any emotions that accompany your procedural learning. Write down your observations in the appropriate column and reflect on the differences between what your mind and body know. What your Pattern of procedural learning that contradict mind what your mind knows: knows:

What you feel:

I am a competent person.

I feel shaky when I talk to my boss.

Insecure, stupid

Other people are there for me.

I feel stuck when I think of asking for help. My arms and shoulders are limp [or tight] and I don’t reach out for support very often.

Alone, unloved

I can be a I go to a party but I don’t make eye contact. I think fun person. of funny things to say, but my body tightens up, holding me back from being spontaneous.

Shy, disconnected

Reflect on what you learned from this worksheet and discuss with your therapist what new actions might help you reconcile your thoughts and your body language.

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CHAPTER 6

Pay Attention The Orienting Response THERAPISTS’ GUIDE TO CHAPTER 6

Purpose of this Chapter This chapter highlights the relationship between the difficulties clients experience in daily life and their habits of paying attention to, or orienting toward, select environmental cues to the exclusion of others. These orienting habits, usually learned as ways to cope with past trauma or attachment deficits, tend to continue after circumstances have changed. The purpose of this chapter is to help clients understand that their habits of orienting toward reminders of past trauma or attachment inadequacies can contribute to present-day distress and dissatisfaction. Discovering the relationships between their internal state and external cues to which they automatically orient is a first step toward developing new habits of orienting that are more rewarding and more in keeping with present circumstances.

Clients Who Might Benefit Most clients will benefit from learning how their orienting habits contribute to their difficulties. Those who suffer from shame and self-loathing may realize that they habitually orient to stimuli that “prove” their worthlessness or inadequacy. Those who repeatedly choose the “wrong” partner may discover that they consistently orient away from partners who might possess sought-after positive qualities and toward partners who possess qualities of people associated with attachment failures of the past. Agoraphobic clients who are housebound because their orienting locates danger outside the home, in public places, or in group situations might learn to orient toward nonthreatening stimuli. Those with difficulty managing anger may find that outbursts of rage are driven in part by orienting patterns that narrowly focus their attention on indicators of threat, betrayal, criticism, or 110

disapproval. Clients who fail to orient toward real dangers in the environment or who hyperorient to reminders of past trauma might discover a correlation between their orienting habits and symptoms such as impulsive behavior or fight–flight responses, depression, cutting, or other types of self-harm. Those who experience difficulty in their families, intimate relationships, and friendships may discover that they routinely orient toward reminders of the painful elements of their early attachment relationships, such as cues that might suggest abandonment, disappointment, or criticism.

Suggestions for Clinical Use Helping clients become aware of orienting habits that contribute to their difficulties is the first step to helping them change these patterns. As clients describe current difficulties, you might call attention to what they are compelled to notice and what they fail to notice. However, you may encounter clients who experience shame or self-critical reaction, blaming themselves for how they hyperorient to reminders of past danger or attachment inadequacies. It may be helpful to remind them that their orienting habits are not intentional and do not indicate a personal deficit. We all become habituated to focusing on specific cues because doing so helped us survive and cope in the past. Once clients identify some of their outdated orienting patterns, you can help them explore the origins of these habits, identify alternative cues they could notice instead, and consider making voluntary decisions about what to orient toward. Often clients have trouble noticing and taking in new information. They may be unaccustomed to recognizing external cues that offer hope, support, or safety in their current environments. Many will be eager to try out new habits of orienting and glad to practice focusing on new or positive stimuli. However, some will need your help to understand that forming new orienting habits does not mean avoiding their distress, but goes hand-in-hand with exploring painful issues and can help facilitate their resolution. With your guidance, clients can begin to make voluntary decisions to practice orienting to new, stabilizing, and satisfying cues in present time. Those who are averse to orienting toward positive stimuli can instead practice orienting to something neutral. Eventually, clients whose orienting habits have contributed to their feeling helpless, trapped, unfulfilled, or without choice can recoup a sense of control over their internal states as they practice orienting to new stimuli. Satisfaction in relationships might improve as they decide to orient to positive interpersonal cues (e.g., a smile or positive comment) instead of preferentially orienting toward negative cues (e.g., a frown or negative comment). 111

Introduction to the Worksheets The first few worksheets that accompany this chapter can be particularly helpful for clients who need some distance to recognize orienting patterns. The WHAT STANDS OUT worksheet invites clients to notice which elements in the environment instinctively draw their attention and to reflect on how those cues might relate to their history and orienting habits. TRACKING YOUR ORIENTING HABITS encourages awareness of those habits and facilitates understanding of how they affect internal states. You can use both of these worksheets to help clients identify orienting patterns that increase their dissatisfaction, stress, or dysregulation and notice how these habits affect the body. You can brainstorm with them to make a plan to practice orienting toward elements that increase satisfaction, reduce unnecessary stress, or help them regulate arousal. CHOOSING WHAT TO ORIENT TO asks clients to select cues they would like to orient toward prior to going for a walk, and afterwards categorize what they noticed and assess whether they were able to focus their attention as desired. Using the information from the previous worksheets on identifying orienting habits, you can help your clients in session with the first part of this worksheet by making a plan together for what they intend to notice, and then review the results at your next meeting. The EARLY ATTACHMENT & ORIENTING worksheet helps clients discover orienting habits they learned in the context of family and other attachment figures and alerts them to how these habits enhance or complicate their current relationships. Clients will benefit from your help to notice the ways these habits affect the body—posture, movement, breath, impulses, and so forth. The last question helps clients identify elements they would rather orient toward in relationships and can be used as reference for the next worksheet, CHANGING ORIENTING HABITS. This final worksheet addresses unsatisfying orienting habits that have come to light from the previous worksheets by encouraging clients to identify the habits they would like to change and to practice orienting to something new.

Adapting this Material for Dissociative Clients This chapter can be a useful introduction to helping dissociative clients notice how different parts of themselves habitually orient toward different stimuli: Young child parts might orient toward someone who could help (e.g., the therapist), a depressed part may only pay attention to cues that exacerbate the depression, a hypervigilant part may orient toward sources of potential threat, or a terrified part might orient toward possibilities of escape such as the door to your office. Differentiating the 112

unique orienting habits of each part may help clients with reality testing in the present, with determining which point of view to trust, and with choosing new habits of orienting that help to reassure rather than alarm the different parts. They might also discover that patterns of orienting can trigger dysregulated parts and learn to consciously direct their orienting in ways that reduce triggering. This chapter can potentially help clients learn the important skill of focusing their attention in specific ways to help regulate their overwhelming feelings and sensations. However, orienting exercises involve the physical action of turning the head and neck to look around at various environmental cues, which can be frightening or seriously uncomfortable for those who have long-standing patterns of freezing or collapsing. Equally, shifting focus from a triggering cue to a neutral or positive one can arouse hypervigilance and anxiety. Proceeding slowly and helping clients separate the past from the present will be useful with those who may question the safety of positive feelings and wonder if focusing on something that feels good will make them more vulnerable to danger. If there are parts that resist exploring orienting patterns, you can acknowledge the function of this resistance, discover what the part is afraid will happen if different cues are chosen to orient toward and explore what kind of orienting might feel right to this part. It is important to respect the resistance while also teaching about the skill of orienting. For example, a hypervigilant part might want to orient toward the doors and windows, toward the exit route, or toward possible dangers. You might acknowledge the protective function of these orienting habits and explore, or even encourage, them in session. Having done so, that part might be more willing to experiment with letting other parts discover or show one another what they tend to orient toward. The key here is that different parts’ points of view are of equal interest and importance in therapy. The function of each part’s orienting habits can be discovered with no pressure for any part to orient in a different way. That lack of pressure often results in a willingness to try orienting to something different—ideally, to something on which all parts can agree. Each part, as tolerated, can explore noticing the orienting habits of other parts.

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CHAPTER 6 Pay Attention: The Orienting Response Our orienting response helps us select what we pay attention to, moment by moment, in the world around us. When an external stimulus is found engaging (e.g., a beautiful sunset or friendly puppy) or demands attention (e.g., an unexpected noise or crying child), we “orient” to, or direct our sensory “radar” toward, this stimulus. Orienting can be a conscious choice, or an involuntary reflexive instinct. Voluntary orienting has to do with choosing what to pay attention to. Right now, for example, you have decided to orient toward this book and the words on this page. But if someone unexpectedly walked into the room where you are reading, your orienting reflex would kick in, and you would involuntarily find yourself looking up to focus on that person. Orienting changes moment to moment—one moment you may be reading quietly, and the next you may shift your attention to a different stimuli in your surroundings. All animals, including humans, have an innate “orienting reflex” that is activated by novel stimuli: a new sight, sound, smell, person, or something we unexpectedly touch. When this reflex is stimulated, we instinctively and involuntarily focus our attention toward the unfamiliar stimulus, automatically turning our eyes or even the entire head and body toward it. This orienting reflex occurs without conscious thought and reflects the innate wisdom of instincts that alert us to pay attention to novel stimuli so that we can determine whether they are safe or dangerous. As the owner of a restaurant, Jerry worked long hours and was constantly focused on improving his productivity. His wife accused him of being a workaholic, and indeed he found that whenever he had free time, his attention went immediately toward work tasks rather than toward pleasurable or relaxing activities. When Jerry sat down to dinner with his family, he ignored the flavors, smells, and presentation of the food, as well as the sounds of the dinner table conversation. Instead, his attention was focused on his cell phone, and his gaze was drawn to the alerts of work-related emails. At his wife’s insistence, Jerry decided to try to change his orienting pattern and began by spending a Sunday afternoon with his family instead of going over his business finances. He was immersed in an engrossing game of catch, orienting toward the ball and the chatter of his nine year old son, when he heard a sudden, loud, unfamiliar sound from the house next door. Instantly, his orienting reflex was activated: He stopped the game, his ears pricked up, and his head snapped to an alert upright position. Turning in the direction of the 115

sound, his nostrils flared, and he remained perfectly still for several seconds. When no further sounds occurred, Jerry’s attention returned to the game of catch. Jerry’s orienting reflex had been triggered, instinctively arresting the activity of catch and compelling him into a more alert state until he could assess the novel stimulus (the sound) and ascertain what to do. By orienting, we consciously or unconsciously select what to pay attention to from all the possibilities available in each moment. If we do not intentionally direct our attention to where we want it to go, we will often find that it automatically goes in familiar directions: toward what we expect, toward what we’re used to noticing, toward what we were taught to notice, or toward where our impulses take us. Jerry habitually oriented toward things related to his job, such as his cell phone, rather than toward his family or other things unrelated to work. Having grown up with a critical father who punished him if he did not perform well in school, Jerry had learned as a boy that if he did not work hard and excel, he could become the target of his father’s disapproval and ridicule. As an adult, the same anxiety he had suffered as a child fueled his habit of over-orienting toward world-related cues. Trauma, attachment and other significant life experiences have a powerful effect on how and what we orient toward. Our attention may automatically go to signals that suggest bad things might happen; to the things that we learned to dread back then; to any potential signs of threat, danger, or interpersonal conflict; or to avoiding such signals. This chapter helps you understand the orienting response and how to direct your attention where you want it to go instead of where your history has taught it to go.

The Importance of Orienting Every moment, we select stimuli on which to focus from the myriad of sights, sounds, and even scents in our surroundings. As we make those selections, our attention to other things is curtailed. For example, Jerry automatically ignored things that were calming and pleasurable in favor of orienting to things related to work. Being able to assess stimuli in our environment in a flexible way is crucial for learning and adaptive behavior. We orient to find out more about a stimulus so that we can move away from people and things that are threatening or unpleasant and move toward people and things that are safe or meet our needs. Our brains automatically make the initial evaluation of the safety or danger of any stimulus by comparing the current stimulus to past experience. For example, if you had a beloved dog as your pet growing up, your brain will be likely to evaluate dogs as safe, but if you were bitten by a dog, your brain might reflexively judge dogs as dangerous to protect you from being bitten again. Jerry’s brain assessed 116

pleasurable, relaxing stimuli (e.g., idle conversations, the vacation brochure his wife brought home, the novel his son wanted to read with him, the hammock in the backyard) as unrewarding due to the experience with his critical father who emphasized achievements and insisted that Jerry be productive rather than enjoy himself. Even on a Sunday drive with his family, Jerry reflexively focused on things that would improve the productivity of his business (e.g., the billboard advertisements of his competitors or the architecture of other restaurants). Once we orient toward and assess whether a stimulus might be harmful, beneficial, or neutral, then we take action in relation to it by moving toward it, avoiding it, or ignoring it. This is an unconscious process much of the time. Often we have oriented and taken action before we even realize we have made a choice. This automatic orienting serves an important role in our ability to get through each day. We are continually bombarded with enormous amounts of information from our surroundings, far too much to pay attention to at any given moment. The deluge of information that enters our senses each moment could easily overwhelm us if we were unable to filter out irrelevant or insignificant information. Selecting relevant cues and screening out irrelevant ones are fundamental to organizing our behavior and even to enjoying a productive and rewarding life. If we cannot select effectively, we may feel overwhelmed or unable to concentrate or focus our attention. On the other hand, if we filter out too much information or become compulsively or habitually focused on certain kinds of stimuli, we may fail to respond to important stimuli. We all develop adaptive habits of filtering out certain cues and selecting others to orient toward. However, when outdated, these orienting patterns can keep us prisoners of the past and diminish our enjoyment of life in the present.

Orienting in the Wake of Adverse Experiences Like Jerry, we all reflexively orient toward people, things, and activities that either directly or indirectly remind us of past experiences or help us avoid them. We may not even realize that we are being influenced by the past. Our instincts and automatic coping strategies tell us that if we literally keep our eyes on reminders of the past, we may be better equipped to protect ourselves from harm or distress. However, Sam’s reflexive orienting habits learned in childhood interfered with his job performance. A particular coworker was overweight and had long gray hair that she wore in a bun—both characteristics of the babysitter who had abused him as a child. Sam found himself compulsively focusing on this woman in staff meetings. With his gaze nervously fixed on her, Sam had difficulty turning his attention toward others in the meeting as they spoke. He was unable to concentrate on the task at hand. He found he often had to apologetically ask a colleague to explain the content 117

of meetings afterwards. Until Sam’s therapist helped him recognize that his coworker’s appearance was similar to that of his abusive babysitter, he was unable to relax and pay attention during meetings. Sam oriented toward women who looked like his babysitter out of fear of being abused again. Jerry oriented toward his work because that would have avoided the criticism of his father in the past. We may also have habits of orienting to external stimuli that seem to confirm our negative thoughts and fears and therefore be unable to take in information to the contrary. Sidney, for example, had unconsciously interpreted his negative childhood experiences as meaning that he was worthless. Later, as an adult, he was hyperaware of every cue on his wife’s face that might indicate that she disapproved of him, such as a furrow in her brow or a narrowing of her eyes. He interpreted these expressions as meaning she thought he was not worthy of her, although that was not his wife’s perception. Without orienting responses that are adaptive for our current lives, we too may fail to assess safety and acceptance accurately. We may then find ourselves feeling threatened or unsupported even with people who love and support us. Or, we may fail to assess danger and risk accurately and repeatedly find ourselves either in threatening situations or too fearful to engage with the world. However, we can learn to make deliberate choices about how and where to orient and by doing so teach ourselves how to take in new information that can help us change outdated orienting habits.

Choosing What to Orient to As we become aware of why and toward what we focus our attention, we can begin to understand how our orienting habits affect our well-being. We can then learn to orient in new ways that foster a more enjoyable life. Sidney learned in couple therapy to become aware of when he compulsively oriented toward certain expressions on his wife’s face (e.g., furrowing her brow or narrowing her eyes) and to ask her directly how she felt about him in that moment. He also practiced orienting toward other cues (e.g., the tone in her voice, the smile on her face, her leaning toward him engagingly). Although his tendency was to orient to potentially negative stimuli, Sidney trained himself to orient toward the signals his wife was giving that told him she loved and accepted him. He began to realize that the furrow in her brow and the narrowing of her eyes only meant that she was thinking, not that she thought he was unworthy. Having been bitten by a dog as a child, Jeanie hypervigilantly oriented toward any signs of dogs. When a small, well-behaved dog on a leash aroused Jeanie’s orienting reflex and triggered a fear response, she learned to pause for a moment and notice the dog’s individual characteristics. During one such incident, she 118

observed that the dog was very tiny, covered with lots of long white curly hair with a snub nose, and she could realize that this was not the same dog that had bitten her. She next chose to focus attention away from the dog and toward other stimuli, such as the person she was with or the appealing landscape around them. At first, this was difficult, but with practice Jeanie found it possible to inhibit overorienting to the triggers of the past and to deliberately focus on other cues. Slowly, over time, whenever she saw a dog, Jeanie trained herself to first notice the features of the dog that distinguished it from the one that had bitten her and then to direct her attention toward other pleasing cues. Understanding how our orienting habits were useful in a previous environment, how they affect us now, and then redirecting our orienting can be liberating. Once Sam realized in therapy that his coworker reminded him of his abusive babysitter, he decided to talk with her on his break and he found he enjoyed her company. Sidney felt great relief that he no longer became triggered in conversations with his wife, and Jeanie was happy to be able to go on walks without anxiously anticipating encountering a dog. Jerry gradually found that his productivity at work did not suffer as he changed his orienting habits to include things that were pleasurable and not related to his job. By choosing to change your orienting habits, different responses and new meanings can emerge, as they did for Jerry, Sidney, Sam, and Jeanie. When they encountered a reminder of the past, instead of fear and avoidance, they could experience a sense of competence, empowerment, and satisfaction. Instead of being driven by outdated orienting habits, we can teach ourselves to become curious and increasingly aware of our orienting habits, taking the first step toward changing them. The second step is to redirect our orienting by choosing to concentrate on an object in the environment that makes us feel “good” or “safe” instead of focusing on something that makes us feel “bad” or “unsafe.” The worksheets that follow are designed to help you discover your orienting habits, explore how they were shaped by your history, and to redirect your attention so that you can begin to focus on a wealth of cues in your current environment that you may not have been able to notice before.

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Pay Attention: The Orienting Response WHAT STANDS OUT? Purpose: To discover what your gaze is drawn to—what you are inclined to notice or orient toward—and consider what experiences you have had that may affect what you pay attention to. Directions: Take a look at the drawing below. Without thinking too much about what you see, circle three things that stand out to you.

1. What stands out to you about each of the three cues you circled? (e.g., I only circled people having a nice time; I only circled things and animals, not people; I only circled people who were alone; I only circled the people who look unhappy.) 2. What happens in your body as you think about the cues that you circled? 3. Describe the types of cues that you circled. Do they indicate relationship problems or that bad things might happen? That life is good or the world is safe? Do they confirm negative thoughts & fears or a positive outlook? 4. Reflect on why you might have circled certain cues. Do they remind you of experiences you have had in your life or relationships with family or friends? Or are they things you would like to experience? 5. Look at the picture again to notice all the cues that you did not circle. Reflect on 121

why you might not have circled them. Are there any you would like to try to pay attention to in the future?

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Pay Attention: The Orienting Response TRACKING YOUR ORIENTING HABITS Purpose: To notice your orienting habits, reflect on the effect of these habits on your experience, and assess if you want to change any habits. Directions: Over the next week, be aware of what you tend to orient toward. At the end of each day, put a check mark next to any stimuli that you recall paying attention to during the day. In the empty rows,you can add whatever else you paid attention to that is not listed. At the end of the week, fill out the prompts below. Signs of potential threat (e.g., people, sounds, things that appear menacing)

Signs of relational strife with family, friends, colleagues

Nature (e.g., rain, clouds, sunshine, trees, the moon, stars, flowers)

Objects (e.g., furniture, buildings, cars, phones, computers, or other devices)

Noises (e.g., pleasant, unpleasant, unusual, music, voices, laughter)

Art, beautiful landscape, colors, design, architecture

People who look friendly to you

Signs of positive relationships with family, friends, colleagues

Praise or compliments

Criticism or negative comments

How people look, their behaviors, movements, postures

Animals (e.g., pets, birds, squirrels)

People’s faces, eyes, expressions

People you find attractive

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1. What did you orient toward that made you feel good or safe? When you think of these cues that make you feel good or safe, what happens in your body? 2. What did you orient toward that made you feel bad or unsafe? When you think of these cues that make you feel bad or unsafe, what happens in your body? 3. What do you want to pay more attention to? How might orienting toward those cues affect your body?

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Pay Attention: The Orienting Response CHOOSING WHAT TO ORIENT TO Purpose: To deliberately choose what you want to orient toward rather than allow your habits to dictate what you notice. Directions: Make a plan to take a short walk during which you can study your orienting habits. Complete the first prompt before you set out on your walk. When you return, complete the rest of the worksheet.

Before the walk: 1. Describe what you would like to orient toward on your walk (e.g., things that make you feel good such as pleasing scenery,interesting sounds, or friendly faces).

After the walk: 2. List all the stimuli you oriented toward on your walk. 3. To get a better sense of the types of things you orient to, try to put the things you listed in #2 into categories. Circle the categories below that represent what you oriented to, or write in a category that is not listed in the empty spaces. Possible signs of danger

People

Animals

Things that make me feel bad

Nature

Unpleasant noises

People I am attracted to

The way people dress Pleasant noises

Things that remind me of the past Friendly faces

Couples

Things that make me feel good

Buildings, houses

Children

Cars, bikes, motorcycles,

People playing sports

Art or artistic objects

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4. Reflect on whether you were able to follow your orienting plan for your walk. Describe why, if at all, you had trouble orienting toward what you wanted to. (e.g., I felt rushed and was only looking straight ahead; I was on the lookout for danger and wasn’t aware of the nice scenery; I was thinking so much, I didn’t notice what was going on around me.) Note: If you were not able to orient toward what you wanted to notice, discuss this with your therapist.

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Pay Attention: The Orienting Response EARLY ATTACHMENT & ORIENTING Purpose: To become aware of habits of orienting toward people or situations that are similar to what you learned in early attachment relationships, and to explore how these habits affect your body today. Directions: Remember a time growing up when you were with your family (e.g., eating dinner together, going on vacation, or playing a game). Follow the prompts below. 1. As you remember, take time to assess the quality of the interactions among your family members. Circle the words that apply, and write in any additional words that apply.

Calm Accepting Loving Supportive Stable Happy Respectful Lighthearted Sad Accepting Safe Judgmental Serious Critical Disrespectful 130

Mean Depressing Frantic Unpredictable Neglectful Demanding

2. Describe how the qualities you selected made you feel when you were younger.

3. Describe any current situations or relationships in which you orient toward the same qualities that you circled. (e.g., If you grew up with critical parents, you may orient toward the slightest hint of criticism from your spouse; if you felt loved, you may notice signs of affection.) What changes in your body when you orient toward those cues?

4. Describe any other cues you would like to practice orienting toward. How might orienting toward those cues change your posture, breath, or movement?

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Pay Attention: The Orienting Response CHANGING ORIENTING HABITS Purpose: To describe current orienting habits that contribute to your feeling bad or unsafe and then choose to focus on something that makes you feel good or safe instead. Direction: Choose three orienting habits that you would like to change. Describe how each orienting habit makes you feel. Then describe what you could orient toward instead to practice changing each habit. Orienting habit you would to change

How the habit affects your emotions & body

• I get hung up on the habitual tone of my wife’s voice and her abrupt manner.

• It makes me feel like she is • I could orient to her angry at me, like I can’t do smile that indicates she anything right. My jaw cares about me rather tightens. I don’t breathe. than to her tone and abruptness.

Orienting habit you would like to change

What you could orient to instead

How the habit affects your emotions & body

Orienting habit you would like to How the habit change affects

What you could orient to instead

What you could orient to instead

Orienting habit you would like to change

How the habit affects your emotions & body

What you could orient to instead

Orienting habit you would like to change

How the habit affects your emotions & body

What you could orient to instead

What effect does changing each orienting habit have on your experiences and interactions with others?

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CHAPTER 7

Mindfulness of the Present Moment THERAPISTS’ GUIDE TO CHAPTER 7

Purpose of this Chapter Complementing the previous chapter on paying attention to external stimuli, this chapter explores paying attention to internal experience. Clients’ internal reactions to all types of stimuli happen rapidly and often unconsciously. When these reactions are distorted by implicit memories of the past or expectations of an adverse future, becoming mindful of them can lessen their negative impact on experience. The purpose of this chapter is for clients to learn to mindfully identify the five “building blocks” of present experience that comprise their internal reactions: thoughts, emotions, internally generated sensory perceptions, movements, and sensations. Practicing the basic mindfulness skills described in this chapter will help clients to become aware of their internal experience, in the here and now, instead being immersed in it or tuning it out.

Clients Who Might Benefit Mindfulness has been found to reduce stress; improve self-regulation, focus and concentration; help us tolerate emotions and think more clearly; and improve equanimity and relational capacity. Thus, nearly all clients can benefit from learning to be mindful. Clients who tend to be overly focused on remembering distressing past events or preoccupied with apprehension of future victimization or maltreatment often gain a sense of agency as they learn to direct their attention to their present-moment internal experience. Those whose triggered implicit memories emerge in the form of sensations, movements, images, emotions, and circular negative thoughts can use mindfulness to gain some control over their internal reactions. Learning mindfulness skills will benefit those who do not understand how their internal reactions influence them to feel or behave in ways that elicit undesirable responses from others or otherwise do not serve them. 134

Clients who feel at the mercy of their distress often feel more empowered when they can name the components of internal experience that contribute to their distress. Those who live in chronic states of dissatisfaction, depression, fear, irritability, isolation, or self-hatred but do not understand why can learn to deconstruct the internal components of their suffering. Doing so can diminish feelings of victimization, foster self-understanding, and eventually lead to mastery over their reactions. On the other hand, clients who tune out, minimize, or detach from their inner world are faced with the challenge of how to feel more connected to themselves and their emotions. Learning mindfulness skills to become aware of the different elements of their internal landscape can support them in this endeavor and enrich the quality of their experience.

Suggestions for Clinical Use The main task of this chapter is to teach clients to observe and name the momentby-moment interplay of the five building blocks of present moment experience— thoughts, emotions, perceptions, movements, and sensations—that comprise the “feeling of what happens” (Damasio, 1999). Mindful attention to and labeling of these components of internal experience can lead to improved autonomic selfregulation and increased self-awareness (Creswell, Way, Eisenberger, & Lieberman, 2007; Holzel et al., 2011; Siegel, 2007). Discovering and naming the building blocks of present-moment experience is prioritized over “talking about” that experience. Thus, the way mindfulness is used in Sensorimotor Psychotherapy represents a paradigm shift for therapists accustomed to conversing and discussing issues with clients (cf Chapter 2, “Orientation for Therapists”). As stated in Chapter 1, “Essential Principles,” during therapy sessions, the use of mindfulness is embedded within what transpires moment to moment between therapist and client. In a discussion or conversation, clients tell their story by “talking about” rather than noticing their internal experience. In mindful awareness, you and your client both notice how the experience of the story unfolds in the present moment, through changes in body sensation, movement, sensory perception, emotion, and thought. This is not a solitary endeavor; both parties are attending to the ebb and flow of the client’s present-moment internal reactions. Taking place within an attuned dyad, mindfulness activates not only your client’s experience of the effects of trauma and attachment inadequacies but also increases the engagement and connection between you and your client. You can teach mindfulness using the skills described in Chapter 2, “Orientation for Therapists.” Asking questions that require clients to notice present-moment experience in order to answer is an easy way to help them become aware of the five building blocks: “What do you notice in your body right now?”; “As you tell 135

your story, what changes inside?”; “Can you describe your experience—your thoughts, emotions, images, movements, or sensations?”; “How do your thoughts or emotions change when you talk about this topic?” When clients express an emotion (e.g., “I feel afraid” or “I’m hurt and disappointed”), you can ask them to notice the building blocks that tell them they are afraid or disappointed. Simply identifying and labeling the building blocks that contribute to an emotion can help clients take a step back from becoming immersed in, dysregulated by, or “ruled” by their emotional reaction. As clients find the words to describe their experience to you, the prefrontal cortex is stimulated (Siegel, 2007). Tightness in the chest can be observed as a sensation; images of the attachment figure can be experienced as a five-sense perception; the impulse to curl up can be noticed as a movement; “I’m a failure” can be recognized as a thought. In normal daily life, these building blocks exert their influence on experience and actions, but usually remain just outside of conscious awareness. Mindfulness brings these elements into consciousness, where they can be addressed directly. Clients’ use of words such as always, never, or constantly usually indicates that they are focused on the past or on future speculations and not on the present moment. To help them differentiate between dwelling on the past or future versus mindfulness of present moment experience, you can ask questions that draw attention back to “right now,” such as: “Are you feeling that right now?”; “Are you seeing the image of that memory right now?”; “Is your body tight right now?” These statements are not meant to correct but to draw clients’ attention to the building blocks that make up their experience in the moment. Many clients have learned to ignore, disconnect from, or minimize their internal experience. When the client is detached from emotion and/or sensation and responds with “I feel numb” or “I don’t feel anything,” various options are available to you. The approach you select to facilitating mindfulness in these cases depends on the reasons for clients’ disconnection and their regulatory capacity. For example, if the “nothing” feeling is the result of past trauma, the sensation itself can become the stimulus for directed mindful exploration. You might ask: “What happens when you sense that ‘nothing’ feeling?”; “Can you describe that sensation of it?”; “Do you feel it throughout your body?”; “Or are there some areas that are not numb, or that feel less numb?” Offering a menu of words to describe experience can help clients increase their internal awareness: “Is ‘nothing’ more of a numb feeling? Or a tightness? Or a spacey feeling?” If focusing on numbness causes distress, you might ask the client to reflect on something neutral or pleasant and then become mindful. For example, you might say: “Let’s just focus on something that feels good, like that memory of your son hugging you, or the safety of our relationship right now, and see if your sensation changes.” 136

If the “nothing” feeling represents a detachment from emotion and if your client is not traumatized, you might ask your client to focus on a building block that might change the sensation. “I wonder, could we come back to the image of your father yelling at you, and notice if your sensation changes?” If your client has the regulatory capacity to integrate strong emotions but has learned to avoid them, focusing on a significant image of a childhood memory such as this, and asking the client to describe the look on the father’s face, the tone of the “yelling,” and to notice the effects on present-moment experience, can help mitigate a sensation of numbness and elicit emotions. Turning mindful attention toward a childhood image of an attachment figure often intensifies the client’s painful emotions and other building blocks, which can then be processed in the therapy hour (cf. Chapter 30, “Making Sense of Emotions”).

Introduction to the Worksheets For some clients, it will be easiest and most regulating to begin to learn mindfulness skills by identifying the building blocks of a positive memory. The BUILDING BLOCKS OF A GOOD EXPERIENCE worksheet helps clients notice the building blocks that are stimulated in the present moment by remembering something positive or neutral from the past. This exercise begins to clarify which building blocks can be most resourcing for your clients. You can remind them to focus on these building blocks that support positive experience when they want to change their state. NAMING THOUGHTS & EMOTIONS will help your clients become aware of the negative thoughts and emotions that arise in their daily lives. In this worksheet, clients learn to name, or label, these disturbing thoughts as “thoughts” and emotions as “emotions” occurring only in the present moment, and then be mindful of how doing so affects the body. In this way, clients differentiate disturbing thoughts and emotions from “facts” or “truths,” and recognize them as transient. The four worksheets—FOCUSING YOUR HEARING, FOCUSING YOUR SIGHT, FOCUSING YOUR SENSE OF TOUCH, and FOCUSING YOUR SENSES OF TASTE AND SMELL—target the building block of five-sense perception as a resource and elaborate what was learned in the previous chapter about orienting to external stimuli. Your clients will have an opportunity to heighten their awareness of one of the senses as a distinctive element of the here and now, and to notice the effects of this awareness on their other building blocks. This ability will serve traumatized clients well when they are dysregulated, because focusing mindful attention on a single sense perception in present time usually regulates arousal. These worksheets can also be particularly useful with clients who have trouble being present in the here-and-now due to internal “chatter” (e.g., 137

self-critical thoughts, worry about the future, rumination about the past), or, those who simply want to reduce their stress.

Adapting this Material for Dissociative Clients Learning how to be mindful of the present moment is an especially difficult endeavor for dysregulated and dissociative clients, yet this is an essential skill for helping them recover from the past. There are several challenges to be aware of that will help you gauge how to use this chapter’s material so that it will be useful for this population. Such clients may have difficulty naming their building blocks because of a variety of reasons. Certain building blocks may be experienced as threatening to some parts of them; the building blocks may change rapidly; the clients’ foci of attention may constantly shift. Awareness of emotion and body sensation may be particularly dysregulating. Clients may be easily triggered into reliving implicit memories of other time periods, and into parts of the self that seem (relatively) unaware of the present. Often, mindfulness is interrupted because different parts become triggered and, in turn, trigger each other. Hyper- and hypoarousal responses from various parts due to triggering can also make it difficult to concentrate, adding to the challenges of learning mindfulness skills. It may be easier for many of your dissociative clients to start by practicing being mindful of any building blocks that are regulating for them, discovering together what elements of present-moment experience bring their arousal into their window of tolerance. Often mindfulness of movements (e.g., walking), peripheral sensations (e.g., in the arms and legs or back), pleasant perceptual stimuli, and more neutral thoughts or emotions are most regulating. Building on Chapter 2, “The Language of the Body,” it can also be helpful for clients with dissociative disorders to begin to be mindful of the moment-to-moment signs that indicate certain parts are being activated. In that way, clients can become aware of the building blocks that might precipitate the emergence of a part. For example, the lump in the throat may be a sign of a sad child part, the clenching of the jaw may indicate the emergence of an angry part, and the collapse in the spine might be the first signal of a depressed part. As clients learn to observe and name the building blocks associated with the different parts, they begin to develop mindfulness of two or more parts simultaneously—a skill that is particularly important in the treatment of dissociative disorders, because it supports integration. As with all the worksheets, it can be useful for different parts to complete each one, and then compare similarities and differences. Dissociative clients will need extra guidance from you and sustained practice to learn the mindfulness skills necessary to stay present. It can be helpful for you to actively encourage them to practice mindfulness skills both in session and several 138

times every day. Persistent practice over time will increase the ease with which mindfulness skills are available to them in the days and weeks ahead.

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CHAPTER 7 Mindfulness of the Present Moment Adverse experiences can interfere with our ability to be “here” instead of “there.” We may find ourselves either focusing on painful memories or anticipating that the future will bring more distress. When we find ourselves dwelling on the past, disturbing memories might intrude upon the present moment, and we often orient to cues that remind us of the circumstances we experienced long ago. When our attention goes to the future, we might imagine the “worst-case scenario,” anticipating that the future will be fraught with unpleasant, disappointing, or threatening experiences. Focusing on the past or the future prevents us from directly experiencing the present moment—here (in this specific place) and now (in this instant of time). We also might have developed habits of ignoring, suppressing, or minimizing our own present moment experience, focusing instead on others, objects, tasks, or the environment. The distinct sense of immediacy, richness, vitality, and aliveness that is available when we are aware of our experience of the present moment is diminished when we disregard it or dwell on the past or the future. In contrast to the previous chapter that explored orienting to external stimuli, this chapter explores how to pay attention to our internal experience, in the here and now, through cultivating mindfulness. When reminders of adverse experiences pull our attention to the past or the future, or when we ignore what goes on inside ourselves, mindfulness of our internal experience helps us come back to and appreciate the present moment.

What Is Mindfulness of the Present Moment? Many mindfulness approaches involve meditation exercises that focus attention upon elements of particular internal experiences (e.g., the breath, body sensation, or words that are repeated silently over and over, called a mantra) or objects in the external environment (e.g., a candle flame). Mindfulness, for our purposes, is different from such practices. The definition of mindfulness in Sensorimotor Psychotherapy is being aware of the five “building blocks” of present experience that occur spontaneously during each waking moment. These five building blocks— thoughts (cognitions), emotions, perceptions (internally generated images, tastes, smells, touch, and sounds), body movements, and body sensations—are the focal 141

points of mindful attention. These building blocks are summarized in Figure 7.1.

FIGURE 7.1

Cognitions Cognitions are thoughts that can describe our experience and convey interpretations, meanings, and theories in words. Cognitions may be spoken or only thought about. Our thoughts include negative interpretations of what happened to us that can become generalized into erroneous beliefs, such as “I’m bad,” or “I will never be safe,” or “Other people don’t like me.” We may criticize or blame ourselves with our words, thinking, “Why did I do that?” or “I’m so stupid” or “It was all my fault.” Or we may accept and compliment ourselves with thoughts such as “I’m OK the way I am” or “I just did a great job at work.” Our thoughts can also describe our attitudes toward others and the world, which can be positive (e.g., “The world is generally a friendly place” or “Most people are kind”) or negative (“The world is a dangerous place” or “You can’t ever trust people”). We are often unaware of our thoughts, although patterns of thinking play a large part in perpetuating our feelings (whether positive or negative) about ourselves, others, and the world.

Emotions Along with thoughts, emotions shape our moment-to-moment experience. The 142

emotions we experienced frequently in the past can bias how we feel in the present. If we were generally content and happy as children, we tend to remain so as adults. If painful emotions such as fear, sadness, anger, or disappointment were pervasive in our childhoods, we may have trouble experiencing the positive feelings (joy, happiness, contentment) available to us in the present moment. We may relive the emotional tenor of previous distress, feel at the mercy of our emotions, or blame ourselves for our out-of-context emotional reactions. Or, we may react to apprehension of experiencing distress by detaching from painful emotions, which can leave us feeling flat and empty. If we expect more painful experiences, we are likely to experience unpleasant emotions such as worry, dread, anxiety, or loneliness as we anticipate the future.

Five-Sense Perception The third building block of present-moment experience is called five-sense perception. When we remember the sensory experiences of the past (the sights, sounds, smells, tastes, and touch), we reexperience them in the present moment. Meg liked to conjure up the smell of vanilla because it reminded her of baking cookies with her grandmother. Jerry was haunted by the sound of his father’s critical voice whenever he attempted something new. Jane hated remembering the smell of the Thanksgiving turkey, which she associated with her anxious parents who took out the stress of the holidays by fighting and yelling at her. Many people with trauma in their histories cannot fully remember what happened but are haunted by reminders nevertheless—like Babs, who was terrified by cats but did not recall that one had severely scratched her when she was a toddler. Others reexperience intrusive sensory reminders of the trauma. Following a tonsillectomy, Terri was distressed by intrusive, scary images of the anesthesiologist in his medical mask, and by the taste and smell of anything that reminded her of the hospital.

Movement The fourth building block, movement, refers to the physical actions of our bodies. Movements range from gross motor movement involving large muscle groups, such as crawling, walking, and running, to the fine motor movements of smaller actions, such as picking up objects with our hands or wiggling our toes. Movement also includes facial expressions, changes in posture or the tilt of the head, and gestures of our hands and arms. We respond to all the things that happen to us, especially how others treat us, with movement. Over time, as described in Chapter 5, “The Language of the Body,” we form procedural habits of movement. If being visible or 143

expressing ourselves brought criticism or other kids of unwanted attention, we may keep ourselves small and contained by slumping or looking down instead of standing with our body relaxed and tall. If reaching out for connection with others brought rejection or abuse, we may literally cease reaching out.

Body Sensation The fifth building block, body sensation, encompasses the physical feelings constantly generated internally from changes in electrical, chemical, and muscular activity. Our sensations inform us about our movements, even those occurring within our internal organs, such as racing of the heart, butterflies in the stomach, nausea, hunger, or those gut feelings. We are often unaware of body sensation, because our attention is on other things or because we learned to disconnect from our bodies (see Chapter 4, “The Wisdom of the Body, Lost and Found”) so as to not experience unpleasant or overwhelming physical or emotional pain. However, we can usually turn our attention toward our sensation at will. For example, most of us can become aware of our heartbeat after a few minutes of attention. And most of us are aware of the strong sensations relating to past distressing experiences, such as a “rush” of adrenaline, a pounding heart, or muscle tension.

Mindful Awareness of the Building Blocks These five building blocks continuously influence each other in a dynamic, fluctuating manner. When we are triggered by reminders of the past, our presentmoment experience of the building blocks can change dramatically. Traumatic reminders can cause intense reexperiencing of danger, even though cognitively we know the danger is not occurring in the present. We might experience disturbing body sensations, movement impulses, intrusive images, smells or sounds, emotions of fear, shame, panic or rage, and negative thoughts—or we might shut down. As one woman, abused by her father, put it, “I know I’m safe, but my body is going crazy. I start to shake when I see my father’s face in my mind, and I feel terrified. But sometimes I shut down and don’t feel anything.” Reminders of distressing family dynamics from childhood can also cause changes in our experience of the building blocks. George, who grew up in an unsupportive family, was often told he was “needy” by his close friends. He was sensitized to any indicators of lack of support from his friends. When he became mindful of the change in his building blocks when his usually supportive friend said she was too busy to help him with a project, he discovered that he felt intense disappointment (emotion), his posture sagged (movement), he felt emptiness in his 144

chest (sensation), an image of himself forlorn as a child emerged (five-sense perception), and he had that thought that no one was ever there for him (cognition). Mindfulness of his five building blocks helped him realize that he was experiencing the present moment as if it were a repeat of his unsupportive childhood, and not an accurate interpretation of his friend’s temporary inability to provide support. Although he felt sad when he thought about the loneliness of his childhood, he was able to separate the past from the present, cease judging himself for being “needy,” and realize that his friend was only busy, not unsupportive. One way to start to change the automatic reactions connected to the past is to mindfully notice these reactions as composed of the building blocks and understand them as related to our history rather than to the present moment. Mindful awareness of your building blocks will teach you to work with the effects of the past without having to relive it. When present-moment cues remind you of the past, your ability to both be mindful of, and to experience, your internal reaction can help you to become curious about your thoughts, emotions, perceptions, and body. You might ask yourself questions such as these: “What is telling me that I’m triggered or upset? The change in my heartbeat? My breathing? Muscular tension?”; “What kind of sensations are telling me right now that I’m frightened?”; “What thoughts are coming up as I see my friend frown?” Through such mindful inquiries, you will learn to “name” the present-moment building blocks that you experience rather than only react to them. Practicing mindful awareness of internal experience can help us be more present in our current lives instead of reliving the past. The death of Ginny’s close friend unexpectedly triggered her terrifying childhood memories of a German death camp, causing body sensations (heart pounding, dry throat, nausea), movements (shaking, restlessness, impulses to run), and emotions (overwhelming fear and rage). Thoughts such as “This will never stop” and “I have no one left” led to panic at times and, at other times, led to a collapse in her spine and the feeling of deep despair. When Ginny became more and more upset discussing her history, her therapist asked her to pause to notice the building blocks she experienced as she told her story, rather than relive the story. Ginny noticed her jaw trembling and tension “everywhere,” and as she observed and named the trembling and the tension, they began to subside a little bit and she felt slightly calmer. That “success” encouraged her to notice other buildings blocks, and she was able to identify her thought, “I have no one left” as just a thought rather than as the “truth,” and her painful emotions as information about how she was feeling that moment, rather than as never-ending pain. Through practicing mindful awareness when her attention was drawn to thinking about the Holocaust, Ginny learned to concentrate on and label the present-moment building blocks. “Right here, right now, what do I notice?” she would ask herself. “What are my thoughts, feelings, five-sense perceptions, movements, and 145

sensations?” Sometimes Ginny would practice attending to the background noises (the buzz of the refrigerator, the children playing next door), visual stimulation (the green trees, the cars parked on the street), and her sense of touch (the feeling of weight on her buttocks as she sat on the chair, the feeling of her clothing on her skin), all of which changed her experience of her building blocks (her breath deepened, her body relaxed, her thoughts and emotions settled) and helped her stay aware of the here and now. Gradually, as she practiced these mindfulness skills, Ginny’s sense of being possessed by the trauma of her childhood diminished. Charles, on the other hand, avoided the strong emotions triggered by relationships by isolating himself and avoiding other people. A latchkey child who grew up alone, feeding himself on frozen dinners and passing time by staring at the TV screen, he described himself as “depressed” and said that all he had the energy for after work was going home to bed. With the help of his therapist, he began to notice the building blocks that added up to “depression.” Charles said his emotions were flat and blunted, but he reported self-critical thoughts (“You’re lazy; you’ll never amount to anything”). He described heaviness in his body as a sense of inertia when he tried to move. As he differentiated each building block of his present experience, and named each one, rather than labeling himself as “depressed,” Charles started to become aware of the fact that his internal landscape was much more nuanced than he had ever noticed. He realized the critical thoughts he heard in his head were in his father’s voice and with that realization, his blunted emotions began to simmer with a touch of anger, which gave him a bit more energy. He saw an image of himself as a neglected child, subject to his father’s criticism, and he felt compassion and an impulse to protect the boy he had been. Gradually, by taking the time to cultivate curiosity and interest in his own internal experience, Charles’s old pattern of depression was challenged by what he discovered. Meg had not suffered the trauma that Ginny had, nor the depression that had plagued Charles, but she often felt rejected by Lindsay, her wife, who did not share Meg’s penchant for an orderly home. Lindsay did not pick up after their toddler, and it didn’t bother her that the dishes remained in the sink overnight. When Meg woke up to dirty dishes, she felt tension in her shoulders, a sensation of emptiness in her chest, and irrational feelings of hurt accompanied by thoughts that Lindsay did not love her. She often would tearfully accuse Lindsay of not caring about her. In therapy, as Meg turned her mindful attention to the building blocks that were evoked when she thought of the dirty dishes, an image of herself as a small, forlorn girl came up. As a child, her interests and preferences were ignored by her parents, who focused more on their own needs than on their daughter’s. Through mindfulness, Meg realized that she had been responding to Lindsay as if Lindsay were not interested in her needs. She was able to separate past from present and realized that Lindsay actually did support her interests and needs in every way except housekeeping. After this realization, Meg decided that when the messy 146

kitchen upset her, she would take time to become mindful of her building blocks and then share what she discovered about herself with Lindsay rather than accuse her of not caring. The worksheets that follow are designed to help you learn how to identify your own building blocks, through mindfulness, instead of becoming immersed in your internal reactions or ignoring or suppressing them. As you learn to identify the components or building blocks of your internal experience, you will better understand the impact of your past on the present moment and on your expectations of the future. These skills can reduce the power of triggers that catapult you into reliving the past, diminish your apprehension of the future, and alleviate some of the stress of difficult moments in your current life. Rather than avoiding or reacting with agitation to your internal experience, you will be able to become mindful of it —and even learn to enjoy the richness of your inner landscape.

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Mindfulness of the Present Moment B UILDING B LOCKS OF A GOOD EXPERIENCE Purpose: To recall a “good moment” and identify the thoughts, emotions, five-sense perceptions, movements, and inner body sensations that make up that moment. Directions: Think of a good moment or a moment when you felt relatively untroubled. The moment can be as simple as eating dinner with a loved one, reading a good book, petting your dog or cat, or taking a walk. As you focus on the moment, complete the three prompts below.

1. Describe your good moment here.

2. Take your time to immerse yourself in remembering that good moment, then describe in as much detail as possible what you notice in each of your five building blocks as you remember it. Be as detailed as possible. Thoughts Five-Sense Perceptions (Images, Sounds, Smells, Tastes, Touch) Emotions Movements Body Sensations 3. Notice which building blocks best helped youre connect with the positive feelings of this good moment. Which one could you focus on to help you revoke the good feelings? (e.g., The sensation of warmth in my belly; the movement of a deep breath; the image of my father smiling; the smell of cookies baking; the emotion of compassion or calm; the thought ‘I am loved’ or, ‘I’m OK the way I am’.)

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Mindfulness of the Present Moment NAMING THOUGHTS & EMOTIONS Purpose: To name, or label, your negative thoughts and emotions as “thoughts” and “emotions” rather than as “facts” or “truths.” When you have a negative thought or emotion, you can name each as a “thought” or “emotion.” Naming the thought or emotion can remind you that it is not forever but occurring in the present moment. See the examples to the right. “Nothing ever goes right.”

“I’m so angry.”

“I’m having the thought right now that nothing ever goes right.”

“In this moment, I’m feeling the emotion of anger.”

Directions: As you go through the day, notice whatever negative thoughts and emotions you have that distract your awareness from the present moment. Use the space below to name them as occurring in the moment (e.g., Right now I’m having the thought that I’m not attractive; I’m feeling an emotion of sadness in this moment). Thoughts Emotions How does naming your thoughts and emotions as occurring in the present moment affect your body? Do you feel more relaxed, tense, energized, or something else? Practice naming your negative thoughts or emotions during the next week, and describe your experience below.

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Mindfulness of the Present Moment F OCUSING YOUR SENSE OF HEARING

Purpose: To become aware of sounds in the environment, notice your thoughts, emotions, and body when you do so, and to practice this skill in stressful situations. Directions: Whenever you think of it, practice focusing attention on the sounds around you—the white noise of background sounds, such as the hum of traffic or the whirring of a fan; mechanical sounds, such as the revving of a motor; nature sounds, such as the wind blowing, trees rustling, or water lapping, and human sounds, such as people talking, arguing, laughing, or playing music. After you have practiced focusing on sounds, follow the prompts below to practice this skill during a stressful situation. 1. During a stressful situation—being stuck in traffic, being unable to fall asleep, after an argument or unpleasant experience, or when you are upset—notice your thoughts, emotions, and body sensations and movements. Hearing 2. Then take a few moments to focus on all the sounds around you (without music or the television playing). Name what you hear to yourself (e.g., I can hear the whirr of the refrigerator, the din of traffic, a clock ticking, horns honking, crickets chirping, dogs barking, music playing or a TV in the background, neighbors chatting, the sound of my own breathing). Be mindful of your internal experience. 3. Describe your thoughts, emotions, and body sensations and movements before and after you practiced focusing on the sounds around you. Before

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Mindfulness of the Present Moment F OCUSING YOUR SENSE OF SIGHT Purpose: To become aware of visual stimuli in your environment, notice your thoughts, emotions, and body when you do so, and to practice this skill in stressful situations. Directions: Whenever you think of it, practice focusing attention on the sights around you—different colors, shapes, sizes of things, people, trees, objects, or animals. After you have practiced focusing on images, follow the prompts below to practice this skill during a stressful situation.

1. During a stressful situation—being stuck in traffic, after an argument, bad day at work, or an unpleasant experience, or when you are upset—notice your thoughts, emotions, and body sensations and movements. Sight 2. Then spend a few minutes taking in all the sights in your environment. Look around, and really notice them, their colors and shapes. Name them to yourself: I can see the orange wall, the little child in the blue dress and red shoes playing in the yard, the shape of the trees, the color of the sky, the shadows cast by buildings, the reflections in the window. Be mindful of your internal experience. 3. Describe your thoughts, emotions, and body sensations and movements before and after you practiced focusing on the sights around you. Before Thoughts Emotions Body Sensations and Movements

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Mindfulness of the Present Moment F OCUSING YOUR SENSE OF TOUCH Purpose: To become aware of tactile sensations, notice your thoughts, emotions, and body when you do so, and to practice this skill in stressful situations. Directions: Whenever you think of it, practice focusing attention on the tactile sensations using your hands or other parts of your body such as your feet. Notice the textures—the soft tufts of fabric, the smooth feel of metal; notice the variety of temperatures—a warm breeze or the cool kitchen counter; notice the feeling of holding someone’s hand or petting the silky fur of a pet. After you have practiced focusing on your sense of touch, follow the prompts below to practice this skill during a stressful situation.

1. During a stressful situation—being stuck in traffic, waking up in the middle of the night, after an argument or unpleasant experience, or when you are upset—notice your thoughts, emotions, and body sensations and movements. Touch 2. Then focus on your tactile sense—what textures or temperatures do you notice? Take a moment to be aware of the feel of your hands on the steering wheel, the sheets on your bed, the chair you are sitting on, your fingers holding the pen or typing on the computer, and any other tactile stimulation around you. Use your sense of touch to really feel and be aware of the texture of whatever it is you are touching. Be mindful of your internal experience. 3. Describe your thoughts, emotions, and body sensations and movements before and after you practiced focusing on your sense of touch. Before Thoughts 159

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Mindfulness of the Present Moment F OCUSING YOUR SENSE OF TASTE AND SMELL Purpose: To become aware of smells and tastes, notice what happens in your thoughts, emotions, and body when you do so, and to practice this skill in stressful situations. Directions: Whenever you think of it, practice focusing attention on tastes and smells, especially at mealtime, but also in nature or in the city. Notice all of the flavors in your morning cup of coffee—the nuttiness, or sweetness of the cream and sugar, the taste and smell of cookies, freshly washed clothes, or the smells of the city. After you have practiced focusing on tastes and smells, follow the prompts below to practice this skill during a stressful situation.

1. During a stressful situation—being stuck in traffic, after an argument, bad day at work, or unpleasant experience, or when you are upset—notice your thoughts, emotions, and body sensations and movements. Taste & Smell 2. Then choose something to stimulate your senses of taste and smell—drink a cup of tea, chew gum, eat a piece of chocolate or a piece of cheese, put on fragrant hand lotion, suck on a piece of hard candy, or take a walk outside and notice the various smells of your surroundings. As you do this, focus all your attention on your taste and smell. Be mindful of what happens. 3. Describe your thoughts, emotions, and body sensations and movements before and after you practiced focusing on your senses of taste and smell. Before Thoughts 162

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CHAPTER 8

Directed Mindfulness and Neuroplasticity THERAPISTS’ GUIDE TO CHAPTER 8

Purpose of this Chapter This chapter refines the mindfulness skills learned in the previous chapter by teaching “directed mindfulness,” which entails purposely focusing mindful attention on particular building blocks considered important to therapeutic goals (Ogden, 2007, 2009). Siegel (2010a) notes: “When we focus our attention in specific ways, we create neural firing patterns that permit previously separated areas to become linked and integrated. The synaptic linkages are strengthened, the brain becomes more integrated, and the mind becomes more adaptive” (p. 43). As the brain changes with the focused attention of mindfulness, new mental capacities are developed that can interrupt old patterns of reaction (Siegel, 2007). With this chapter, clients learn to capitalize on the neuroplasticity of the brain by applying the skills taught in the previous chapter to purposefully direct their mindful attention to a building block they typically do not notice, thereby creating a new experience.

Clients Who Might Benefit Clients who find themselves unable to alter their automatic reactions will find this chapter particularly helpful. Traumatized clients whose attention seems repeatedly drawn to dysregulating bodily sensations, overwhelming feelings, or intrusive sensory cues, despite their best efforts, or who obsess over negative beliefs or emotions, can benefit from the skill of deliberately directing their mindful attention. Clients who are not suffering from PTSD but who wish to change the physical patterns, emotions, thoughts, and sensory memories associated with past attachment inadequacies can also benefit from directing, mindful attention toward new elements of internal experience, rather than feeling compelled to focus on the building blocks that exacerbate their distress.

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Suggestions for Clinical Use The idea that clients can deliberately choose to focus attention toward particular thoughts, feelings, perceptions, movements, and sensations runs contrary to the tradition of therapeutic free association. When we encourage clients to free associate, we facilitate open-ended awareness of wherever their attention is drawn. Directed mindfulness requires that instead of free association, you help your clients deliberately direct their attention toward specific selected building blocks to support therapeutic aims. For example, if an image or memory of past trauma (e.g., the sound of a siren) or of attachment difficulties (e.g., being criticized) causes hyperarousal or dysregulating emotion, you might direct your client to become mindful of the sensation in his or her legs to foster a new experience of grounding, rather than fixating on the distressing memory. Or, if your client’s regulatory capacity is sufficient, you might direct his or her mindfulness toward a strong emotion as a way to deepen the emotional experience and discover the building blocks that correlate with it. You might ask questions such as these: “What happens in your body as you feel this anger? What thoughts seem to go with it? Are there any images that arise when you sense the anger? What movement does your body want to make when you experience the anger?” In this way, information is revealed that creates a new experience of the emotion and often supports expression and resolution of it. A challenge in the use of the chapter may be clients’ misinterpretation of the material. They might misunderstand your suggestion that they refrain from focusing on particular building blocks and turn their attention elsewhere. They may think you are suggesting they avoid or discount their painful experience. In this situation, psychoeducation is crucial. The point is to help clients understand the difference between avoidance of distress and mastery over it, and between deliberate focus versus habitual focus. It may be helpful to reference the chapter’s emphasis on neuroplastic change, highlighting that habitual focus on the effects of the painful experience may validate the client’s distress, but it will not create new experiences or change the brain, and the latter is the goal with this chapter. Research on neuroplasticity suggests that structural changes in the brain are dependent upon the ability to maintain focused attention on the novel elements of experience and on new patterns. ”The discovery that neuroplasticity cannot occur without [focused] attention has important implications. If a skill becomes so routine that you can do it on autopilot, practicing it will no longer change the brain. And if you take up mental exercises to keep your brain young, they will not be as effective if you become able to do them without paying much attention.” (Begley, 2007)

Challenging your clients in different ways to practice directed mindfulness and concentrate on new experiences must be repeated over and over to facilitate the activation of new neural networks. 165

Introduction to the Worksheets CHANGING NEGATIVE BELIEFS helps clients identify how they are affected by negative beliefs by asking them to direct their mindful awareness to the physical elements, particularly movement and posture, associated with a specific negative belief, then experiment with performing the opposite physical action and notice the effect. The goal is to challenge the negative belief by practicing a new, opposite physical posture or movement that elicits new reactions in the building blocks and would be more suited to present-day life. CREATING NEW PATTERNS is a good fit when clients come in with repetitive, familiar complaints or disappointments because this worksheet helps them deconstruct a pattern they would like to change into its component building blocks. Clients then explore creating a different experience by mindfully directing their attention to something that challenges the old pattern. Unless your clients are adept at being mindful of the building blocks, these first two worksheets are best completed in session to so clients can benefit from your prompting and feedback to assure success. And, clients will need you to remind them to repeatedly practice what they discover through these worksheets. The worksheet on HARNESSING NEUROPLASTICITY FOR POSITIVE CHANGE helps clients become aware of the power of their thoughts to influence the body. It first asks clients to identify the effects of negative thoughts on the body, and then direct their attention to a positive experience or something for which they are grateful and notice the effect on the body. Your encouragement to repeatedly direct attention to more positive elements of their lives, along with working on the problems that brought them to therapy, can build new patterns of brain circuitry that can support clients’ goals. The last worksheet for this chapter, DIRECTED MINDFULNESS, teaches clients to change their relationship to a current problem by first identifying how the problem affects their building blocks, and then directing mindfulness to a specific building block in order to alter their experience in a positive way. This worksheet will be particularly useful for clients who tend to ruminate on current difficulties in their lives.

Adapting this Material for Dissociative Clients Dysregulated and dissociative clients generally experience that their attention is instinctively drawn toward building blocks that dysregulate them. They may focus on racing thoughts/voices (internal “noise”), their fogginess or spaciness, painful emotions, disturbing physical sensations or images, or dysregulating emotions. Keep in mind that the goals of this chapter are to help clients learn the skills of directed mindfulness so that they can first identify and describe, and then 166

deliberately alter, their experience. With this skill, they can learn to mindfully focus on building blocks that are regulating. These clients will need your encouragement and support to diligently practice this skill because it is difficult to deliberately redirect attention when it has always been compelled by hyper-/hypoarousal, dissociation, impulsive action-taking, or shutting down. Each time your client experiences one of these symptoms, an opportunity is provided to teach directed mindfulness. You can pause the narrative or interrupt the silence by saying, for example: “Notice how your body shuts down when you try to describe what sensations and feelings you were having. What building blocks tell you that you’re shutting down? Is it more like a numb feeling? Or thoughts getting blurry? Or a collapse in your body?” Once the building blocks are discovered, you can help clients practice directed mindfulness with suggestions such as: “Try focusing on your breath and see what changes. Maybe pay attention to your feet right now, or the image of your lovely home. Describe what changes inside.” If your clients are triggered when experimenting with a positive belief or a new response, you might experiment with selecting and directing mindfulness toward building blocks that help them feel better. If they are distracted by switching between parts (e.g., when certain parts monopolize the client’s consciousness or function involuntarily), mindfulness can be directed toward the building blocks involved in switching. You might suggest, “Let’s pay attention to what just happened. What changes inside as this part of you comes forward?” Or you may try to direct their mindfulness away from a triggering building block to something else. You might say, for example, “What do you notice when you attempt to put aside that image and focus on your breath?” Whenever they attempt to direct their mindful attention to specific internal phenomenon of their choosing, your clients are doing the work of this chapter.

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CHAPTER 8 Directed Mindfulness and Neuroplasticity Distressing events cause all kinds of changes in the five building blocks that comprise our experience of the present moment. These changes include: negative thoughts that provoke shame, hopelessness, self-judgement, or other forms of discontent; Emotions such as fear, disappointment, anger, or sadness; Sensory, or perceptual, cues such as distressing images seen in the mind’s eye; Movements such as turning away, lowering the head, or an impulse to run or leave; Sensations such as numbness, heaviness, shaking, or tightness. If upsetting experiences are enduring or repeated throughout childhood, these internal reactions might become so common that they feel normal or “just the way I am.” Such familiar, habitual reactions tend to go unquestioned—even when they become the source of our distress or limit our ability to function fully in our lives. In the last chapter, we focused on becoming mindful of the five building blocks of present experience as they emerge moment by moment, and then we learned how to name and describe them. In this chapter, the emphasis is on how to consciously direct mindful attention to specific building blocks. By doing so, we create new experiences with the intention of capitalizing on the brain’s capacity for change and shifting trauma and attachment-related patterns of response.

The Plastic Brain We know that our brains are “plastic,” or malleable, which means that they are capable of growing new neural networks (a group of neurons whose impulses coordinate to define a particular circuit) and making old networks obsolete. Neuroscientists have discovered that throughout the lifespan the brain can actually change in response to novel experience. This discovery disproves century-old assumptions that the brain only changes for the worse or cannot change at all after a certain age. This is good news for anyone suffering from trauma or attachment inadequacies because it means that, since our brains are plastic, new learning and the practice of new actions and thoughts can change our brains and transform outdated or painful patterns. Directed mindfulness means deliberately selecting particular elements of present-moment experience on which to focus. Doing so can create new experiences, capitalizing on the brain’s capacity to change, called neuroplasticity. 169

Rather than focusing on building blocks connected to old, disruptive patterns, we can direct mindful awareness to those building blocks that help us feel calmer or more energized, centered, or able to act instead of react. For example, if we feel anxious, rather than asking ourselves, “What am I noticing right now?” (nondirected mindfulness), we might ask ourselves, “As I feel this anxiety, what happens if I bring my full attention just to the feeling of my feet on the ground?” Or “What happens if I focus on an image of my wife’s smile instead of the butterflies in my stomach?” When you want to create a different, new internal experience, directed mindfulness can help you deliberately shift your attention to building blocks that are resourcing for you and change your experience. Directed mindfulness can also be used to focus on certain emotions, thoughts, images, or body experiences that might be unpleasant or triggering when you want to discover more about them. For example, if your habit is to try to relax tension, you might direct your mindfulness in this way: “Instead of trying to relax the tension in my shoulders, what happens when I focus on the tension? What can I learn about it? What images, thoughts or emotions are connected with it?” In this way, the usual pattern of trying to relax the tension is interrupted, and mindfulness is directed so as to discover new associations with the tension. By doing so, you can learn more about the tension, what causes it, and what it needs, rather than just trying to make it go away. When we decide to interrupt what we habitually pay attention to internally by directing mindful awareness to the building blocks we usually do not pay attention to, we interrupt old patterns and create a new experience. By doing so, we hope to actually support our brains to change, as they did during our formative years of early development when nearly everything was a new experience. This chapter introduces you to some simple practices of directed mindfulness that are designed to help you take advantage of your brain’s capacity for neuroplasticity.

Tasks of Directed Mindfulness Becoming curious about all five building blocks that occur automatically— thoughts, emotions, five-sense perceptions, movements, and body sensations— slows down our reactions. This mindful curiosity helps us push the “pause” button, so that we can notice the familiar automatic reactions as they arise, rather than become immersed in them or detached from them. Applying what we learned in the last chapter, we can ask ourselves, “What building blocks are telling me I’m scared? Or that I’m ashamed? Or excited? How do I know?” By considering the building blocks that comprise our inner experience we are able to take charge of it and choose to pay attention to those building blocks in a new way. We may focus on a familiar building block to learn more about it, or we may focus on a different 170

building block to help us feel better or at least feel something new. It is important to recognize that trying to resolve our difficulties solely by thinking about them is limited because our ability to think up a new solution is constrained by our habits of thinking and by the beliefs we have formed. In addition, talking about distressing things can sometimes cause us to feel more detached or more unsettled, interfering with our ability to think clearly. But, mindful concentration is associated with increased activity in areas of the neocortex, a part of the brain that helps us think clearly. Mindful concentration is also associated with decreased activity in parts of the brain that register upset or distressed states and reactivity to triggers. Directing mindfulness not only helps us to develop new patterns of response in our brains and bodies, but in and of itself can help settle upsetting feelings. Annie had survived years of severe abuse as a child. She often felt dysregulated by everyday occurrences in her current safe environment. If she unexpectedly met a neighbor on the street, she would immediately freeze, her body would begin to shake, she would feel a wave of flushing that turned her face bright red. She would momentarily lose the capacity to speak and her body would “go completely numb.” These types of experiences felt humiliating to her and caused her to withdraw from friends and neighbors for periods of time. In therapy, she and her therapist repeatedly worked on developing her ability to use directed mindfulness when triggered. Annie brought to mind the image of the neighbor whom she met on the street to evoke her troubling reactions in therapy so that she could be mindful of them. Mindfulness helped Annie pause and observe, rather than react to, the shaking and flushing, and the pause itself helped her to calm down. Then she could begin to focus on the building blocks of her reaction, deliberately choosing to notice and name her negative thoughts as thoughts but not to dwell on them. She began to consider where to direct her mindful attention. She realized she could choose to focus on the sensations and impulses that were so familiar to her to learn more about them, or she could focus exclusively on the image of her neighbor’s kind eyes and notice how her building blocks were affected. Sometimes she decided to focus on an area of her body that was not activated, such as her back. Each time she directed mindfulness to a specific building block, she created a different inner experience. Annie felt empowered when she realized she was not at the mercy of her reaction, but could choose where to focus her attention. To review: the first step in promoting neuroplastic change is to mindfully notice the building blocks comprising our familiar reaction. This noticing naturally puts the brakes on the reaction. We can then direct mindful attention to other building blocks that we would typically ignore. If the new focus does not yield a more settled or pleasurable feeling, we can experiment with different focal points until there is a desired shift in experience. The final step is to be mindful of how that 171

new experience changes our building blocks. The brain changes slowly, in increments. The same circuits have to fire over and over again to create a reliable new neural pathway that will lead to a different reaction. Rather than trying to suppress her distressing reactions, as she had done for many years, Annie learned to pause, direct her attention to the building blocks comprising her reactions, and then consciously choose where to focus next. The moment of pause was critical for Annie, because in that moment of pause, she regained her ability to choose. Instead of letting herself be driven by her internal reactions or putting all her energy into suppressing them, pausing to notice them helped her experience a sense of choice. She could then experiment with new possibilities. She practiced directing her mindful attention to something new and more regulating, focusing on the change in her building blocks that was created by the new experience. Repeating this process over and over gradually decreased her dysregulated reaction and brought her arousal into a window of tolerance. Though Mark had not suffered severe trauma as Annie had, he learned as a child that keeping his thoughts and opinions to himself gained his parents’ approval. In his current life, he still found himself unable to speak his mind when opportunities to do so arose. He often became quiet with his friends and did not spontaneously engage in conversation even when he wanted to. Through using mindfulness to learn about what was happening inside him when he felt an impulse to speak but was quiet instead, he noticed that his body tightened, and he felt inadequate the way he had as a child. When he was with his friends, Mark experimented with inhibiting the tension and concentrating on keeping his body relaxed. He tried a new movement of voluntarily leaning slightly forward instead of pulling back and noticed that, when he did so, his breathing deepened. As he directed mindfulness to the sensation and movement of his breath, Mark noticed that the feelings of inadequacy lessened. Next, he decided to orient toward his friends, their smiles, friendly faces, and the sound of their voices and notice the change in his building blocks. This further diminished his feeling of inadequacy. He noticed more relaxation, a feeling of wellbeing, and the thought came to his mind, “They accept me.” As Mark repeated these steps over and over—pausing, noticing his building blocks, then inhibiting his automatic response of tightening, relaxing his body, and finally directing his attention to something new—his old pattern of keeping his thoughts to himself began to change. He began to enjoy his time with his friends more and more. Gradually he became more participatory and vocal, lessening the impact of his past conditioning on his present relationships. Current experiences that remind us of the past activate parts of the brain and body that drive actions suited for these past experiences. But new experiences alter these old neural pathways and activate new ones. We can support the remarkable ability of the brain to reorganize itself by consciously inhibiting old habits and 172

redirecting mindful attention to something new. When we notice the building blocks that contribute to our habitual reactions, and then selectively attend to those we would not normally pay attention to, we are taking advantage of our brain’s capacity for neuroplastic change. The worksheets that follow will help you recognize when patterns of thoughts and movements are keeping you stuck in the past, and how to use directed mindfulness to create a different experience and lay down new pathways in your brain.

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Directed Mindfulness and Neuroplasticity CHANGING“NEGATIVE” B ELIEFS Purpose: To identify a limiting belief, discover the movements that go along with the belief, and then intentionally practice the opposite movement to create a new experience of the building blocks. Directions: Identify one of your negative beliefs and then complete the prompts below. 1. Identify your negative belief: (e.g., I’m not good enough; I’ll never get what I want;I’m unlovable). 2. What happens in your body when you think that negative thought? (e.g., When I think “I’m not good enough” my chest collapses, my shoulders slump, and my breathing is shallow). 3. Describe an opposite movement you could make: (e.g., Square my shoulders, sit up straight, and take a deep breath). 4. Make the opposite movement several times and mindfully notice what changes inside. Write below what happens in each of your other four building blocks when you make the opposite movement. SENSATIONS I feel more energized, alert, and strong, instead of a collapsed, weak feeling in my body. FIVE-SENSE PERCEPTION I see myself being outgoing, talking, and laughing with other people. EMOTIONS I feel happier and more hopeful. THOUGHTS I don’t have to hide. People like me. I don’t have to be perfect. 5. Remember that change requires a lot of repetition. Practice this new movement throughout the week and describe your experience below.

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Directed Mindfulness and Neuroplasticity CREATING NEW P ATTERNS Purpose: To support your brain’s ability to change and grow new connections; to identify and interrupt a negative pattern; and to use directed mindfulness to deliberately focus on something new that might help you respond to an old situation in a different way. Directions: Identify a repetitive pattern that interferes with your ability to enjoy your life in some way, and then follow the prompts below. 1. Describe a pattern you would like to change (e.g.,I feel stupid when I’m in a class or trying to learn new things). 2. Identify the building blocks that contribute to the unwanted pattern. Five-Sense Perception

(e.g., Images of my critical father keep coming up.)

Emotions

(e.g., I feel incompetent and scared.)

Sensations

(e.g., My muscles feel tense, and I feel heavy and sluggish.)

Movements

(e.g., I tighten my shoulders, and look down.)

Thoughts

(e.g., I can’t do it. I’m stupid.)

3. How can you direct your mindfulness to create a new experience for yourself? (e.g., When I feel stupid in class, I can name my negative thoughts as just thoughts, not facts, and my emotions as emotions,and focus my attention only on what I see and hear right now.) 4. What building blocks can you direct your mindfulness towards to create a new experience for yourself? Five-Sense Perception

(e.g., I can remember the smile on my teacher’s face when I did well in class.) 177

Emotions

(e.g., I can remember times when I felt proud and competent.)

Sensations

(e.g., I can focus on the sensations of my breathing.)

Movements

(e.g., I can lift my chin and take a deep breath.)

Thoughts

(e.g., I can say to myself, “I can learn new things. I’m not stupid.”)

5. Choose one way to direct your mindfulness from #s 3 and 4 that you found effective in creating a new experience. Practice directing your mindfulness in that way many times and describe your experience.

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Directed Mindfulness and Neuroplasticity HARNESSING NEUROPLASTICITY FOR P OSITIVE CHANGE Purpose: To identify repetitive negative thoughts connected to what has not gone well in your life; to identify positive thoughts about what has gone well in your life; and to notice how your body responds to both positive and negative thoughts. Directions: Reflect on things that have not gone well and things that have gone well in your life. Then complete the prompts below. 1. Name three things that have not gone well in your life (e.g., regrets, arguments with others, mistakes you feel you have made, resentments, and disappointments) that you think about often, and write down the negative thoughts that relate to them. Describe how your body feels when you think these things. Three Things That Have Not Gone Well (e.g., I completely botched an interview.)

Negative Thoughts

How My Body Feels

(e.g., How could I be so stupid; what do (e.g., Collapsed, they think of me; I’ll never get a job I like; head down, no I’m a failure; what’s wrong with me?) energy, feel like hiding.)

1. 2. 3. 2. Now think of three things that have gone well in your life (e.g., personal connections, the ways you enjoy yourself, the things you do well, and whatever you are grateful for). Describe how your body feels when you think these things. Three Things That Have Gone Well (e.g., My relationship with my partner goes

Positive Thoughts

(e.g., I’m one of the lucky ones; I can just be myself; I don’t have to worry about this part of my life.) 180

How My Body Feels (e.g., Posture straightens, feel more energy.)

well.) 1. 2. 3. 3. Describe one thing you learned from this exercise that you can practice often with the intention to build new patterns of brain circuitry that contribute to your well being. (e.g., I will remember to stand up straight and think about how much my partner cares about me when I find myself ruminating about when I botched that job interview.)

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Directed Mindfulness and Neuroplasticity DIRECTED MINDFULNESS Purpose: To practice directed mindfulness to help you relate to a current problem in a different way. Directions: Reflect on current problem you are experiencing. It could be a problem at work, a difficulty in a relationship, being too busy, not taking care of yourself, or anything else that bothers you. Then follow the prompts below. 1. Describe your current problem in the box below. (e.g., I never express ideas at work.) 2. Describe your thoughts, emotions, and body sensations/movements that go with this problem below. Thoughts/Beliefs

Emotions

Sensations/Movements of the Body

(e.g., I will be at fault if the idea fails. People won’t give me a chance. I’m worthless.)

(e.g., frightened, somber, angry, lonely, frustrated, nervous, miserable, dejected, inadequate.)

(e.g., I feel tension in my neck. I don’t breathe much. I feel my stomach tighten, my shoulders sag, and I have the impulse to curl up in a ball.)

3. Decide to direct your mindfulness toward a building block that could change your experience in a positive way (e.g., your feet on the ground, a good sensation in your body, take a deep breath, sit up straight and tall, an image of someone you love, remember a song you enjoy or the sound of your kids happily playing). Write down what you decide to focus on. The building block I will focus on is: ______________________________ 4. Spend a few minutes directing your mindful attention to this building block and not on the problem. Below, describe what happens in your thoughts, emotions, and body sensations/movements. Thoughts/Beliefs

Emotions

Sensations/Movements of the Body

5. Now think about your problem again, but also direct your mindfulness on the 183

building block that changed your experience. For example, if you lengthened your spine, keep your spine lengthened while you are thinking of your problem. Describe your experience below. 6. How can you incorporate the directed mindfulness you practiced on this worksheet in your daily life?

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CHAPTER 9

The Triune Brain and Information Processing THERAPISTS’ GUIDE TO CHAPTER 9

Purpose of this Chapter Traumatic and early attachment experiences, as well as triggers reminiscent of them, affect sensorimotor (or body), emotional, and cognitive processing. These three levels of information processing correlate roughly with MacLean’s (1985) triune brain model, which divides the human brain into three “brains.” The reptilian brain has “innate behavioral knowledge . . . basic instinctual action tendencies and habits related to primitive survival issues.” The mammalian brain offers “affective knowledge . . . subjective feelings and emotional responses.” The neocortex generates “declarative knowledge . . . [and] propositional information about world” (Panksepp, 1998, p. 43). These three brains are mutually dependent and intertwined (Damasio, 1999; LeDoux, 1996; Schore, 1994) but may not work well together (MacLean 1985), especially after adverse experiences. The purpose of this chapter is to explore how the three brains relate to cognitive, emotional, and sensorimotor processing; how the functioning of each is experienced through the building blocks; and how trauma and attachment deficits might impair their synergistic functioning. Differentiating how each one of the three brains is activated by certain stimuli will help your clients understand that the functioning of the brain influences their symptoms and problems, as they are reflected in the building blocks of the present moment. Clients will also acquire tools they can use to support the integration of their thoughts, emotions, movements and sensations.

Clients Who Might Benefit This chapter holds special benefit for clients whose difficulties are directly tied to 185

a particular level of information processing. For example, for clients who have trouble thinking clearly, understanding that the neocortex might be shutting down in response to triggers will help them make sense of this difficulty rather than judging themselves as incompetent or “stupid.” Clients who try unsuccessfully to use topdown management skills to regulate their emotions or physical responses—such as trying to convince themselves they are not in danger or should not feel the way they do—will find an explanation of why such self-talk may be ineffective. Clients who are emotionally disconnected, reactive, or flooded by their emotions will better understand how their reptilian and mammalian brains contribute to their emotional patterns. Learning how distressing reminders activate the amygdala and stimulate volatile emotions may be a first step toward managing them. Impulsive clients can be helped to decrease shame and put their impulsivity into better perspective if they understand that bottom-up “hijacking” by the subcortical brains (Goleman, 1995) results in the loss of neocortical monitoring. Understanding why their hearts race, why they experience urgent impulses to take action, or why they have undesired emotional reactions to certain dynamics of close relationships may help clients to understand these as related to brain activity without judging themselves, and without having to act on them. Clients who report being “in their heads,” “analytical,” “too emotional,” or “not able to feel” might benefit from understanding that their neurocortex, or thinking brain, is overriding their emotional brain.

Suggestions for Clinical Use Understanding that the functioning of the three brains is experienced in the present moment through the five building blocks will help your clients relate the material in this chapter to Chapter 7, “Mindfulness of the Present Moment.” The building block of cognition correlates with cognitive processing and the functioning of the neocortex, and emotions with emotional processing and the functioning of the mammalian brain. The final three building blocks—movement, five-sense perception, and body sensation—are roughly correlated with sensorimotor processing and the functioning of the reptilian brain. Although the motor cortex and premotor cortex are responsible for many forms of movement, we have included this building block in the sensorimotor level of information processing because of its obvious somatic component (Ogden et al., 2006). It will help your clients in their work with the body to understand that “the ‘higher level’ integrative functions evolve from and are dependent on the integrity of ‘lower-level’ structures and on sensorimotor experience” (Fisher, Murray, & Bundy, 1991, p. 16). In other words, the sensorimotor level of information processing has a strong influence on the other two brains, which speaks to the 186

viability of sensation and movement of the body as targets for therapeutic intervention. Understanding how one “brain” may become dominant and interfere with or override the others can help make sense of difficulties that our clients experience. Some clients will benefit from learning that activation in the subcortical brains in response to perceived threat tends to automatically decrease neocortical activity and increase bottom-up reactions (LeDoux, 2003). As a result, it can be difficult to think clearly, distinguish cause and effect, process what happened, make plans, or realistically anticipate the future. It might be useful to build the concept of information processing into your instructions to your clients for reading the chapter. For clients who become easily dysregulated, you might suggest that they explore reading the chapter with their thinking brain, rather than focusing on any emotional or body reactions. For clients who are not at risk of becoming dysregulated, you might suggest they be curious about their building blocks as they read the chapter. They might notice how they are reacting to the chapter’s contents physically, emotionally, and cognitively, and perhaps write down their reactions to share with you at their next session. In clinical practice, it is useful to examine each level of information processing separately and also observe the interweaving of cognitions, beliefs, emotions, images, and bodily responses. Typically, as you and your client deconstruct a difficult experience, you will find that a reminder of the past prompts a sensation or movement (e.g., an elevated heart rate, or tension and clenched jaw), which is followed by a thought (“Something’s wrong—something’s not safe” or “I’ll never be good enough”), which leads to an emotion (fear, helplessness, irritation, sadness, anger) and a snowballing of similar thoughts, body responses, and emotions. Throughout therapy, you can refer back to this chapter as clients report and experience how they think, feel, and act to help them differentiate the impact of the different types of information processing, and the functioning of each “brain,” on their experience.

Introduction to the Worksheets THREE LEVELS OF INFORMATION PROCESSING can be a first step in helping clients consider how each brain might react differently to stimuli, and speculate on which brain is most active in particular situations. HOW OUR DIFFERENT BRAINS REMEMBER takes this inquiry one step further by asking clients to examine the possible ways that each brain might remember positive and negative experiences. The three worksheets on MY THINKING BRAIN, MY EMOTIONAL BRAIN, and MY BODY BRAIN will help your clients consider how their three brains 187

interact and reinforce or contradict each other in how they process information. Clients also have the opportunity to notice patterns of dominance—whether they tend toward emotional, cognitive, or physical reactions. Awareness of how information processing occurs will help clients to understand how bottom-up therapy works. HIJACKING OF YOUR NEOCORTEX explores how the triggering of subcortical reactions can interfere with cortical functioning and cause a variety of symptoms. This knowledge, in and of itself, can be stabilizing. Clients typically feel less confused by their symptoms and often stop blaming themselves as they reframe them as a function of the brain, and also as they consider that hijacking might serve a useful purpose.

Adapting this Material for Dissociative Clients For dissociative clients the triune brain model can promote understanding, from a neuroscientific perspective, of themselves, their parts, and the puzzling and troubling symptoms of dissociation. The model can help explain dysregulation as a function of a highly activated mammalian brain and impulsive behavior as an expression of the reptilian brain. The interaction of parts can be explained through the triune brain model in a more neutral, less judgmental, or pejorative way. For example, clients might notice that a rageful part driven by an instinctive fight defense (reptilian survival brain) reacts impulsively to the emotionality (mammalian brain) of a sad or ashamed part, or that the more rational, thinking part (neocortex) fails to implement the safety plan discussed in therapy because the thinking brain is not available when dysregulated parts are triggered. Clients may learn to appreciate how triggers activate parts driven by the mammalian and reptilian brains, rendering their neocortex no longer available to think things through. They may begin to see how they can access cortical functioning to solve problems and respond thoughtfully, as long as other parts ruled by subcortical functions are not triggered. It may be best for dissociative clients if you go over the chapter together and fill out the worksheets in therapy so that you can facilitate thoughtful responses. As the chapter describes, subcortical hijacking can be addressed by increasing activity in the cortex, which you can encourage by helping clients think about and make sense of their reactions. If clients encounter challenges with this material, such as getting triggered or dysregulated, you might ask them to consider which level of information processing was triggering and what part of the brain reacted so strongly. You can also help them make sense of their reactions by saying something like this: “I can understand that you were confused when you ran out of the room. Maybe, your reptilian brain took over and your neurocortex was shut down.” Or: “Maybe when something triggers your emotional brain, your neocortex stops 188

functioning so you can’t think clearly. It isn’t that you’re ‘stupid.’ ” You can also help clients notice the effects of being triggered on their building blocks. Since focused attention activates the prefrontal cortex, directed mindfulness itself can help clients manage reactivity of dissociative parts better by consciously engaging this part of the brain.

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CHAPTER 9 The Triune Brain and Information Processing Our brains are wondrous, awe-inspiring organs that weigh only a little over 3 pounds but contain about 100 billion nerve cells, or neurons, that can transmit signals at a speed of over 200 miles per hour. Capable of processing a colossal amount of information in a split second, the human brain is so complex and mysterious that even neuroscientists are far from fully understanding it. In this chapter, a simple model of the brain called the triune brain is described, which can help clarify how the brain might change after adverse experience. Triune means, literally, “three in one.” The triune brain model describes three areas within the brain that are designed to function as a cohesive whole, yet each one has a particular way of understanding and processing information. The reptilian brain, the oldest of the three, operates on instinct and is responsible for the survival-related functions of the body. The mammalian brain, so called because it emerged with the first mammals, is concerned with our emotional and relational experience. Last to develop in evolution, the neocortex is sometimes called the “thinking” brain because it is responsible for our reasoning, selfawareness, and abstraction abilities. Figure 9.1 illustrates these three brains. Each of these three brains contributes its own unique understanding of the world and guides our actions according to that understanding. They each process information in their own particular way to make sense of things, which roughly corresponds with the building blocks. The neocortex correlates with cognitive processing and the building block of cognition. Emotions are the purview of the mammalian brain and emotional processing. And the reptilian brain corresponds with sensorimotor processing, which includes the building blocks of movement, five-sense perception, and sensation. See the following table for an illustration of the correlations between building blocks, type of information processing association, and each of the three “brains.”

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FIGURE 9.1 “Brain”

Building Block(s)

Type of Information Processing

Neocortex

Cognition (thoughts, beliefs)

Cognitive processing

Mammalian

Emotions

Emotional processing

Reptilian

Movement, 5-Sense Perception Sensation

Sensorimotor (body) processing

Although these three regions of the brain, along with their way of processing, are designed to function in an integrated manner, they don’t always work well together. You may have noticed times when your building blocks do not seem to go together. Maybe your body tenses up, you sense butterflies in your stomach, and you feel uneasy, even though your thoughts are telling you that everything is fine and you have no reason to feel the way you do. Since we are born with very immature brains, the relationship among these three brain regions and their individual ways of processing information is dependent upon experience. The information in this chapter and the worksheets at the end are intended to provide a basic understanding of the effects of trauma and early attachment relationships on these three brains, how their functioning is experienced through the building blocks, and to help you make better sense of why you think, feel, and act as you do.

Information Processing and Our Three Brains The Neocortex Located all across the top of the head and behind the forehead, the neocortex (also 192

called the cerebral cortex, frontal cortex, or neomammalian brain) is divided into the left and right hemispheres, both of which are involved in nearly all our activities. The more intuitive right hemisphere, fully “online” at birth, sees the world in a holistic, “big picture” way and is more creative and artistic. It processes information implicitly and symbolically in a nonlinear, intuitive manner. The more rational left hemisphere, undeveloped at birth, sees the world in an increasingly rational way as it matures over the course of childhood and young adulthood. It processes information in a logical, explicit, analytical, and linear manner and is the seat of most of our language abilities. The corpus callosum bridges the right and left hemispheres to facilitate their communication, coordination, and consolidation of information. Babies are born with nearly all of their brain cells, but these cells have not formed the connections necessary for complex thinking or for regulating the emotions and physiological arousal of the subcortical brains. As the neocortex develops throughout childhood, children acquire a greater capacity to control their behavior, reason things out, use their imaginations, and self-soothe because connections are made from the neocortex to the subcortical brains. The neocortex keeps maturing into our 20s, enabling us to develop greater social judgment, regulation of our emotions, and self-awareness to become more stable and skilled socially, emotionally, and intellectually. Cognition and cognitive processing—the abilities afforded by executive functioning skills such as reasoning, abstraction, planning, and problem solving— correlate with the functions of the neocortex. Operating both intuitively and logically, these higher cortical areas enable us to collect data, analyze it, develop insights and theories, and make meaning that guide future decision-making. This “top-down” processing, which includes planning and drawing on both the left (logical) and right (intuitive) hemispheres of the neocortex, governs many of our adult activities. We might consider how we want to spend our time, make plans, and structure our day to accomplish certain tasks. We can override emotions, such as frustration, and body sensations of hunger or fatigue or even physical pain, to continue with what we have planned, following the lead of the neocortex. With this top-down control, we might be aware of our emotions and bodily experiences, but we may not allow them to determine our actions. Most of us have had experiences of using top-down control to study late into the night to pass an exam, overriding fatigue, hunger, boredom, and impulses to do something else. The Mammalian Brain The mammalian brain (also called the emotional brain or limbic brain) is right in the very center of the whole brain, connecting the reptilian brain and the neocortex. The mammalian brain understands the world through emotions and is in charge of our emotional responses to relationships and events. Emotions lend another 193

dimension to our experience by letting us know of our likes and dislikes, identifying what is emotionally significant to us, and adding emotional richness in our lives and relationships. Different components or structures of this part of the brain enable us to subjectively experience our emotions, form attachment to others, feel drawn toward or away from things, and hold emotional memories of our experiences. The thalamus receives information from our senses. When that information includes threat or danger cues, the amygdala signals us to protect and defend ourselves. The amygdala also alerts us to stimuli associated with reward and good feelings, along with those related to fear. Our mammalian brain influences our perception of sensations of pain and pleasure and gives us emotionally based signals so that we orient toward and respond to meaningful stimuli. The hippocampus remembers important information and consolidates it into long term memory. The mammalian brain is essential to our relationships because it generates feelings that make us aware of the effect of our actions on others and the impact of their actions on us. In infants, this brain fosters social engagement and attachment behavior with the people who take care of them (usually the parents) and to whom they have an emotional bond, their “attachment figures.” The sight of the attachment figure’s face activates amygdala-driven pleasure and excitement, causing the baby to smile, coo, wiggle, make eye contact, and begin to mimic sounds, expressions, and movements of the parents. The mammalian brain will prompt the infant to initiate these action sequences again and again. These experiences of shared pleasure are also encoded as nonverbal memories of attachment experiences, laying down templates for expectations of future relationship. The Reptilian Brain Surrounded by the mammalian brain, the reptilian brain (also called the survival brain) includes the main structures of a reptile’s brain, the brain stem and cerebellum. Located at the very back of your head, the reptilian brain is associated with reflexive behaviors present in reptiles and is the oldest part of the brain, fully developed at birth. It understands the world through survival instincts and controls autonomic functions that we experience as body sensations and basic life-sustaining processes: heart rate, respiration, digestion, and body temperature regulation. The reptilian brain is active whether we are asleep or awake to make sure that these vital functions are working properly. Whether we are experiencing the pulses and movements of our organs or engaging in purposeful voluntary movements, such as running or walking, the reptilian brain is engaged in one way or another. With a primary concern of physical survival, this brain is also responsible for reflexes and instinctive responses to stress and trauma, from the startle reflex to the defensive responses of crying for help, fighting, fleeing, freezing, and feigning death. It might stimulate other behaviors that have to do with survival as well, such 194

as competition, aggression, domination, or a compulsion to hoard resources. Because the reptilian brain governs basic instinctive actions, it acts very quickly, much more quickly than the neocortex. If a snowball is thrown toward your head, you don’t have to think about what to do because your reptilian brain makes you duck instinctively.

How Our Brains Develop The development of our brains depends upon our early interactions with our caregivers. Since there are very few connections between the cortex and the lower brains at birth, the immature brain of an infant or young child is extremely vulnerable to environmental conditions and attachment relationships to acquire the pathways necessary to regulate lower brain arousal, impulses, and emotions. From the millions of possible neural pathways available at birth, those synapses that are used repeatedly are strengthened, and the ones that are used infrequently are pruned. Thus, our brains grow in response to the unique demands of our surroundings, and different neural networks are developed that best fit our family environment. Both attachment relationships and trauma influence the development and functioning of each of the three brains. When we are stressed or in danger, our amygdala signals “danger,” our reptilian brain takes over, and we act on survival instinct. If the stress or threat is ongoing or repeated, the amygdala may become sensitized to cues that remind us of these situations and repeatedly signal to us that we are in danger even after we are no longer stressed or the danger has passed. The reptilian brain also tells us to use the defense that has worked best in the past, so if we froze during childhood trauma, as adults we may still be inclined to freeze in the face of traumatic reminders. If we became anxious and hyperaroused in response to pressure from our parents, we are likely to respond similarly when stressed as adults. Our subcortical brains have been primed to deal with stress and threat and take every precaution to assure our survival. The down side of this learning process is that we might continue to be repeatedly triggered long past the time when there was a need to defend and protect or otherwise respond to stressful situations. Our neocortex is affected by trauma and stress, too. When in danger, we literally don’t have time to think. In the face of threat, our mammalian and reptilian brains prompt us to act quickly to stay alive. Time is of the essence during threat, and since it takes longer to think things through than to act on instinct, our neocortex is rendered temporarily less active. The reptilian and mammalian brains take over the functioning of the neocortex so that precious time is not lost by thinking. This is called “bottom-up hijacking.” When we feel threatened and bottom-up hijacking 195

occurs, we may notice that it’s harder to think clearly, plan, or analyze. Our neocortext is highly sensitive to stress, and when we are chronically stressed or anxious, even if not in immediate danger, we will not be able to learn new things easily. Temporary stress is thought to help us develop resilience, but when children are chronically stressed from feeling pressure to “do it right” or please attachment figures, they are not able to learn well because there is less activation in the neocortext and more in the subcortical brain. Excessive stress can disrupt the development of the brain. Over time, engrained habits of response to threat from our subcortical brains (reptilian and mammalian), such as rapid heart rate, shortness of breath, anxiety, fear, rage, or other strong emotions, might be interpreted by our neocortex as indicating that we are not safe in the here and now, even when we are. Or, the three brains may understand things differently, leaving us confused. As one client reported, her thoughts, feelings, and body responses did not go together: “I know my husband loves me, but my heart starts racing when he talks to other women. I feel angry, but there is nothing to be angry at. He is totally committed to me.” Her neocortex understood things a certain way, but her reptilian and mammalian brains assessed things differently.

Top-Down and Bottom-Up Processing When we are faced with reminders of the past, we have the option to “tune in” to our three brains to see if we can become curious about how they are functioning. We can use our top-down capacity for observation to ask ourselves, “What’s happening to me right now? How is each of my brains understanding the world at this moment?” We can examine our emotions (mammalian brain); our heart rate, sensations, breathing, and impulses (reptilian brain); and our thoughts or conclusions we are drawing (neocortex). Through mindful awareness of the building blocks that relate to each of these levels, we might learn about how each of our brains is taking in and processing information from our environment. We can practice using the abilities of each part of the whole brain, perhaps learning to move when we feel stuck or to stop and calm the body and emotions before reacting. For example, Mary was looking forward to giving a toast at her best friend’s birthday party. But shortly after she arrived at the party, she felt her heart rate speeding up and she started feeling frightened. She tried to tell herself everything was OK, but this top-down attempt to manage her subcortical responses did not quiet her fear or calm her body. Her body sensations and emotions threatened to take over her ability to enjoy herself at the party. She decided use her top-down ability of thinking things through to try to understand each of her three brains. 196

Rather than try to talk herself out of her feelings and bodily responses, she began to consider what was going on in her mammalian and reptilian brains. First she noticed the feeling of fear and said to herself, “That is my emotional brain feeling afraid. It does not actually mean that I am in danger right now. It’s not a fact, it’s just a feeling. I’m with my friends, and they are not dangerous.” Mary identified the sensations of her increased heart rate and tense muscles as signs of her reptilian brain preparing her for action. She then paid attention to her shallow breathing and noticed that her chest was constricted and hunched, so she decided to relax her muscles and take some deep breaths. By harnessing her ability for topdown awareness, she was able to identify her emotional and physical reactions and then choose to intervene on a physical level. Mary had become curious about how her three brains understood her world, reflected in her experience of her building blocks, instead of allowing this bottomup hijacking to ruin the party. Identifying her fear as her mammalian brain alerting her to possible danger lowered her heart rate, and changing what was going on physically by relaxing and breathing deeply helped her fear quiet down. After her body and emotions had calmed down, and her three brains were working in sync again, she suddenly realized that one of the men at the party was wearing cologne similar to that of her father, who had been extremely critical of her and showed little confidence in her abilities. The smell had triggered her survival responses and feelings of fear and incompetence. With this understanding, Mary could appreciate that her reptilian and mammalian brains were doing their best to protect her from being criticized again and that they had not yet understood that cologne did not indicate impending threat of devastating criticism in her current life. She was able to enjoy the rest of the party and give her toast with aplomb. Top-down and bottom-up processing represent two directions of information processing, and we can use both to help all three of our brains respond to current reality, interrupting the habits from the past. Mary first used her top-down ability to try to control her lower brain responses by telling herself she was safe. When that was not effective, she used her top-down ability to mindfully observe the building blocks correlated with the subcortical brains, and she tried to understand the information from each of them (mammalian and reptilian). She also used bottom-up interventions of relaxing and taking a deep breath to interrupt her tendency to tighten her chest and hold her breath, and that quieted her fear. The worksheets that follow will help you speculate about how each of your three brains processes information. By mindfully becoming aware of your building blocks, you can explore which level of processing—cognitive, emotional, or sensorimotor—will most successfully support your well-being at any given moment. Using top-down approaches of thinking and mindfulness, as well as bottom-up interventions of interrupting your physical reactions, can be especially helpful when the three brains are not working in sync or when your brains are 197

responding as if what happened in the past is still occurring in the present.

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The Triune Brain and Information Processing THREE LEVELS OF INFORMATION P ROCESSING Purpose: To speculate on the differences in how each of the three brains processes information and to identify situations in which each of them is most active. Directions: Complete the prompts below. 1. Your neocortex is responsible for cognitive processing: thinking things through, putting words to experience, reasoning, logic, meaning making, decision making, and self-reflection. Reflect on how your cognitive brain functions in various situations. (e.g., When I’m watching a documentary that I’m interested in, I am actively thinking about the topic. I don’t think clearly when I get angry at other drivers on the road or when my mom yells at me.) Neocortex Cognitive Processing 2. Your mammalian brain is responsible for emotional processing: connecting to emotions and expressing them. Reflect on how your mammalian brain functions in various situations. (e.g., I’m more in touch with anger than sadness. I can only cry during sad movies. Anger is triggered in my relationship with my mom.I feel emotionally reactive over little things. At work I feel calmer and less emotional.) Mammalian Brain Emotional Processing 3. Your reptilian brain is responsible for your sensorimotor, or body, processing, such as autonomic arousal and survival functions (i.e., fight, flight, freeze, feigned death, and cry for help.Reflect on how your reptilian brain functions in various situations. (e.g., My reptilian brain is fast to react, especially when my boss is unhappy with me. I tend to freeze, feel heavy and stiff, and look away when I receive criticism at work.) Reptilian Brain Sensorimotor Processing

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The Triune Brain and Information Processing HOW OUR DIFFERENT B RAINS REMEMBER Purpose: To consider how you might remember an event differently depending upon which of your three brains is most active during recall. Directions: Answer the questions below to explore how each of your three brains might remember positive and negative experiences. (e.g., When you remember an argument, you might think about it as “not that bad” [neocortex], feel hurt, angry, or sad [mammalian], and your body might tighten, your breath become shallow, or your arousal change [reptilian].) 1. Think about a significant positive experience you have had. Take your time to remember the event, the good feelings, and the people involved. Record in the chart below how your three different brains remember this positive experience. 2. Then think about a significant negative experience you have had. Take your time to recall what happened, the circumstances, and the people involved. Record in the chart below how your three different brains remember the negative experience. What are your thoughts How do you remember about each experience? each experience emotionally?

How does your body remember each experience?

Neocortex

Mammalian Brain

Reptilain Brain

Positive Experiences

Positive Experiences

Positive Experiences

Negative Experiences

Negative Experiences

Negative Experiences

3. Reflect on how each brain remembers a positive or negative experience. Is one brain more active than the others when you remember something positive or when you remember something negative? Describe below.

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The Triune Brain and Information Processing MY THINKING B RAIN Purpose: To identify repetitive thoughts and explore how your neocortex (i.e., thinking brain) might affect the functioning of your other two brains. Directions: Reflect on your repetitive thoughts, then follow the prompts below. 1. Write down three repetitive thoughts you have. (e.g., I have good friends. I’m too busy. I always screw up.) a. b. c.

2. How do each of these thoughts affect your emotions [mammalian brain]? (e.g., When I think, “I have good friends,” I feel happy and loved. When I think, “I’m too busy,” I feel a little anxious and frantic. When I think, “I always screw up,” I feel ashamed and hopeless.) a. b. c. 204

3. How do each of these thoughts affect your body [reptilian brain]? (e.g., When I think, “I have good friends,” hold my head up, I look around at my surroundings, and I feel warmth and relaxation in my chest. When I think, “I am too busy,” my shoulders tighten, and I don’t breathe as deeply. When I think, “I always screw up,” my chest deflates, my head comes down, and the energy drains out of my body.) a. b. c. 4. Assess whether each of these thoughts affects your quality of life in a positive or negative way. What steps might you take to address negative effects? (e.g., When I have the thought, “I’m too busy,” I will assess my activities and see which ones I can decrease or omit. When I think, “I always screw up,” I will notice when I have that thought and will change how it affects my body [e.g., take deep breathes and sit tall] and talk to my therapist about how to address this thought.)

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The Triune Brain and Information Processing MY EMOTIONAL B RAIN Purpose: To notice those emotions that you commonly experience more than others and explore how your mammalian brain (i.e., emotional brain) might affect the functioning of your other two brains. Directions: Reflect on the emotions you tend to experience often, then follow the prompts below. 1. Write down three emotions that you commonly experience. (e.g., panic, sadness, playfulness) a. b. c.

2. How do each of these these emotions affect your thoughts[neocortex]? (e.g., When I feel panic, I can’t think straight, and my thoughts go round and round on negative topics. When I feel playful, I think my friends and family enjoy my sense of humor and that I am fun to be with.)

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a. b. c. 3. How do each of these these emotions make your body feel [reptilian brain]? (e.g., When I feel panic, my jaw tenses and my stomach pulls in, my eyes get wide, and I feel like I can’t breathe. When I feel playful, my body feels light, I smile a lot, and I feel energized.) a. b. c. 4. Assess whether or not the reactions of your neocortex and reptilian brain to your emotions is beneficial to your wellbeing. What steps might you take to address responses to emotions that you experience negatively? (e.g., When I feel panic, I can practice changing my body response by taking deeper breaths and trying to relax my jaw and muscles. I can talk to my therapist about ways to reengage my neocortex to help regulate the panic.)

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The Triune Brain and Information Processing MY B ODY B RAIN Purpose: To notice the habits of posture and movement, hyper- or hypoarousal, relaxation or tension, breathing, gestures, and internal body sensations that you experience frequently, and to explore how your reptilian (i.e., body brain) might affect the functioning of your other two brains. Directions: Reflect on your body patterns, then follow the prompts below. 1. Write down three body patterns that you commonly experience. (e.g., Tension in shoulders, furrow in my brow, rapidhear rate, shallow breathing, warmth in the chest.) a. b. c.

2. How do each of these these body patterns affect your emotions [mammalian brain]? (e.g., When I have tension in my shoulders, I get irritated easily. When my heart 210

beats rapidly, I feel anxious and scared.) a. b. c. 3. How do each of these body patterns affect your thoughts [neocortex]? (e.g., When I get tension in my shoulders, I start to think that no one is on my side. When I feel my heart beat rapidly, I think I am not safe, or that there might be something wrong with me.) a. b. c. 4. Assess whether each of these body patterns affects your quality of life in a positive or negative way. What steps might you take to address negative effects? (e.g., When I get tension in my shoulders, I can practice breathing deeply and relaxing my muscles. I can find something relaxing to do, like take a bath or go for a walk. I can think about all the times in my life that others have been on my side and supported me.)

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The Triune Brain and Information Processing HIJACKING OF YOUR NEOCORTEX Purpose: To understand how your subcortical brains (i.e., mammalian and reptilian) might hijack your neocortex, reflect on when hijacking has happened, why it happened, and how it might have helped you or hindered you. Directions: Think about a time when your mammalian (i.e., emotional) or reptilian (i.e., body) brain hijacked (i.e. took over) your neocortex so that you could not think clearly. It could have been during an argument, or when someone criticized you or abandoned you, or when something reminded you of a trauma. Then answer the prompts below.

1. Describe the situation. 2. Describe your experience—what you remember happening in your body, if you felt your body, what your emotions or thoughts were. 3. Why do you think the hijacking happened? Were you reminded of something from your past? Were you overly tired or stressed? Did you feel misunderstood, criticized, or rejected? 4. Did the hijacking help you in any way? Did it keep you safe or mobilize you to take action, for example? Or did it affect the behavior of people around you in a way that benefited you? 5. How did (or could) such hijacking hinder you? Did it make you feel bad about yourself, for example? Or did it adversely affect a relationship or cause others to think you were overreacting or being unreasonable?

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CHAPTER 10

Exploring Body Sensation THERAPISTS’ GUIDE TO CHAPTER 10

Purpose of this Chapter The purpose of this chapter is to help clients deepen their awareness of interoceptive cues, or body sensation, one of the five building blocks introduced in Chapter 7, “Mindfulness of the Present Moment.” Although work with body sensation has been neglected as a focus in most talk therapy models, it has a long history in somatic psychotherapy practices (Aposhyan, 2004; Bakal, 1999; Eckberg, 2000; Janet, 1925; Levine & Frederick, 1997; Ogden, 1997, 1998; Ogden & Minton, 2000; Ogden et al., 2006; Rothschild, 2000; Sollier, 1897). Because traumatic and early attachment experiences are often remembered and reexperienced implicitly in the form of body sensations, addressing sensation directly can foster the integration of past experience. Becoming mindful of sensation helps clients to consciously attune to interoceptive cues that are usually processed unconsciously. Tuning into these cues can help regulate arousal, enhance self-understanding, alter negative internal states, and establish new meanings. This chapter is designed to help clients increase their interoceptive awareness and develop a vocabulary to describe their body sensations that is different from language used to describe emotions and cognitions.

Clients Who Might Benefit Since one of the goals of the chapter is to help clients notice body sensations and name them as somatic phenomenon divorced from other building blocks, such as fear, shame, and negative cognitions, this material can be of value to those who suffer from such symptoms. Clients who are in need of relief from dysregulation are likely to experience a stabilizing effect from learning to describe the sensation of dysregulation using words, such as “tightness” or “a numb sensation” rather than as “terror” or “something bad is going to happen.” For clients whose attention is 214

pulled toward past events and future difficulties, learning to notice and describe their body sensations as they occur moment by moment can help them stay in the here and now. Those who feel disconnected from themselves, confused by their reactions, or out of touch with their needs or desires will benefit from awareness of their sensations. Clients who are overly concerned with their body image (rather than how their bodies feel) can be helped by tuning in to the experience of their sensations, instead of their perceptions about how their body looks. Clients who are adept at attuning to interoceptive cues can benefit quite quickly from this chapter because they will already be familiar with, and able to learn from, their sensations. And for those who describe a positive experience, deepening their physically felt sense of this experience and tuning in to the interactive relationship between the building blocks of sensation, emotion, and thoughts can enhance their pleasure.

Suggestions for Clinical Use The first step is to teach clients to direct mindful awareness toward their sensation and to describe it. Because the concept of body sensation is a new idea for many clients, this material is often easier for them to assimilate when you explore the chapter and worksheets together in session. In much the same way that knowing a variety of words to describe various emotions helps clients distinguish the richness and variety of their emotions, developing a vocabulary for sensation can help your clients distinguish the richness and variety of their physical feelings. Clients may not complain about their “sensations,” but when they say, for example, “I feel sick about what I’ve done,” “I’m so frightened,” “I always feel alone,” they are unknowingly describing sensations that contribute to these feelings. Mindfulness questions such as “How do you know, right now, that you are feeling frightened?” or “What in your body tells you that you feel alone?” will help clients begin to develop a sensation vocabulary. They might respond with, “It’s a hollow feeling” or a “heavy feeling” or “It’s like vibrations” or “I feel nauseous.” Providing a menu of sensation vocabulary words may help your clients find their own words to describe their sensations. For example, a client with physical tension may simply say, “My body feels tight.” You can help him or her refine that description with a menu: “I wonder if that tension is dull? Achy? Sharp? Or maybe it feels like pressure?” If clients report numbing and disconnection from sensations you might acknowledge both of these as learned in the service of coping with difficult or traumatic circumstances. Questions like the following will help clients find the words to say more: “How can you tell you feel disconnected? What does numb feel like? Is the sensation of numb more like foggy or like congested or heavy?” Clients 215

who feel frightened can be encouraged to notice the fear as a sensation rather than as an emotion, as “just your heart beating really fast,” or as “tension in your arms.” The ability to sense the physical feeling of the body and to differentiate thoughts, feelings, and body sensations is often a way out of self-defeating feedback loops. Clients often perceive emotions and beliefs as “truths.” Building on Chapter 7’s worksheet, NAMING THOUGHTS & EMOTIONS, describing a negative belief or emotion as a “thought” or “emotion” evoked by body sensations in the present moment can help clients realize that beliefs and emotions are often their experience rather than “facts” or “truth.” When clients discuss positive experiences, such as “I’m having a great day,” they can learn to describe the sensation that contributes to the positive feeling. For example, one client reported, “When I remember that wonderful trip to the zoo with my granddaughter I feel ready to smile and an open feeling in my chest. I get warm all over.” Helping your clients elaborate on the sensation of their positive experiences in this way teaches them tools to enhance their pleasure. Your willingness to model curiosity and interest in sensation, to use the language of sensation described in the chapter during therapy, even to name your own sensations or those that commonly occur when we are happy, afraid, sad, or angry is essential. Slow pacing and use of a sensation vocabulary that works for each individual client will facilitate successful mastery of this skill.

Introduction to the Worksheets The worksheet INCREASING SENSATION offers two exercises that are especially useful for clients who have difficulty understanding what body sensation is. It asks clients to try squeezing an arm with one hand up and down; you can do it with them (Marianne Bentzen, personal communication, March 2000). Most clients are impressed to find that the sensation of the arm that has been squeezed is noticeably different from the sensation of the one that has not. This worksheet includes using movement to increase sensation so that clients experience the connections between movement and sensation that most of us overlook. You can pique their interest by demonstrating a movement yourself, such as clenching your hand into a fist or raising your arm, and then reporting the sensations you notice: “I can feel the tension in my hand as I clench it—it’s sharp and goes all the way to my elbow—and the prickly sensation of my fingernails pushing into my palm.” You might suggest that you and your client walk together, raise your arms, stretch, or move in a way of your client’s choosing to notice and describe the various sensations that movement generates for each of you. The worksheet VOCABULARY FOR SENSATION instructs clients to notice the situations in which they experience pleasant and unpleasant sensations and 216

select words that describe them from the list of sensations already named on the worksheet. VOCABULARY FOR EMOTION not only teaches clients to put language to their emotions but also aids them in distinguishing between an emotion, a body sensation, and a belief. The VOCABULARY FOR BELIEFS & MEANING worksheet further develops awareness of the interactive relationship among thoughts, emotions, and sensations, and can demonstrate how beliefs can feel true because of their impact on the body. BELIEFS, EMOTIONS, AND THE BODY elaborates on this idea by teaching clients to notice how changes in body movement can literally change their thoughts, emotions, and sensations.

Adapting this Material for Dissociative Clients Challenges in using this chapter with dissociative clients are likely to come from several sources: shame and negative beliefs about body sensation, unpleasant or painful sensations they want to avoid, fear or numbing of the sensations because of their association with trauma and upsetting emotions, or the activity of particular dissociative parts and a tendency to dissociate when attention is turned toward the body. Clients’ propensity to associate sensation with traumatic memory can quickly cause arousal to exceed the window of tolerance. Clients who have dissociative disorders may tend to shut down and “go away” or switch to another part of themselves when asked to notice body sensation. Often the shutdown or switching is triggered by an implicit fear that something bad is about to happen, usually associated with the prospect of becoming aware of disturbing body sensations they have tried to avoid. Thus, you might first invite them to notice if they feel any sensation at all that is neutral or not triggering, scary, or overwhelming—such as perhaps being able to sense their back leaning against the chair or their feet on the ground. For many dissociative clients, noticing peripheral sensation is easier than noticing visceral sensations. You might suggest: “Let’s start with just the soles of your feet. Can you feel your feet on the ground? What sensations are telling you that your feet are grounded?” Or perhaps you could begin by asking clients to direct their mindfulness towards their movements: “I’m noticing that when you say those words, ‘It’s not safe to have a body,’ your head turns toward the window—did you notice that? Could you feel your head turn?” If these less challenging entry points are difficult, you can experiment with asking clients to notice what feels “better,” “worse,” or “the same” by asking questions such as “When you place your hand on your heart, do you feel the same, better, or worse?” Although we are not asking for a direct report of sensation with these questions, they can only be answered by noticing one’s body sensations. You may notice a tendency for different parts of your clients to be associated 217

with different body sensations that correlate with that part’s emotions and beliefs. Helping clients track these somatic indicators of parts will eventually help them with the important task of increasing internal cooperation and coherence. In addition, some parts of the client may be better able to tolerate sensations, in which case that part can be encouraged to share this ability with other parts of the client, so that safety can become better associated with particular sensations. This inner cooperation can gradually overcome systemic avoidance of sensation.

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CHAPTER 10 Exploring Body Sensation As noted in Chapter 7, “Mindfulness of the Present Moment,” body sensations are the physical feelings that are created by all kinds of activity within the body. When a physical change occurs, like a hormonal shift or a muscle tightening, this change can be felt as body sensation—tingly, pressure, constricted, heavy, shaky, and so on. The peristalsis of the intestines, fluids circulating through the body, biochemical changes, the ebb and flow of the breath, and the movements of muscles, tendons, or ligaments, all cause different body sensations. Our body sensations, in turn, contribute to internal states of well-being or distress. Butterflies in the stomach tell us we are excited; a heavy feeling in the chest speaks of grief; tension in the jaw informs us that we are angry; a full feeling in the chest might tell us we feel happy; a warm feeling lets us know we are at peace; and an all-over tingling feeling indicates fear or excitement. Beliefs too are informed by body sensation: Tension in the body may tell us that we are not safe; the sensation of relaxed muscles might speak of well-being; a hollow feeling in the chest might communicate that we are alone without support; the sensation of a deep breath or lift of the chin might go with beliefs such as “I have value” or “I’m competent.” A belief might seem true because we have a visceral response when we say it, and another will feel untrue because it generates a different, perhaps discordant sensation. Our sensations are a continuous and significant background that send us ongoing signals about our internal state. However, we process and react to most of them unconsciously. We may not even be aware of our sensations unless they are obvious, intense bodily feelings, such as physical discomfort, pain, or the sensations generated by hyperarousal or strong emotions. In this chapter, we will learn to increase awareness of body sensation and develop a vocabulary that describes what we feel in our bodies that is different from language that describes thoughts and emotions. Learning to experience and find words to describe sensations can help us “read” important cues in the body, become more aware of our present-moment experience, and in general, sense ourselves more fully.

Introduction to Exploring Body Sensation You may be excited and optimistic about the prospect of tuning into your sensation, 220

or you may be uncomfortable, anxious, or even scared about it. As we have learned in earlier chapters, many of us disconnect from our bodies because its sensations are uncomfortable. Hyperarousal can cause intense and overwhelming sensations, and hypoarousal can cause disconcertingly numb sensations. We may disengage from sensation to dull painful emotions so that we can tolerate them more easily. If you have habits of disconnecting from your body, remember that doing so was originally an adaptive measure that helped you cope. Becoming aware of body sensations opens up a whole new avenue of discovery for us, enriching our internal experience and sense of vitality. However, it can initially trigger emotions that feel out of control, especially after trauma. Your sensations may make you feel terrified, rageful, panicky, frustrated, inadequate, weak, or helpless. If this is true for you, your therapist can help you put aside these dysregulating emotions to gently reconnect with your sensation, to take all the time you need to tune in to physical feelings in a way that is regulating for you. It may feel easier to sense a particular part of the body, such as head, feet, or hands, than to try to sense your entire body. You may find that descriptive concrete words such as “tightening,” or “sinking,” or “shaky,” are not as triggering as the more general word “body.” Developing your own vocabulary to describe your physical sensations as different from your emotions or thoughts can be helpful. On the other hand, you and your therapist may decide to use your sensations to connect with and integrate emotions you have avoided. In any case , it is important to acknowledge, rather than override, any anxiety or discomfort you may experience and remain curious about ways to increase your comfort level, determining with your therapist the best way to proceed.

Developing a Sensation Vocabulary Most of us do not have an extensive repertoire of words to describe our sensations. You might experience a good or bad feeling in your body, but not have the language to express the many different qualities of what good or bad feel like physically. Increasing your repertoire of words to develop a more expressive vocabulary can deepen your experience of the richness and variety of body sensation. For example, the sensation of feeling good might then be described as energized, tingly, buzzy, or bubbly—or as calm, settled, relaxed, or warm. Table 10.1 provides a menu of words that describe sensation and is intended to prompt you to develop your own vocabulary for sensations. Alexis did not have trauma in her history, but she had grown up in a serious, academic family that emphasized work and education over everything else. She complained to her therapist that she was out of touch with her body. “I’m not in my body,” she said. “I’m too in my head. I don’t feel anything in my body.” As long as 221

she could remember, Alexis had “lived in [her] head.” Always moving at a fast pace, she was concerned about her habit of pushing herself beyond her limits, often depriving herself of sleep. Her headaches had become worse, and she had a mild eating disorder. Alexis felt that if only she could connect to her body, these problems would be resolved. As she spoke, Alexis leaned forward in her chair, her arms resting on her knees. Her therapist asked her if she could sense the sensation of contact between her arms and knees. “Not really,” she said, “I don’t know what you mean.” Her therapist asked Alexis to lift her arms and then rest them again on her knees, feeling the different sensations in her arms and knees in each of these positions. “Just notice the difference in your body sensations when your arms are resting on your knees and when you lift them off,” her therapist said. “Can you feel the sensation of your arms and knees touching, and how that sensation changes when they are not in contact?” Alexis explored this movement several times. Her eyes lit up. “It does feel different,” she finally said, surprised. Alexis’s curiosity about body sensation was aroused. She then reported that her neck and shoulders were often in pain, and she wondered if it had to do with her poor posture. Her therapist asked her to simply notice the pain, suggesting that perhaps she could find words to describe the sensation. “There’s a sharp sensation at the base of my neck, and it moves into my right shoulder,” she said. “I can feel the beginning of a headache, a dull numb feeling on the right side of my head. It feels thick.” With her therapist’s help, Alexis experimented with changing her posture by slowly and gently straightening her spine a little. Alexis felt how the sensation changed. “The pain gets less, and instead, there’s an odd sensation in my neck, kind of a tingling, and it moves down my arm. My chest gets warm.” After these beginning explorations of body sensation, Alexis said, “Maybe I really am connected to my body. I always thought I was out of my body, but maybe I just didn’t know how to feel it.” Take a moment right now to lean forward and rest your elbows on your knees and tune in to the sensation, like Alexis did. You might experiment with this simple movement a few times, just feeling the sensations of your arms and knees touching and how the sensation changes when they are not touching. Can you feel the different sensations in your back, knees and arms as you do this? What do you notice? Is there a word or two from Table 10.1, or another word that describes the sensations you feel? Then try scanning your body, starting with the top of your head, and direct your mindful awareness slowly down through your face, neck, shoulders, chest, arms, hands, belly, hips, thighs, calves, and feet. Can you find three or four words from Table 10.1 that describe what you feel in different places in your body right now? TABLE 10.1. Vocabulary for Sensation

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Distinguishing Sensation, Emotion, and Cognition Often we confuse sensation and emotion. When we try to describe sensations, we may use words that describe emotions, such as sad or angry, rather than words such as numb or heavy that describe physical feelings. Developing a vocabulary for emotions will help you not only expand your perception of emotions but also differentiate words that describe emotions from those that describe sensations. You can see that the emotion vocabulary in Table 10.2 is very different from the sensation vocabulary in Table 10.1. Take a few minutes right now to become mindful of how you are feeling emotionally. What words in Table 10.2 describe your emotions? Notice the body sensations that correlate with your emotion. For example, if you feel calm, you might feel a sensation of heaviness in your lower torso and a relaxation in your shoulders. If you feel anxious, you might feel tension in your stomach or pressure behind your eyes. See if you can find a few words that describe the sensations that correlate with an emotion you are feeling. TABLE 10.2. Vocabulary for Emotion

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Just as words for sensations are often confused with those for emotions, words for sensations can be confused with those for meanings, interpretations, and beliefs. When asked about body sensations, some people answer “I feel like I’m no good,” or “I feel it’s all my fault,” or “I’m OK right now.” These words convey meanings and beliefs, but not body sensations. The language of meaning and belief is very different from both sensation vocabulary and emotion vocabulary. As you read the entries in Table 10.3 that describes beliefs, which ones apply to you? Can you think of words for the emotions and sensations that accompany the belief? TABLE 10.3. Vocabulary for Meaning and Belief Positive Beliefs about Self

Negative Beliefs about Self

I am okay the way I am. I’m a decent person. It’s OK to accept help. I don’t have to be perfect. I have the right to set boundaries.

I’m not good enough the way I am. I deserve the bad things that happened to me. It’s all my fault. My feelings aren’t okay. I don’t belong here.

Positive Beliefs about Others

Negative Beliefs about Others

I can usually count on others. My boundaries are usually respected. Most people are decent human beings. I can basically trust others to treat me well. Conflict between people is normal and can be resolved.

I’ll be hurt if I depend on others. Other people are just out for themselves. People will leave me when I need them. No one will ever understand me. Relationships are never safe or stable.

Positive Beliefs about the World

Negative Beliefs about the World

There is pain, but also a lot of joy in the world.

The world is a dangerous place. There is no hope for the future.

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There is a place for me here. There is no justice in the world. Scary things happen, but the world is usually Everything always works against me. safe. There is nothing that the world can offer me. I can look forward to the future. There are resources to help me cope with hardship.

Beth interpreted the sensation of arousal (rapid heart rate, tension, and a buzzy feeling) as meaning “The world is never safe.” She had experienced those same sensations as a child when her parents fought. Whenever she had these sensations, she felt frightened. Her therapist helped her to direct mindful attention exclusively toward the sensations, away from the old belief and fear. As she put aside her fear and belief and only paid attention to sensation, Beth became more curious and less frightened about what was going on in her body. She became aware of tension in her chest, trembling in the core of her body, a fast heartbeat, and an overall feeling of high energy throughout her body. She learned that the sensations themselves felt more neutral when she used sensation vocabulary to describe them and differentiated sensations from emotions and beliefs. Directing mindful attention exclusively toward body sensations and using sensation vocabulary to name the sensations are particularly helpful when arousal is dysregulated, or emotions and beliefs take us out of the present moment. If body sensations like Beth’s are interpreted as an emotion, like panic, each begins to compound the other. Both the sensations and panic are exacerbated when experienced simultaneously. When we use emotion vocabulary and say, “I’m afraid,” we trigger more panic. If, on top of that, the sensations and emotions are then interpreted as a fact or belief, such as, “The world is not safe,” the tension, pounding heart, and panic are all likely to intensify. Beth found her autonomic arousal escalating beyond her window of tolerance when she experienced all three—the panic, the sensations, and the thought/belief that “The world is not safe”—at the same time. But when she directed her mindful attention to just her physical experience and used sensation language to describe it (“My body just tensed, and I can feel trembling in my spine, and my heart is pounding”), she recognized that her sensations were only sensations and did not mean that she was actually in danger, and she began to feel calmer. By differentiating her body sensation from the emotion and belief, the escalation of Beth’s arousal was interrupted. As she became mindfully aware of her heart pounding, tension, and trembling, and realized that “they are just sensations,” the sensations themselves spontaneously began to change. She became more relaxed, could breathe more deeply, and the shaking diminished. And, as her body settled down, so did her emotions and thoughts. She no longer felt panicky. Her bodily experience no longer supported the belief that the world was not safe. Beth also sometimes experienced hypoaroused states in which her body felt numb, with no sensation at all. She felt spaced out and not present. Her therapist 225

helped her learn to start moving her arms at those times. This movement helped her to feel her sensation and bring her arousal up into a window of tolerance. She described her sensation in this way: “I can feel the general tension in my forearm and a sharper tight feeling in my shoulder. Most of the sensation is on the top surface of my arm; I don’t feel much on the lower surface. As my arm gets higher, I sense a different kind of tight feeling in my shoulder as it starts to engage. If I really stretch my arm, the sensations increase, and I feel the length of my entire arm. Then, I take a deep breath, and I feel like I am ‘back.’” Sometimes Beth would use her hands to squeeze her legs and arms to generate body sensation, which also helped her to be present. You can learn to become more aware of your body sensations and develop a rich language to describe them, as Alexis did. And like Beth, you can also learn to recognize sensations that herald the beginning of dysregulated arousal or emotions, rather than numbing out, becoming emotionally reactive, acting impulsively, or running away from these sensations. The worksheets that accompany this chapter will help you notice sensations and how they go along with the emotions and beliefs you experience, discover situations that elicit them, and find words to describe them. As you explore your sensations over time, your vocabulary to describe their variety and richness will expand and your confidence in the natural intelligence of your body will grow.

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Exploring Body Sensation VOCABULARY FOR SENSATIONS Purpose: To become aware of both pleasant and unpleasant body sensations, find words to describe them, and explore the thoughts, emotions, images, movements, or memories that go along with them. Directions: Look over the sensation words below. Throughout the day, pay attention to your body sensations, noticing two times when the sensations were pleasant and two times when they were unpleasant. Then follow the prompts below. achy

chills

damp

flaccid heavy

moist

Airy

churning

dense

flushed hot

nauseous quivery

suffocating

Bloated

clammy

dizzy

fluid

numb

sweaty

Blocked

clenched

dull

fluttery jerky

electric

floaty

jumbly pins and needles

shivery

fuzzy

knotted prickly

shuddering tight

breathless congested

itchy

bubbly

constricted empty

burning

cool

energized goose- light bumps

buzzy

cold

faint

quaking

radiating

paralyzed sharp

puffy

sore

stiff

tense thick

tickley

1. Circle two words that best describe the pleasant sensations you noticed and underline two words that best describe the unpleasant sensations you noticed. You can write in new words that fit your experience more accurately in the empty spaces. 2. In the first two boxes of the left column, write the words for pleasant sensations. In the second two boxes of the left column, write the words for unpleasant sensations. Then, for each sensation, describe, the situation you were in when you experienced it, and the thoughts, emotions, images, movements, or memories that seem to go along with the sensation. Pleasant Sensation Situation Thoughts, emotions, images/memories, movements

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Pleasant Sensation Situation Thoughts, emotions, images/memories, movements Unpleasant Sensation

Situation Thoughts, emotions, images/memories, movements

Unpleasant Sensation

Situation Thoughts, emotions, images/memories, movements

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Exploring Body Sensation INCREASING SENSATION Purpose: To use your own touch and movement to stimulate nerve endings, generating sensation in specific places in your body. Directions: Experiment with the two exercises below and notice the effect on your sensation. Record the sensations you notice after each exercise by selecting words from the “Vocabulary for Sensations” in the chapter, or choosing your own words to describe your sensations. Using Touch to Increase Sensation 1. Squeeze up and down one arm with the opposite hand, experimenting with the pressure, speed, and type of touch. Squeeze firmly, then lightly, quickly, then slowly, and notice the different sensations. 2. Continue to squeeze up and down the same arm several times. 3. Then pause and feel the contrast between the sensations in the arm that you squeezed and the arm that you didn’t squeeze. Record the difference in the sensations of the two arms.

Using Movement to Increase Sensation 1. Take a moment to become aware of your body. Choose one of your arms and shoulders to explore. 2. Slowly lift that arm, turning your awareness to the sensations generated by 231

your movement. Then explore different ways to use movement to generate the most sensation in your arm and shoulder, such as stretching your wrist in both directions, or reaching up as high as you can toward the ceiling. 3. What sensations do you feel in your joints and muscles? Where do you feel the most sensation? What words describe the quality of sensations that you feel in different areas—your shoulder, upper arm, forearm, wrist, or hand? Describe your sensations below.

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Exploring Body Sensation VOCABULARY FOR EMOTIONS Purpose: To help you notice your emotions, discover the sensations, movements, thoughts and memories that accompany them, and differentiate the vocabulary for emotions from that for beliefs and sensations. Directions: Throughout the day, pay attention to your emotions, noticing times when you felt pleasant emotions and times when you felt unpleasant emotions. 1. Look at the words below and circle those words that best describe the pleasant emotions you noticed and underline the words that describe the unpleasant emotions you noticed. You can also write in new words that describe your emotions more accurately in the empty spaces. afraid

contrary

downhearted grateful

indignant

loving

alarmed

crabby

embarrassed grieved

inspired

miserable

amazed

crestfallen

empathic

grim

infuriated

morose

angry

dejected

enraged

happy

intimidated mortified

annoyed

delighted

enthralled

hateful

irate

nervous

anxious

depressed

exhilarated

helpless

irritated

outraged

ashamed

despairing

fearful

hopeless

jovial

panicky

bitter

devastated

frightened

horrified

joyful

passionate

cheerful

disappointed furious

hostile

jubilant

pitiful

compassionate disgraced

glad

humiliated loathing

remorseful

cherished

disgusted

gleeful

humble

revolted

confused

distressed

lonely

2. In the first two boxes of the left column, write in the two words for pleasant emotions that you circled. In the second two boxes of the left column, write in the two words for unpleasant emotions that you underlined. Then, for each emotion, describe, the situation you were in when you experienced it and the thoughts, images, memories, sensations, or movements that seem to go along with it.

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Emotion

Situation Thoughts, images, memories, sensations, or movements

Pleasant Pleasant Unpleasant Unpleasant

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Exploring Body Sensation VOCABULARY FOR B ELIEFS & MEANING Purpose: To discover beliefs and meanings, identify the sensations, movements, emotions, images, or memories that accompany them, and differentiate the vocabulary for beliefs and meaning from that for emotions and sensations. Directions: Read and reflect on the two sets of meanings and beliefs below, then follow the prompts. 1. Circle the beliefs in each set below that feel accurate for you. You can also write in new phrases that describes your meaning and beliefs more accurately in the empty boxes. It’s all my fault.

People are not on my side.

I’m not good enough.

The world is not safe.

I’ll never be safe.

It’s not OK to be angry.

My feelings are not OK.

I’m worthless.

I deserve what happened to me.

I can’t get the support I It’s not OK to have fun. need.

I have to do what others want.

I’m a bad person.

There is no hope for the future.

There is something wrong with me.

I do not belong. I’m OK the way I am.

The world is safe.

My feelings are OK.

I can count on others.

It’s OK to ask for what I need.

I deserve respect.

I don’t have to perform to be loved.

I can do what I want.

I have the right to exist.

There is nothing wrong with me.

My needs can be met.

It’s OK to make mistakes.

The future is hopeful.

I’m lovable as I am.

It’s OK to relax.

I’m a good person. 2. Choose three of the beliefs that you circled, write each in the space below, then 237

describe the emotions, sensations, movements and images/memories that go along with the belief. Belief/Meaning • Emotions: • Sensations/Movements: • Images/Memories: Belief/Meaning • Emotions: • Sensations/Movements: • Images/Memories: Belief/Meaning • Emotions: • Sensations/Movements: • Images/Memories:

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Exploring Body Sensation B ELIEFS, EMOTIONS, & THE B ODY Purpose: To further explore the specific vocabulary appropriate for each level of information processing: cognitive, emotional, and sensorimotor. Directions: Complete the following prompts using the designated vocabulary sheets from the chapter.

1. Using the VOCABULARY FOR BELIEFS AND MEANING as a guide, identify a limiting belief that you have recently experience. Write it below. My Belief (e.g., People are not on my side.) 2. Write down other thoughts that accompany your belief. (e.g., I can’t trust others; I’m on my own; I have to be on guard; I’m suspicious of their motives.) 3. Using the VOCABULARY FOR EMOTIONS as a guide, write down the words that best describe the emotions connected to the belief and related thoughts you identified. My Emotions (e.g., dejected, spiteful,hopeless, sad, angry) 4. Using the VOCABULARY FOR SENSATIONS as a guide, write down the sensations that best describe what happens in your body as you think about the belief, associated thoughts, and emotions you identified. My Body Sensations

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(e.g., constricted, achy,deadened, heavy) 5. Describe any movements your body wants to make when you think about this belief and the associated thoughts, emotions and sensations. My Body Movements (e.g., My body wants to curl up in a ball; my forehead furrows and my shoulders tense; my head comes down, my spine slumps; my chest and jaw tighten.) 6. Explore doing the opposite of what your body wants to do (e.g., instead of curling up, open up and sit tall; instead of furrowing your forehead and tensing your shoulder, relax them; instead of dropping your head and slumping your spine, lift your head and straighten your spine; instead of tightening your jaw and chest, relax them). Notice and describe how this opposite action affects your sensations, and describe the emotions and beliefs that might go along with this new movement.

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CHAPTER 11

Neuroception and the Window of Tolerance THERAPISTS’ GUIDE TO CHAPTER 11

Purpose of this Chapter The purpose of this chapter is to introduce your clients to the “window of tolerance” (Siegel, 1999), elucidate “neuroception” (Porges 2004, 2011), and explain dysregulated arousal. Recall that neuroception, discussed in Chapter 1 “Essential Principles,” is a term used to describe the nervous system’s ability to automatically detect environmental features that are safe, dangerous, or lifethreatening and stimulate appropriate behaviors according to this assessment. This chapter helps clients identify their triggers, recognize the bodily signals of neurocepting safety, danger, or threat, and begin to make changes in their habitual reactions when they are dysregulated or emotionally reactive in order to return arousal to the window of tolerance.

Clients Who Might Benefit The material in this chapter is essential for all clients, but it will have particular benefit for those who experience dysregulated arousal or emotional reactivity triggered by reminders of trauma or attachment inadequacies. Those who are baffled as to why they become dysregulated or reactive will benefit by beginning to identify their triggers. Those whose hypoarousal leads them to feel “empty” or “dead inside” will learn that these states might be related to faulty neuroception, which challenges cognitive schemas of defectiveness and unworthiness. Conversely, clients whose hyperarousal causes them to be impulsive, selfdestructive, or terrified will benefit from understanding hyperarousal as faulty neuroception, triggered by reminders of past danger. If they have judged themselves for their impulsivity, understanding that hyperarousal sends a message to “do 242

something” may facilitate an appreciation of impulsive behavior as a response to faulty neuroception, however self-destructive it might have been. For those who have been paralyzed by fear, it might be a relief to learn that this can result from faulty neuroception that elicit animal defenses of hiding, freezing, or becoming invisible. Clients whose relational triggers echo unsatisfactory aspects of early attachment can also benefit from identifying their triggers. If they have criticized themselves for being overly emotional or reactive, the concept of a faulty neuroception might help them understand their emotions from a different perspective. They will learn to recognize the situations and behaviors of people in their current lives that remind them of the past and cause them to neurocept danger. Clients will be able to distinguish the bodily signals that indicate that their arousal is at the edges of, in contrast to outside of, the window of tolerance. Once these triggers and signs are identified, these clients too will benefit from this chapter’s instruction to explore alternative responses that bring arousal into the window of tolerance.

Suggestions for Clinical Use Often clients report: “I never feel safe,” “I feel dead,” “I get upset easily,” or “I don’t feel centered.” These statements usually reflect a nervous system biased to neurocept danger rather than safety. Clients are often relieved when such statements are reframed as evidence of faulty neuroception, a survival mechanism inclined to assess reminders of the past as current dangers, rather than of personal deficit. As we have emphasized, new learning requires the engagement of the neocortex, which in turn depends upon arousal remaining within the window of tolerance. For clients whose arousal tends to be chronically hypo- or hyperaroused, it may initially work better to discuss this information in the session so that you can use the relationship to help them regulate. You might then assign the chapter as reading if they seem to be absorbing the material and finding it meaningful. Because neuroception is automatic and often unconscious, clients’ attempts to change it via top-down strategies will fail. However, identifying the antecedents to and signs of faulty neuroception, as described in this chapter, can give clients the information and the bottom-up interventions they need to help them learn how to bring their arousal into the window of tolerance. It might be helpful to review the signs of regulated and dysregulated arousal, as described in the chapter, together with your client. Observing the signs of dysregulated arousal requires using mindfulness skills of noticing rather than interpreting or judging, becoming aware of moment-to-moment changes in body sensation, and, of course, eliciting curiosity and interest. Clients can be reminded that dysregulated arousal is a survival 243

mechanism governed by subcortical (mammalian and reptilian) areas of the brain, and asked to speculate what might be happening in all three “brains” when arousal goes up or down (see Chapter 9, “The Triune Brain and Information Processing). Since clients may be unable, based on prior conditioning, to consistently detect whether the environment and you, the therapist, are safe, from time to time you yourself might become a trigger for your clients. In one moment, clients might feel safe with you, but then, exposed to an inadvertent trigger (e.g., your tone of voice, particular words spoken, the way you move, your facial expression), suddenly neurocept danger. These moments create opportunities for identifying the nonverbal signals that suggest state changes from regulated arousal (i.e., the neuroception of safety), as reflected in a calmer body, clearer mind, and emotions within the window of tolerance, to dysregulated arousal and defensive responses (i.e., the neuroception of danger and life threat). When you or your client notice these signs of dysregulation, the skills of present-moment observation, directed mindfulness, psychoeducation, interactive repair (if you are the trigger), interactive regulation, and regulating your own nervous system can support clients to again neurocept some degree of safety with you so that therapeutic engagement can continue. Clients’ efforts to please you, be a “good client,” or meet the expectations they perceive that you have of them may be attempts to preserve social engagement with you and ensure that you will continue to work with them. Safety is assured for children when they meet parents’ expectations, so they will adjust their behavior to them; these adjustments may carry over into adult relationships, as well. As stated in Chapter 1, “Essential Principles,” children have two reactions available to them in the face of their caregivers’ expectations: either try to meet them and stay “safe,” or risk criticism, rejection, or withdrawal by not meeting them, which to a child is experienced as dangerous. For some clients it may be important to address their attempts to meet your expectations as attempts to stay safe. Exploring neuroception in this way can help clients examine their behavior and open communication about the relationship between you.

Introduction to the Worksheets The worksheet YOUR AUTONOMIC AROUSAL PATTERNS asks clients to identify the signs of high or hyperarousal, low or hypoarousal, and regulated arousal within the window of tolerance and describe how each affects how they feel. RECOGNIZING TRIGGERS & REGULATING HYPERAROUSAL and RECOGNIZING TRIGGERS & REGULATING HYPOAROUSAL teach your clients to anticipate one of their triggers (rather than repeatedly being surprised by it), identify the bodily signals of hyper- or hypoarousal that the particular trigger elicits, and also identify what helps them regulate. These worksheets also teach 244

clients what stimuli trigger a neuroception of danger or threat. As you and your clients explore these two worksheets, many will need your input and skillful questioning to come up with ideas for how to regulate their arousal. UNDERSTANDING YOUR NEUROCEPTION helps clients understand the internal components of neuroception by asking them to describe their experience when they detect safety, danger, and threat, building block by building block. As you work with this worksheet, it may be helpful to remind clients that it is natural for neuroception to be biased after trauma or attachment difficulties, but that they can become aware of such faulty neuroception through mindful noticing of their building blocks. Returning to previous chapters on orienting to new environmental stimuli (Chapter 6, “Pay Attention: The Orienting Response”) and on directing mindful attention to new building blocks (Chapter 8: “Directed Mindfulness and Neuroplasticity”) can also help clients learn about their change faulty neuroception. TRACKING YOUR AROUSAL guides clients to become aware of the natural fluctuations in arousal that occur throughout a particular day, whether tied to triggers or simply to normal demands in the environment. You can help clients discover their arousal peaks and valleys so they can predict them in the future and take steps to regulate as needed. The final worksheet, RECOGNIZING OPTIMAL AROUSAL, is intended to help clients recognize when their arousal is within the window; determine the people, situations, or events that promote regulated arousal; and identify the thoughts, feelings, emotions, body sensations, changes in hearing and sight, and movements associated with an optimal level of arousal. Hopefully, once clients have identified “triggers” of optimal arousal, they can call on these regulating people or situations when they are dysregulated.

Adapting this Material for Dissociative Clients Severe, chronic dysregulation of clients with dissociative disorders reflects faulty neuroception. By nature, many dissociative parts are fixed in animal defense mode, are hyperfocused on cues of danger, and do not neurocept cues of safety. In addition, dissociative clients are often triggered by their own hyperarousal and the subjective sense of inner activities and intrusions of parts, which they interpret as signals of danger. Other dissociative parts may be so numb and avoidant that they are unable to even notice if they are safe, leaving the client vulnerable to exploitation and further traumatization. Thus, with dissociative clients, it is best to review this chapter together in session so that you can help them regulate as they explore this topic. Sometimes the very words safe or safety can be triggering for highly dissociative clients. You might use different language temporarily, such as “Let’s see if we can help you learn to distinguish situations that are less dangerous than 245

others. Maybe together, we can identify situations in which you might feel calm or pleasant without so much tension in your muscles, where your breathing feels a bit deeper and easier.” In this way, you can emphasize the client’s subjective physical experience that accompanies neuroception of safety without using the words safe/safety. For such clients, it may be more helpful to first emphasize mindfully tracking results of faulty neuroception, the signs of hyper- and hypoarousal, or noticing which parts have different tendencies. Psychoeducation that trauma sensitizes the nervous system to detect traumatic reminders and that the faulty neuroception of parts in response to these reminders is learned as a survival strategy might be helpful to these clients. You might illustrate this point by tracking the signals of hyper- and hypoarousal responses associated with a crisis. Generally, a crisis is most often the result of triggered hyperarousal, stimulating animal defenses of fight and flight in different parts. Using your ability to track fluctuations in arousal as signs that different parts are responding to triggers and neurocepting danger, you will also be able to use your presence, pacing, and tone of voice to help regulate hypo- and hyperaroused parts. Remembering that dissociative clients need the information contained in this chapter, even if it takes many months for them to assimilate it, will hopefully help you feel comfortable repeatedly going over it each time there is a crisis or a triggered reaction.

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CHAPTER 11 Neuroception and the Window of Tolerance Our autonomic arousal naturally fluctuates between high and low levels throughout the day. Higher arousal and alertness are needed for invigorating activities, such as a sporting event, a brainstorming session at work, or a stimulating conversation. Lower arousal and calm states support relaxing activities, such as listening to soft music, snuggling in front of the fireplace, or going to sleep at night. We can enjoy these different high- and low-arousal activities when we feel safe. But when we feel threatened, our arousal quickly escalates up, sometimes to hyperaroused levels, to prepare us to flee, fight, freeze, or call for someone to help us. If these survival defenses are unsuccessful, our arousal may plummet into a state of hypoarousal in which we shut down and become still and immobile. Along with trauma, stress related to our attachment figures can cause these survival responses. We feel unsafe when we feel at risk of being criticized, rejected, or abandoned, and if we do not have the resources to deal with these stresses, our arousal can become dysregulated. Changes in arousal reflect the innate capacity of our nervous systems to instinctively evaluate whether we are at risk or safe and then help us achieve the arousal level—high, low, or in-between—that would support adaptive behavior. The nervous system’s appraisal capacity, called neuroception, occurs automatically, without awareness, in the primitive areas of the brain. Unlike perception, which relies on the senses for information, neuroception relies on the nervous system to recognize genetically programmed behavioral cues from others that indicate safety, danger, and life threat. This chapter will help you understand neuroception and variances in arousal levels as adaptive functions of your nervous system, and guide you to identify your own internal signals of these different arousal levels. We will also explore how to identify stimuli and triggers leading to regulated and dysregulated arousal in order to learn how to better regulate the nervous system.

Neuroception of Safety, Danger, and Threat As we see, hear, or otherwise perceive stimuli from our environment with our senses, neuroception occurs automatically. Through neuroception, the level of autonomic arousal is activated that promotes the best adaptive behavior toward a 248

perceived stimulus. When we neurocept safety, our arousal fluctuates within a window of tolerance, a regulated zone within which we can enjoy others and the world around us because we feel safe. Our innate social engagement system (controlled by the parasympathetic nervous system) is stimulated when we feel safe, prompting us to engage in social interaction. Infants are born with this system intact, but in order for it to develop into a healthy and adaptive system that supports flexible and stable engagements with others, adequate support from caregivers is needed. If we experience safe and nurturing caregiving fairly consistently in our early years, our nervous systems will develop a robust capacity for states of optimal arousal and social engagement. Neuroception of danger, instead of safety, can stimulate extremely high or (hyperarousal), and low (hypoarousal) to promote protective behaviors. We may neurocept danger when others criticize us, fail to pay attention to us, or are angry with us. We may defend ourselves in any number of ways in an effort to reestablish safety. We may withdraw, demand attention, denounce, or try to please the other person, or justify ourselves and our behavior. As children we need the acceptance and care of our attachment figures to survive and we can be frightened when they criticize us for making mistakes, push us to excel, are disappointed in us, or punish us if we are idle or fail. In these cases, we neurocept danger because at a primitive level, their disapproval implicitly threatens our safety. Elevated arousal, or even hyperarousal can be activated to mobilize us to strive hard to meet their expectations in order to stay safe, rather than go against their expectations and risk more punishment, disappointment, rejection, or criticism. Donnie came to therapy because he was anxious and could not relax. His hyperarousal was the result of having been pushed by his parents to always try to do better and to never be complacent or satisfied with his accomplishments. He mobilized a hyperaroused state not to fight or flee, but to have the energy to meet their expectations and therefore stay safe and accepted in his family. But, later in life, his chronic hyperarousal diminished his ability to relax with and enjoy other people and caused him to misread the behaviors of others as “demanding” or “intruding” when all they wanted was to interact with him. Profound loss, such as the death of a parent or a divorce, can also cause a child to neurocept danger in the absence of an attachment figure. Janice’s father was killed in a car accident when she was 8, and she subsequently became afraid and hyperaroused whenever her mother was not with her. Even as a teenager, she felt anxious when her mother drove away in the car to run an errand. Bonnie’s parents had survived the Holocaust, both managing to immigrate to the United States, where they met, after losing their entire families in the death camps. The family atmosphere was full of anxiety and stress, left over from her parents’ experience of horror and loss, leaving Bonnie with a continual sense of profound grief and 249

impending doom that caused her arousal to remain high. The neuroception of danger may activate adaptive behaviors to fight, flee, or cry for help, which all require a lot of arousal and physical actions. In these cases, our sympathetic nervous system is stimulated, and a mind-body chain reaction is set in motion. Neurochemicals are released that increase our arousal to fuel the vigorous activity that might be needed to fight back, flee, or cry for help. Our respiration accelerates because we need more oxygen. Blood flow to muscles increases, whereas blood flow to the cortex decreases so that we react instinctively and swiftly from our mammalian and reptilian brains, instead of spending critical time thinking about what to do. We experience increased vigilance toward the environment, and our bodies suppress the physical systems that are not essential for self-protection. Neuroception of danger sends arousal into hyperarousal to maximize our chances of survival by mobilizing defensive behaviors that can restore safety. If we have suffered inescapable danger such as sexual abuse and other forms of trauma, fighting back, fleeing, and getting help were all impossible. When we neurocept that survival is at risk and there is no one to help, no way to escape, no possibility of success if we were to fight back, the best option is often to shut down. The hyperarousal that is activated when we neurocept danger will then plummet to hypoarousal via the activation of a primitive branch of the parasympathetic nervous system, the dorsal vagal system. This immobilization defense also called “feigning death” or “playing dead,” causes a decrease in heart rate and respiration, leaving us feeling collapsed, numb, and often unable to think clearly. Severe hypoarousal might result in fainting and even vomiting—which might be why many of us feel nauseous when we think about past trauma from which we could not escape, fight back, or get help. Figure 11.1 illustrates these three zones of arousal that correlate with neuroception of safety, danger, and life threat in relation to the window of tolerance.

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FIGURE 11.1

We can also develop patterns of hypoarousal when attachment figures fail to help us regulate our fears or are themselves the source of those fears. Taylor, for example, was frightened to go to school, a fear that his parents did not understand or help him resolve. He became silent and still at school and shut down in other social contexts as well. We might also experience the same arousal levels as our parents, caused by the transgenerational transmission of arousal states. Stephan came to therapy because he felt lethargic and had trouble being interested in his life. His chronic low arousal was related to having grown up with a single mother whose parents and grandparents had suffered numerous misfortunes that strengthened a sense of hopelessness and resignation in the family. His mother was depressed and could not provide the stimulating environment that Stephen needed as a boy. Such transmissions, however, are not always linear and completely predictable. For example, Louise, who also had parents who were depressed and disinterested in her, became hyperaroused, mobilized to rely on and take care of herself.

Identifying Triggers and Signs of Dysregulated Arousal When our nervous systems are not able to recalibrate after distressing events, or when the atmosphere we grow up in elicits sustained high (or hyper-) or low (or hypo-) arousal, we may develop “faulty neuroception,” which causes us to routinely appraise safety or danger inaccurately. When faulty neuroception causes arousal to be too high or too low, we cannot interact easily with others or the environment because we do not feel safe or comfortable enough. Long-standing hyperarousal can cause us to feel chronically anxious, angry, frightened, on guard, pressured, or impulsive. Even in safe, peaceful settings, our hearts might continue to beat fast and our bodies may still be tense. Long-standing hypoarousal can cause us to experience the opposite: our heart rates may slow, our bodies may feel numb. We may feel lethargic, weary, dead, empty, flat, or depressed. With faulty neuroception, people, things, and situations that remind us of past stress and trauma trigger us and we are less able to cope with, let alone enjoy, the normal stimulation of daily life. A first step to regulating arousal is to learn to identify your personal triggers— those things, situations, people, or even internal experiences you automatically neurocept as threatening when they are not. The smell of aftershave was a trigger for Janie; loud voices were triggers for Jim; shirts that were red were triggers for Julie; “all men” were triggers for Victoria; the barking of neighborhood dogs was one of Susie’s triggers; criticism was a trigger for Maggie; and other people telling him what to do was a trigger for Brent. When we are faced with these common 251

occurrences that repeatedly trigger us, we may discover that we are neurocepting threat over and over—without knowing that we are only triggered and not actually in danger. When we are triggered, we instinctively “believe” the signals of our bodies that tell us we are in danger. However, when we are aware that these sensations and movements are signs of having been triggered, then we have an opportunity to begin to bring arousal back into the window of tolerance. Jim did not understand why he became hyperaroused and reactive at work. He had a good relationship with his boss, and his performance was excellent. But when his boss used a loud voice when critiquing his performance, Jim neurocepted danger. He began to anticipate criticism and became hyperaroused at the slightest indication that his boss might have negative feedback for him. Jim had grown up with critical parents who frequently raised their voices in anger, and he had worked very hard as a child to “be a good boy” so that his parents would not become angry and he could feel safe. With his therapist’s help, Jim identified his trigger—his boss’s loud voice. He learned to recognize the physical signs of faulty neuroception of danger that often occurred when he expected his boss to raise his voice in criticism: tension in his shoulders, shortness of breath, and increase in heart rate. When he became aware of these signs, Jim could learn to take measured, deep breaths, sit back in his chair, and relax his shoulders to help him calm himself and return his arousal to a window of tolerance. As his body calmed down, he was able to neurocept safety again and could realize his boss was trying to help, not threaten, him. He could then respond positively to his boss’s critique of his work. On the other end of the spectrum of arousal, Victoria complained of a lifelong pattern of being withdrawn, “spaced out,” and unable to sense her body or emotions. Abused as a preteen, Victoria’s nervous system inaccurately neurocepted threat on an ongoing basis in her adult life, evoking chronic hypoarousal. She described herself as “passive,” had difficulty initiating action, and reported spending long periods of time sitting on her couch “spacing out.” Hypoarousal was exacerbated whenever Victoria ventured outside her home, and over time she developed agoraphobia—a fear of open spaces and crowds. She stayed home more and more, unaware of the triggers that caused her to neurocept threat. With her therapist’s help, Victoria realized that all men were triggers to her. She learned that when she ventured outside, she neurocepted threat whenever she saw men walking along on the sidewalk. Her spine would collapse, her head would turn downward, and she would feel as if her energy were draining out of her body. In therapy, she practiced standing tall instead of slumping. She learned to walk with an assertive gait and to look around, deliberately orienting to all the other sights around her—the women, children, dogs, and cars on the street—rather than just the men on the sidewalk. At first Victoria was afraid of standing tall and walking assertively, remembering that if she asserted herself or even moved during the abuse, things got worse. Realizing that immobility was a response that had 252

helped her in the past, and that the past was different from the present, she was able to stand tall and walk more assertively. Both this realization and changing her posture helped to bring her arousal up into the window of tolerance. With repeated practice of these new actions, Victoria was able to maintain arousal within the optimal zone for increased time intervals, and she became less and less triggered by the presence of men. Like Jim or Victoria, you too may have triggers that automatically cause you to inaccurately neurocept danger and threat. The worksheets that follow will help you recognize faulty neuroception and identify the triggers and the signs of your body’s dysregulated arousal in the face of these triggers. You can then practice new actions and reactions, as Jim and Victoria did, that will help regulate your arousal so you can neurocept safety when your environment actually is safe. And when your arousal is regulated, and you neurocept safety, you can better enjoy your environment and the people in it.

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Neuroception and the Window of Tolerance SIGNALS OF AUTONOMIC AROUSAL Purpose: To identify the internal signals that tell you when your arousal is a little high and when it escalates to hyperarousal, when it is a little low and when it drops to hypoarousal, and when it is within the window of tolerance. Directions: Follow the prompts below. 1. Circle any internal signals of high or hyperarousal that you have experienced. Add any signals that are not on the list in the empty box. Urge to run, leave, fight, verbally attack

Restless, easily startled, jumpy, fidgety, tense, shaky

Angry, afraid, enraged, panicked, anxious, nervous, irritated

Racing mind, obsessive or repetitive thoughts

Easily distracted, difficulty focusing or concentrating

Sense of danger, uneasiness, discomfort, lack of safety

Easily overwhelmed or distressed

Wound up, hard to relax or go to sleep

2. Using one of the signals you circled, described the difference when your arousal is a little high and when it escalates to hyperarousal. (e.g., When I am angry and experience high arousal, my jaw tightens and my voice tone changes, but I can still think and carry on a conversation. When I am angry and hyperaroused, my heart starts pounding,I get a ringing in my ears, and tingling in my fingers; I can’t think clearly,I blow up and start yelling.) Window of Tolerance 3. Circle the internal signals of your arousal being within your window of tolerance that you have experienced. Add any signals that are not on the list in the empty boxes. In charge, capable, able to make decisions

Curious, engaged, interested

Centered, able to respond instead of react

Alert, open mind, able to Safe and secure think clearly

A sense of trust in yourself and your abilities

Composed, calm,

Ability to focus, concentrate

Competent, able to 255

relaxed, or at peace

handle challenges

and ignore distractions

4. What sensations and movements tell you your arousal is in the optimal arousal zone? 5. Circle any internal signals of low or hypoarousal you have experienced. Add any signals that are not on the list in the empty box. Motionless, weak, still, powerless, unable to move

Collapsed felling, passive, can’t move quickly, unassertive

Bored, spaced out, apathetic, lethargic, disconnected

Emotionally flat, dull, Compliant, don’t care, Depressed, despairing numb, empty, dead disinterested, indifferent unmotivated, bummed out, hopeless, discouraged Sluggish, inability to think clearly

Heavy, low energy, go to sleep easily during the day

6. Using one of the signals you circled, describe the difference when your arousal is a little low and when it drops to hypoarousal. (e.g., When I have I low arousal, I feel spacey, become less verbal, and my body feels heavy and a bit numb. When I am hypoaroused, sounds are muffled, objects seem to be far away, I am so far removed from everything that I take a long time to respond or I don’t respond at all.) Discuss with your therapist any ways you might increase your tolerance of high and low arousal and regulate hyper or hypoarousal.

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Neuroception and the Window of Tolerance RECOGNIZING TRIGGERS & REGULATING HIGH OR HYPERAROUSAL Purpose: To identify a trigger that increases your arousal and describe what will bring your arousal back into an optimal arousal zone. Directions: Determine a trigger that causes your arousal to increase. It could be a trauma trigger (e.g., a loud noise, an intrusive image, a person who reminds you of the trauma, or other traumatic reminder), or it could be a relational trigger (e.g., being criticized, rejected, not attended to, pressured, or someone being disappointed in you). It could be a trigger that causes your arousal to exceed the window, or it could be a trigger that upsets you and causes your arousal to increase uncomfortably, but not so much that it exceeds your window of tolerance. 1. Describe your trigger. 2. Describe the body signals that indicate you have been triggered into high or hyperarousal. AROUSAL Hyperarousal High arousal Your Window of Tolerance Optimal Arousal Zone. 3. What helps you feel better again when your arousal has been triggered into high or hyperarousal? List several things you could do to bring your arousal back into a more comfortable zone.

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Neuroception and the Window of Tolerance RECOGNIZING TRIGGERS & REGULATING LOW OR HYPOAROUSAL Purpose: To identify a trigger that decreases your arousal and describe what will bring your arousal back into an optimal arousal zone. Directions: Determine a trigger that causes your arousal to decrease. It could be a trauma trigger (e.g., a feeling of being helpless or trapped, an intrusive image, a person who reminds you of the trauma,or other traumatic reminder), or it could be a relational trigger (e.g., being criticized, rejected, feeling abandoned or neglected, or someone being disappointed in you). It could be a trigger that causes your arousal to exceed the window on the low end, or it could be a trigger that upsets you and causes your arousal to decrease uncomfortably, but not so much that it drops below your window of tolerance. 1. Describe your trigger. AROUSAL Your Window of Tolerance Optimal Arousal Zone Low arousal Hypoarousal 2. Describe the body signals that indicate your arousal has been triggered into low or hypoarousal. 3. What helps you feel better again when your arousal has been triggered into low or hypoarousal. List several things that you could do to bring your arousal back into a more comfortable zone.

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Neuroception and the Window of Tolerance UNDERSTANDING YOUR NEUROCEPTION Purpose: To use mindfulness to increase your awareness of the relationship between your building blocks and neuroception of safety, danger, or threat. Directions: Think about times you neurocept safety (and experience optimal arousal), times you neurocept danger (and experience hyperarousal), and times you neurocept threat (and experience hypoarousal). Then complete the prompts below. 1. Reflect on what thoughts, emotions, five-sense perceptions (images, sounds, smells, tastes), sensations, or movements tell you that you feel safe, or in danger or threatened? Then fill in the hexagons with descriptions of your building blocks that correspond to a neuroception of safety and optimal arousal (in the top half) or of danger and hyperarousal or threat and hypoarousal (in the bottom half). 2. What situations or people in your life go together with a neuroception of safety (and optimal arousal)? 3. What situations or people in your life go together with a neuroception of danger (and hyperarousal) or threat (and hypoarousal)? 4. Are you more likely, in general, to be biased toward neurocepting safety (and optimal arousal) danger (and hyperarousal) or threat (and hypoarousal)? Describe why you think that is. 5. If you discovered that you are prone to faulty neuroception (neurocepting danger when you are safe, or vice versa), what changes can you make to promote more accurate neuroception? (e.g., Orient toward different cues; change body posture or breathing.) “People are usually friendly.” Thoughts People aren’t safe.” “There’s no way out.” peace, joy Emotions terror, despair See a smiling face, hear children playing 262

Five-sense Perceptions see an angry person, hear a siren, smell the same aftershave my abuser wore warm, energized, fluid Sensations numb, paralyzed, shaky relax body, breath fully, reach out to others Movements tighten my muscles, hold my breath

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Neuroception and the Window of Tolerance TRACKING YOUR AROUSAL Purpose: To understand how your arousal naturally fluctuates throughout the day, depending upon your internal state and what is occurring around you. Directions: For three days, pay attention to the fluctuation of your arousal at specific intervals of each day. Notice if you woke up energized or with low arousal, when people or situations causes your arousal to rise (e.g., with excitement, joy, enthusiasm, anger, fear, panic, anxiety, frustration, aggravation) or to drop (e.g., with boredom, sadness, despair, calmness, contentment, sleepiness), and then follow the prompts below. 1. At the end of each of the three days, record your arousal on the graph below using a different color for each day. Make a dot on the graph at each interval of the day (waking, early-morning, mid-morning, etc.) to indicate where your arousal was, and then draw a line connecting the dots to show how your arousal fluctuated. Waking EarlyMidNoon EarlyMidEarly Late Morning Morning afternoon afternoon Evening Evening Hyperarousal High arousal Your Window of Tolerance Optimal Arousal Zone Low arousal Hypoarousal 2. What thoughts (e.g., I did a terrible job.), emotions (e.g., frustration, boredom, joy), people, activities, or situations influenced your arousal over the past three days? 3. Describe anything that caused your arousal to escalate or drop to an uncomfortable level. 4. Assess the patterns of arousal you noticed and if your arousal was where you 265

wanted it to be throughout each day. If not, what might you do to influence your level of arousal? (e.g., My arousal slumped after lunch every day, but might stay higher if I went for a walk.)

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Neuroception and the Window of Tolerance RECOGNIZING OPTIMAL AROUSAL Purpose: To recognize when you neurocept safety and your arousal is within your window of tolerance, and to identify some activities, things, people, or situations that bring your arousal into this optimal zone. Directions: Think of what evokes optimal arousal for you, then focus on three significant moments in your life in which you neurocepted safety and experienced a state of optimal arousal. 1. Describe what evokes optimal arousal for you (e.g., animals, certain people, children, nature, listening to music, making art, prayer or meditation, physical activities, reading, certain smells, tastes, a massage)? List all the stimuli that you can think of that promote optimal arousal. 2. Think of three moments in your life in which you neurocepted safety and experienced optimal arousal. In the chart below, describe each moment and the thoughts and beliefs, emotions, five-sense perceptions (images, sounds, tastes, smells, touch), movements (changes in posture, breath, impulses, gestures), and body sensations, you experience as you remember of each of these moments. Moment 1

Moment 2

Moment 3

The Moment Thoughts Emotions Five-sense Perceptions Movements Sensations How might you use what you learned about what evokes optimal arousal for you in #1 and #2 so that you can experience optimal arousal more frequently? (e.g., I realized that most of the moments of optimal arousal I experience have to do with music and other people. But I could also do other activities that I listed in #1 that promote optimal arousal, such as sports, yoga, taking a walks in nature, and reading novels.)

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Three Phases of Therapy THERAPISTS’ GUIDE TO CHAPTER 12

Purpose of this Chapter Psychotherapy with clients who have suffered trauma and attachment inadequacies warrants thoughtful psychoeducation, planning, and staging. This chapter provides you and your clients with a loose structure for establishing long-term goals and priorities and for helping clients become informed collaborators in their therapy. The phase-oriented model originated with Pierre Janet (1898) and is still the standard of treatment for complex PTSD and dissociative disorders (Brown & Fromm, 1986; Brown, Schlefflin, & Hammond, 1998; Cardeña, Maldonado, van der Hart, & Spiegel, 2000; Chu, 2005; Cloitre, Koenen, Cohen, & Han, 2002; Courtois, 1988, 1991, 1999; Courtois & Ford, 2011; Herman, 1992; National Collaborating Centre for Mental Health, 2005; Ogden et al., 2006; van der Hart et al., 2006; van der Kolk, McFarlane, & van der Hart, 1996). Although this model was originally conceived as a trauma model, the adaptation of it in this book accommodates working with the attachment and life issues of nontraumatized clients as well. In the modification of this model elucidated in this and in subsequent chapters, Phase 1 focuses on developing resources to regulate arousal and increase self esteem and competency, Phase 2 on addressing memories, and Phase 3 on exploring relationships and moving on from the past. This chapter provides an overview of the tasks and goals of each phase and how this model might be applied in therapy, emphasizing that the work of each phase should be used in a manner and in an order that best addresses each client’s immediate and long-term goals. Since the subsequent sections of this book correspond with the three phases of therapy, this chapter will aid you and your clients in making thoughtful decisions about how to utilize the remainder of the book.

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Since this chapter sets the stage for the rest of the sections in this book, it is a useful synopsis for all clients who are continuing to work with this material. Clients who are confused about the progression of a course of therapy will be relieved to learn that therapy has a structured beginning, middle, and end. Those who want to move rapidly and “get it all out,” as well as those who are afraid to delve into past hurts, will be better informed about the pacing of therapy through the information in this chapter. For clients who struggle with dysregulated arousal or safety issues (i.e., selfharm, suicidality, eating disorders, or addictions), the three-phase model can be used as a treatment frame to keep the focus on regulation and stabilization. This focus is especially useful when clients minimize their unsafe behavior and push to address memory before they are stabilized. For other clients who are afraid to address their memories, a phase-oriented approach can provide reassurance with its promise that memories will not be a focus of therapy until sufficient resources are developed and stability is achieved. Such clients might also be relieved to understand that memory work has a structure that maximizes the chances of satisfying results. For clients who want to participate more fully in life and improve their relationships, Phase 3 will be valuable. If they are plagued by limited beliefs and emotional biases, understanding the purpose of Phase 3 will provide the reassurance that a methodology exists for addressing these issues. For clients who prefer to remain in Phase 1 or fear moving forward in therapy, this model can be used to encourage them to progress to another phase in order to challenge themselves to address painful memories, deal with emotions, and improve their relationships. This chapter can help clients make a plan to complete one of the three phases of treatment when they have previously been unable to do so. It provides the structure to assure they can progress effectively through a course of treatment by helping them determine the objectives and skill acquisition necessary for each phase, and understand why they might need to remain in a particular phase until skills of that phase are acquired.

Suggestions for Clinical Use The work of the chapters in the previous sections has increased your clients’ knowledge and developed their capacities in preparation for the challenges of these three phases. Your acknowledgment of the progress they have made and the skills they have learned will be encouraging to them as you embark on the journey of the three phases together. Facilitating clients’ broad understanding of the goals and tasks of each phase and how the phases fit together will help clarify therapeutic priorities, guiding you and your clients in the use of the remainder of the chapters. It will most likely be 270

helpful to discuss this chapter fairly thoroughly together in session, so that you can provide psychoeducation as needed to assure clients’ comprehension of the model, address any of their concerns, and plan where to start and how to move forward with the rest of the book. As you work with this chapter, it is important to understand that these phases are not necessarily sequential and should not be implemented in a rigid fashion. For example, attachment-related emotions are a topic in Phase 3, but often these emotions emerge in Phase 2 work with memory, and must be addressed when dealing with past events. Additionally, skills described in one phase can also be used to support the goals of another phase. For example, the proximity-seeking actions in Phase 3 may be helpful to treat a client who needs to reach out to others to regulate around and decrease isolation in Phase 1. Additionally, as you are working with memory, it is often essential to implement resources learned in Phase 1 to help clients regulate. And it will also be necessary to address strong emotions and beliefs, described in Phase 3, as they emerge when working with memories. Clients who become dysregulated when they explore Phase 3 topics of positive emotion, play, and taking risks will benefit by returning to Phase 1 to deepen their resources. So it is important to be flexible in your use of this material and in assessing, moment to moment and session-to-session, which interventions form which phase will be most useful. Discussing options with your clients in a spirit of collaboration assures you are in agreement and will maximize their ability to benefit from the structure provided by these three phases.

Introduction to the Worksheet This chapter has one worksheet, PHASES OF TREATMENT: GOALS & TASKS, that will help your clients understand the model in the context of their own therapy. Whether the two of you complete it together, or whether the client completes it as homework and you subsequently review it together, it can serve as a way to plan and review each client’s course of treatment, and to determine the starting point for making use of the chapters that follow. Discussing together that the three phases of therapy occur in a spiral rather than linear fashion will increase clients’ confidence in this model as a framework that is not rigid but holds their treatment flexibly and thoughtfully. This worksheet can serve as an assessment tool that can be used periodically during the course of therapy to reassess the course of treatment.

Adapting this Material for Dissociative Clients This chapter holds particular relevance for dissociative clients because it 271

conceptualizes and prioritizes the need for stabilization, resourcing, and selfregulation that are so lacking in these individuals. Since dissociative fragmentation tends to be associated with hyper- and hypoarousal, easily activated animal defenses, and impulsive behavior, Phase 1 treatment is a priority for this population. For example, if hypervigilant parts of clients perceive you to be rigid, controlling, and uncaring or see you as the only source of safety, having a treatment model to guide the therapy will provide you with a format for collaborating with clients and their parts that is fairly objective. The worksheet for this section not only facilitates therapeutic collaboration but also provides an objective tool for assessing the focus of therapy. Using it repeatedly, you can assist clients with dissociative disorders to identify the markers that inform both of you about which phase should be the focus of treatment. Dissociative clients may be triggered by some of the material in this chapter. Most have a strong conflict between knowing and not knowing about their trauma history, and this conflict is often held by different dissociative parts. Thus, parts intensely focused on disclosing memories may be angry when you insist on a focus on regulation and resources. In this case, you might ask if all parts of the client are in agreement with doing memory work, or whether some parts are more afraid or ashamed to do so. And ask whether some parts do feel the need for help with stabilization in daily life. Once the client understands that he or she has inner conflicts among parts, the different parts may become more in agreement with the sequence of therapy. In Phase 2, the client or some parts of the client, may object to the focus on implicit rather than explicit memory, intent on “telling the story” without sufficient attention to inner awareness or recognition of the objections and fears of other parts. Parts who are phobic or avoidant of memory will be triggered by information about Phase 2. Some parts might want to skip both Phases 1 and 2 to proceed headon to addressing strong emotions and relationship issues in Phase 3 before they have the resources necessary to address such issues. On the other hand, Phase 3 can support the integration of parts, leading to resistance of certain parts who are terrified of integration. It might be helpful to explore the worksheet from the perspective of different parts of the client so that he or she can help the parts work through conflicts about various aspects of phase-oriented therapy. You will have the clinical challenge of eliciting and listening to the fears and preferences of each part, while simultaneously using the relationship and the skills clients have learned to regulate their arousal. Through going slowly and exploring the needs and desires of all parts, you can meet the challenge of helping the client as a whole learn a paced and thoughtful approach to the therapeutic priorities, and collaborate with you in planning their treatment.

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CHAPTER 12 Three Phases of Therapy The therapeutic journey of dealing with the past and moving on to a fulfilling life in the present may seem like an exhilarating challenge or an impossibly daunting task. You may feel excited to embark on this adventure in self discovery, or you may be intimidated and discouraged before you even begin. Therapy is a step into the unknown, full of mystery, surprises, and complexities. This journey becomes clearer and more manageable if we divide it into steps, or phases, an approach to therapy that has been used since the 1800s. The remainder of the book is divided into three sections, one for each of the three phases of therapy, to explore the legacy of both trauma and attachment. The three phases are divided as follows: Phase 1, developing resources; Phase 2, working with memories; and Phase 3, creating healthy relationships and satisfaction in life. By breaking down the therapeutic process in this way, we can feel encouraged that each step we take along this journey is part of a larger whole, which, all together, will help us steadily become who we want to be. We can develop confidence that addressing the past, and moving on to a brighter future is within our reach. All that you have learned from the previous chapters has built a foundation of skills and capacities in preparation for embarking on the three phases of therapy: developing confidence in your body’s wisdom, understanding procedural learning, orienting to selected stimuli in the outside world, learning mindfulness skills, recognizing your arousal levels, and understanding neuroception and a bit about your brain. The material in this chapter is an overview of the three phases of therapy that will help you determine how to integrate what you have already learned and best use the remainder of the book.

Phase 1: Developing Resources The three phases begin with learning to identify and develop a variety of resources —strengths, capacities, competencies, and skills—that can fortify your self-esteem and support you in maintaining your arousal within a window of tolerance. If your arousal is not regulated, if you are easily triggered by reminders of your past, if you want to increase your confidence in your abilities, or if you simply want to develop your body as a resource, Phase 1 is the place to start. You will learn to recognize the strengths, competencies, and talents you have 275

acquired through all your life experiences, both positive and painful, as well as how to use these resources and new ones to build your capacity for coping with adversity. You will discover somatic resources that teach you how you can call on your movement, posture, and gesture to regulate arousal and generate more positive feelings so that you can continue to expand your confidence in your body as a source of wisdom and support for your well-being. By acknowledging your resources, developing those that are undeveloped, and implementing them in your life, you will learn to draw on your body and mind to regulate your nervous system and expand your sense of mastery.

Phase 2: Memory: Integrating the Past The second phase focuses on the memories of the past—not just by remembering what happened or finding the words to describe it, but also by reorganizing how trauma and attachment experiences are held in the body. Rather than focusing only on a verbal narrative of the events, the goal is to integrate the effects of those memories that interfere with your life today. Working with the thoughts, feelings, images, and body reactions connected to the past will help you achieve a felt sense that the grip of the past is lessening, opening up your capacity for new experiences in your life today. A goal of this phase is to learn to identify current signs of implicit nonverbal memories that are formed in childhood, perhaps even before the acquisition of language, or that are dissociated in the wake of trauma but continue to strongly affect us. You will learn how to work with these implicit memories in a way that integrates their effects, rather than continuing to relive or avoid them. As you remember the past, you will also rediscover resources that you may have forgotten but that you used to your benefit when painful events took place. Instinctive survival defenses, emotions, and actions that are stimulated when we are threatened will be clarified. If you are easily triggered or dysregulated, you can explore somatic interventions designed to help regulate your arousal as you address memories. You will discover empowering physical impulses (e.g., pushing away) that were not possible at the time of the original event, but emerge spontaneously when the past is remembered. You might also revisit upsetting childhood experiences with your attachment figures and address the painful emotions associated with them.

Phase 3: Moving Forward In Phase 3, the focus turns to increasing our enjoyment of and satisfaction in life, 276

participating more fully in the world and especially in relationships. At this phase, we start to attend to areas of daily life that might have been neglected due to dysregulated arousal, old orienting patterns, disruptive procedural learning, emotional reactivity, or triggered responses. With the somatic skills to regulate arousal already established and with many memories already addressed, our confidence in the body as an ally instead of an enemy is growing. This confidence supports our readiness to turn attention to ways in which the body can serve as an asset in enriching our everyday lives. The resources learned in previous phases are used again in Phase 3 to support healthy relationships and more active engagement in the world. We learn to use our bodies in new ways that challenge the patterns of the past, such as reaching out to others for connection or discovering the movements that help us play, explore the world, and meet new challenges. Our goals at this phase of therapy include taking up the tasks of growth and development, overcoming limiting beliefs and how they “live” in the body, navigating painful emotions, participating fully in work and relationships (especially intimate ones), and increasing joy and pleasure in life. We will also focus on challenging your windows of tolerance by taking healthy risks. The feeling that your present life is dictated by your history is diminished as you learn to expand your window of tolerance to deepen your intimate relationships and satisfaction in life.

How to Use the Phases Each of the three phases of therapy has its own goals, interventions, and skillbuilding requirements. The phases can be thought of as forming a sequence, with each phase building on the one before. However, the phases are seldom used in a strictly linear fashion because each of us is different. Everyone should use the phases in a manner that best meets his or her needs and goals. Thus, the phases are meant as a loose structure, not a rigid one. If you want to develop your confidence or increase your self-esteem by discovering competencies and strengths you might have not acknowledged, or learn how to draw upon the resources of your body, Phase 1 will meet those goals. Those of you for whom instability remains the most significant problem will find that the stabilizing resources of Phase 1 benefit you the most, because the tasks of Phases 2 and 3 are not primarily focused on regulating arousal. Some of you for whom dysregulated arousal is not an issue may be ready to address memories and you might start with Phase 2. If your primary goals are to overcome issues related to intimacy and success in life and relationships you may find that the focus of Phase 3 is the best place to begin. 277

You also might find it most useful to skip around between phases, rather than progressing through them sequentially. For example, you may discover a few resources in Phase 1 that help you feel ready to address memories in Phase 2, then work with relational issues using interventions in Phase 3—which may evoke intense emotions, sending you back to Phase 1 to develop more resources to regulate those emotions, and so forth. Some of you will move slowly but surely through all three phases of therapy in a spiral fashion, cycling back to Phase 1 as needed to deepen stabilizing resources when dysregulation is encountered during the work of Phases 2 and 3. Others will find the most benefit by skipping around, in no particular order. You will probably discover that some of the skills and interventions in one phase support you in another. For example, strong emotions and beliefs learned in childhood are discussed in Phase 3, but they might emerge in Phase 2 while working with memories, or even in Phase 1, when new resources might challenge these beliefs. So we encourage you and your therapist to be flexible in using this three-phase model so that it suits your own process and needs. The worksheet that follows this chapter will help you and your therapist assess where you are in therapy right now, which phases you have already worked with, and which phase you are ready for next. With careful attention to the tasks of each phase and using the window of tolerance as a guide to assure that arousal is sufficiently (but not overly) regulated, we can be confident that our progress will proceed at an appropriate pace. How much time we spend in each phase, and indeed the duration of therapy itself, varies depending on the severity and complexity of our history, inborn physical and temperamental factors, and other factors hard to pinpoint. Each one of you should trust your own pacing as you move more quickly or slowly through the phases. With the flexible structure of these three phases to guide you and your therapist, and with pacing that encourages mastery in each phase, you can challenge yourself in just the right way to ensure satisfaction and growth in working through trauma and attachment issues.

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Three Phases of Therapy P HASES OF TREATMENT: GOALS & TASKS Purpose: To assess the goals and tasks of each phase of therapy and determine which tasks are important in your therapy now, which ones were important in the past, and which will be important later. Directions: Read through the goals and tasks of each phase of therapy below and then answer the questions about your own therapy. You can either fill out this worksheet with your therapist, or complete it yourself and bring it to your next session to discuss with your therapist. Phase 1: Developing Resources

Phase 2: Addressing Memories

Phase 3: Moving Forward

• Identify survival resources that help you cope with adverse experiences • Assess, acknowledge & develop your strengths, talents & competencies • Recognize triggers & signs of excessive or dysregulated arousal • Develop & use new resources to regulate arousal & increase competency • Increase awareness of how posture, movement & gesture affect arousal & well-being • Discover your natural somatic resources & learn new ones • Change traumatic, distressing or unsatisfying orienting

• Recognize signs of implicit memories in your current life • Identify, embody & practice resources to cope with effects of memories • Discover resources used in painful events of the past • Maintain “dual awareness” to address state specific memories without reliving the past • Explore the effects of memories (sensations, sensory intrusions, emotions, movements, thoughts) • Practice empowering actions you couldn’t use in the past • Address dysregulating arousal & emotions related to animal defenses

• Address the legacy of your relationship history, including early attachment • Discover limiting beliefs & how they affect your body • Explore connecting with & expressing emotions •Use movement to increase connections & intimacy • Explore physical actions of boundariessetting • Assess your gait & explore new ways of walking • Increase positive emotions, pleasure & your capacity to play • Widen your window of tolerance; take healthy risks & tend to

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1. Which of these phases of therapy is your current focus? Using the tasks in the chart above, describe what you’ve accomplished and what is still left to work on in this phase. 2. What other phases have you been in during your therapy? Describe your experience of the other phases–successes,struggles, and difficulties. What tasks remain to be addressed or learned in those phases? 3. What tasks do you think will be important in your therapy as you move forward?

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PHASE 1

Developing Resources

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Appreciating Your Strengths Survival and Creative Resources THERAPISTS’ GUIDE TO CHAPTER 13

Purpose of this Chapter Traumatic experiences and attachment difficulties can dramatically interfere with clients’ abilities to perceive and appreciate their strengths. Hughes (1997) writes: “All children, at the core of their beings, need to be attached to someone who considers them very special and who is committed to providing for their ongoing care” (p. 8). When caregivers fall short of meeting these needs, children can be left with a diminished sense of their strengths and their worthiness. So many clients with histories of trauma, neglect, and attachment difficulties are conditioned to focus on their flaws and mistakes, neglecting to recognize their positive qualities. Acknowledging their resources challenges feelings of inadequacy, unworthiness, incompetence, shame, and mitigates “learned helplessness” (Seligman, 1975). Such validation can increase clients’ self-esteem and bolster their courage to address difficulties. Reframing self-destructive, eating disordered, and other such behaviors as “survival resources” they use to try to regulate arousal and cope with adverse experiences can challenge their tendency to pathologize these behaviors and symptoms as shameful. Similarly, reframing attachment related difficulties—such as problems sharing feelings, or inability to ask for support—as survival resources helps clients understand the source of these difficulties. These reframes often pave the way to replace survival resources with more adaptive capacities. The purpose of this chapter is to enable clients to recognize and acknowledge their creative resources, to help them identify and appreciate their survival resources, both those that continue to be useful and those that have become selfdestructive or maladaptive, and to begin to consider replacing them with creative resources.

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Clients Who Might Benefit Clients who suffer from low self-esteem or who judge themselves as lacking will benefit from this chapter’s focus on their competencies. Destabilized clients who struggle with such issues as self-destructive behavior, eating disorders, chemical dependency, and other symptoms that cause shame and self-doubt can benefit by learning to acknowledge these as survival resources—as attempts to regulate arousal and cope with distress. Clients with issues related to early attachment, such as detrimental relational habits and shortcomings, can also redefine their issues as survival resources or as coping strategies developed in the context of their family dynamics. For clients who have overlooked or negated their creative resources, the material can serve as an opportunity to identify and deepen access to capacities that can increase their internal support and self esteem.

Suggestions for Clinical Use Your ability to define resources as facts and capacities rather than as opinions is crucial. Especially when clients are phobic or wary of good feelings or positive acknowledgment, understanding that a resource is not merely a viewpoint, but an unbiased, objective assessment of ability will help clients to acknowledge their own strengths. Approaching the topic with an unsentimental yet genuinely appreciative attitude will set an example that your clients can mirror as they explore their resources. They will need your help if they have difficulty perceiving their abilities that, in fact, exist. An attitude of diminishing themselves might be a survival resource, in and of itself, perhaps learned in families where modesty was valued and “Don’t brag about yourself” was a common response to expressions of accomplishment. At the same time, it is crucial to approach the topic of resources from a sincere appreciation of them and not a negation or denial of the difficulties that continued use of survival resources may cause. Survival resources, although they did assure survival in the past, may now interfere with client’s current functioning, and this needs to be recognized as well. You are probably aware of your clients’ abilities and positive qualities even when they are not, putting you in a very good position to challenge any negative view of themselves as inconsistent with factual information. For example, you might say, “I recall your taking in that stray puppy and nursing it back to health,” or “Do you remember that time you hiked to the top of the peak?” “What about your painting [poetry, gardening, knitting, carpentry]? That is considered to be a creative resource, too.” Perhaps there are certain creative resources (e.g., commitment to parenting or to certain personal or spiritual values) that have special meaning to the client and can therefore be more easily recognized. 284

It might be challenging to help some clients acknowledge their resources when they are adamant that they have none. It is important to remember that even clients who struggle to function possess skills and resources. You can increase their awareness of their resources by acknowledging daily abilities, such as typing on the computer, driving a car and knowing where to go, working out at the gym, or fixing a child’s lunch. Clients may not think of these abilities as competencies, and in fact some have even learned patterns of automatic negation of success or competence, saying, “Anyone could have done that,” or “That was a fluke.” It is important that you carefully track your clients’ responses to your acknowledgment of their resources. Many clients experience difficulty taking in positive feedback. Studies show that people with PTSD, in particular, tend to respond to compliments negatively (Frewen, Dozois, Neufeld, Stevens, & Lanius, 2010), and many people hold limiting beliefs that prevent them from accepting positive regard from others. When positive moments have been absent or invariably followed by abuse or humiliation, then compliments, praise, or positive attention of any kind may engender dismissal, fear, or shame, which might also be acknowledged as survival resources. Asking questions such as “What do you imagine would have happened if you had been proud and assertive, instead of being compliant and submitting to the abuse?” or “How do you imagine your dad would have treated you if you had been laid back and relaxed instead of always working hard to be the best at everything?” can often help clients realize that the behaviors they are trying to change were once adaptive responses—survival resources—that helped them in difficult situations. Clients often view symptoms and certain behaviors as liabilites. Reframing them as survival resources conveys that these symptoms and behaviors have actually helped them cope with difficult conditions of the past. Qualifying the behaviors clients are trying to change or the symptoms that destabilize them as survival resources opens up new options for addressing them and finding other, more creative resources to fulfill their purpose. You may find that helping clients acknowledge the survival resources that once helped them slowly opens up an ability to acknowledge other ways they have coped with adverse experiences. When survival resources are exacerbated in current life, your emphasis on the behavior as an attempt to resource unbearable feelings or regulate dysregulated arousal may help motivate clients to manage their stress differently.

Introduction to the Worksheets The worksheet entitled RECOGNIZING YOUR SURVIVAL RESOURCES may be a good place to begin acknowledging how clients coped with adversity. Not only does it help clients identify some of their symptoms and behaviors as survival 285

resources, but it also asks them to assess if the resource still has value for them now. REFRAMING A SURVIVAL RESOURCE is particularly appropriate for clients who are ashamed of their survival resources or who have self-destructive survival resources. It asks them to identify a survival resource that they consider a liability and then describe how it helped, and may still help, them cope with difficulties. As mentioned, creative resources often go unnoticed or unmentioned. YOUR CREATIVE RESOURCES invites clients to discover what creative resources they already possess, to practice using one of them and notice what effect doing so has on their body, thoughts, and emotions. As suggested in the worksheet, it might be helpful to encourage clients to ask someone they know and trust to give feedback on their creative resources. EMBODYING A CREATIVE RESOURCE helps clients define a creative resource, remember the last time they used it, and describe how this resource affects their body. Your encouragement to practice one of their physical responses to this resource can support clients to integrate it into in daily life. Once clients understand how their survival resources have served them, they may realize they are no longer helpful in their current life. REPLACING SURVIVAL RESOURCES WITH CREATIVE RESOURCES asks clients to imagine creative resources that could replace the survival once they commonly use, and then to describe what the creative resource would feel like physically. This worksheet helps clients recognize that they have a choice whether to continue to use survival resources or to replace them with creative ones that have the potential to enrich their current life.

Adapting this Material for Dissociative Clients The behavior of dissociative clients tends to reflect their survival resources—how they adapted and endured the painful experience of the past. When you emphasize the role of different parts in creating and maintaining survival resources, clients are more likely to become curious about this topic. By regarding each part of the client as a survival resource and reframing even symptoms such as self-destructive behavior as an attempt by parts to regulate or protect, the whole dissociative system and each part of it is validated. But even in doing so, other parts may be triggered, such as an ashamed part that feels mortified by what the angry part said to her partner, or a part that just wants to be loved who is now afraid the angry part will drive everyone away, including you. This requires that we also reframe the ashamed part as a survival resource as well as the part that seeks approval and protection—and the angry, devaluing part as well. Dissociative clients are likely to be triggered by the request to consider what 286

creative resources they possess, especially because past trauma and neglect might result in phobias of positive affect, sense of worth, or positive acknowledgment. They may shut down, become mute, switch into another part, or actively refuse to continue with the discussion—all of which are survival resources to avoid what is unfamiliar or potentially dangerous. Although discussing creative resources with such clients increases the risk of triggering judgmental or ashamed parts that feel unworthy, doing so also provides an opportunity to help clients become curious about what creative resources each part might hold or what creative resources they have developed to help them function even when parts are triggered and dysregulated. Thus, for clients with dissociative disorders, the chapter may be both validating and triggering. Although the material may be challenging, you have a unique opportunity to celebrate whatever unfolds as either a reflection of a survival resource or of a creative one, and to address clients’ negative reactions to acknowledgment of their resources as needed. You can guide clients to recognize the interconnectedness of their internal parts through understanding that the functional resources they each possess in some way serve the entire dissociative system.

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CHAPTER 13 Appreciating Your Strengths: Survival and Creative Resources Personal strengths and competencies are resources that help us maintain our arousal within a window of tolerance so we can enjoy the activities and relationships in our lives. All of us possess a myriad of resources. For example, skills such as operating a computer, riding a bicycle, or reading, are all resources. So are talents, flairs, abilities, and aptitudes, such as playing an instrument or a sport, navigating an unfamiliar city, doing a job well, painting, drawing, or having personal style. We also have internal capacities that are resources, such as the ability to experience our emotions, be in tune with our bodies, or stay grounded. Almost any capacity, aptitude, interest, or skill that we have can be a resource if it supports our wellbeing, helps us meet life’s challenges, or find relief in difficult times. Certain resources that helped us tolerate and survive trauma and attachment inadequacies or failures in the past—such as hypoarousal or keeping silent—may not serve us in our current lives. But, other resources, such as knowing how to read or enjoyment of physical exercise, can continue to serve us no matter what the circumstances. When we experience challenges or stress, our resources help keep us calm and centered or give us energy to solve a problem or negotiate a resolution. The more resources we have, the better we can cope with life’s challenges and disappointments. When we are aware of our resources and know how to draw on them when needed, we are better able to adjust and respond in a balanced and creative way to a wide variety of events and interactions, even demanding or unpleasant situations or encounters with others. Our resources are often compromised during adverse experiences. Attachment inadequacies of our caregivers or adult partners may leave us feeling rejected, unloved, abandoned, or criticized. As a result, we may perceive ourselves as inadequate, stupid, incompetent, or unworthy. Our resources are overwhelmed or inadequate to protect us from harm during trauma, which may cause us to feel that we lack the resources to deal with life in general. Through such experiences, we may focus more on our shortcomings than our strengths we may develop habits of self-criticism or ruminate about our negative traits, distressing memories, and current life situations and relationships that are upsetting or unfulfilling. We may even view our strengths as shortcomings or feel that we have no resources at all. However, each of us, even the most dysregulated or unstable trauma survivor, undoubtedly has many resources that might have gone unnoticed 289

and unacknowledged. When we overfocus on negative qualities and experiences, we tend to forget or overlook all the resources we possess and utilize every day. This attitude diminishes self-esteem, interferes with our enjoyment of life and can be destabilizing. If you view yourself negatively or do not acknowledge your competencies, this chapter will help you achieve a more balanced perspective. Its focus is to teach you to recognize and reacquaint yourself with the strengths and abilities you have developed over your life. Learning to appreciate resources is not meant to deny that all of us have personal struggles, weaknesses, or shortcomings that may also need attention. However, your own flaws (which everyone has) and the difficult situations in your life will be easier to face if you perceive not only your imperfections but also your strengths. And, resolving the suffering associated with the past goes more smoothly when you learn to recognize and realistically associated with that you possess many resources and competencies. This chapter focuses on identifying and acknowledging the resources you already have and can use. You will discover and strengthen your “creative” resources—the ones that help you learn and grow and support your well-being. You will also learn to appreciate your “survival” resources—those that enabled you to cope with difficult situations, inadequate attachment, and trauma. Let’s talk about the survival resources first.

Survival Resources In distressing situations, we instinctively use resources that ensure that we make it through the ordeal. These survival resources help us endure and cope with whatever is happening to us. For example, to freeze, collapse, run away, or fight back might be survival resources that helped us during trauma. Habits of being on the alert for danger or being afraid to venture out of the house can be thought of as survival resources that at one time helped us endure horrible situations. Survival resources also help us adapt to the demands and expectations of our families. If you grew up in a family that expected children to be obedient and not “talk back” or voice their own opinions, you may have embodied this expectation by rounding your shoulders, lowering your head, and having a meek demeanor that goes along with not being allowed to be assertive. If you grew up with caregivers who expected you to challenge people who stood in the way of what you wanted, you might have embodied this expectation by lifting your chest, setting your jaw, and squaring your shoulders, all of which support being assertive and confrontational. These somatic and psychological adaptations can be thought of as survival resources that helped you avoid the disapproval of your attachment figures by trying to meet their expectations. 290

Nadine’s habit of slouching, pulling in her shoulders, and bringing her head forward went along with a tendency to become hypoaroused—in short, hold still and remain quiet. These unconscious habits, coupled with a negative belief (“I have no right to assert myself”), had helped her navigate the difficult circumstances of her childhood. Her parents had required her to obey them and had punished her when she stood up for herself or voiced her opinions. But Nadine’s physical pattern and the belief that went along with it lowered her self-esteem and had serious consequences in her current life. As an adult, Nadine could not stand up to the unwarranted ridicule and emotional abuse from her boyfriend. Although she tearfully expressed the desire to leave the relationship to her therapist, she had been unsuccessful in doing so. At first, Nadine defined her compliance and hypoarousal as a personal shortcoming saying, “What’s wrong with me? I should stand up for myself. I’m such a week person.” But with prompting from her therapist, Nadine asked herself, “What got me through my childhood? How did I survive?” She realized that her droopy posture and low energy were adaptive responses that had literally made the painful circumstances of her family more tolerable than they might have been had she not been so compliant. Reframing the low energy of hypoarousal, slouched posture, and compliance as survival resources that had helped her cope with a rejecting, punitive early environment validated them as skills Nadine was forced to develop. She began to understand her own hypoarousal as an adaptive response. Recognizing that she had done her best to adjust to her family’s demands, given her age and circumstances, and that the patterns she had developed reflected an innate ability to adapt, helped Nadine feel better about herself. She told her therapist, “I didn’t have any choice but to comply. If I had fought back, my parents only would have gotten angry and punished me more. The slouched posture helped me comply and the hypoarousal helped me tune out and not feel how much it did hurt.” Instead of self-judgment, Nadine began to appreciate that she had been able to utilize these survival resources when she most needed them. By reframing what she had thought of as weaknesses as resources instead, she could explore new options more adaptive to her current circumstances from a place of competency rather than selfdeprecation. We all develop survival resources to manage painful situations in childhood, and these patterns often continue in our adult relationships with people who are important to us. Using anger to push people away could be a survival resource in an environment in which trusting others increased the vulnerability to criticism. Becoming a workaholic can develop in a family that stressed achievement. When expressing how we feel is not valued or is punished by our caregivers when we are children, becoming emotionally withdrawn is a survival resource. In the context of trauma, neglect, and betrayal by the people responsible for our care, hyperarousal and hypervigilance might become survival resources. Or, we might develop 291

survival resources in attempts to regulate arousal and overwhelming emotions, such as using substances to numb the body or to increase energy. Feelings of powerlessness might lead to thinking about suicide as a survival resource. Wishing for or planning a way out through suicide might bring relief or increase a sense of having control. Because trauma is associated with the failure of others to comfort and protect us, and a need to find some way to regulate unbearable feelings on our own, survival resources, such as addictions or self harm, can become extreme and even threaten our safety. Acknowledging such resources for their survival function is a first step, followed by learning to replace them with more creative resources capable of supporting regulated arousal and well-being.

Creative Resources Alongside the resources that help you survive, you also developed personal strengths and competencies that help you learn new things, develop talents, integrate your experiences, and grow from them. These creative resources nurture your spiritual, physical, emotional, and mental development; they help you fulfill your potential to become the person you want to be. To identify your creative resources, you might think about competencies, talents, abilities, or strengths that you possess. Do you work out, hike, or play a sport? Do you read, write, play music, knit, or draw? Are you a handyman/woman, or a cook, or a gardener? Are you good at math, history, or science? Are you known for your sunny disposition, being a deep thinker, or your ability to solve problems? Are you the life of the party or the person everyone comes to for advice or comfort? Do all the children in your neighborhood end up at your house after school? Do you have a special affinity for animals? All these, and many more, are creative resources that immensely increase our satisfaction in life, enhance relationships, and boost selfesteem. Along with honoring your survival resources, you can learn to recognize your creative resources and enhance them, and practice using them in place of outdated survival resources. Robert’s father had supported him in his schoolwork and in his job as a paperboy when he was in elementary school. Some of Robert’s most pleasant memories of childhood were of doing homework with his older brother, his father reading nearby, always ready to help. Robert remembered the happy look in his father’s eyes when he got his first job as a paperboy. His father had respected his accomplishments and taught him the value of a job well done and Robert enjoyed sharing his successes, basking in the look of pride on his dad’s face. However, his father was killed unexpectedly in an accident when Robert was 12, and his mother imparted a different message: to be modest and “not brag.” Robert learned to keep his accomplishments to himself, a survival resource. 292

As an adult, when Robert thought about how much he enjoyed his work and how good he was at it, his shoulders squared, his breathing deepened, and his chin lifted with pride. Typically, that moment of pride would be interrupted by a negative thought that reminded him of his mother, (e.g. “Now you’re getting a big head,”) which would trigger a return to his usual rounded shoulders and shallow breathing. With his therapist’s encouragement to notice these physical habits as survival resources and the pride in his work as a creative resource, he became determined to embody how he felt when he acknowledged his competency. He wanted to reclaim the early message from his father. Robert practiced replacing his survival resource with the creative one by deliberately breathing deeply, squaring his shoulders, and lifting his chin. Robert found that he enjoyed himself more and felt a bit better equipped to deal with the difficulties in his life from this stance of embodying this creative resource. The worksheets that follow will help you discover your survival and creative resources to foster a fuller capacity to self-regulate and an increased sense of competency. Like Nadine, you can learn to reframe habits that you might have thought of as liabilities as survival resources that were adaptive responses to earlier circumstances. And like Robert, you can explore replacing your survival resources with creative ones to enhance your well being and increase your satisfaction in life. The first step is to recognize that you already have within you a rich variety of resources and to become aware of how your body reflects them. From this recognition, your survival resources can be validated, outdated ones replaced, and your creative resources acknowledged, deepened, and embodied.

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Appreciating Your Strengths RECOGNIZING YOUR SURVIVAL RESOURCES Purpose: To identify survival resources you used in the past and to reflect on the survival resources that you still use in your life today. Directions: First read the examples below of survival resources that might have helped you cope with trauma, adapt to the expectations of your attachment figures, manage emotional pain, regulate arousal, or deal with other difficulties. Then circle those that you currently use or have used in the past. Describe others that occur to you in the empty box. Then answer the prompts below. Possible Survival Resources • “Read” others or try to predict what they might do • Anticipate other’s needs • Soothe or comfort caregivers • Please or take care of others or tend to their needs instead of your own • Cling to others to feel safe • Rely on things, not people • Over-shop or over-spend • Focus excessively on making money • Acquire lots of “things” • Rely on excessive physical activity, such as running,extreme sports, or lifting weights. • Dissociate • Shut down and become numb • Comply or submit • Push parts of yourself away • Show only those parts of yourself that others will accept • Become a “workaholic” • Overdo or keep too busy • Need to know everything • Excessive need to excel at school or your job

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• Be hypervigilant • Experience hyper/hypoarousal • Leave, flee, run away, or hide • Fight, get irritated or angry easily • “Blow off steam” with emotional outbursts • Escape into books, art, or music • Become preoccupied with a spiritual or fantasy world • Isolate or withdraw • Disconnect from yourself or others • Stop “feeling” • Keep emotions that were not accepted at bay • Become detached from life • Become apathetic or inactive • Sleep too much • Engage in extreme, dangerous, or self-destructive activities • Harm your body • Over or under eat • Rely on alcohol or drugs • Develop other addictions Other: List any survival resources that you still use. Describe how they are useful or hinder you in your life today.

Describe any of your survival resources that overlap with creative ones (e.g., soothing a caregiver and exercise could be both a survival and creative resource).

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How do your survival resources affect your arousal and your body? (e.g., My arousal decreases if I exercise; I feel my body again when I hurt it; I become less tense when I take care of others.)

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Appreciating Your Strengths REFRAMING A SURVIVAL RESOURCE Purpose: To identify a survival resource from the previous worksheet that you view negatively and to reframe it as a resource that helped you when you needed it. Directions: Look over the survival resources you circled on the worksheet RECOGNIZING YOUR SURVIVAL RESOURCES. Choose one of these resources that you think of as a liability or a personal shortcoming, deficit, or weakness. Then answer the prompts below. 1. Describe the survival resources you chose. (e.g., I work all the time because that’s what made my dad proud, but it gets in the way of me enjoying my life and building relationships.) 2. Describe your negative thoughts, emotions, and body movements and sensations when you think of this survival resource as a shortcoming. (e.g., I think there is something wrong with me because I don’t enjoy life very much and I can’t relax. I think about how I can hide my workaholism from others. I feel ashamed, guilty, and anxious. My body tightens up, and my head comes down.) 3. When have you used this survival resource? How did your resource help you when you needed it? (e.g., I started working hard as a teenager to keep my dad from criticizing me. When I didn’t work, or just hung around with my friends, he called me a slacker and said I was lazy. This survival resource helped me gain the respect of my dad, and kept me from having to hear his criticism.) 4. Describe your thoughts, emotions, and body movements, and sensations when you think of this survival resource as something that helped you deal with difficult times. (e.g., I think I was a resourceful 15-year-old. I feel compassion for that person I was. I should have been allowed to just be a teenager and have fun. I feel a sense of pride, as well, for having made it through and for the determination I have. My body feels less tense, and I am able to breathe more deeply. I have the thought that maybe I don’t have to work all the time to be OK, that I’m anything but lazy, and the guilt I felt earlier is diminished.)

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Appreciating Your Strengths YOUR CREATIVE RESOURCES Purpose: To reflect on the creative resources that help you enjoy yourself and your relationship and generate satisfying experiences in your life. Directions: Think of the creative resources that are available to you—your competencies, talents, abilities, strengths, and activities you enjoy. Then follow the prompts below. Note: You might consider asking your therapist or a person who knows you well to help you fill out this worksheet.

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Reflect on your creative resources. Do you work out, hike, or play a sport? Do you read, write, play music, knit, or draw? Are you a handyman, or a cook, or gardener? Are you good at math, history, or science? Are you the person everyone comes to for advice or comfort? What other competencies or abilities do you possess? Write down your creative resources below.

Choose one of the creative resources above that you want to use more in your life today. Describe three times you have used this creative resource in the past, starting with the first time you can remember using it.

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Describe how you can practice using the creative resource that you selected.

After you have practiced using your resource, reflect on the effect of using it. Then describe how this resource affects your body, your thoughts, and your emotions.

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Appreciating Your Strengths EMBODYING A CREATIVE RESOURCE Purpose: To select a creative resource, discover how it affects your body and then draw on the somatic elements you discovered to recapture the good feeling of that resource when you need it. Directions: Think about one of your creative resources and describe it in the center circle. Then, take a moment to remember the last time you engaged that resource. For example, if your resource is enjoying nature, picture yourself in nature, smelling the smells, hearing the sounds, seeing the sights. Take your time remembering the resource until you can feel how you experience it in your body. Describe the resource in the center circle and your body’s responses in the outer circles. My Creative Resource Is: How does your arousal change? Is this resource energizing or calming? How does your breathing change? Do you take a deep breath? Does your breathing slow down or speed up? How does your tension change? Do areas of your body, such as your jaw or shoulders, let go? Do you feel more relaxed? Or do you feel more alert or stronger? Describe any impulses you have when you embody your resource. Do you want to smile, reach out, dance, open up, go for a walk, sit back and relax? How does your posture change? Do you sit up straighter, relax your posture, lift your chin? Pick one or two of your body’s responses to remember and practice daily. For example, if you took a deep breath and lengthened your spine, remember to practice this whenever you think of it. This will help you embody the good feelings of your creative resource and draw on it when you need it.

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Appreciating Your Strengths REPLACING SURVIVAL RESOURCES WITH CREATIVE RESOURCES Purpose: To explore replacing two survival resources that you no longer find helpful with two creative resources, and to identify how each kind of resource affects your body. Directions: Complete the following chart. 1. On the left side of each diagram below, describe a survival resource you commonly use and the situations in which you use it. Beneath each survival resource, describe how that resource affects your body—your sensations, movements, impulses, and posture. 2. On the right side of each diagram below, describe a creative resource that could replace the survival resource you described on the left. Beneath each creative resource, imagine how the creative resource would affect your body. Survival resource and situations in which I use it: Creative resource How it affects my body:

How it would affect my body

Survival resource and situations in which I use it: Creative resource How it affects my body:

How it would affect my body:

Work with your therapist to implement these creative resources in your daily life.

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Taking Inventory Categories of Resources THERAPISTS’ GUIDE TO CHAPTER 14

Purpose of this Chapter This chapter expands on the previous one by delineating various categories of resources: relational, somatic, emotional, intellectual, artistic, material, psychological, spiritual, and nature resources. Clients are encouraged to delineate their survival and creative resources associated with each category. The primary purpose of this chapter is to explore the abundance of different resources across multiple categories that are available to your clients, to help them recognize resources they currently use but may not realize are resources, and to further expand the tally of resources actually accessible to them. For each category, clients will identify both their internal resources or capacities within them, and their external resources that reside in their environment. By exploring a wide variety of categories, this chapter is designed to expand clients’ curiosity and discovery of the often (to them) novel idea that they might possess numerous internal, external, survival, and creative resources in several categories, rather than identifying themselves by the problems that brought them to therapy.

Clients Who Might Benefit Like the previous chapter, this one will be of special use to clients whose low selfesteem or negatively biased self-evaluation hinders progress in therapy and constrains their enjoyment of life. It will also be helpful for those who possess an abundance of resources but have little ability to connect to them or recognize their variety and richness. Clients with low self-esteem might learn that the lack of connection to their strengths and competencies fosters a negative view of themselves, and that validating and embodying resources in the different categories 307

can help. For clients who are missing resources in some categories but may have a number of identifiable resources in other categories, this material can teach them to deepen the resources already available, as well as spark ideas about filling out the categories in which resources are sparse, preparing them for the work of Chapter 20, “Developing Missing Resources.”

Suggestions for Clinical Use Asking clients to think more precisely about what a resource is and how many different categories of resources are potentially available to them broadens their view of themselves and their capacities. Through encouraging them to identify and embody resources in various categories, clients begin to learn which categories of resources are most useful to them. With some clients, it might be helpful to prompt their awareness of resources in each category by asking them questions such as: “Can you remember any times when you enjoyed doing something physical?”; “Do you ever enjoy beautiful scenery, art, or museums?”; “What were your favorite subjects in school?”; “What kinds of things do you love to do?”; “What do you do when you are feeling down?”; “Can you describe one of your closest relationships?” Some clients may recognize that they have resources in a variety of categories but minimize them. They may need your validation in order to validate these resources themselves. Others might be able to reconnect to resources they used in the past. Opportunities to help clients reclaim resources they previously used emerge when they say things like, “I used to love nature and love walking my dogs in the woods, but I do not do that anymore. Maybe I will start doing that again, because I do enjoy it.” Or “I don’t read as much as I used to.” In any case, discovering underacknowledged resources or reconnecting with those of the past can be an important step toward expanding clients’ resource repertoire. Occasionally, clients may interpret the material as an exercise in positivity or think that the focus on resources prevents them from getting to the “real” issues. These clients will need psychoeducation about how embodying resources in numerous categories can promote their specific therapeutic goals, such as regulating arousal, increasing self-esteem, or countering negative self-thoughts. Some clients can benefit by delving into their resistance to the categories. For example, one client remembered, with her therapist’s help, that her mother had told her that she should always be modest, never brag, and never think that she was good at anything because she could always improve beyond her current level. For this client, it was helpful to realize that her own reluctance to acknowledge her numerous resources had been developed as a survival resource necessary to win her mother’s acceptance. Afterwards, the client and her therapist read the chapter 308

together and were able to identify an abundance of creative resources in a variety of categories.

Introduction to the Worksheets The three-page worksheet on INTERNAL & EXTERNAL RESOURCES is a good starting point for most clients because it asks them to think about and describe internal and external resources they possess in each category. You can support them if they have questions about the categories by reviewing the examples in the chapter, identifying their resources in each category on the worksheet together during a session. Clients with seemingly few resources will need your help to recognize some in each category. For example, you might identify a pet or yourself as an external relational resource. An ability to trust a few people just a little, to ask for help, or even to come to therapy all can be identified as internal resources. CATEGORIES OF RESOURCES provides further expansion and clarification by helping clients classify their survival resources into the appropriate category and identify creative resources to use instead. Expanding on the previous chapter, the worksheet EMBODYING A RESOURCE asks clients to choose a creative resource and explore how embodying it affects their building blocks, especially the body. You might go over this worksheet together in therapy because your support and direction is likely to be needed for clients to connect to the physical and emotional elements of the resource and what it means to them. For example, it might not be obvious to your clients that a spiritual resource (e.g., prayer), an intellectual resource (e.g., the enjoyment of reading), or an artistic resource (e.g., going to a gallery) would have an effect on the body—until you help them to notice what happens in their bodies when they focus on remembering a moment of prayer, quiet reading, or looking at art. HAVING A BAD DAY? is meant to help clients integrate their newly realized resources by intentionally choosing to embody them in order to alter the autonomic, somatic, and emotional components that create the feeling of “having a bad day.” The therapist’s role here is to help clients connect somatically to the resources identified and then invite them to practice accessing the resources again and again. Remembering that repetition coalesced clients’ old procedural learning and repetition is necessary for new procedural learning will help dispel any feeling that you are simply repeating yourself as you encourage your client to practice their resources.

Adapting this Material for Dissociative Clients 309

Dissociative clients often find it challenging to identify and embody resources in various categories because they tend to be fixed in their patterns and avoidant of change. Identifying internal and external resources in each category that are useful to all parts can be demanding and frustrating. Categories that are regulating to one part may dysregulating to another, and those accessible to particular dissociative parts will not be accessible to others. It may be necessary to differentiate parts with various resources in different categories from parts that resist believing that the client has any resources at all or from parts overwhelmed by fear, rage, shame, and self-loathing. You may need to begin by simply asking these clients to engage all parts in a dialogue about each potential category of resource. For example, you might ask: “Have some parts of you ever found it helpful to talk with others, or to write or draw or listen to music to feel better?”;“Are there some parts that prefer doing things with your body (e.g., running) and others that prefer doing things with your mind?”; “Is there any part of you that finds comfort in something beautiful, enjoyment of nature, or in taking care of others or learning something new?” If the client is currently unable to pursue interests or activities that were once resources in various categories, your questions can refer to what the client used to do in the past. However, this may lead to grief for what has been lost. But if possible, you can explore together what makes it difficult to use the resource in his or her current life. If judgmental or self-doubting parts interfere with an exploration of the different categories of resources, you might first elicit the client’s curiosity about which part might have trouble believing that resources are available or even might not want the client to have them, by asking questions such as, “What belief does that part have about this category of resource?” or “Why might that part believe it is important not to use this category?” If you familiarize yourself with all these different categories, it will be easier to notice and then bring your clients’ attention to the categories available to certain parts, or to identify those internal and external resources in the categories that are being drawn upon unconsciously. You can weave the work of this chapter into the moment-by-moment work of therapy. For example, if the client is a parent, you can ask him to draw upon his resources as a father to support or regulate a young part of himself. If the client has a spiritual life or a love of animals or creative ability, you can spontaneously integrate those into therapy: “When you think about your Buddhist belief of acceptance, what happens to that part of you that is ashamed?” Further work can be done eventually to encourage all parts work together to resolve the conflicts and protective behaviors that prevent use of resources in each category, and then restore access to them.

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CHAPTER 14 Taking Inventory: Categories of Resources During childhood, with care and encouragement from our families, we acquire a personal repertoire of internal capabilities that support our development. These internal resources include a variety of capacities, such as the ability to recognize our own needs, ask for support, enjoy ourselves, and so on. We also draw on external resources, people, organizations, and things from the environment for safety, support, and learning. Building on the previous chapter, this one is designed to help you further identify resources you already possess, some of which you may not have realized you have. Your awareness of the diversity and number of resources you already have at your disposal will be expanded. Exploring both internal (within you, part of who you are) and external (outside of you, part of your environment) resources and grouping them into several different categories will help you develop, classify and refine your personal inventory of resources.

Internal and External Resources Internal resources refer to capacities, developed over time, that reside within us. The ability to reflect on our behavior, talk easily with others, set boundaries, experience body sensations, nurture our intellectual development, form a spiritual connection, be creative, and articulate feelings are all internal resources. External resources reside outside us, in the environment, and include: organizations (e.g.: associations, teams, schools, clubs, extracurricular activities); religious institutions (e.g.: churches, mosques, synagogues, temples, sangha meditation groups); health resources (e.g.: medical centers, doctors, health clinics), social resources (e.g.: friends, family); and material resources (e.g.: financial support or a place to live). Both internal and external resources help us feel safer, stronger, more competent, creative, peaceful, or lighter in spirit. They work hand in hand so that gains in one of them will bring about expansion in the other. Our ability to utilize external resources stems from internal resources. A strong support system grows from the inner ability to give and receive support; accessing services requires knowing we deserve them. Jane was prone to depression and isolating herself. She used her resources one Sunday morning to help her feel better after she woke up feeling despondent and alone. For a while, she curled up in bed, snuggling into the warm covers around 312

her, and listened to her favorite classical music, all of which helped her feel safe but not less alone. Eventually, she decided to call a friend and invite her for a walk. They drove together to a beautiful lake, and the movement of walking with her friend made Jane feel more alive and less depressed. She began orienting toward the beautiful scenery and to enjoy the smell of autumn in the air, the vibrant colors of the trees and the cool breeze on her cheeks. She confided in her friend that she sometimes felt depressed and alone in the world, and she was comforted by her friend’s empathic response. Jane and her friend discussed how both used to go to church as children and how walking in such a beautiful place induced a feeling of reverence and spiritual connection. They talked of their shared love of dance and discussed enrolling in a beginning jazz dance class together. Jane suggested that they find a performance of a local dance troop that they could attend together. At the conclusion of their outing, Jane noticed that she felt energized rather than fatigued by the long walk. Her breathing was not as shallow as it had been, she felt less depressed, and was able to formulate a plan for the rest of her day, which included renting a documentary on the history of jazz dance. Jane’s ability to recognize and call on her resources contributed to a more enjoyable and uplifting Sunday. She realized that she had a choice: She could think about all the things that bothered her: winter, her least favorite season, was about to arrive; she was middle-aged and not in very good shape, so she would not be able to dance as she did when she was young; her friend rarely took time away from her family to spend time with her; her husband had left her for another woman and now she lived alone. These were a few of the negative thoughts that normally drew her attention. But if she focused on her resources, her mood lifted, and the things that normally bothered her became easier to accept. Notice that Jane utilized many internal resources: the ability to reach out to her friend, the skills of driving and knowing where she was going, appreciation of nature, communication skills, love of dance, the capacities to walk, and breathe deeply. She also drew on a number of external resources: her cozy bed and her music, her friend, the telephone, the lake, nature, dance classes, her car, and warm clothes, to name a few. Jane used internal and external resources from a variety of “categories” of resources, noted in the classifications on the following page. When we are aware of the many categories from which we can and do draw resources, our resource inventory begins to expand almost immediately. Note that the examples provided for internal and external resources in each category are but a few of many more possibilities, so you can add to the examples. To validate and deepen resources in each of these categories, we can first identify the ones that we have intact, consciously draw on them, and then deepen a bodily felt sense of how these resources help us. They may regulate our arousal, shift our mood, open up new possibilities, or otherwise contribute to our well313

being. One way to do this is by focusing on the resources available in the here-andnow moment, as Jane did on that Sunday. Focusing here and now (see Chapter 7, “Pay Attention: The Orienting Response”) often means putting aside the thoughts and feelings that might be unpleasant and instead orienting toward whatever can be enjoyed around us. For Jane, that meant feeling the warmth of her bed, the sensation of the sheets and blankets around her body and listening to the sound of music. Then, later on, she was able to shift her focus from feeling depressed to the experience of walking side by side with her friend and looking around to appreciate the bright fall foliage and feeling the air on her face. Table 14.1. Categories of Internal and External Resources (with examples)

Relational Internal: Sense of valuing and deserving friendships and family, general belief that others can be supportive, the ability to reach out to others and to set healthy boundaries, communication skills, ability to give and receive emotional support, a connection with pets External: Close friends or family, a primary relationship, support groups of all kinds, group activities, colleagues, different kinds and ages of friends and acquaintances, such as kids, elderly people, activity partners or pets Somatic Internal: Good health, ability to connect with the body and its sensation, feeling grounded through the legs, deep breathing, good posture, supple, toned muscles, enjoyment of sexuality or sensual activities, the senses, capacities such as walking, running, dancing, ability to regulate arousal, flexibility External: Health clubs, gyms, studios, classes in yoga, dance, Pilates, aerobics, martial arts; sports; running trails, bike paths, ski slopes, skateboard parks, tennis courts; equipment such as bicycles, roller blades, skateboards; rocking chairs; health practitioners such as doctors, chiropractors, naturopaths, herbalogists, osteopaths, body workers, movement teachers, massage therapists; warm baths and things that are pleasing to the senses (candles, scents, soft textures, colors, tastes) Emotional Internal: Having access to a full range of positive high-arousal emotions (joy, elation, passion) and low-arousal emotions (tenderness, tranquility, contentment), ability to tolerate emotions 314

such as anger and sadness, not being stuck in or “run” by one’s emotions, ability to express and communicate emotions, appropriately regulate emotions effectively and utilize emotions to guide action External: Friends, family, and pets with whom to give and receive emotional support, circumstances and people that elicit richness of emotions, people with whom to share the emotional highs and lows of your life; activities, people, or pets to inspire high-arousal emotions such as joy, passion, and elation and low-arousal emotions such as peace, comfort, and tenderness Intellectual Internal: Creative thinking, capacity to “think things through,” problem-solving ability, intellectual clarity, the ability to selfstimulate cognitively, interest in developing the mind, ability to read and take pleasure in learning and figuring things out External: Schools, classes, colleges, universities, libraries, study groups, workbooks, public television, public radio, documentaries, crossword puzzles, Sudoku, brain games, computer courses, books, language courses, books on tape, cognitive training therapy Artistic/Creative Internal: Ability to access the creative process within oneself through music, dance, poetry, writing, sculpture, visual arts, design, sewing, cooking, acting, crafts, interior decorating, landscaping, building, or any other creative endeavor External: Having people to share creative activity with; artistic material and equipment such as: paints, musical instruments; CD player; access to music/dance lessons; writing classes or groups, museums, performances, art shows, theater, movies; cooking classes; special-interest groups; computer; and pen and paper Material Internal: The ability to earn an income, create financial security; the capacity to enjoy material things, such as a cozy chair, a great car, a lovely home, or objects that enhance one’s pleasure in life External: Having a job, a home, utilities, transportation; tools and labor-saving devices of all kinds, from kitchen appliances to washing machines; a comfortable bed, and items such as bicycles, pianos, running shoes, telephones, computers, or art supplies that support other categories 315

Psychological Internal: Strong sense of self, sense of competency, good self esteem, feeling safe in the world, ability to notice one’s experience, sense of being OK, nonjudgmental self-awareness, ability to reflect on one’s behavior, emotions, or thoughts External: Having access to a therapist, self-help books, workbooks; ability to take advantage of what’s offered in the community such as therapy groups, support groups, or workshops Spiritual Internal: Ability to connect to God, the Buddha, Allah, spiritual guides, or to any form of deity, gods or goddesses, spiritual teachers, spiritual energy or faith; prayer, the capacity to experience reverence or sense one’s own essential or spiritual nature External: Meditation instruction; participation in a spiritual community, such as church, synagogue, temple, sangha, mosque, or meditation center; or other activities with a spiritual element, such as family prayer, Shabbat, or group sharing and ceremonies, spiritual poetry or readings; access to spiritual teachers Nature Internal: Ability to connect to and appreciate the sounds, sights, and smells in nature, enjoy activities in natural settings, create gardens or nurture houseplants, use senses to enjoy nature, appreciate the seasons External: Gardens, lakes, mountains, nature walks or drives, access to trails, beautiful scenery, the ocean, sunsets and sunrises, the moon, rocks, flowers, butterflies, birds, wild animals, or anything else in nature that you find nourishing Another way to deepen our connection to our resources is to repeatedly practice remembering those moments when a resource was most useful or vivid. Jane drew on the memory of walking with her friend, reexperiencing the images, smells, sounds, sights, and good feelings she felt emotionally and in her body. She recalled the beautiful view of the lake and the feel of the crisp autumn breeze on her cheeks. She especially enjoyed remembering the warmth and relaxation that came over her as she confided that she sometimes felt depressed and her friend listened receptively, with compassion. She could visualize her friend’s empathic expression, hear the comforting cadence of her friend’s voice that helped her feel less alone and more hopeful, and sense the relaxation in her body and the deepening 316

of her breath. When Jane mindfully noticed her building blocks as she remembered the walk, she had the thought, “I’m going to be OK.” Deepening and embodying the memory of these moments helped Jane challenge both her negative belief (“I’m not going to be OK.”) and the low arousal that characterized her depression. As she remembered how that walk felt, emotionally and physically, she had more energy and her depression lifted a bit. Each time she deliberately recalled each piece of the memory, she increased her capacity for experiencing herself as a competent, regulated person rather than as someone in a chronic state of distress and low arousal. The following worksheets will help you identify your internal and external resources in each category, and then begin to discover what happens in your body, thoughts, and emotions when you validate, enhance, and embody these resources that you already possess.

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Taking Inventory: Categories of Resources INTERNAL & EXTERNAL CREATIVE RESOURCES, P ART 1 Purpose: To identify internal and external creative resources within a variety of categories. Directions: For each category below, describe the internal creative resources you have within you and how they affect your body, and the external creative resources that reside in your environment and how they affect your body. Refer to the examples in this chapter for suggestions of internal and external resources in each category.

Relational

Somatic

Emotional

Internal Relational Resources:

How they affect your body:

External Relational Resources:

How they affect your body:

Internal Somatic Resources:

How they affect your body:

External Somatic Resources:

How they affect your body:

Internal Emotional Resources:

How they affect your body:

External Emotional Resources:

How they affect your body:

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Taking Inventory: Categories of Resources INTERNAL & EXTERNAL CREATIVE RESOURCES, P ART 2 Purpose: To identify internal and external creative resources within a variety of categories. Directions: For each category below, describe the internal creative resources you have within you and how they affect your body, and the external creative resources that reside in your environment and how they affect your body. Refer to the examples in this chapter for suggestions of internal and external resources in each category.

Intellectual

Artistic

Material

Internal Intellectual Resources:

How they affect your body:

External Intellectual Resources:

How they affect your body:

Internal Artistic Resources:

How they affect your body:

External Artistic Resources:

How they affect your body:

Internal Material Resources:

How they affect your body:

External Material Resources:

How they affect your body:

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Inventory: Categories of Resources INTERNAL & EXTERNAL CREATIVE RESOURCES, P ART 3 Purpose: To identify internal and external creative resources within a variety of categories. Directions: For each category below, describe the internal creative resources you have within you and how they affect your body, and the external creative resources that reside in your environment and how they affect your body. Refer to the examples in this chapter for suggestions of internal and external resources in each category.

Psychological Internal Psychological Resources:

Spiritual

Nature

How they affect your body:

External Psychological Resources:

How they affect your body:

Internal Spiritual Resources:

How they affect your body:

External Spiritual Resources:

How they affect your body:

Internal Nature Resources:

How they affect your body:

External Nature Resources:

How they affect your body:

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Taking Inventory: Categories of Resources CATEGORIES OF RESOURCES, P ART 1 Purpose: To further identify survival resources in each category and to explore the creative resources you could use instead. Directions: Complete the prompts below using your responses from the worksheets, RECOGNIZING YOUR SURVIVAL RESOURCES, in Chapter 13, and INTERNAL & EXTERNAL CREATIVE RESOURCES in this chapter. 1. Review the survival resources you identified in RECOGNIZING YOUR SURVIVAL RESOURCES. Write each survival resource in the appropriate category on this two-part worksheet. 2. Review the creative resources you have that you identified in INTERNAL & EXTERNAL CREATIVE RESOURCES. For each category, choose and write down one creative resource that you could use instead of the survival resource you identified. Emotional Survival

Creative Resource to Use Instead Somatic

Survival

Creative Resource to Use Instead Relational

Survival

Creative Resource to Use Instead Artistic

Survival

Creative Resource to Use Instead Psychological

Survival

Creative Resource to Use Instead Nature

Survival

Creative Resource to Use Instead 325

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Taking Inventory: Categories of Resources CATEGORIES OF RESOURCES, P ART 2 Purpose: To further identify survival resources in each category and to explore the creative resources you could use instead. Directions: Complete the prompts below using your responses from the worksheets, RECOGNIZING YOUR SURVIVAL RESOURCES, in Chapter 13, and INTERNAL & EXTERNAL CREATIVE RESOURCES in this chapter. 1. Review the survival resources you identified in RECOGNIZING YOUR SURVIVAL RESOURCES. Write each survival resource in the appropriate category on this two-part worksheet. 2. Review the creative resources you have that you identified in INTERNAL & EXTERNAL CREATIVE RESOURCES. For each category, choose and write down one creative resource that you could use instead of the survival resource you identified. Emotional Survival

Creative Resource to Use Instead Somatic

Survival

Creative Resource to Use Instead Relational

Survival

Creative Resource to Use Instead

3. Practice using your creative resources whenever you feel the impulse to use a survival resource. Record your successes and challenges below. Successes:

Challenges:

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Return to parts 1 and 2 of this worksheet often and continue to explore exchanging your survival resources for creative ones. Discuss your successes and challenges with your therapist.

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Taking Inventory: Categories of Resources EMBODYING A RESOURCE Purpose: To remember a time when you used a creative resource, re-experience how it changes your building blocks, and reflect on its meaning. Directions: Think about a creative resource you possess that you would like to use more often (e.g., maybe you’re a great cook, or can fix things around the house, or are good with kids). Remember a time when you used the resource. Then follow the prompts below. 1. Describe your creative resource.

2. Remember a time when you engaged this resource, and focus on the images, sounds, tactile stimulation, smells and tastes in the memory that stand out. Describe below. Images/Sights Sounds Touch Smells/Tastes

3. How does your arousal change as you remember? Does it go up (more energized, excited, enthusiastic) or down (calmer, tender, content)? 4. Notice all the changes in your body as you remember. Describe what you notice below. Changes in posture: Changes in your facial expression: Changes in tension: Impulses to move: 5. Mark the diagram where you notice changes in your sensations when you 331

remember this resource and then make a note describing the sensation.

6. What thoughts do you notice when you connect to the resource? 7. What feelings and emotions do you notice? 8. Reflect on the meaning of the resource: what does your experience of engaging this resource tell you about yourself, others, or the world? (e.g., That I can relax; my world is safe now; others want to be with me; I don’t have to work so hard.)

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Taking Inventory: Categories of Resources HAVING A B AD DAY? Purpose: To determine resources you have available to you when you’re having a bad day in order to interrupt the negative cycle of beliefs, judgments, emotions, body sensations, and body movements that can often prolong or intensify a bad day. Directions: Complete this worksheet when you are having a bad day, following the prompts below. 1. Describe one or two things that happened that make it a bad day, and write down your feelings.

2. As you think about the things that make it a bad day, what beliefs or judgments about yourself, others, or the world come up?

3. Describe your sensations (e.g., heavy, numb, agitated, tense), movements (e.g., rapid heart rate, shoulders lifting up, head turning down, brow furrowing), posture (e.g., slumped, rigid, collapsed) and breathing (shallow or held).

4. Think about the internal and external resources you have in different categories that could help you feel better today. Write them down below. Somatic

Psychological

Material

Emotional

Artistic/Creative

Relational

Intellectual

Spiritual

Nature

Internal: External:

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5. Right now, try one of the resources you listed in #4. Write down how this resource affects you below. Thoughts

Emotions

Body Movements and Sensations

6. Remember to practice the resources you identified in #4 whenever you are having a bad day, and notice how doing so changes your experience.

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Somatic Resources THERAPISTS’ GUIDE TO CHAPTER 15

Purpose of this Chapter With sufficient attunement and care, children develop a physically felt sense of competency and well-being that is evident in the way they unconsciously use their bodies to regulate arousal, stay centered, and engage with the world. When early environments have not been adequate, these natural physical capacities, or “somatic resources,” are absent or distorted. Even in good environments, over time posture and movements are adapted to the demands of attachment figures, school, and so forth, restricting maximal somatic resources. The purpose of this chapter is to acknowledge more precisely the somatic resources clients have intact and can use. By identifying and deepening the physical resources available and by continuing to embody positive experiences, more opportunity are provided to anchor positive states in the body. Clients will also learn and practice internal somatic resources of centering, containment, and movement, as well as explore external somatic resources, such as manipulating visual, auditory, and tactile stimulation in ways to regulate arousal and emotions.

Clients Who Might Benefit All clients interested in this book will benefit from this chapter because it is designed to deepen their connection to their bodies. Clients who need help with the Phase 1 challenges of self-soothing, modulating emotions and cognitions, regulating arousal, and stabilizing symptoms will find this material useful. Those who have distorted views of the ability of their bodies to support them will benefit by recognizing the ways their bodies already do support them, even without their conscious intent or effort. Clients who believe themselves to be incapable of somatic resources may discover that they are already spontaneously using physical capacities and actions that help them in some way. Those who feel overwhelmed or 336

understimulated by sensory input might benefit from following the chapter’s suggestions to identify which types of sensory stimulation could be reduced or increased to promote well-being. Those who are uncontained or emotionally volatile might enjoy learning containment resources or making greater use of external somatic resources such as warm baths. Clients who are easily thrown “off center,” who are workaholics, who “overdo” or fail to listen to their inner needs can benefit from the centering resources described in this chapter. Those who have difficulties in relationships, particularly, inability to self-regulate during disagreements, can explore a variety of somatic resources that can be utilized in heated moments. Clients who take their work home with them and are unable to relax after the workday might learn resources that help them achieve calm states. Clients who enjoy and take pride in physical activities (e.g., yoga, running, dancing, hiking, working out) may find it helpful to recognize these activities as external somatic resources that they naturally use and then focus on more deeply embodying them.

Suggestions for Clinical Use Somatic resources are not static, but are dynamically changing in response to environmental opportunities or demands and one’s internal state. As Bainbridge Cohen (2011) asserts, “All somatic resources are . . . a continual dialogue between awareness and action—becoming aware of the relationships that exist throughout our body/mind and acting from that awareness.” With practice, the capacity to draw upon the relationship of body and mind to achieve competency and well-being will increase and gradually become automatic. The chapter starts with discovering and practicing spontaneous physical actions that clients use unconsciously to regulate themselves, which can further pique their interest in the inherent intelligence of the body and foster confidence in the dialogue between mind and body. The skills of orienting to new stimuli, leaned in Chapter 6, “Pay Attention: The Orienting Response,” and focusing the senses, learned in Chapter 7, “Mindfulness of the Present Moment,” can be revisited and integrated with this chapter’s focus because both these are also somatic resources. Opportunities for exploring somatic resources will emerge as you track your clients during the therapy hour for the ways in which they spontaneously resource themselves with physical action when they are facing challenging situations or dysregulated arousal. For example, if a client is rocking (a somatic resource) You might say something like this: “You might think that you don’t know what to do with all these painful feelings, but notice your movement. You started rocking back and forth, and everything just relaxed and it looks like your feel better now.” You can 337

also track and bring to clients’ attention the changes in the body when they report a positive experience by saying, for example, “When you talked about doing so well on that exam, you took a deep breath, and your chest opened!” Once you have brought the resource to the attention of your clients, you can invite them to engage it voluntarily (e.g. to take another deep breath), mindfully noticing the effect of the somatic resource on their building blocks. Clients’ appreciation of their somatic resources will increase as you help them identify the function of each resource and how it helps them (e.g., regulates arousal, gets them out of the house, supports relationships) or what it tells them about themselves (e.g., that they are OK, connected, strong, capable, or just “alive”). However, some clients who are averse to feeling “good” or to self-care may need you to emphasize that the purpose of these somatic resources is to regulate the nervous system and increase well-being; they are not self-indulgent. As your clients practice their own somatic resources or try out new ones that are suggested in this chapter, you can increase their comfort level and receptivity to the resources by demonstrating or “mirroring” the same movements and reporting on your experience. For example, you may say, “Let’s try this together and see what it’s like. When I place my hands over my heart, I get a feeling of relaxation in my chest, and I can feel my whole body relax—it is a calming feeling. What happens when you do this?” As Gallese and Goldman (1998) write, “Every time we are looking at someone performing an action, the same motor circuits that are recruited when we ourselves perform that action are concurrently activated” (p. 495). If you are able to embody being proud or strong by lifting the chin or lengthening the spine, your client’s body will most often respond in kind. In addition, mirror neuron research seems to confirm that imagining a past or future intentional action also activates the body’s premotor neurons as if the person were preparing to make that same action (Gallese & Goldman 1998). Even if the client is certain that he or she cannot possess a particular capability, seeing it in someone else, visualizing it, or imagining how it would feel in the body may provide support for developing that very resource.

Introduction to the Worksheets The first worksheet for this chapter, INTERNAL SOMATIC RESOURCES, should pique your clients’ curiosity and interest in the somatic resources they already use, notice the circumstances that prompted the use of the resource, and also note the effect of using it. This initial worksheet describes several common internal somatic resources that clients might recognize as ones they use, and invites them to notice others they might find themselves using during the week. It can increase clients’ understanding if you go through these somatic resources with them, try them out 338

together in session, and share your experiences with them. Similarly, the EXTERNAL SOMATIC RESOURCES worksheet offers a menu to spark your clients’ recognition of their own external resources and help them recognize otherwise overlooked ones they already use. As you review this worksheet in session, you might prompt clients by providing some examples, for instance: “Some people take warm baths, go for a run, snuggle under a warm blanket, make a cup of hot chocolate, do yoga, and so on. I wonder what physical or sensory things you do when you feel stressed or anxious, or to just enjoy yourself.” This worksheet also asks clients to determine whether a resource had an energizing or calming effect. Or, the same resource might have different effects at different times, depending on the context. Several worksheets teach specific resourcing actions to accomplish particular goals that are described and illustrated in the chapter. It may be helpful for you and your client to review together the sections in the chapter that are relevant to the resources taught in a worksheet. The one entitled CENTERING: HAND ON HEART/HAND ON BELLY provides a concrete, structured way of trying out a somatic resource for regulating arousal and feeling more centered and connected to oneself. CONNECTING WITH THE BACK OF THE BODY describes a set of concrete, physical actions that help clients sense their backs, which often decreases feelings of vulnerability and provides a felt sense of protection. Since so many of our clients felt unprotected as children and still suffer from feelings of vulnerability, this resource may be particularly valuable to them. It can be helpful to explore the resources on these two worksheets in session, emphasizing the effect of using a particular resource on the building blocks. When your client finds one that is most resourcing, you can discuss together situations in which it could be most useful. Clients who struggle with how to contain their thoughts, emotions, or impulsive actions will benefit from the CONTAINMENT RESOURCES worksheet. Containment is akin to Winnicott’s (1945) concept of the “holding environment” in which the mother literally swaddles or holds her infant’s body. Without such containment, an infant has no one to “gather his bits together [and] starts with a handicap in his own self-integrating task” (Winnicott, 1945, p. 150). Containment resources can help clients tolerate the physical sensations of their thoughts, emotions or physiological arousal without behavioral reactivity. Steele and van der Hart (2001) caution that emotional discharge can exacerbate traumatized clients’ difficulties and this worksheet can help these clients learn to contain rather than discharge their emotions (cf. Chapter 2 “Emotions and Animal Defense”). It describes, encourages clients to try out, different containment exercises. Your reminder to repeat those that are most effective between sessions will support them in making use of the resource in their daily lives. The worksheet on ADJUSTING SENSORY STIMULATION gives clients a 339

detailed and concrete way to explore a “sensory diet”—a plan for reducing or increasing various what sensory stimuli can be reduced or increased to help them feel soothed or energized: for example, soft or enlivening music, earplugs, darkened room or bright sunlight (Lande, personal communication, June 11, 2003; Wilbarger & Wilbarger, 2002). Suggestions are offered for all five senses (taste, sound, touch, hearing, and sight) so that clients can experiment with the potential benefits of different kinds of sensory stimuli.

Adapting this Material for Dissociative Clients Because their neuroception is biased to detect threat, dissociative clients have great trouble feeling physically safe, soothed, or regulated. Although clients with dissociative disorders are most in need of somatic resources, exploring them can be triggering, especially for those parts that are fixed in animal defense or who are phobic of self-care or of the body. The invitation to explore somatic resources can prompt internal struggles between different parts with deeply divided points of view. Some parts might interpret terms such as centering, containment, or selfsoothing as indicating “I still have to take care of myself!” leading to the lament, “Why doesn’t someone else soothe or contain me? I shouldn’t have to do it myself!” Other parts might protest that “I don’t deserve to feel centered” or “It’s dangerous to feel soothed; something bad will happen next.” Some parts might be confused: “What do you mean by centering?” Still others might react with anger or disgust: “I don’t need to center myself—I’m fine! Only wimps need that baby stuff.” Given that these terms and concepts are potentially loaded for these clients, you might instead talk about somatic resources for regulation or for helping with overwhelming feelings. The expressed need for relief from both hyper- and hypoarousal may be a helpful motivator for dysregulated clients to begin to experiment with discovering what movements or actions help shift states of activation closer to the window of tolerance. If clients become more hyper- or hypoaroused by this material, it can be an opportunity to express curiosity about the triggers or beliefs that make somatic resources threatening rather than regulating. You might ask questions that help them discover the building blocks that comprise their reactions, such as: “What happens when we just talk about finding a resource in your body that would help you with the numbing/feeling overwhelmed? Do you notice more curiosity or tensing and pulling back, or perhaps something else? What belief goes with that tensing or sensation? That it’s not safe to have resources? Or frightening to try something new? Or something else?” As always with this population, exploring how different parts react to an intervention or concept (in this case, the intervention or concept of somatic 340

resources) can facilitate compassionate understanding and help various parts begin to communicate and work together more effectively. Perhaps a somatic resource can be found that is acceptable to many dissociative parts, or parts that have one resource that is effective may be open to sharing it with other parts, and discover those parts that might also become more open to receiving it.

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CHAPTER 15 Somatic Resources Somatic resources reside within the body. They are the physical functions, actions, and capacities that provide a sense of well-being and competency on a physical level and in turn positively affect how we feel. Literally thousands of somatic resources exist, from basic physiological functions (e.g., digestion, blood flow) to sensory capacities (e.g., the ability to see, hear, smell, touch, and taste) to movement capacities (e.g., the ability to walk, reach, run, push away) to selfregulatory abilities (e.g., grounding or centering) to creative physical activities (e.g., dancing or playing a sport). Since the movement of our bodies is inextricably linked with our emotions, beliefs, and general sense of competency, working with posture, movement, gesture and our senses can directly support our well-being. You have already practiced two skills that are considered somatic resources: orienting to new stimuli, in Chapter 6, “Pay Attention: The Orienting Response,” and focusing your senses in Chapter 7, “Mindfulness of the Present Moment.” This chapter expands on these somatic resources and the ones introduced as a category in the last chapter by describing several physical actions and external sensory and physical activities that you can try out to discover which ones are helpful for you. We will explore in detail somatic resources of grounding, alignment, breathing, and boundaries in chapters to come. Somatic resources are highly individual and should be tailored specifically to your body, according to your unique needs and goals at a particular moment in time. What is resourcing for one person may be de-resourcing for another. For example, one person felt better when she was still; another felt better when she was moving. In the first case, somatic resources could include sitting still and enjoying that feeling of motionlessness, or perhaps curling up in a fetal position to feel safe and comforted. In the second case, somatic resources could include exploring some kind of movement, such as walking, dancing, or a sport that felt good. By experimenting with a variety or specific physical postures, movements, gestures, and activities, you will discover which ones feel right for you. The barometers to use for evaluating the efficacy of any somatic resource are noticing how it affects your building blocks when you are using it. If a physical action or activity helps to bring dysregulated arousal within the window of tolerance or helps you feel good in some way, then it is resourcing. If it does not, it is not resourcing for you at that time, and that is OK, because another action or activity will be. It just takes experimentation to discover the somatic resources that work 343

best for you.

Discovering Somatic Resources You Already Use You have already explored orienting and focusing your senses, but there are many other somatic resources you can call upon that you have used throughout your life. As children, everyone unconsciously develops somatic resources. A little girl rocks from foot to foot rather than seeking out her mother for comfort; a boy throws his ball up as high as he can and then focuses all his attention on catching it; another child rubs her feet together when she’s asked a question by the teacher. You may not recognize such actions as somatic resources, but they in fact serve a regulatory purpose: The little girl comforts herself to avoid rejection; the boy’s nervous system regulates as he focuses on the ball; rubbing her feet together decreases the anxiety of the school-age child triggered when her teacher asks her a question. As adults, we also intuitively use physical actions and engage in physical activities that are calming or energizing, such as rubbing an achy neck, stretching, or going for a walk. Usually these actions take place without the conscious awareness that they are, in fact, somatic resources. A good place to start to learn about your somatic resources is to become aware of those you already use—to find out which postures, movements, gestures, or activities feel good to you. You might pay more attention to how you spontaneously soothe or energize yourself with physical action or activities, without even thinking about it. Once you are aware of these natural somatic resources, you can better appreciate the intelligence of your body and how you already know intuitively how to self-soothe or energize from the bottom up. For example, Ann discovered a habit of hugging herself by wrapping her arms gently around her body and squeezing. Her anxiety calmed down, and she felt warmed and comforted when she hugged herself. As she explored this simple action, she was reminded of being with her aunt, to whom she was close as a child, and who often hugged her when she was upset. This motion helped Ann appreciate that, despite her difficult relationship with her parents, she had internalized the comforting feeling of being hugged by her aunt. Because Ann, like many of us, often felt that she had little control over how she felt, a benefit of this awareness was realizing that she could often transform feeling anxious into feeling calm by simply hugging herself. She decided to consciously hug herself whenever she felt anxious or needed soothing. In this way, a somatic resource that had helped her when it occurred without awareness could now become a conscious source of support available whenever she needed it. Below, three somatic resources—centering, containment, and movement—that we often use without thinking are described.

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CENTERING RESOURCES

Centering refers to regaining a sense of being connected with ourselves when we are distressed or “off center.” Being centered is dynamic—when we are thrown off balance by life’s challenges, we can reconnect with the “home” inside ourselves. Resources of all kinds facilitate centering. Somatic centering resources involve locating and sensing the physical center of gravity in the body about 4 inches below your waist. Your own self-touch can help you contact your center of gravity. Placing your hands on your lower belly and bringing your mindful awareness to your hands touching your belly is a centering resource. Some people find that other ways of using touch are more centering for them. A war veteran found that placing one hand over his heart and the other on his lower belly worked best for him. A woman who felt unloved in childhood by her self-absorbed parents felt more centered when she placed both hands over her heart. Others find that one hand over the heart and the other on the belly works best. Using a pillow can be especially helpful for people with trauma in their histories who become dysregulated using their own touch. It may be more resourcing to hold a pillow against your lower belly, or your heart, or both. CONTAINMENT RESOURCES

Our bodies are our containers. They hold everything we experience—all our emotions, thoughts, sensations, memories, plans, and so on. Containment resources help us sense the actual physical container of our bodies, especially the skin and superficial muscles. Containment resources work in two ways. They allow us to contain feelings and arousal, helping us to regulate before expressing ourselves to ensure that what we express is not explosive or dysregulating for us. Containment also allows us to decide how much or how little to express of what we feel, automatically adjusting our expression according to the responses of those around us and our internal state. We know that babies often calm down when they are swaddled firmly in a blanket, and many of us seek a similar feeling of containment by hugging ourselves, like Ann did, or wrapping ourselves up in a blanket. Jim, who often felt uneasy in groups, as if he were “floating away,” discovered a containment resource that gave him a feeling comparable to wrapping up in a blanket. He noticed that he had spontaneously tightened his muscles when he was in groups. The tension literally hardened his superficial muscles, giving him a feeling of being more compact and less permeable. He felt that he could both “keep things out” and “keep things in.” Practicing this resource consciously made it easier for Jim to be in groups. Awareness of the back of the body can also provide a sense of containment and protection for the vulnerable front part of our bodies. Jim’s therapist taught him to press the back of his body into the back of his chair to lessen the floating away feeling when he was in groups. Another person described that awareness of her 345

back helped her slow down, sense herself, and change her pattern of overdoing. Lonnie learned a different containment resource. In a seated position, with her feet flat on the floor, she crossed her arms and placed each palm on the inside of the opposite knee. The she pressed her knees hard, pushing inward against the palms of her hands, while pushing outward with her hands. She felt her muscles tighten throughout her body, giving her a feeling of being “solid and in control.” MOVEMENT RESOURCES

Many people respond best to somatic resources that involve movement. A survivor of sexual abuse discovered that stroking her own cheek comforted her; another found herself rubbing the tops of her thighs with her hands, which helped her feel soothed. One woman discovered that pacing back and forth when she was overwhelmed helped her body to become calm. Being rocked is comforting to infants and children, and we may continue to use rocking as a resource into adulthood. One man noticed that he calmed himself down by rocking side to side when he felt upset; another used her rocking chair, and yet another favored his porch swing. You might discover other movements that are somatic resources for you by noticing how you feel if you go for a walk, stretch your body in a way that feels good, swing, sway, fidget, dance, or move in some other way.

Positive Memories Lead to Somatic Resources As we have explored in previous chapters, somatic resources can be discovered by remembering times when you felt calm, competent, or good in some way and then mindfully noticing what happens in your body when you think about these experiences. For example, Ben had enjoyed playing soccer as a young adult, and as he remembered his prowess on the soccer field, his legs felt energized and strong, his spine straightened, and his breathing deepened slightly. This straightening of his spine and deeper breathing, as well as becoming mindful of the strength in his legs, became somatic anchors for feeling competent. Once he discovered them, he decided to practice these resources whenever he felt inadequate.

External Somatic Resources The somatic resources described so far in this chapter are all internal ones, but external somatic resources can also be explored—warm baths, massage, pleasant scents, sounds, favorite foods or textures of foods, invigorating or calming tactile stimulation such as the touch of soft fabric, and other physical activities. You can make a plan to reduce or increase particular types of sensory stimulation as a 346

somatic resource; for example, you might find it soothing to sit in a darkened room or wear earplugs to reduce auditory stimulation, or you might discover that listening to enlivening music lessens low arousal or increases your energy. Janet said she was a “worrier” whose anxiety often prevented her from going to sleep. She developed external somatic resources to use before bedtime. She turned off all the lights, lit candles, put on soothing cello music at low volume, and slowly stretched on her sheepskin rug, enjoying its texture. These relaxing sensory experiences quieted her nervous system so that she could fall asleep more easily. Ben enjoyed sensing the strength in his legs, but realized his arms felt weak and typically hung limply by his sides. He needed more active external resources to help him feel the strength in his arms. He liked to put a big therapy ball against the wall to push against or visit the gym where he did pull-ups and lifted weights. When he was in a public place where these external resources were not available, he often used the internal resource of pushing the palms of his hands together to feel his upper body strength. There are many other kinds of physical activities that can serve as external somatic resources: Sports, bike riding, skateboarding, swimming, dancing, yoga, walking, running, massage, petting your dog, cuddling a child, or working in the garden are just a few.

The Role of Practice Somatic resourcing begins with acknowledging the rich variety of somatic resources that you already use without thinking. You can discover your natural somatic resources by mindfully noticing your spontaneous resourcing actions and physical activities. When you discover a somatic resource that works for you, it can be helpful to exaggerate it and study it mindfully to sense the finer components, feelings, and effects of it. You can consciously practice these resources by repeating the action or activity, taking the time to enjoy the effects of these resources. You can also experiment with trying out other actions and activities, such as the ones described in this chapter. Once you find a resource that works for you, you can then use it at will when you need it. The more you use a new resource, the more automatic and resourcing it becomes. The worksheets that follow describe many internal and external somatic resources to explore so that you can discover the ones you already use and learn new ones that work for you, in order to begin building your own, personal somatic resource repertoire.

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Somatic Resources INTERNAL SOMATIC RESOURCES Purpose: To become aware of the internal somatic resources you already use that help you enjoy yourself, regulate your arousal, or feel good in some way. Directions: Read the list of internal somatic resources (i.e., postures, movements, or gestures) that you might use spontaneously below, and write in any additional somatic resources you use in the empty boxes. Hugging yourself

Curling up in a ball

Rocking side to side or front to back

Stretching your Massaging your arms, neck or other part neck, legs, or other area of the body

Twirling your Wrapping up in a hair, biting blanket your lip

Being still, not moving

Moving (jiggling your foot, walking, running, pacing, squirming)

Placing your hand on your heart Rubbing your temples or other part of the body Squeezing or rubbing your hands together

Throughout the next week be aware of whether you use any of these resources. In the chart below, write down the resources you used throughout the week, the circumstance and internal experience that led you to use them, and how each helped you. Internal Somatic Resource

Circumstance and internal experience that led you to use it

Effects of using the resource

Hugged myself and curled up in a ball.

My husband went on a business trip and left me alone for the weekend. I was missing him. My body felt heavy and hollow. I felt lonely.

I felt better, my breathing deepened, and I felt more in touch with myself. I still missed my husband, but I didn’t feel as sad.

Rubbed my temples.

I felt tense and stressed at work when I realized I might not meet my deadline. I felt upset and wasn’t able to focus.

I didn’t feel so agitated, and my arousal came down. I was able to focus a little better.

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At the end of the week, review the somatic resources you already use with your therapist. Together you can determine how to call upon these resources in moments when you need help to regulate your arousal, want to feel more energized or calmer, or just want to feel better.

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Somatic Resources EXTERNAL SOMATIC RESOURCES Purpose: To become aware of the external somatic resources that you already use, assess whether they are calming or energizing, determine their effectiveness, and identify additional resource you could use the future. Directions: Read the list of external somatic resources below, and notice which ones you use throughout the week. Add any others that you use in the empty spaces provided. Put a “↓” by the ones that comfort or calm you and a “↑” by the ones that energize you. You might notice that the same resource may have a different effect at different times. Review your list at the end of the week and answer the prompts at the bottom.

Key: ↓ = Calming Resource ↑ = Energizing Resource Walking or running

Going to the gym

Dancing

Skateboarding or roller blading

Taking a shower or bath

Petting or playing with a pet

Snuggling with your kids or Holding hands partner

Having sex

Using sensory stimuli (soft afghan, scents, tastes, colors) to calm or increase arousal

Playing group sports Skiing, sledding, (volleyball, basketball, snowboarding, ice skating, baseball, handball) or engaging in other winter activities

Feeling a breeze or the warmth of the sun on your skin

Swimming, building sand castles, or engaging in other summer activities

Relaxing on a cushy sofa or Enjoying a hot or cold hammock drink

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Getting a massage or other form of bodywork

Using a heating pad on shoulders

Floating in a pool

Playing with children

Bouncing on a therapy ball

Getting a pedicure or manicure

Biking

Breathing fresh air

Swinging, rocking in a rocking chair

Lifting weights

Doing yoga or stretching

Holding an object (a stone, a stuffed animal, squishy ball)

Getting your hair washed by a hairdresser

Boating, canoeing, kayaking, water skiing

Which ones were the most effective calming resources?

Which ones were the most effective energizing resources?

Which other resources could you begin using that you did not use during the week?

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Somatic Resources CENTERING: HAND ON HEART, HAND ON B ELLY Purpose: To explore the centering resource of placing your hands on your torso and be mindful of the effect of your hands touching your body. Directions: Follow the prompts to practice this somatic resource and then complete the chart.

1. Try placing one hand on your heart and one on your lower belly. Sense the weight of your hands on your torso, the coolness or warmth of your hands, the movement of your breath under your hands. Take your time to notice what happens in your body as you place your two hands over your heart and belly. 2. Mindfully experiment with other hand positions on your torso to discover whether another position is more resourcing for you (e.g., place your hands on different areas of your torso or place both hands over your heart or over your belly, or press a pillow against your torso). Take your time to experience the effect of each position. Notice the quality of the touch, the pressure, warmth or coolness, and the feel of your breathing. Be mindful of what happens in your body as you compare these positions to each other and to the position in # 1. 3. Identify the hand position that feels “right” and is most centering for you. 4. Mindfully practice this resource at least three times during the week when you feel triggered or upset, and record your experience below. Trigger or situation that

What was happening in What happened in your body your body when you when you used the resource? 355

prompted resource felt triggered? use Boss yelled at me about being late to work

Heart pounding; blood rushing in my ears; felt very still

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Breathing slowed; heart rate calmed; felt more settled and relaxed in my body

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Somatic Resources CONNECTING WITH THE B ACK OF THE B ODY Purpose: To explore resources that help you become aware of the back of your body in order to support feeling better in some way. Directions: Try out the resources below that are designed to stimulate sensations in and increase awareness of your back, or try another way that you think of, being mindful of the sensations you generate as you use the resource and of the sensations in your back after you complete each exercise. Then follow the prompts.

Touch and Press or move your back against a massage your wall, the floor (lying down), or the back with your back of a chair. own hands, or get a back massage.

Move your spine, bending forward and back, side to side. Try an undulating motion.

Feel the water on your back in the shower, or use a back scratcher.

Slowly walk backwards in a safe space outdoors or in your home, letting your back be your “eyes.”

Reach your fingertips toward your spine on your middle back, letting your hands rest on your ribs. Feel your ribcage moving as you breathe.

1. Which of these resources felt best and most resourcing to you? 3. What emotions or thoughts do you have after you connected with your back? (e.g., I feel competent and less vulnerable. I have the thought that I can protect myself. I feel calm.) 358

4. Describe what happened in your body after you connected with your back or as you were connecting with it. (e.g., I felt more sensation in my back, breathed more deeply, and felt a sense of protection and strength in my back.) 5. Use the resource that felt best to you during or after a triggering situation occurs and record what happens below. Trigger/situation What was What back resource that prompted happening in your did you use? resource use body?

What happens in your body as you use the resource?

I had to speak in front of my class, and I felt really nervous.

I felt my eyes relax. After a few moments, I took a deep breath.

My heart was beating fast, my breathing was shallow, and my eyes bugged out.

I pressed my back into the back of my chair and focused my attention on the sensation of the pressure.

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Somatic Resources CONTAINMENT RESOURCES Purpose: To explore resources that bring awareness to your skin and superficial muscles in order to better sense your physical “container” and help you tolerate and contain the thoughts, emotions, sensations, or memories that you experience. Directions: Try each of the different containment resources below and describe the effects on your thoughts, emotions, and body. You can try the ones that work best when you are feeling dysregulated or stressed, and discover which ones are most resourcing for you. Make a star next to any that are most useful to you and discuss with your therapist. Use your hands to squeeze the muscles all over your body—head, face, neck, arms, back, hands, chest, belly, hips, arms, legs, feet. Then try tapping your body with your fingertips. Be mindful of the sensations this produces all over the container of your body.

Thoughts Emotions Body

Explore tightening the muscles all over your body, sensing how the tension literally hardens your container. Sense the feeling of being less permeable, and perhaps more able to keep things out, and more able to contain your emotions and thoughts.

Thoughts Emotions Body

Use a loofah, washcloth, or soft brush to rub all over your skin on one side of your body and be mindful of the sensations this activity stimulates. Then pause 361

before you do the other side to notice the difference in the two sides. You might try this resource in the shower or bath.

Thoughts Emotions Body

Wrap yourself up in a blanket or a shawl. You can do this in bed or while seated in a chair. Pull the blanket or shawl as tight as feels good to you in order to capture that feeling of being swaddled and snug.

Thoughts Emotions Body

In a seated position, with your feet flat on the floor, cross your arms and place each palm on the inside of the opposite knee. Then while pressing outward with your hands, press your knees inward against yours palms. Hold the pressure as long as you like, then release and repeat.

Thoughts Emotions Body

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Somatic Resources ADJUSTING SENSORY STIMULATION Purpose: To identify sensory resources that calm or energize you, and list specific sensory stimuli that you find unpleasant or that bother you. Directions: Think about how you intuitively use sensory stimuli and sensory activities as resources. For each of the senses, put a “↓” next to those stimuli that are calming for you and a “↑” next to those that are energizing. Add more stimuli you enjoy in each category that you already use or might want to use. List the stimuli in each category that bother you. Then write down one situation in which you might want to use a sensory resource in that category. (e.g., I’ll put on calm music before bed; I’ll wear an eye mask to see if I fall asleep more quickly). Sense of Taste Tastes you enjoy: • Favorite foods and flavors • Sweet: fruit, ice cream, honey, desserts • Salty: pretzels, popcorn, soup, cheese • Savory: meat, fish, cheese, mushrooms, fermented beans,cured meats • Sour: lemons, yogurt, sauerkraut, pickles • Bitter: ginger, dark cocoa, beer, tea, spinach • Other tastes you enjoy: List tastes that bother you: Situation in which you could use taste as a resource:

Sense of Smell Scents you enjoy: • Favorite scents • Candles, soap, perfume or cologne, or lotion 364

• Food vendor or kitchen smells you love • Smells of different seasons or weather conditions • Flowers, leaves, or freshly cut grass • The smell of someone you are close to • Other smells you enjoy: List smells that bother you: Situation in which you could use smell as a resource: Sense of Touch Tactile stimulation you enjoy: • Soft fabric, fur, or hair • Warm baths or showers • Massage • Putting on lotion or sunscreen • Scrubbing your skin • Food textures and temperatures • Snuggling with a person or pet • Running your fingers through your hair • Other textures or types of touch you enjoy: List textures or types of touch that bother you: Situation in which you could use touch as a resource:

Sense of Hearing Sounds you enjoy: • Kinds of music you like • Loud or soft sounds • Energizing or calming music • Particular singers, composers, songs, or compositions • Natural sound recordings • Silence, wearing earplugs 365

• Moving water • Chanting, repeating a mantra • The sound of someone's voice • Other sounds you enjoy: List sounds that bother you: Situation in which you could use sound as a resource:

Sense of Sight Sights you enjoy: • Bright light, shade, or darkened rooms • Candles, dawn, midday, dusk, twilight • Sights you particularly love (e.g., sunsets, the ocean,mountains, the sky, green hills, rivers, your partner’s eyes, a kind face, the place where you grew up) • Favorite colors • Other sights you enjoy: List sights that bother you: Situation in which you could use sight as a resource:

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Grounding Yourself THERAPISTS’ GUIDE TO CHAPTER 16

Purpose of this Chapter Many psychotherapeutic approaches discuss grounding in general terms of being able to stay present and calm. In this chapter, grounding is defined as the capacity to direct somatic energy toward the ground and bring awareness to legs and feet in order to increase the felt sense of a physical base of support. Grounding in this way is a foundational somatic resource that underlies and supports many psychological capacities. The purpose of the chapter is for clients to appreciate the concept and importance of grounding as a felt sense of connection to the ground, understand ungrounded and overgrounded, and discover and practice specific grounding resources.

Clients Who Might Benefit Grounding is a skill that benefits a wide range of clients. It is an especially valuable tool for those struggling with hyperarousal, hypoarousal, or the biphasic alternation of the two. For that reason, grounding should be part of the resource repertoire for all traumatized clients. Another group of clients who can benefit from this chapter are those who lack focused attention to the body or report feeling “out of body” or are prone to accidents. Clients who complain of being scattered, spacey, having a short attention span, are easily distracted, or find it difficult to focus for periods of time on a particular task will benefit from grounding exercises. Those who are overly absorbed by their thoughts or in trying to figure things out will also benefit. If clients are overfocused on the needs and demands of others, they may have lost the capacity to fully ground themselves. Attachment-related beliefs such as “I’m never good enough,” “I have to do it right,” or “I have to entertain to be accepted” might contribute to a loss of feeling grounded within oneself. Such 367

clients need to regain the internal experience of their own internal foundational base of support. Clients who feel chronically stuck, heavy, hopeless, or trapped in a life of drudgery, with little fun or lightheartedness to counter these weighty feelings will benefit by learning about being overgrounded. Those with beliefs such as “It’s all hopeless . . . life is hard . . . things will never get better” might find that being overgrounded contributes to these beliefs. These clients need to experience a sense of lightness, energy, and hopefulness through becoming appropriately grounded.

Suggestions for Clinical Use Most clients find it logical that we need to “stand our ground” or feel our “feet on the ground” as a prerequisite to feeling confident, solid, focused, or able to respond instead of react. However, they may not have known that these idioms refer to a somatic resource that can be developed. The need to ground often arises spontaneously in the context of therapy. As clients become dysregulated, anxious, or report events in which they have become ungrounded, you have an opportunity to say something like, “Would it be helpful if I taught you a resource for this feeling of ‘losing yourself’ when you are confronted?” or “Let’s see what happens to that feeling of being out of control if we practice a grounding resource together.” Each time you ask clients to try out a somatic resource exercise, it can be framed as an experiment, which can mitigate clients’ feeling beholden to have a positive reaction. Instead, clients are asked to direct mindfulness to the effects of one of the grounding exercises described in this chapter and then share what they notice as a result. You might try saying something like, “Notice what happens when you feel your feet against the floor. What happens in your body? What happens if you push your feet against the floor a little bit?” Tracking your own body and sharing what you observe in yourself as you try out the same movements alongside your clients will facilitate their mindful observation. You might share, for example, “Interesting—when I push my feet against the floor, I can feel all my leg muscles engage, and my back straightens up spontaneously—does that happen for you, too?” When you are at ease and enjoy grounding exercises yourself, you communicate that sense of enjoyment to your clients, much as do parents who smile, and communicate excitement as they lead a child into a new or anxiety-provoking situation. The implicit communication might be something like, “Give it a try—you might find you enjoy it, like I do.” Clients who are overgrounded and ungrounded can learn from the examples in this chapter about how over- and ungroundedness develop and what each feels like somatically. Most of the resources described in this chapter address being under grounded, but future chapters that are referenced offer resources that are 368

particularly helpful for being overgrounded (Chapter 17, “Core Alignment: Working with Posture,” and Chapter 31, “Moving through the World: How We Walk”). As you and your overgrounded clients study this chapter, you may decide together that some of the resources described from these future chapters would be beneficial. In that case, moving ahead in the book to learn those resources instead of practicing the ones in this chapter would be appropriate. A single session of practice will not create the neural pathways and somatic skill to support spontaneous, automatic use of grounding. To ensure that the learning from this chapter is well integrated so that grounding becomes available to the clients as a viable resource, it will be necessary to return to grounding exercises in subsequent sessions. As clients express issues or distress that might be helped by grounding, you can build on previous sessions by saying “It seemed to help last time when we grounded. Maybe this time, we can experiment with standing up and reinstalling a grounding resource . . . maybe that will help the flashbacks [or feeling of being so scattered or off balance].” To support clients’ efforts at integrating any resource, be sure to emphasize the value of practice: “Remember, it took many repetitions to develop this habit of being ungrounded, so it will take many repetitions to learn how to connect to the ground.” Always, the secrets to success in teaching and integrating somatic resources is helping the client use directed mindfulness to discover the results of using the resource and then repeating the movements that facilitate the desired effects.

Introduction to the Worksheets The three worksheets on GROUNDING RESOURCES provide specific instructions for a variety of grounding exercises, directing clients to experiment with them and notice the effects on their thoughts, emotions, and body. By trying out several different kinds of grounding resources, clients can discover the ones that work best for them. They will find the exercises more meaningful if you do them too, and the two of you share what each of you experiences. Doing so provides an opportunity for you to model mindfulness by reporting a change in your own building blocks when you do an exercise. The grounding resources clients find most effective will be used in the next two worksheets. WHEN YOU FELT UNGROUNDED guides clients to rehearse a grounding resource they could use to regulate in situations that cause them to feel ungrounded, and then mindfully study their building blocks. The worksheet on REGULATING AROUSAL WITH GROUNDING RESOURCES offers the opportunity to anticipate triggers of high and low arousal as well as hyper- and hypoarousal, identify bodily signals of these arousal levels, and then use grounding exercises to regulate. You can prompt your clients to continue to use these resources as needed when the triggers and situations 369

that they identify in the worksheets as un-grounding reoccur in the future.

Adapting this Material for Dissociative Clients For many dissociative clients, grounding is an accessible somatic resource because it is simple to learn and usually not triggering. Grounding exercises can support clients with dissociative disorders to achieve more control over “fading away,” impulsivity, and “out-of-body” experiences. Having their feet on the ground is often the most effective way to teach dissociative clients how to stay present or to interrupt switching. However, some dissociative clients may associate the idea of being grounded with being visible, conspicuous, or assertive, which may have increased abuse in the past. It may be triggering to even imagine grounding themselves. They will need your continued encouragement and support to separate past from present in order to develop this resource. Others may become triggered by the feeling of their feet against the floor or by feeling their connection to the ground. For instance, one client said “It feels as if I can’t run—I’m trapped.” A few clients may further dissociate with any attempt at grounding because of their extreme and chronic avoidance of being present. A more effective way to help such clients might be to engage them in activities that are grounding, but without conscious awareness of feeling their feet on the floor. For example, having them stand up with you and walk around the room or throw a stuffed animal or soft ball back and forth can promote grounding without drawing attention to the legs and feet. Just the acts of standing, walking or the subtle movement through the legs and feet that are required to throw and catch a ball can increase the sensation of being grounded. It can be useful to explore grounding exercises together as an experiment and to help clients become aware of the reactions of their various parts. You might ask your clients to “try out” these skills by asking, “Let’s see what happens if together we just feel our feet on the floor. Are there some parts of you that enjoy feeling your feet on the floor, and other parts that do not?” On those occasions when certain parts are triggered, you can titrate the intervention and perhaps find a way of beginning to explore grounding that is acceptable to most internal parts by asking questions like: “Let’s see what happens if you put just one toe on the ground—what happens? Could you put one other toe down? How are different parts of you responding to this?” For some clients, grounding might be triggering because it interrupts patterns of avoidance and switching. When a particular part, such as a child or angry part, wants to be “out” in therapy, you might notice more resistance to grounding practice. In this case it can help to gently ask what is the part of the client worried or concerned about if grounding is practiced The client’s submissive parts may 370

avoid grounding because they are afraid to take a stand. To feel solid and strong might feel frightening to a young part of the client that learned to be compliant or “seen and not heard.” In this case, it may be helpful to pair this part with a “stronger” part of the client, so that the exercise can be done cooperatively, and the submissive part can feel inner support.

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CHAPTER 16 Grounding Yourself Grounding is an electrical term that indicates an electric circuit is connected to the earth. In a properly grounded electrical system, any leaking current of electricity is safely carried away into the ground, where it can do no harm. Similarly, grounding for our purposes involves making an energetic and physical connection with the earth, or ground, so that the energy of the body is directed downward. We live in relationship to the earth’s gravitational field, and gravity continually holds us to the earth. Grounding is the concrete sensation of connecting to the earth, of our body responding to the pull of gravity by settling downward, much as the water in a pitcher sinks to the bottom, the lowest level. Many expressions in our language refer to grounding: “down to earth,” having our feet “on the ground,” “standing our ground,” “standing on our own two feet,” or “holding our ground.” These expressions refer to qualities like firmness, steadfastness, and the ability to support ourselves. They speak to the strength, stability, internal security, and support that come from feeling grounded. Those of us who are grounded are often described as steady, reliable, in touch with reality, balanced, and secure in ourselves and our convictions. Trauma, attachment inadequacies, and other painful events can cause us to “lose our ground,” which disrupts the foundational base of security from which we draw support to move through the world and interact with others. We can also become overgrounded: We can be so solid, weighed down, fixed, and immovable that we lack the flexibility and lightness to move and live with grace and ease. We are all ungrounded or overgrounded at times in our lives, but when either becomes a more or less permanent condition, the quality of our lives is diminished. In this chapter our main focus is to describe the concept of grounding, look at how we become ungrounded, and explore somatic resources that can be practiced to support grounding. Being overgrounded is also briefly described in this chapter and contrasted with being ungrounded.

Becoming Ungrounded When we are shocked or alarmed, whether by sudden trauma, receiving terrible news, or being unexpectedly rejected or criticized by important people in our lives, our energy typically rises upward in our bodies, causing us to feel ungrounded. We 373

might inhale suddenly or hold our breath, widen our eyes, raise our shoulders, or tighten our bodies. These are common physical responses that go along with the neuroception of threat. Right after such an experience, we can feel insecure, reactive, and easily distracted instead of balanced and connected with ourselves. We might find it hard to concentrate and fail to recover a sense of our own solidity. We say colloquially that such experiences have “knocked us off our feet.” They have ungrounded us. Feeling ungrounded can continue after such experiences, causing us to feel offbalance and unable to concentrate. Cindy felt scattered and prone to panic. She attributed these symptoms to her “defectiveness,” just as she had always thought it was her fault when her mother was emotionally reactive and abusive. Cindy said she felt as if she never really exhaled or let herself settle or relax because she was always on the lookout for danger. Until her therapist noticed the connection of these symptoms to the tense muscles of Cindy’s lifted shoulders and her energy—which was directed upward instead of settling downward toward the ground—it had never occurred to Cindy that her symptoms reflected a childhood of having no parent who could bring her back to earth and help her develop a solid base of grounded support within herself. We can also lose our grounding in other circumstances with attachment figures. For example, as children we might be anxious for fear of disappointing our attachment figures or doing something wrong. We might feel constantly on edge and worried about how we can please them and meet their expectations in order to feel safe. Our energy may become mobilized up and out, rather than settled downward. Having learned that we must please others or avoid making mistakes, we may fail to connect with ourselves sufficiently to develop our own base of support that grounding provides. Some of us have grown up in high-energy, high-achieving families, pushed ahead faster than our developmental skills warranted. Such pressure to achieve can promote an upward mobilization of energy in our bodies not counteracted by grounding. Ted, who came from such a high-performance family, tried to follow in the footsteps of his two older exceptionally successful siblings. Ted remembers his childhood: “It was like I was always running to catch up—to prove I was as good as they were—but I never was.” Without support or encouragement to feel his feet under him or go at his own pace of development, Ted’s forward rush turned to hyperactive clowning and silliness, which won him the title of “family clown” as a substitute for the approval of his parents. Years later, his friends complained that he was always “wired” and could never engage in a serious conversation. His ungrounded style undermined his work, his relationships, and even his therapy. An inability to effectively ground can adversely affect our ability to follow through on our intentions and goals. We may find it difficult to concentrate on or to finish a task. Perhaps we start out to do something, like answer our e-mail, but then 374

discover ourselves doing something else, like surfing the Internet. We may get distracted or find that our mind wanders. We may be so spacey or so absorbed by the thoughts inside our head that we lose our awareness of what we are doing or where we are in time and space. Without the support of a solid basis for our actions that grounding provides, we may be more vulnerable to accidents like falls or fender-benders or worse. We cannot fully experience the steadfastness, here-andnow presence, and solid sense of self that comes with feeling grounded. Being chronically ungrounded might be reflected physically in a restriction of the body’s energy flow that makes it difficult to feel our legs and feet. We may inhibit our breathing, fail to exhale fully, tighten our pelvic muscles, lock our knees, or tense the muscles of our feet. The energy of the body can feel as if pulled upward, which can prevent our feet from fully contacting the solidity of the ground beneath us. We might notice that our legs and feet are cold or numb, which can happen when tension in the body interferes with circulation, preventing blood from flowing fully into lower extremities. Unable then to experience a solid foundation for our bodies through our legs and feet, it can become difficult to feel grounded.

Becoming Overgrounded If you feel heavy, entrenched, or stuck in a way that keeps you from taking action, you might be overgrounded. In contrast to being ungrounded, it might feel as if your feet are glued to the ground or a weight is holding you down. It might feel effortful to lift your legs and feet to take a step. People who are overgrounded seem overly rooted, as if their feet are pushing strongly downward without the counterbalance of lengthening and lifting toward the sky. Peggy remembered a childhood of drudgery and depression and told her therapist that she felt stuck and gloomy in her current life, just like she had as a kid growing up in poverty with no respite in sight. Peggy moved with a plodding, sluggish gait that went along with an excessive tendency to endure tedious situations which prevented her from having fun and welcoming change. She seemed to get through life with willpower and perseverance, remaining in a wearisome, uninteresting job and a lacklustre dead-end relationship. She held a dim view of the possibility of future happiness. Peggy literally needed to “lighten up,” take action on her own behalf, and engage her imagination in fantasizing a better, more satisfying, and enjoyable future for herself. Carl became overgrounded as a child burdened with the adult duties and responsibilities of taking care of his younger siblings. His family valued hard work and reliability and made little room for fantasy or play. His rounded muscular shoulders and square body reflected a feeling of “carrying the world on his shoulders.” He had difficulty saying no to requests for help from others. Although 375

he was frequently praised for his responsible character and endurance, Carl complained of having no fun and feeling that all of life was drudgery. He also needed to lighten up and get the world off his shoulders.

Becoming Appropriately Grounded It is difficult to respond to adversity or even the everyday challenges of life with flexibility, perseverance, and adaptive action if we are ungrounded. And it is difficult not to get bogged down in the mundane elements of life and to respond to possibilities with imagination and lightness if we are overgrounded. If you are grounded but not overgrounded, you can respond to unnerving situations thoughtfully and effectively instead of reacting or shutting down. When our actions stem from a feeling of being grounded within ourselves, we usually feel good about the thoughtful way we are able to respond to the events in our lives, even to unexpected or unpleasant ones. The lower extremities of the body—feet, calves, thighs, and pelvis—provide our base of support and connection to the earth. As a somatic resource, grounding is the physical process of being aware of our legs and feet and their connection to the ground, and to directing our energy downward into the earth to sense the support of gravity. Through grounding, the support of the earth can be experienced, providing a feeling of both physical and psychological solidity and stability. To ground ourselves, we need to relax the tension in our bodies so we can let our bodies yield into the support of the ground beneath our feet, yet the muscles should maintain tonicity. Both excessive tension (such as locked knees or tight feet, legs, or hips) and excessive flaccidity (such as weak, limp muscles in the feet, legs, or pelvis) interfere with grounding. The inability to sense the pelvis, legs, and feet or to experience them as a base of support for the upper body, also diminish feeling grounded. Many different somatic resources support grounding. Mindful awareness of the “sitting” bones at the bottom of the pelvis, relaxing the pelvic floor, sensing the weight of the body and the pull of gravity downward into the earth can promote grounding. Cindy found that more active grounding exercises helped her feel less scattered and spacey. She practiced pressing her feet into the floor while sitting, sometimes stomping her feet on the ground to help her sense her legs, or squeezing and massaging her legs and feet to relax the tension and increase sensation. Ted’s therapist taught him exercises to increase his awareness of his legs by standing and shifting the weight of his body to his toes, heels, and sides of his feet, then balancing his weight on the entire surface of his feet, letting them soften on the floor. Learning to unlock his knees, shift the weight from leg to leg, and then allow the weight to balance between them all helped Ted feel more grounded. He also 376

enjoyed standing on one foot and placing a small ball under his other foot that he could press and roll around to increase the sensation in his foot. Our feet are very sensitive, having over 200,000 nerve endings on their soles, and, as such, are designed to help us balance and give us information about the surfaces on which we are walking or standing. Bringing mindful attention to the sole of the foot as he moved it around on the ball, becoming aware of the shape of his foot and the sensation he was generating helped Ted become more grounded. In contrast to learning to connect to the ground, learning to lengthen the spine upward, push off with the toes of your feet, and swing your arms while walking can bring a spring to the step to counter overgroundedness. These actions are thoroughly explored in Chapter 17, “Core Alignment: Working with Posture,” and Chapter 31, “Moving through the World: How We Walk.” Peggy’s therapist helped her to notice when she was overgrounded and then to take a breath, feel her rib cage lift, and lengthen her spine gently toward the sky. Immediately, she could feel a slight increase in energy in her body. As she practiced this posture whenever she felt overgrounded, she also practiced letting her feet soften on the ground, increasing their sensitivity as she relaxed the tension. With practice, Peggy became increasingly able to ground herself while also feeling the length of her spine and the energy in her upper body, easing the sense of burden she experienced. Learning to push off with the toes of her feet as she walked also helped her feel lighter and have more energy. Peggy explored movement in general—walking, running, jumping, skipping, jumping, dancing—and found that all these different forms of motion counteracted her overgrounding and helped her feel more lighthearted and light in her body. Carl first explored pushing his rounded-over shoulders and arms back and saying “no” to counter the excessive responsibility he had taken on to please his earliest caregivers (a resource as described in Chapter 19, “A Somatic Sense of Boundaries” and Chapter 25, “Restoring Empowering Actions”). He then explored massaging his feet with mindful attention to the sensations produced by the touch. Massage relaxed the tension in his feet and increased sensation, both of which helped Carl better sense the ground beneath him and the pull of gravity holding him to the earth. Through his touch and awareness, his feet became more sensitive and he enjoyed the feeling of walking more lightly rather than heavily. He learned to elongate his spine, pushing gently upward with his head and lengthening his neck while sensing his feet on the ground. Learning physical grounding skills will help you manage and regulate your emotions as well as help you feel more relaxed and secure in yourself. The following worksheets are designed to help you reconnect with your legs and feet, direct your energy downward into the earth, and draw on the support and security that grounding affords. They are designed primarily as resources for being ungrounded. However, like Peggy and Carl, you might find that increasing the 377

sensitivity in your legs and feet from working with some of these exercises can help you lighten your step if you are overgrounded.

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Grounding Yourself GROUNDING RESOURCES, P ART 1 Purpose: To practice grounding resources and discover ones that best help you to sense a connection with the ground. Directions: Follow the prompts below to discover what changes you notice after you try out the two grounding resources. Then use these resources when you feel ungrounded. Feet on the Floor 1. Before: Be mindful of your thoughts, emotions, and body and write down your experience of the building blocks below. Thoughts Emotions Body 2. Practice pressing your feet on the floor. • Sitting, place both feet on the floor, with your feet and thighs both pointed forward and lower legs perpendicular to the floor. • Press one foot firmly into the floor, then the other, engaging your thighs and buttocks, then push both feet into the floor at the same time. • Notice the sensations in your legs, feet, and back as you press your feet into the floor. • Sense the effect on your spine and the rest of your body. • Keep doing this until you feel sensations in your lower legs and feel grounded.

3. After: Write down the differences you notice in your body, emotions, and thoughts in the boxes below. 380

Thoughts Emotions Body

Attention on Your Feet 1. Before: Be mindful of your thoughts, emotions, and body and write down your experience of the building blocks below. Thoughts Emotions Body 2. Practice focusing attention on your feet. • Standing, direct your mindful attention to your feet. • Notice the soles of your feet, the tops of your feet, your toes, your ankles. • Notice if they feel hot, cold, achy, tired, numb, tense, or relaxed. • Hold on to a piece of furniture and lift one leg, wiggle your toes, and stretch your feet and ankles, noticing the sensations, then switch to the other foot. • Standing with both feet flat on the floor, imagine letting your feet soften as if they were melting butter or soft clay. Let them spread out and rest more fully on the ground.

3. After: Write down the differences you notice in your body, emotions, and thoughts in the boxes below. Thoughts Emotions Body

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Grounding Yourself GROUNDING RESOURCES, P ART 2 Purpose: To practice grounding resources and discover ones that best help you to sense a connection with the ground. Directions: Follow the prompts below to discover what changes you notice after you try out the two grounding resources. Then use these resources when you feel ungrounded. Massaging Your Legs & Feet 1. Before: Be mindful of your thoughts, emotions, and body and write down your experience of the building blocks below. Thoughts Emotions Body

2. Practice massaging your legs and feet. • Using your hands, squeeze and massage your legs and feet. • Take your time trying different degrees of deep and light pressure, massaging each toe, in between your toes, the soles of your feet, the tops of your feet, your ankles, working your way up your calves, paying attention to your knees and thighs, then back down, ending with your feet. • Focus all your attention on the sensations in your legs,and feet as you massage them. • Feel the sensations on your skin and in the muscles underneath. Be curious! • You might pretend you are discovering your legs and feet for the first time. 3. After: Write down the differences you notice in your body, emotions, and thoughts in the boxes below. Thoughts 383

Emotions Body

Standing on Your Own Two Feet 1. Before: Be mindful of your thoughts, emotions, and body and write down your experience of the building blocks below. Thoughts Emotions Body

2. Practice standing on your own two feet. • Stand barefoot and position your feet so that they are under your shoulders. • Notice if your feet are splayed outward, or if your toes are pointed inward. • If it is comfortable for you, point your feet directly forward. • Relax and soften your feet; slowly rock side to side, front to back, feeling the weight on different parts of your feet. • Bend your knees slightly and then push against the ground with the soles of your feet to straighten your legs. • Shift the weight from leg to leg, and then allow the weight to balance between them. • Then stand still and sense or imagine the pull of gravity holding you to the ground. 3. After: Write down the differences you notice in your body, emotions, and thoughts in the boxes below. Thoughts Emotions Body

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Grounding Yourself GROUNDING RESOURCES, P ART 3 Purpose: To practice grounding resources and discover ones that best help you to sense a connection with the ground. Directions: Follow the prompts below to discover what changes you notice after you try out the two grounding resources. Then use these resources when you feel ungrounded. Sit Bones 1. Before: Be mindful of your thoughts, emotions, and body and write down your experience of the building blocks below. Thoughts Emotions Body 2. Practice feeling your sit bones. • Sit on a hard chair with your feet flat on the floor and your feet and knees pointed forward, and sense your sit bones (the little bones at bottom of your pelvis that you sit on). • Slowly rock forward and back, and side to side on your sit bones, feeling the pressure on different areas. • Find a place of balance by sitting still and letting the weight of your body settle downward in front of your sit bones. Push gently upward with the top of your head. • Sit tall and visualize small weights attached to each sit bone, exerting a downward pressure or pull toward the earth, feeling a sense of connection to the ground through your pelvic floor.

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Thoughts Emotions Body

Inhaling & Exhaling 1. Before: Be mindful of your thoughts, emotions, and body and write down your experience of the building blocks below. Thoughts Emotions Body 2. Practice inhaling and exhaling to ground yourself. • Sit tall or stand up straight in a comfortable position. • Breath naturally and notice your breath. Sense the soles of your feet. • Then as you breathe in, imagine that you can draw your breath upward through the soles of your feet. • As you breathe out, imagine sending your breath down your body, through your pelvis, legs and feet and into the ground. • Imagine that your breath wraps around roots and rocks that are deep in the earth as you exhale. • Repeat this breathing as often as you like, slowly inhaling the breath upward and exhaling downward through the bottom of your feet.

3. After: Write down the differences you notice in your body, emotions, and thoughts in the boxes below. Thoughts Emotions Body 388

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Grounding Yourself WHEN YOU F ELT UNGROUNDED Purpose: To identify a situation that caused you to lose your ground, describe how you responded, and plan ahead to use a grounding resource the next time you experience a similar situation. Directions: Think about a situation in which you felt ungrounded. Take your time to remember it, and be mindful of your internal experience. Then, answer the prompts below. 1. Describe what happened that made you feel ungrounded. (e.g., I briefly lost track of my 4-year-old in a store; I discovered my car was broken into; I saw a man who reminded me of the man who abused me; my husband was late to a special dinner I prepared; people laughed at me when I tried to play drums.) 2. Describe your arousal level in that situation (e.g., high or hyperaroused; low or hypoaroused). 3. How do you feel in your body as you remember? (e.g., Tense, numb, spaced out, jittery, pulling away, head down, fragmented, or something else.) 4. What emotions do you feel? 5. What thoughts do you have?

6. Describe a grounding resource you could use to help you regulate your arousal. 7. Imagine the same situation, using your grounding resource. 8. Describe how your experience of the situations might have been different if you had used this grounding resource. 391

Thoughts Emotions Arousal Sensation and Movements 9. Identify three situations that you might face in the future in which this grounding resource could be helpful.

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Grounding Yourself REGULATING AROUSAL WITH GROUNDING RESOURCES Purpose: To explore grounding resources that can be used to regulate your arousal when it is high or hyperaroused and when it is low or hypoaroused. Directions: Follow the prompts below to assess when your arousal begins to increase or decrease so that you can use a grounding resource before it rises above or falls below the edges of your window of tolerance. AROUSAL Hyperarousal High Arousal 1. Think about a situation or person that provokes unpleasant high or hyperarousal. Describe the high/hyperarousal trigger. (e.g., When I call my best friend on the phone and all she does is talk about herself; when a colleague at work interrupts me during meetings; when someone is mad at me; when I hear sirens.) 2. Would you describe your arousal as high or is it hyperaroused? What bodily signals tell you so? 3. Which grounding resource works best for high or hyperarousal? Try using this resource during the above situation. What happens? 4. Think about a situation or person that provokes unpleasant low or hypo-arousal. Describe the low/hypoarousal trigger. (e.g., When my partner shoots down my ideas; when I talk to my mom and she sounds depressed and complains about her health; when someone is mad at me; when I have to go to the doctor.) 5. Would you describe your arousal as low or hypoaroused? What bodily signals tell you so? 6. Which grounding resource works best for low or hypoarousal? Try using this resource during the above situation. What happens? Low Arousal

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CHAPTER 17

Core Alignment Working with Posture THERAPISTS’ GUIDE TO CHAPTER 17

Purpose of this Chapter This chapter builds on the work of previous chapters to delve more deeply into exploring posture and alignment. Our sense of well-being is strongly tied into the core of the body, the spine, and the surrounding muscles, and particularly to whether the spine is aligned. Traumatic and suboptimal attachment environments promote postural adaptations suited to unsafe, rejecting, or critical conditions. If caregivers reprimand a child for crying and showing negative emotions, the child will learn to hold back emotions and tears, sometimes aided by tension and a rigidly upright spine. In other settings, a child’s safety or well-being is better assured by patterns of compliance, submission, or “invisibility.” The spine and core of the body then might collapse, slump, or droop. Posture has a powerful influence on emotions and well-being. Fixed postures, such as a chronically slumped spine or “military” posture, can be viewed as positions from which only select emotions and behaviors can be possible (Barlow, 1973). Stepper and Strack (1993) found that subjects who received good news in a slumped posture reported feeling less proud of themselves than subjects who received the same news in an upright posture. The purpose of this chapter is to understand the relationship between clients’ difficulties and how they carry themselves. By emphasizing the influence of the alignment of the physical core, or spine, on clients’ psychological functioning, this chapter provides a basic education to support working with posture in your clinical treatment. Such a focus will be rewarded as clients begin to notice discernible benefits from making small changes in their physical stance toward increased alignment.

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In general, any clients whose posture of collapse or rigidity does not have an organic origin can benefit. Even those with minimal, barely noticeable degrees of collapse or rigidity may find that increasing alignment initiates profound changes. Those who demonstrate a curved posture that reflects and sustains chronic depression and shame will benefit from this material, as will clients with the desire to experience a sense of pride and self-worth that they cannot attain fully with a misaligned posture. The core resource of alignment of the spine described here will be invaluable for any client with a slumped posture that reflects his or her struggles to stabilize, regulate arousal more effectively, or feel healthily entitled and proud. As mentioned in the previous chapter, clients who are overgrounded will find postural alignment an effective resource to mitigate feeling heavy and stuck. Those who feel fragmented or unreal might find that attention to developing a stable but flexible core can help them feel more integrated. Clients with chronic distrust and hypervigilance may have developed inflexibility that is reflected in a rigid spine. An overly rigid posture may hold emotions at bay and communicate arrogance or rigidity to others. These clients may find that relaxing a rigid spine to achieve alignment promotes more relational intimacy and emotional connection.

Suggestions for Clinical Use Siegel (1999, 2010a) points out that chaos and rigidity or both can be the result of integrative failure. If, as he suggests, our clients tend to suffer from internal chaos or rigidity or the alternation of the two, one possible antidote to those states can be attending to both the stability and flexibility of the core of the body. Bull’s (1945) assertion that “motor attitude” or “posture of the body” paves the way for particular emotions to be experienced highlights the impact of the way we hold our bodies on how we feel. When you teach your clients to lengthen their spines or engage core muscles, they will typically feel less chaotic and also less rigid. It is more difficult for them to feel depressed or ashamed if their spines are vertically aligned and their shoulders dropped back into a squared but relaxed stance. However, it is important not to lose sight of the fact that the client’s posture was a salubrious adaption to past circumstances. Thus, changing it can be frightening to parts of the self that developed the adaptation in the first place. For example, if a client slumped to try to be invisible, becoming more visible through standing up straight can be threatening to parts of the self that try to stay safe by being invisible. If a clients lifted the chest in rigid, military posture to avoid vulnerability in a context where being vulnerable would have led to ridicule, then exploring a relaxed alignment can be threatening to those internal parts of the self that protect by appearing tough. With an aligned core, poise and confidence often increase along with a feeling of being solid yet flexible. For overgrounded clients, a sense of 397

lightness and energy can be supported as they learn to lengthen their spines. The use of this chapter is dependent upon being able to capture your clients’ interest and even enthusiasm to explore their posture. Your ability to confidently demonstrate a collapsed posture, a rigid posture, and an aligned posture, and to work collaboratively with them on posture in a standing position will help them feel comfortable. If you find yourself feeling uncomfortable with the exercises described in this chapter, it would be helpful to explore your own posture prior to working with your clients’ posture. You can explore a posture assessment exercise collaboratively with your clients to evaluate their alignment (“Secret of,” 1998). The assessment will work best if you do it together with them, after trying it out yourself to become familiar with the exercise and evaluate your own alignment. Stand with your backs against the wall, your heels about 3 inches from the wall, and each place one hand behind the low back with the palm against the wall, and the other hand around the back of the neck. If your client can move his or her hands more than an inch or so in the space between the wall and the body, this chapter will be particularly helpful. If your own posture is out of alignment, sharing your own discoveries with your clients as you perform the assessment with them will help them feel more comfortable with this exercise.

Introduction to the Worksheets You should become familiar with your own habitual posture and complete the worksheets on your own before working with posture in your practice. Your comfort with and awareness of posture will be enhanced by trying out different postures in front of a full-length mirror, assessing their differences, and imagining demonstrating them for your client. Once you have had a chance to observe and sense the impact of these exercises yourself, it will be easier to communicate the benefits to your clients. The two CORE ALIGNMENT AND POSTURE worksheets use drawings of different postures that you and your clients can imitate. Experiencing the contrast between them will increase awareness of the impact of each on mood, beliefs, and body sensation. Starting with these worksheets will be less threatening to some clients because they do not require that clients analyze their own posture until the very end. It will be effective to do these together in session so that you can help clients discern the more subtle effects of each posture. DISCOVERING YOUR CURRENT POSTURE instructs clients to assess their own alignment, exaggerate their posture, and notice what happens. Since it requires studying ones own posture, it will be challenging for those who do not like to look at themselves, or have an aversion to, seeing themselves in the mirror. If this is true 398

for your client, instead of looking in the mirror, the client can choose a drawing from the first two worksheets that is closest to his or her natural posture and then reference that drawing to follow the directions on the worksheet. EXERCISES FOR POSTURE & ALIGNMENT affords clients an opportunity to explore some simple exercises to increase alignment and compare the results to their natural posture. As you and your client try these exercises together in session, you can model mindfulness by sharing what you notice internally, and also point out changes you see in your client, saying things like, “When you bring your shoulder blades back and down, it looks like your neck lengthens. Do you feel that, too?” ENGAGING YOUR TVA MUSCLE also teaches simple, practical somatic resources that increase awareness of the support that the transverse abdominal muscle, or TVA, provides for the core (Bond, 2007). The benefit of this exercise can be increased if you contact the changes in the client that you notice, such as “When you engage your TVA, it seems like your spine lengthens.”

Adapting this Material for Dissociative Clients For some dissociative clients, the psychoeducation about posture in the chapter will be valuable and motivating. For others, it will be easier if you demonstrate the exercises first before providing much cognitive psychoeducation. Often, dysregulated and dissociative clients are triggered by experiments requiring movement, and they may be reluctant to try out physical experiments until they see you perform the exercises yourself. It may be more effective for you to focus on making your own movements and to model mindfully noticing what happens inside yourself as you do so. And, for all clients, but especially for traumatized or bullied clients, with histories of humiliation and attack, trying out movements and postural adjustments under the gaze of the therapist can be triggering. It is important that clients do not feel you are directly observing their movements. You can look out the window, look at the floor, or otherwise avert your gaze away from your clients when they try out different posture. With some, you might suggest that the two of you perform the exercise with your eyes closed. Even then they may at first refuse or be reluctant to imitate you. But, with your modeling and selfreports, most clients are usually willing to try a simple movement such as lengthening the spine, pushing upward with the top of the head and downward with the feet, or gently engaging the TVA. Often, these simple movements regulate hyper- and hypoarousal, lift the mood of a depressed part, or decrease fear and anxiety. Once clients experience these benefits in their own bodies, it will become easier to practice the exercises in subsequent sessions. Modeling how to notice the effects of an experiment is crucial for clients with 399

dissociative disorders who have difficulty tracking their internal states. In Sensorimotor Psychotherapy, we try to facilitate clients to mindfully notice the effects of an experiment. Some dissociative-disordered clients need quiet time to notice the effects of the experiment without your making any sort of comment or interpretation. For others, your mindfulness questions will help them gradually develop the ability to notice their own responses and discover how various dissociative parts respond to a change in posture. As always, be careful not to force or rush the pacing with any client, especially with this client group. Rather than encouraging them to take bigger steps or to repeat a movement when they are triggered by it, slow the pace, take a few steps back to find an experiment that is not so triggering. You can perhaps demonstrate the movement again to shift the focus away from them and onto you, or ask clients to notice how their bodies are communicating that the experiment is triggering, or if they notice how different parts are triggered. In all cases, exploring alignment resources in ways that are tolerable for various parts of the client will be more effective than overriding a part that is frightened of, or very uncomfortable with, alignment. Dissociative parts fixed in a shutdown or submissive defense or parts that are very young and vulnerable will typically have a collapsed posture and might need the support of both the therapist and of a more resourced part of themselves. It is important whenever possible to have all parts of the client experience the movement, even if only by observing it, to realize that it is not dangerous in the present moment. Alignment exercises can be done with the cooperation of different internal parts, for example, so that a collapsed part might feel the inner support of a stronger or more resourced part. A part fixed in a “fight” defense might have a rigid posture and feel threatened at the prospect of relinquishing the rigidity to foster alignment. This part might be encouraged to watch a trusted other part being able to relax the rigidity of the posture and see that there is no danger. You can reassure a fight part that danger can still be neurocepted when necessary. An adult part of the client should be encouraged to be present at all times to promote integration and communication among parts as you explore alignment resources.

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CHAPTER 17 Core Alignment: Working with Posture How we hold our bodies is rich with meaning, conveying to others our mood in the moment and providing hints as to how we feel about ourselves and the beliefs we hold. When we sit or stand slumped, upper back bowed, shoulders rounded, and head forward, we might appear detached, frightened, insecure, or compliant. Colloquialisms about being “spineless” or having “no backbone” testify that a collapse in the spine is associated with shame, low self-esteem, or difficulty with self-assertion. In contrast, when we have a rigid, tense “military” posture, with head and shoulders pulled back, knees locked, and muscles tense, we might appear arrogant, intimidating, adversarial, or inflexible. Terms such as unbendable or “puffed up with pride” describe a rigidly held spine and a core of the body characterized by inflexibility. But when we sit or stand tall yet relaxed, with our shoulders open and our chins level, we appear more focused, confident, and receptive. Our posture is dependent on the core of the body–the spine and surrounding muscles. A strong but flexible core and aligned posture stabilizes us both emotionally and physically while also supporting our actions. The spine underpins our movement throughout the day in a dynamic process that adjusts to the variety of our activities. We need both stability and flexibility in our core to support us, physically and psychologically. This chapter focuses on how posture develops, the possible meanings of different postures, and how to increase the vertical alignment of the spine.

How Posture Develops An infant’s spine at birth is curved forward, shaped like the letter “C.” It changes over time as it responds to the effects of gravity and to the body’s movement. The first movements of an infant start in the spine and radiate out to the periphery—the arms, legs, neck, and head—and then contract back inward to the core. These movements of extension and flexion build tone in the small, intrinsic muscles that link the parts of the spine together and coordinate its movements. Spinal curves develop as muscles develop and as new physical abilities are acquired. When the infant learns to lift the head while lying face down, the cervical curve at the neck begins to develop. The lumbar, or lower back, curve develops through standing and 402

walking. These curves act like a spring to absorb shock, maintain balance, support the movement of the spinal column, and hold the body upright. If the curves become either too straight or too curved, added physical stress is placed on the body, and the adaptive functioning of the spine is compromised. Figure 17.1 shows the three spinal curves. Trauma and other emotionally painful events take their toll on our posture, especially if we had little or no support from others to deal with them. Closed postures, where the body is slumped forward or curled inward, protect the parts of the body that are most vulnerable—the abdomen, throat, and genitals. Animals, including humans, instinctively curve their spines to protect these areas in threatening situations. A spine that sags and collapses might also serve to avoid threatening people who might hurt us or helping us keep ourselves small so that we are not noticed in negative ways. In some environments, the spine may become rigid and tense in a “chin up, chest out, shoulders back, stomach in” stance in an effort to appear invulnerable or to keep fear and other difficult emotions at bay. Our posture also develops as a result of the expectations of our attachment figures and other people in our environment. If our parents, or later a coach, wanted us to be strong rather than needy, our spine might also become rigid. If appearing weak or needy received the attention we required for support and contact, we might slump. If our hearts have been hurt and we need to protect them, we might curve our shoulders inward. If our environments are hurtful to us, emotionally or physically, these postural adaptations may become chronic.

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FIGURE 17.1 The Curves of the Spine

The Psychological Effect of Poor Posture When our spines are not aligned, strong, stable, and flexible, we can have trouble handling life’s “curve balls.” We might feel at risk of “losing ourselves” easily if our spine is collapsed because a solid sense of self is related to an aligned core. When our spines remain chronically slumped, our feelings about ourselves are impacted. We might lose confidence and fail to assert ourselves. Such a posture can reinforce limiting beliefs (and vice versa), like “I should not show myself or be visible” or “I must be compliant and do what others want.” When our spines remain too rigid, our feelings about ourselves are also affected. With rigid posture, we may feel inflexible, ready to fight, on guard, or fearful of bending or relaxing. This posture also reflects beliefs, such as, “I have to be on guard and closed” or “I can’t show my needs,” or “I’ll be attacked if I am vulnerable.” A rigid, overly protective posture can diminish the emotional intimacy of our relationships. Whatever posture we have, it influences how we feel and the beliefs we hold about ourselves, others, and the world.

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Good Posture An aligned posture lies somewhere between the two extremes of a collapsed spine and a rigid spine. Good posture varies a bit from person to person, depending on the physical makeup. But in general the shoulders are relaxed and drawn downward, the head reaches toward the sky and sits centered over the shoulders, the chest rests over the lower half of the body, the torso is stacked above the pelvis, not leaning backward or forward, and the legs and feet are under the body. Good posture can be seen from the side as a line that passes through the curves to go straight through the ear, shoulder, hip, knee, and ankle. When these points are in a line perpendicular to the ground, each segment of the body supports the one above, and the body is in balance with gravity. Often this imaginary line is jagged as parts of the body are displaced from optimal alignment. Some bodies are bowed forward, others are bent backward, the head may jut forward, or the pelvis may be retracted. When the body is out of alignment, we use more muscular tension to hold ourselves upright. The more the body is aligned, the less muscular effort is needed to hold ourselves up. An aligned core is dependent on the grounding we learned in the previous chapter. You can try a grounding exercise when you are sitting in a chair by placing both feet on the floor with your thighs parallel and gently pressing your feet into the floor. Can you sense how this action not only connects you to your legs and to the ground but also lengthens your spine? If your spine is rigid, learning not to depend on scaffolding your core through muscle tension can be useful. If your spine is bent forward, slumped, or flexed, working with increasing vertical alignment and strengthening core muscles can be useful. And if you are overgrounded, lengthening your spine will be a good resource for you, as described in Chapter 16, “Grounding Yourself.” It is important to encourage your alignment without using too much muscular compensation, because that could lead to more effort and another set of postural distortions. Simply lifting up the spine and holding it upright with muscular tension and force can make things worse. Instead, you might experiment with very gently extending the crown of your head upward toward the sky, being sure to keep your chin parallel to the floor. If you are standing, try pushing downward with your feet as you push upward with your head to help you develop vertical alignment. Imagining being lifted upward by the crown of your head, while your feet stay planted firmly, can also allow the spine to straighten and the chest to lift without undue tension. This posture may feel awkward initially if you are strongly out of alignment, but with gentle practice and a feeling of “allowing” the spine to lengthen rather than forcing it, a more aligned posture will become increasingly comfortable. Always be sure that these exercises are not painful in any way; if they are, you should stop. 405

Activating core muscles will also improve our posture. The broad, horizontal sheet of muscle that wraps around the abdomen is a primary muscle for supporting the core. Called the transverse abdominal, or TVA for short, this important muscle gently squeezes the abdomen, supports the lower back and organs, and stabilizes the spine. In a balanced, well-functioning, and pain-free body, the TVA contracts automatically to stabilize the body before the arms and legs are engaged. Healthy muscle tone in the TVA, neither too tight nor too lax, often fails to develop for many of us. Because we use the muscles of our shoulders, back, and neck when the TVA is not strong, you may experience tension or discomfort in these areas. Working with the TVA so that it can fulfill its function as a primary core stabilizer can sometimes help decrease the misplaced tension in these other parts of your body, alleviating some stress and leaving you feeling stronger. We need the core support of the TVA especially when we are challenged, when we feel like giving up, or when we are triggered by reminders of the past. Since the TVA is a primary stabilizing muscle, the goal is to teach your TVA to sustain a low level of tension so that your core is consistently supported and stabilized. We can learn to increase our awareness of the core of our bodies and vitalize its strength, and in doing so, we may find our spines becoming less collapsed or less dependent upon tension and rigidity. An enlivened core supports an internal locus of control—a sense that we are guided into action from the inside rather than controlled by outside pressures. Becoming aware of the physical core and exploring an aligned posture are important steps to finding that literal home inside ourselves where we feel secure in our core. Through the worksheets accompanying this chapter, you can learn about your own posture and explore resources to support your physical core to be strong, relaxed, and aligned.

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Core Alignment CORE ALIGNMENT AND P OSTURE, P ART 1 Purpose: To explore various postures and contrast the emotional and physical effects of each posture, what message might be conveyed by each one, and which ones feel familiar or unfamiliar to you. Directions: Study the postures below and then experiment with imitating each of them, noticing the differences. Then imitate each posture one at a time, and answer the questions in the space provided.

Posture #1 In this posture, the shoulders are rounded forward, the head and neck are forward, and the weight is on the ball of the foot. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? What message might be conveyed by this posture? Does this posture feel familiar or remind you of anything?

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Posture #2 In this posture, the knees are locked, the belly protrudes, the upper body leans back, the head comes forward, and each part of the body seems to be at an opposing angle. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? What message might be conveyed by this posture? Does this posture feel familiar or remind you of anything?

Posture #3 In this posture, the tail bone is tucked under, the pelvis tilted, the low back flattened out, the knees are slightly bent, and the weight is toward the back of the foot. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? 409

What message might be conveyed by this posture? Does this posture feel familiar or remind you of anything?

Posture #4 In this posture, the weight is on the heels, the chest is collapsed, the head comes forward and the arms hang limply. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? What message might be conveyed by this posture? Does this posture feel familiar or remind you of anything?

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Core Alignment CORE ALIGNMENT AND P OSTURE, P ART 2 Purpose: To explore various postures and contrast the emotional and physical effects of each posture, what message might be conveyed by each one, and which ones feel familiar or unfamiliar to you. Directions: Study the postures below and then experiment with imitating each of them, noticing the differences. Then imitate each posture one at a time, and answer the questions in the space provided.

Posture #5 In this posture, the chest and the spine are collapsed, the knees are locked, the belly protrudes, the shoulders slump and the head droops a little. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? What message might be conveyed by this posture? Does this posture feel familiar or remind you of anything?

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Posture #6 In this posture, the chest is pushed out, the breastbone is lifted upward, the shoulders are held back, the chin is up, the spine is rigid, and the whole body is at attention. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? What message might be conveyed by this posture? Does this posture feel familiar or remind you of anything?

Posture #7 In this posture, the muscles in the shoulders and neck are tense, pulling the shoulders forward and up, the neck and head are pulled into the shoulders, and the knees are locked. How does your body feel? What emotions do you experience? How do you think others would react to you in this posture? What message might be conveyed by this posture? 414

Does this posture feel familiar or remind you of anything?

Reflect on what you learned from these two worksheets on core alignment about your own posture and describe below. What insight did you gain about another person you know whose posture is similar to one of these on the worksheets.

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Core Alignment DISCOVERING YOUR CURRENT P OSTURE Purpose: To discover qualities of your own posture and the message your posture might convey. Directions: Stand as you would naturally and look in a mirror at your posture from the front and then the side, or have someone take front and side view pictures of you standing that you can look at. 1. Circle all of the descriptions below that apply to your posture, writing other postural elements you notice in the empty boxes, and then follow the rest of the prompts. Head Chin tilted Shoulders Curved forward downward held back lower back

Pelvis tilted under (tail between the legs)

Knees straight

Head erect

Knees locked

Knees or Shoulders, feet ears, hips, turned in and ankles in the line

Chin forward

Shoulders Flat level lower back

Posture demonstrates three curves

Head Shoulders Shoulders Collapsed Knees or Abdomen tilted to rounded uneven spine or feet protrudes one forward (one chest turned out side higher) Chin Shoulders Back tilted hiked up rounded upward forward

Stiff/rigid Knees spine bent

Abdomen is flat

2. Read the prompts in the boxes below, then exaggerate the elements of your posture that you circled: If your head comes forward a bit, bring it forward a little more. If your shoulders slump, slump them a little more. Stay in this exaggerated posture for a few minutes reflecting on the questions below. Then answer the questions.

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How does your body feel? What emotions seems related to your posture? What impulses do you experience? What message does your posture convey to you about yourself? What message might it convey to others? 3. Are the messages conveyed by your posture the ones you want to communicate? If not, what postural changes might help to communicate a different message?

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Core Alignment EXERCISES FOR P OSTURE & ALIGNMENT Purpose: To experiment with exercises that can support alignment and contrast a more aligned posture with your typical posture. Directions: Follow the prompts below to practice exercises that support aligned posture. 1. Shoulder roll: • Shrug your shoulders up to your ears. • Press your shoulders back and your shoulder blades together. • Then slide your shoulder blades down your back. • Do this a few times and notice how it affects your posture.

2. Lengthening your core: • Stand with your feet under your shoulders and pointed forward (if comfortable). • Keep your chin parallel to the floor. • Visualize yourself gently being lifted up by the crown of your head while your feet are planted firmly on the ground. • Experiment with gently extending the crown of your head upward toward the sky (while keeping your chin parallel to the floor) and gently pushing downward into the floor with your feet. • While sitting with your feet and thighs both pointed forward and your feet flat on the floor, gently push downward with the tail of your spine and the soles of your feet and simultaneously gently push upward with the crown of your head.

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3. Contrast the more aligned posture you experienced in the exercises above with your normal or familiar posture—go back and forth between them a few times. Describe the difference below. My Familiar Posture

A More Aligned Posture

Thoughts I have:

Thoughts I have:

Emotions I feel:

Emotions I feel:

Movements and sensations I experience:

Movements and sensations I experience:

Remember to practice a more aligned posture!

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Core Alignment ENGAGING YOUR TVA MUSCLE Purpose: To become aware of your transverse abdominal muscle, or TVA, the deep, flat muscle along the front and sides of your abdomen, and begin to strengthen it in order to help stabilize your core and support an aligned posture. Directions: Experiment with the two exercises below, following the prompts, and report your findings at the bottom.

1. Sensing Your TVA In order to strengthen your TVA, you must first sense the muscle. Look at the diagram of the TVA on the right to see where it is located in your body. Then complete the exercise below to sense your TVA before proceeding to the strengthening exercise. 1. Lie down on your back with your knees bent. 2. Place your hand on your belly, just below your navel. 3. With each exhale, feel your abdomen gently move away from your hand. 4. You might experience a hollowed-out feeling. Imagine your TVA hugging your spine, moving inward and upward. This is not a strong contraction, but very 423

gentle and subtle. Try to relax the superficial abdominal muscles and sense the deeper TVA muscle instead.

2. Strengthening Your TVA 1. Stand or sit in an aligned posture and relax your body. 2. Place your hand on your belly, just below your navel. 3. As you exhale, very gently pull your belly button backward toward your spine, visualizing your TVA hugging your spine and also pulling slightly upward. 4. Hold that position for a few seconds and repeat several times. 5. Notice how this exercise affects your posture. After practicing, describe your experience of sensing and strengthening your TVA. Include how your posture changes and how you feel about yourself. Don’t be concerned if you do not feel a difference right away. Practicing this exercise will support a more aligned posture over time.

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CHAPTER 18

Using Your Breath THERAPISTS’ GUIDE TO CHAPTER 18

Purpose of this Chapter Habits of breathing might contribute to, or exacerbate, the cognitive distortions, emotional biases, relational difficulties, dysregulation, fears, and phobias for which clients have come to therapy. Less than optimal breathing patterns can vary from “a general lessening of the volume of air exchange to hyper-tonicity or hypotonicity of the breathing muscles, to inspiration being confined to the upper chest, to a lack of graceful flow from inhale to exhale, and to disturbances in the rate of breathing” (Fogel, 2009, as cited in Caldwell & Victora, 2011, p. 90; see also Braddock, 1995; Chaitow, Bradley, & Gilbert, 2002; Christiansen, 1972). Exploring different breathing interventions can be a valuable resource for a variety of symptoms, such as regulating hyper- and hypoarousal, increasing or decreasing emotional intensity, providing energy or fostering relaxation, and even promoting physical health (Caldwell & Victora, 2011). The purpose of this chapter is to help your clients become aware of the habitual ways they breathe, explore how these habits affect their well-being, and experiment with new ways to breathe.

Clients Who Might Benefit Traumatized clients who tend to underbreathe (hypoventilate) or overbreathe (hyperventilate) can benefit from this chapter. Those who underbreathe often struggle with depressive states and avoidance behaviors, such as avoiding excitement or other strong emotions, whereas those who overbreathe might suffer from chronic dysregulation, panic, or anxiety attacks (Caldwell & Victora, 2011; Macnaughton, 2004). If clients grew up in pressured situations, where keeping busy, high achievement, and successful performance were emphasized, their breathing may be high and fast but shallow. An underbreathing habit full of sighs and extended exhales may characterize clients who feel stuck and hopeless. Those 425

who need to appear tough and invincible may inflate their chests with an inhalation, but fail to exhale or “let go” fully. This chapter supports all these clients to identify their breathing habit and explore alternatives.

Suggestions for Clinical Use Breathing techniques should be used with caution. Interventions that strongly change breathing, such as hyperventilation techniques, can trigger catharsis, and are nearly always ill-advised. Even deep relaxing breathing interventions can be problematic because they stimulate the dorsal vagal complex, which may induce anxiety for clients who are implicitly reminded of past trauma during which they experienced increased dorsal vagal tone and shutdown. A relaxed deep breath can also challenge clients for whom states of calm and relaxation were unwelcome or ridiculed in their families of origin. We suggest a conservative, undramatic approach to breath work, with emphasis on observing the breath first and then experimenting with small, titrated changes and mindful awareness of the effects. If interventions cause dizziness, headache, pain, unpleasant sensations, or any other uncomfortable symptom, clients should return to their normal way of breathing. As described in the chapter, issues such as heart problems, seizures, asthma, emphysema, diabetes, migraines, or anger management can be contraindications to breath work. You can teach your clients to avoid pushing themselves, but rather to proceed slowly, with mindful awareness, to discover what ways of breathing work for them. Tracking and assessing your clients’ breathing with them is the first step. You both can notice whether they breathe in a shallow manner, as is often seen in hypoarousal; breathe deeply in a relaxed manner; hold their breath, as often found in freezing; or breathe rapidly, as might be seen in hyperarousal. You might notice whether they emphasize the inhalation or the exhalation. You can become aware of the connection between their breathing patterns and their symptoms, sharing what you notice with statements like, “It seems as if your breath gets more shallow as you get more upset. Do you notice that, too?” or “It seems that the deep sighs become more frequent when you discuss how hopeless you feel.” These moments lend themselves to experimenting with alternative ways of breathing in session. You can also help clients make connections between their breathing patterns and their history. For example, you might help make sense of why they hold the breath by saying something like this: “It seems as if it must have been safer to hold your breath and be very still as a child—does that feel true?” or “When children learn to breathe shallowly, it might keep them from being noticed or from expressing their emotions—would that have helped in your family?” Discovering the adaptive function of breathing habits pave the way to experiment with new and 426

different ways of breathing. You might directly propose experimenting with changes in breathing by suggesting: “I wonder if we could address this difficulty just by playing with how you are breathing now and if the depression [anxiety, anger, loss of energy] changes with different kinds of breathing.” Once you and your clients have identified a new, more resourcing way to breathe and have practiced it in previous sessions, then their presenting issues at subsequent appointments can be used as a context for further practice of these new skills. You can frame moments of emotional stress and dysregulation as opportunities to experiment with a new breathing resource, suggesting to your client, for example, “Let’s try out that new belly breathing that was so calming for you in the last session and see how it affects your level of stress today.” As stated in previous chapters, how you engage somatic resources yourself will impact your clients, due to mirror neurons (Gallese & Goldman, 1998). Your clients will unconsciously notice the movement of your breath, and a similar way of breathing may be stimulated in them. You might experiment with changing your breathing and notice if your client’s breathing changes. For example, if your client is agitated, you might slow your own breathing or sigh audibly. Your deeper, calmer breath may regulate your client.

Introduction to the Worksheets The worksheet NOTICING YOUR BREATH should begin the this exploration the breath because it helps clients discover their habitual ways of breathing, without trying to change anything. It also teaches them various components of breathing in detail. POSTURE, TENSION, AND BREATH instructs clients to notice the effects of posture and tension on their breathing. Many authors have pointed out the relationship between posture and breath (e.g., Keleman, 1985; Kurtz & Prestera, 1976; Lowen & Lowen, 1977). A collapsed or rigid posture will diminish breathing capacity; an aligned posture will support it. Similarly, tension in the abdomen, shoulders, chest, or back can inhibit full breathing. You might do the exercises in the worksheet together and share your discoveries. DIFFERENT WAYS OF BREATHING allows clients to experiment with a few different breathing interventions and discover which ones are resourcing to them. Your guidance with each of these alternative ways of breathing will help clients to remain curious about the effect of each exercise, and also help to advert any dysregulation should it start to occur. DEVELOPING A RESOURCE IN BREATHING should be used with clients who are able to work with an exercise independently. It encourages clients to notice their breath throughout the day, especially the times their breathing felt good 427

to them, describe the breathing pattern that felt good, and then consider when they could use that way of breathing as a resource. REGULATING YOUR AROUSAL OR MOOD WITH YOUR BREATH encourages clients to track their breath during their daily life and notice times when their breathing is affected by triggers, and then experiment with practicing a way of breathing that is resourcing or feels good physically. The worksheet can be used in session to support clients to recall a time when their breathing did not feel good, and demonstrate that way of breathing for you. Your encouragement to explore the impact of a negative experience on breathing and then discover the effects of a different way of breathing, rather than focusing just on achieving a particular result, will help clients stay curious even when they may not experience the immediate gratification of success.

Adapting this Material for Dissociative Clients As much as breathing can be a resource for clients, it can also be especially difficult to use for those who are highly dysregulated or have dissociative disorders. Levine (2004) advised caution in working with the breath, especially with traumatized clients, because it can be triggering. Also, dissociative clients may unconsciously use their breath as a survival resource to maintain dissociation and avoid being present. It is helpful to discover whether some parts are fearful of changing breathing patterns, and if so, to discover what they are worried about. You can also identify any parts that are curious and want to try breathing interventions. Negotiation between these parts might open the door to small experiments: for example, taking little sips of breath for 10 seconds and then stopping and checking in with all parts. You may discover that a hypervigilant part is unwilling to try slower breathing because of a belief that “you can’t let down your guard,” or a frightened part is afraid that if she takes a deeper breath, someone will see her and she will be in danger. Other parts fear breathing more deeply because it decreases numbness, and they feel more sensations or emotions if they breathe. Each of these parts, of course, is being driven by a survival resource, and that fact needs to be acknowledged before the client can participate in successfully developing the use of breathing as a more creative resource. Often, clients are more open and comfortable with titrated breathing exercises, such as taking little sips of breath to increase energy or induce states of “calm alert,” but not evoke the deep relaxation of full diaphragmatic breathing. Some dissociative clients might breathe very shallowly or hold their breath for long periods, which increases sympathetic arousal reactions due to decreased oxygenation and increased carbon dioxide retention. One way to work with this is not to focus on the breath, but to use a cold compress of ice or cold water on the client’s face. This can induce a sudden increase in dorsal vagal tone that slows 428

sympathetic arousal to create a decreased need for oxygen. It can be an effective way to help a client calm down or stop dissociating (Kathy Steele, personal communication, June 20, 2013). Once the client is calmer, a focus on breathing can perhaps commence cautiously. It usually is best to use experiments that minimally challenge the existing habits of breathing, or use your own breath to slow down the level of activation or to increase the energy before trying out more advanced techniques. By exploring specific breathing experiments to discover what is regulating for each client and his or her parts and taking very small steps (e.g., “Let’s try half a sip of breath”), dysregulated and dissociative clients may be able to make good use of breath as a resource.

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CHAPTER 18 Using Your Breath Breathing is critical to life. We can go without food, water, or sleep for fairly long periods of time, but we cannot go without air for more than a few minutes. Breathing happens automatically every moment of our lives, typically about 12–22 times per minute. By moving air in and out of our lungs, essential fuel is delivered to places in the body that need it, and chemical excesses and wastes are removed. Every cell in the body requires oxygen to convert nutrients into useable energy. When we inhale, we take in oxygen, without which we cannot move, metabolize, or transform food into energy. When we exhale, we breathe out carbon dioxide, which can poison us if it builds up in the bloodstream. Our ability to balance these gasses automatically is another example of the body’s miraculous wisdom. Our breathing automatically responds to metabolic needs and continually regulates our energy and arousal. We breathe faster and harder under exertion, slower and deeper during relaxation. Exceptional experiences, magnificent performances, or glorious vistas “take our breath away.” We pause to fully take them in. Trauma and other distressing events, too, leaves us breathless, but not in a positive way. When we experience a threat in the form of shock or even disapproval, ridicule, or the like from our attachment figures, we often curtail our breathing, hold our bodies still, and may have trouble “catching our breath” after the situation has passed. We might live with a legacy of poor breathing habits, such as shallow breathing or chronic holding of the breath. We may over- or underbreathe, failing to balance inhalation and exhalation adequately. Our rate of breathing may be too fast or too slow, or our breathing muscles may be too constricted or too flaccid to promote healthy breathing. Although different ways of breathing are appropriate in different circumstances, we are healthier, tend to live longer, and feel better all around when we are generally able to breathe in a full and balanced way. We can learn to counteract limiting patterns of breathing and maximize what our breath can do for us as a resource. In this chapter you will learn about the mechanics of breathing, discover your own breathing patterns, and explore some basic breathing exercises that might help you center yourself and upregulate (increase your arousal) or downregulate (decrease your arousal) when you wish.

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Breathing Mechanics Breathing involves inhalation and exhalation, which you can notice right now just by turning your attention to your breath. You inhale through nasal passages that filter, cleanse, and moisten the air, which then proceeds down your windpipe into your lungs. Inhaling is caused primarily by the contraction of the diaphragm, the flat, pancake-like muscle that attaches to the lower ribs, spine, and breastbone, separating the chest from the abdomen. Perhaps you can sense that the domed diaphragm muscle flattens out as it contracts with your inhalation, causing your abdomen to protrude and your lungs to expand downward. Figures 18.1 and 18.2 illustrate how the diaphragm changes with the breath. The muscles between your ribs also contract as you inhale, lifting your ribs upward, expanding your chest, and further increasing the volume of your chest cavity. Pause for a moment and take a deep breath, letting your belly inflate as the dome of your diaphragm contracts and flattens out. Do you sense your ribs lifting upward, your chest cavity expanding?

FIGURE 18.1

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FIGURE 18.2

Inside your lungs, there are tubes, called bronchi, which branch out like a tree into smaller tubes with little sacs on their ends. These sacs transfer the oxygen from the air you breathe into your bloodstream. They also take in the by-product of metabolization, carbon dioxide, from the bloodstream, which then travels up through your lungs and windpipe as you exhale. Can you notice the effort required as you inhale and contract your diaphragm and muscles between your ribs to take in air? When we inhale, our sympathetic nervous system, which is responsible for exertion and increasing arousal, is slightly activated. With each inhale we are a bit more energized. Exhaling takes less effort and usually no contraction, activating the parasympathetic nervous system, which is responsible for relaxation. Of course, if we are exercising or otherwise need to breathe hard, we do need to contract muscles to exhale. But in normal circumstances, with every exhalation we experience a letting go rather than a contraction, and a subtle increase of rest and calm. Perhaps you can sense that when you exhale, your diaphragm and the muscles between your ribs simply relax and the volume of your lungs diminishes as they return to their resting state. Simultaneously, your chest cavity decreases in volume, increasing the air pressure in your lungs to force the air out. But our lungs never completely deflate on an exhalation—there is always air left over. Take a deep breath again, sensing the increased volume in your torso as your lungs expand with your inhalation. Then just relax and feel the air being pushed out as you exhale, with no effort. Can you sense a tiny moment of rest in the brief pause before the next inhale? Our breathing is controlled automatically by specialized centers in the brain that regulate the depth and rate of the breathing in relation to our body’s needs. If we are exercising vigorously, the carbon dioxide level in our blood increases 433

because we are metabolizing faster, and we automatically increase our respiration rate. Although overall we are taking in more oxygen the faster we breathe due to the increased rate, we take in less on each inhalation. The faster we breathe, the more carbon dioxide we exhale. When we are at rest, the carbon dioxide level is lower because our metabolism is slower, so our rate of breathing is also lower. Although at times the need for oxygen is paramount, it is often the buildup of potentially poisonous carbon dioxide in our blood that provokes the need to breathe faster, because our bodies strive to get rid of the carbon dioxide by breathing more rapidly. However, breathing is affected not only by our physiological state (the need for oxygen or to discharge carbon dioxide) but also by our emotions. Amazement may cause us to gasp in wonder, anger may cause jerky breathing, fear may stop our breath, and deep sadness may cause a choking breath. Breathing is one of the few bodily functions that can be conscious and voluntary or unconscious and involuntary. We can decide to hold our breath or to take deep belly breaths. However, we cannot voluntarily stop our breathing for very long because our breathing reflex will be triggered. Once the carbon dioxide builds up in the bloodstream and oxygen drops to a certain level, we experience an overwhelming urge to inhale. Without this reflex, our oxygen level could become dangerously low very quickly, leading to brain damage or even death, and the carbon dioxide levels could become dangerously high. If we try to hold our breath, the breathing reflex is typically triggered so that we automatically begin breathing again before we completely lose consciousness.

Breathing: Benefits and Cautions Although ways of breathing change naturally depending on internal and external conditions, an overall pattern of relaxed, balanced breathing is thought to have many benefits; such as helping nutrients be absorbed, boosting the immune system, contributing to bone growth, increasing circulation, strengthening organ functions, and even relieving pain. Relaxed, balanced breathing has even been shown to sometimes help panic attacks and migraines or to lessen the symptoms of asthma. With every deep breath, internal organs are massaged, circulation is enhanced, and lymph flow is increased. In short, good breathing promotes good health. However, we may have developed breathing patterns that helped us adapt to the expectations of our attachment figures or to trauma. We might benefit from exploring the way we breathe. But because breathing patterns might have begun as responses to fear, changing your breathing can be triggering. If you are triggered or experience dizziness, headache, pain, unpleasant sensations, or any other uncomfortable symptom, just return to your normal breathing pattern. If you have heart problems or seizures, asthma, emphysema, dissociative symptoms, migraines, 434

or anger management issues, breathing exercises should be used cautiously. Since changing your breathing alters blood sugar levels, caution is advised if you have diabetes as well. In any case we recommend a conservative approach to experimenting with breath so that any breathing exercises are done carefully with the guidance of your therapist.

Experimenting with Changing Breathing Habits There are many ways our normal style of breathing can be less than optimal. Fear may cause us to hold our breath or breathe only in the upper chest, failing to fully engage the diaphragm to do its job. Patterns of holding the breath or breathing shallowly to hold back certain emotions that were not welcomed in our families may cause tension in the chest and stomach and inhibit our breathing even more. Poor posture also contributes to poor breathing—if we are slumped, our lungs are compressed and do not have much room to expand as we inhalate. We may habitually breathe shallowly if we experience depression. Fast breathing that emphasizes the inhale may contribute to panic or anxiety. The neck and shoulders, which should be relaxed during healthy breathing, may be tense and constrict more while inhaling or exhaling. Our breath may be uneven, rapid, or shallow. We may not be able to “let go” as we exhale. Ted became aware that his frantic approval-seeking, achievement-oriented lifestyle affected his breathing habits. Rather than breathing from his diaphragm, he tended to breathe in little gasps that contributed to feeling scattered, off-center, and ungrounded. As Ted observed his normal way of breathing, he noticed that although he breathed more in the front of his body, his chest did not expand much, nor did his ribs lift with his inhalation. His neck and shoulders tightened with each inhale. It was a big realization when Ted became aware that his breath was actually threedimensional. It goes up and down, side to side, and front to back, expanding the lungs and rib cage in all directions. This awareness was the first step for Ted in learning to breathe more slowly and deeply. He tried to relax his neck and shoulders, and sense the three-dimensional expansion of his rib cage. He found this new way of breathing helped him slow down and relax. Annie was unaware that her breathing pattern increased her arousal and fueled an expectation of danger. She did notice a sense of panic each time her therapist asked her to relax and breathe, and she would often protest, saying, “No! Don’t ask me to breathe!” With her therapist’s encouragement, Annie became aware that she tended to inhale quickly but deeply and then hold her breath—which led to more observations about the connection between holding her breath and a sense of “threat everywhere” that ultimately increased sympathetic arousal and made her tense, frightened, and restless. With the help of her therapist, Annie gradually explored 435

taking little sips of breath and allowing a longer exhalation, which proved to be calming and regulating for her. On the other hand, Sayid felt apathetic about life and cut-off from himself. He wanted to get more in touch with his emotions. In therapy, Sayid discovered an overall pattern of tense, shallow breathing that increased when he began to experience his emotions. He realized that breathing shallowly kept his emotions at bay. With his therapist, he explored taking deeper breaths to help him connect with his emotions instead of inhibit them. Gradually, with practice, he developed a new breathing pattern that increased his connection with himself and his emotions. Generally, emphasizing the inhalation increases arousal slightly and gives us a little more energy, whereas emphasizing the exhalation decreases arousal slightly and supports relaxation. If you tend toward low energy or hypoarousal, you can notice what happens if you experiment with a longer inhalation and shorter exhalation. Brie sighed deeply with each exhale, which reflected and even strengthened the feelings of hopelessness that she so often felt. Learning to make her inhale as long as her exhale helped her feel more vitality and lessened her depression. If you tend toward being excited, anxious, or hyperaroused, see if you feel more relaxed if you spend a few minutes emphasizing a long, slow exhalation. This awareness of how your breath can support more arousal (sympathetic nervous system) or relaxation (parasympathetic nervous system) can be useful for increasing the width of your window of tolerance. The worksheets that follow will help you first discover your own breathing patterns, as you observe your breath objectively without trying to change it or evaluate it as “right” or “wrong.” Like Annie, Ted, Sayid, and Brie you can decide to pay more attention to how you breathe so that you can use your breath mindfully as a resource to help you regulate your arousal or experience your emotions more deeply. Remember to listen to your body’s responses and never push yourself when experimenting with breathing exercises.

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Using Your Breath NOTICING YOUR B REATH Purpose: To practice mindfully observing your breath, without trying to change or evaluate it, in order to learn about your habitual way of breathing. Directions: Find a comfortable position, sitting or lying down, and take your time to become mindful of your normal, resting breathing. Begin with the first circle below, and follow the arrows.

1. First, describe how you are feeling right now. 2. What is your posture like? Are you sitting straight up? Slumping? Do you feel tightness in your neck and shoulders or anywhere else? 3. Take your time to sense how you are breathing. How would you describe your breathing right now? Fast or slow? Deep or shallow? Smooth or jerky? Regular or irregular? 4. Does your breathing feel comfortable, natural, and easy? Or does it feel strained, tense, or uncomfortable? 5. Which is longer, your inhale or your exhale? Or are they about the same? 6. Notice your ribs as you inhale. Do you feel them moving? Do they seem to be moving mostly in your upper chest? Do you sense their movement on the sides of your body or in the back of your body? 7. Describe if and how your way of breathing changed as you observed it. 8. What did you learn about your normal way of breathing? How do you feel after completing this exercise?

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Using Your Breath P OSTURE, TENSION, AND B REATH Purpose: To discover how your posture and the tension in your body affect your breathing and to determine any physical patterns you want to change to support your breathing. Directions: Explore the different exercises below. Start with #1 and follow the arrows. 1. Sit in a chair with a hard surface, or stand, and describe your way of breathing right now. 2. Describe your posture. Is your spine aligned? Slumped? Rigid or tense? Do you feel tension in your neck and shoulders, belly, or anywhere else in your body? 3. Try lengthening your spine, as you learned in Chapter 15. Gently push upward with the crown of your head, and downward into the earth with your feet. How does your breathing change? 4. Try making your shoulders a little tense. Hold that tension for a few moments and describe how your breathing changes. Then relax your shoulders and describe what changes in your breathing. 5. Try tensing your belly, just a little, and hold the tension for a few moments. What happens to your breathing? Let your belly relax and describe the difference. 6. Try breathing just in your upper chest. Then in just your belly. Then both. What differences do you feel? 7. Try letting your posture slump. Notice how your breathing changes. Contrast the slumped posture with a rigid, tense posture and describe the differences in your breathing. 8. Which way of holding your body feels familiar to you? Tight shoulders, tight belly, slumped, rigid, or aligned posture? Do you notice any physical habit you might want to change to support your breathing?

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Using Your Breath DIFFERENT WAYS OF B REATHING Purpose: To become aware of the way you breathe, explore a few different ways of breathing, and notice how they affect your experience. Directions: Follow the prompts below to notice your way of breathing, then practice each of the five different exercises below and notice the difference. If at any time you feel uncomfortable, discontinue the exercise. 1. Notice your normal breathing right now. Circle all the words in the chart below that describe it. Write in additional descriptors in the empty boxes. held breath

steady

tight

Shallow

heavy, sighing

deep

Labored

fast

slow

Struggled

irregular

winded

through the nose

through the mouth

ribs move/don’t move

mostly in the belly

longer inhale than exhale

longer exhale than inhale

mostly in the chest 2. Try taking tiny sips of breath. Notice what happens—does this way of breathing feel resourcing to you or not? Describe your experience.

3. Sitting or lying down, place your hands on your belly. As you inhale, let your belly push out against your hands. Maybe you can sense your ribs lifting upward and your chest cavity expanding with each inhale. Describe your experience.

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4. Place your hands on the sides of your ribcage, with your fingers reaching around the front of your body. As you inhale, see try to sense your hands moving apart, and as you exhale, sense your hands coming closer together. Describe your experience. 5. How do you feel when you emphasize your inhale, letting it be a little bit longer than your exhale? Try it for a few minutes. Is your arousal affected? What do you experience? 6. As you exhale, imagine just letting the air fall out of the body without effort, allowing gravity to do the work. Try it for a few minutes, allowing your exhale to be a little bit longer than your inhale. Is your arousal affected? What do you experience? 7. Which way of breathing feels natural to you? Which feels good or resourcing? Which way of breathing might you use in the future as a resource to alter your arousal or mood?

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Using Your Breath DEVELOPING A RESOURCE IN B REATHING Purpose: To notice and reflect on times when your breathing felt good to you (maybe it felt regulating, energizing, or calming), and practice using that way of breathing as a resource. Directions: Be aware of your breathing and notice times during the day when your breathing feels good to you—maybe it feels better when your breathing is deep, smooth, easy, and regular, or when you are not breathing so deeply. You might also remember some moments in your past when your breathing felt good. Then follow the prompts below.

1. Describe the moments, situations, or people you were with when your breathing felt good to you, and what felt good about the way you were breathing. (e.g., I noticed I took long, deep breaths as I was snuggling with my wife before I fell asleep; when I was sitting out on my deck in the sun with a cup of coffee, my breathing felt full and steady; when I was working out, I took deep breaths that expanded my chest.) 2. What did you feel in your body? Did your emotions or thoughts change? What was the effect of breathing in this way? (e.g., When I was working out, I felt a strength in my body, felt my ribs expand in the back of my body. I felt energized and alert. Emotionally, I felt good and I had thoughts that I was doing something good for myself.) 445

3. When might you use this way of breathing as resource in the future? (e.g., When I get anxious, I can try taking deep, full breaths instead of short, shallow ones, and I can be aware of my ribs expanding in the back of my body.)

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Using Your Breath REGULATING YOUR AROUSAL OR MOOD WITH YOUR B REATH Purpose: To notice situations in which your breathing did not feel good to you, discover how it relates to your arousal, and try out a different way of breathing. Directions: Notice your breathing during the week and identify a time when you experienced a change in your breathing that did not feel good (e.g., felt too fast or slow, deep or shallow, irregular or jerky). Or recall a recent upsetting memory, thought, or trigger that altered your breathing in a way that did not feel good. Then follow the prompts below. 1. What triggered the changes in your breathing that did not feel good? 2. What was it about your breathing that did not feel good?

Hyperaroused

Hypoaroused 3. How did your breathing relate to your arousal? Was your arousal high, or hyperaroused, or low, or hypoaroused? 4. For a moment, try on the way of breathing that did not feel good and write down the effects. 5. Describe a different way of breathing you could use as a resource. 6. Try on the different way of breathing. Describe the effect here. 7. In what situations, or with which people, might you want to remember to use the different way of breathing?

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CHAPTER 19

A Somatic Sense of Boundaries THERAPISTS’ GUIDE TO CHAPTER 19

Purpose of this Chapter A physically felt sense of boundaries that clients can draw on to increase their safety and well-being is an essential resource that many will need your help to embody (Kepner, 1987, 1995; Levine & Frederick, 1997; MacNaughton, 2004; Ogden et al., 2006; Rosenberg, Rand, & Asay, 1989; Rothschild, 2000; Scaer, 2001). Feeling disrespected, inconvenienced, used, or victimized by others, acting intrusively themselves, or failing to respect the boundaries of others (whether unconsciously or knowingly), are all signs of unhealthy boundaries. Given that clients might attribute such difficulties to their own inadequacy, violation by others, or problematic relationships, it can be useful to learn that they might be struggling with a failure of adaptive boundaries rooted in their history. The focus of this chapter is to help your clients understand that knowing when they need a boundary and communicating it to others are both primarily nonverbal, body-based abilities. They will gain awareness of how their boundary difficulties are related to one or both of these two somatic abilities. Although they may be intellectually ready to set limits, the procedural learning of the past often inhibits their doing so effectively. This chapter will increase clients’ ability to notice their internal body signals that tell them when they need a boundary. Clients will mindfully practice physical actions and expressions that communicate boundaries and foster a somatic sense of boundaries. This chapter will also educate clients about physical (pertaining to proximity and touch) versus internal (pertaining to thoughts, emotions, and opinions) boundaries. The material in this chapter is a precursor to Chapter 32, “Boundary Styles in Relationship,” in which more complex relational boundaries are explored.

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This chapter will aid clients who have difficulty protecting themselves, are repeatedly victimized or taken advantage of, expend more than they can afford financially or emotionally, cannot set limits, or feel violated or put upon in their relationships. Some may be unable to discern their preferences for physical closeness with or distance from, another person, or may engage in physical intimacy (e.g., hugging, sexual contact) when they would rather not. Others may have insufficient internal boundaries. They might feel assaulted by the criticism or feelings of others, unable to screen out the emotions of others, experience other people as “making” them feel ashamed, sad or angry; or be unable to tolerate others having different opinions or feelings from their own. Issues of enmeshment or mistrust in relationships often reflect underlying boundary problems, as well as tendencies to avoid or distance oneself from others. Some clients may only know how to set boundaries aggressively, and they will benefit from differentiating signals that indicate to them that they need a boundary from signals that indicate a need for aggression. Clients with boundary issues that emerge in the therapeutic relationship will also benefit from this material. Some may want to disclose too much personal information too quickly before sufficient trust has been established, and then react by becoming withdrawn, clingy, or distrustful. Others might reveal less than you need in order to understand their internal world. Some clients may test or intrude upon your boundaries by asking for personal information such as your home telephone number or challenging the treatment frame or even your competence. Your own boundaries may feel threatening, unwelcoming or too permeable to your clients. This chapter provides a jumping-off point to explore these issues.

Suggestions for Clinical Use Clients who confuse nonverbal boundary setting with verbal boundary setting, or do not understand the crucial role of the body in setting boundaries, will need your help to learn that healthy boundaries are felt as an internal experience and communicated primarily nonverbally. In addition to the didactic material that helps clients understand the nature of boundaries, experiential education within the session is also beneficial. For example, you might contrast the somatic expression of two ways of setting boundaries. You can demonstrate body language that has “no” written all over it—a stern face, head up, erect spine, shoulders square and back, or both hands up, palms facing outward in a classic “stop” gesture. Then you can contrast those indicators with body language that is timid—a collapsed posture, head ducked, pulling back, eyes averted, and the “stop” gesture tentative. You may become aware of clients’ failure to set boundaries by what they say— for example, “I feel invaded,” “I wonder what they want from me now.?”, “I feel 450

like a doormat,” or “People always expect me to do things for them”; by their body —such as a slump in the posture that goes along with “I can’t say ‘No’”; or by their tendency to be “too close” to others or override their own needs to take care of others. Clients will benefit from your asking them to report the physical signs of their needs for boundaries or their lack of ability to set a boundary. For example, when a client says, “I feel invaded,” you can ask what internal bodily signals tell them they feel invaded. Often, they will report an impulse to pull back, withdraw, or constrict. Sometimes they might report feeling too open. You can help them understand that such signals are their body’s communications that signal a need for a boundary and then use some of the exercises described in the chapter and the worksheets to explore physical boundary actions that mitigate the sense of feeling invaded. Consistently providing choices for clients and reinforcing their ability and right to choose is useful for integrating this material. You can directly support the possibility of setting a boundary in session by saying, “You don’t have to divulge anything you don’t want to” or “It’s fine if you don’t want to ‘go there’ right now— it’s up to you.” You might ask questions such as, “What feels right to you?” and “What sensations in your body tell you that that feels right?” The question “How do you know?” will help clients tune into these bodily signals. For example, when clients reject a suggestion of yours, saying, “I don’t want to work on that,” you might acknowledge their boundary by responding with a something like, “That’s great that you know! I wonder how you know you don’t want to work on that? Does your body tighten up, or does your breathing change? Your body must give you some signal that it’s not the right time.” Statements and questions such as these convey respect for boundaries and help clients attune to their bodily signals.

Introduction to the Worksheets The worksheet NONVERBAL BOUNDARY SETTING provides a platform to practice a number of different ways of setting limits or saying “no” with the body without the confounding pressure of an interpersonal situation. Clients should be encouraged to try out these different actions and postures, mindfully noticing what changes inside, what actions are familiar or unfamiliar, and “what feels right in the body,” rather than judging any of these exercises as practical or impractical or morally good or bad. Keep in mind that these actions may feel awkward or uncomfortable for clients who did not learn to set adaptive boundaries. Trying them out can provide a starting point for delving deeper into boundary issues. Practicing them together in session can help set clients at ease. AWARENESS OF PHYSICAL BOUNDARIES is designed to help clients 451

identify when their physical distance, energetic, or contact boundaries have been violated, to pinpoint their somatic reactions, and to reflect on how they handled these boundary violations. This will be especially helpful for clients who have learned to ignore violations and their own internal signals. This worksheet lists a variety of boundary violations, and thus can be evocative and triggering for those who have experienced trauma, so it is usually best completed in session where you can help them regulate as needed. INTERNAL BOUNDARIES helps clients identify their bodily reactions to remembering a conflict in which a person close to them had a different feeling or opinion from theirs. This worksheet sparks insights into inadequate internal boundaries, and forecasts what might be different if internal boundaries were clear and strong. VERBAL AND NONVERBAL BOUNDARIES explores the difference between saying “yes” and “no” with words and with the body. It can be especially helpful if clients’ verbal messages are incongruent with their nonverbal ones because this worksheet helps them develop congruence between the two. For clients who find it challenging to tune into a somatic sense of boundaries, the worksheet TANGIBLE BOUNDARY EXERCISE is a good place to start. Often it is easier for clients to sense their internal signals of having a boundary when they can actually see a physical representation of the boundary. This worksheet instructs clients to explore constructing a boundary that is tangible and visible with rope or cushions, and can be practiced in session with your guidance. It can be illuminating if you help clients notice what changes in relationship to you when they have a tangible boundary. Finally, the worksheet on BOUNDARIES: RESPECTED AND BREACHED instructs clients to mindfully study the impact on the five building blocks of two past incidents: one when their boundary was respected and one when it was breached. Contrasting these two opposite experiences can clarify internal signals, because they are very different in each case. Most clients will reap maximum benefit from this worksheet if you direct their mindful attention to their building blocks in response to recalling each situation.

Adapting this Material for Dissociative Clients The topic of boundaries and the exercises for exploring them are likely to exceed the window of tolerance for dissociative clients unless broken down into very small steps. Missing a somatic sense of having boundaries, hypoaroused clients or certain dissociative parts might automatically comply with your suggestion to work with this material, but then become more hypoaroused. Hyperaroused clients may respond with fight or fear responses, either active refusal to participate or terror and freezing. As explained in Chapter 1, “Essential Principles,” some clients have 452

an overactive “cry for help” defense, meaning that as adults they depend on the nearness and care of others to feel safe, similar to infants who cry for their attachment figures when they feel frightened. If this is the case, clients may perceive boundary exercises as meaning that you do not care about them or want distance from them. When such clients refuse a suggestion or exercise, you can use the opportunity to reframe the refusal as a boundary, even if it is accomplished in an animal defense state. In clients with dissociative disorders, you might discover that different boundary tendencies are held by different parts of the client. A protector part might have an automatic “no” reaction, whereas a part that wants closeness and connection might have an automatic “yes.” One part might be ashamed for setting a boundary (“That’s not nice or polite”); another might be afraid (“I’ll get hurt if I set a boundary” or “I don’t deserve to have boundaries”). The adult part might want healthy boundaries, not too rigid and not too permeable. You can help clients understand that each part is attempting to maintain some sense of safety by dealing with boundaries in a particular way a client can also begin to understand that each part is reacting to how other parts deal with boundaries. For example, the more a child parts says “yes,” the more an angry part says “no,” or the more a client strives to set boundaries, the louder an internal voice says, “You don’t deserve it.” As a result, you might find that boundary exercises, although useful to some parts, dysregulate other parts. The solution is to slow the pace and create a sense of experimentation and exploration, helping clients to be curious to find out how various parts respond to the idea of setting a boundary. It is essential to help parts understand each other and begin to work more effectively with each other. You must explore whether the “no” part can experience what it is like to say “yes”? And can the “yes” part can experience what it is like to say “no.” Perhaps parts could work together to learn when boundaries are good to put up, and when they might be helpful to take down. It is important to encourage communication and collaboration among dissociative parts so that each one is supported in boundary setting, rather than either overridden or allowed to take over. It will take time and experimentation to gradually work toward a somatic sense of healthy boundary setting for all parts of the client.

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CHAPTER 19 A Somatic Sense of Boundaries A boundary represents a limit or barrier. In our everyday lives, we constantly set boundaries by making choices, saying “yes” to some things and “no” to others, orienting toward some people and things and away from others. With good boundaries, we are able to protect ourselves and make choices that are true to our preferences, needs, rights, and desires, while maintaining connections and respecting the boundaries of others. Without good boundaries, it may seem that we have no choice but to comply with the demands of others, endure repeated violations, aggressively set limits, or withdraw from contact. The world and other people can feel unsafe, intrusive, demanding, or burdensome. Our bodies give us internal signals that tell us how close we want to be to another person, what our feelings and beliefs are, which activities feel “right” and which do not. These signals, such as tightening, leaning back, turning away, or the impulse to push away, are indicators that we need to set a boundary. Communicating a boundary is first and foremost a nonverbal capacity. Before we have learned to speak as infants, we could communicate our boundaries through vocalizations, facial expressions, and actions of turning away, shaking the head, or pushing away. Only later do we learn to say “no” with words. Even as adults, boundaries are instinctively sensed and communicated through the language of the body. To learn healthy boundaries, it is essential to develop a felt sense in our bodies of our preferences, needs, rights, and desires, and to be able to nonverbally and verbally communicate them to others. This chapter emphasizes how to attune to the somatic cues that signal the need for a boundary and explores boundary-setting physical postures and actions. We will also differentiate physical and internal boundaries and how early experiences influence both kinds of boundaries today. Later in the book (Chapter 32, “Boundary Styles in Relationships”) we will delve more deeply into the complexity of relational boundaries.

Physical Boundaries There are two types of physical boundaries. The first type pertains to how physically close or far away we want to be to another person. Our bodies let us know our need for closeness and distance through visceral and muscular signals. 455

Tightening or butterflies might indicate a need for distance, but a deeper breath and relaxation might indicate a desire for closer proximity. When we have healthy physical boundaries, we convey our preferences for distance or closeness primarily through our body language—tensing, grimacing, or moving back if someone is too close—as well as through words. We are also sensitive to the signals of others about their needs for proximity or distance. The second type of physical boundary pertains to touching and being touched when two or more people are close enough for physical contact. Based on the often unconscious internal communications via our body sensations, impulses, thoughts, and emotions, we determine if, when, and how we wish to be touched. Touch boundaries are conveyed by adjusting our body position—leaning away, turning away, walking away, and even pushing away—and through verbal requests or demands, typically used when physical signals are not respected. Physical touch boundaries protect us by making it possible for us to fend off unwanted touch, say “no” to a request with words and with our bodies by moving or pushing away, or moving back when someone touches us or is about to touch us. When we have healthy touch boundaries, we also are naturally aware of and respectful of the touch boundaries of others.

Internal Boundaries Internal boundaries pertain to internal processes such as thoughts and feelings. They enable us to take in information that is nourishing or educational while screening out that which is unpleasant or detrimental to our well-being. With healthy internal boundaries, we can separate our opinions, thoughts, and feelings from those of other people so that we are not unduly swayed when others try to convince us how to feel or think. We are open to other perspectives, but we make up our own minds and allow our feelings to guide us. Internal boundaries affirm and enforce our right to our own opinions, beliefs, and feelings even if they are different from those of others. With good internal boundaries, we also do not try to convince others that they should feel or think a certain way. We can acknowledge and accept differences in thoughts, opinions and feelings and yet still stay connected to the other person. When our internal boundaries are strong but flexible, we do not blame others for how we feel, and we are empathic toward others without taking responsibility for their emotions or opinions. Instead of feeling threatened by differences, we can accept and even enjoy them. If a friend fails to understand what something means to us or has a different perspective or opinion about a topic that is important to us, we can accept this dissimilarity without rejecting our friend or changing our minds to agree with him or her. We do not need our friends or family members to agree with our point of view, or have the same likes or dislikes, or feelings to feel close to 456

them.

Healthy Boundaries Healthy boundaries are elastic and flexible, shifting each moment according to our needs and preferences. They are different with different people and in different situations. We have more relaxed boundaries with dear friends than we do with acquaintances because we want to be closer physically and emotionally to our friends. If we are tired or stressed, we may set firmer boundaries, but if we are relaxed and energized, we may have more open boundaries. With healthy boundaries, we can respond to the moment-to-moment choices in our lives with an internal sense of being true to ourselves and being able to intuitively discriminate what is appropriate to take in and what is appropriate to keep out. For example, when we receive negative feedback that does not feel entirely accurate, we are able to realize that some elements of it are applicable to us, and that other elements reflect the other person’s views and are not applicable. However, this is usually not a conscious process. We automatically adjust, moment-to-moment, intuitively making choices that support our needs and preferences. Our body sensations, muscle tension, or movement impulses tell us if we have let in too much, too little, or just the right amount, guiding us in setting our boundaries.

How Boundaries Develop We learn about boundaries in the context of our family dynamics. If our parents respected our boundaries and their own, we probably developed good boundaries. When we have suffered relational trauma, our boundaries have been violated by others. Unwanted physical or sexual contact overrides both our physical and internal boundaries, often giving a message that we do not have a right to have a boundary. Healthy internal boundaries may fail to develop because, to survive and adapt, we learn to do what others want at the expense of taking care of ourselves. There are many different dynamics that interfere with healthy boundary development. Our caregivers may have insisted on determining what was best for us, failing to validate our own preferences or needs. They may have coerced us to think or feel a certain way that met their needs, not ours, so that we sacrificed our own boundaries. Parents may have accused us of “hurting” them when we set boundaries. They may have given the message that we need to pay them back when they do something nice for us by letting them violate our boundaries in some way. Or they might have threatened to withdraw their love or care if we did not obey them. If our parents instilled in us an extreme sense of duty, we may have learned to 457

override our own boundaries in order to be “responsible.” Sometimes children have to choose between loving contact with their parents and honoring their own boundaries. When Bob was 10 years old, he wanted to set a boundary by refusing to sit on his mother’s lap when she asked. He sat next to her instead, but she frowned at him and then looked away from him. As a child, Bob overrode his own boundary and, to keep his mother’s approval and maintain connection with her, he reluctantly sat on her lap as she wished. When Bob remembered this incident in therapy, his belly tightened and his whole body stiffened. He had felt torn between what the tension in his body had told him (that he did not want to sit on her lap) and how he felt when she frowned and looked away (sadness and fear at her disapproval and withdrawal). From such early experiences, we instinctively internalize the different reasons why we should or should not set boundaries. When parents respect our boundaries and teach us to respect the boundaries of others, we learn that all people have a right to their own boundaries. But when attachment figures disapprove of our setting boundaries, we often internalize a belief that we must do what others want. We might not want to risk losing important relationships or causing negative reactions, fearing that the other person will withdraw, be angry or hurt, or punish or reject us if we set boundaries. If parents viewed our attempts to set boundaries as controlling or selfish, we might still be fearful of coming across as self-centered, controlling, or egotistical if we set boundaries. We may feel guilty if we set a boundary, or we may feel we just do not have a right to do so. Once we have developed boundary habits, it simply may seem easier to follow these old habits of being silent, complying, withdrawing or becoming unduly aggressive than to directly set a healthy boundary. It is important to remember that even our unhealthy boundary habits were survival resources in the past. But in the long run, we pay a price for not setting good boundaries. We may allow ourselves to be emotionally or physically abused, manipulated, or otherwise mistreated. Without healthy boundaries to support a clear sense of choice between saying “yes” or “no,” we may feel used or coerced even when others have no intention of taking advantage of us and would respect our boundaries if we could only set them.

Nonverbal Boundary Setting Many approaches to setting healthy boundaries are based on the use of language. However, nonverbal messages convey our boundaries long before our words, and the vast majority of boundaries are established through the posture, gesture, expression, and stance of the body. If we grow up in an environment where boundaries are respected, we learn how to naturally send nonverbal messages that convey our boundaries, without thinking about them. If we did not learn this, even if 458

we are able to set a boundary verbally, our body language may not be consistent with the verbal message. We may say “no” with our words, but our bodies may say something else. Kate, a college student, was confused and ashamed because she often found herself having sex when she did not want to, even after she told her suitor “No, please stop.” She was not aware that her body language conveyed a different message than her words. Her therapist asked her to try saying the word “no” directly to an imagined suitor while being mindful of her body’s reaction. Kate became aware that she slumped and looked down and away, avoiding eye contact. Her body gave a different message from the verbal message. Kate felt that her body communication said “maybe,” which reflected a belief leftover from her childhood in which she was taught never to hurt anyone’s feelings and to sacrifice her own preferences for those of other people. Unbeknown to her conscious mind, her body seemed to have communicated this belief to her suitors, who then persisted in their advances until she acquiesced. Through her therapy, Kate came to realize that setting a boundary did not mean she was hurting someone else, and that she deserved to honor her own preferences. Kate practiced standing up straight and saying “no” definitively, in a strong voice, while looking into her therapist’s eyes. With practice, her body language gradually became congruent with her verbal message, which gave her a physically felt sense of setting a boundary that honored her preferences and needs. When she said “no” clearly with her words and her body, she found that others usually backed off and respected her boundary. If we are not tuned in to our body’s cues, we may habitually override them as Ashan did. Whenever anyone asked something of Ashan, she complied. When she came to therapy, she was run down and overwhelmed by the demands of the people in her life. As she learned to listen to her body, she found that her body gave her many signals telling her that she needed to set a boundary when someone asked her to do something she did not really want to do; she felt tightness in her chest and jaw, her breath became shallow, and she started to feel slightly agitated. Once Ashan learned to listen to her body’s signals, she was able to respond to them by setting appropriate boundaries. We may fear that setting boundaries will decrease closeness with others, but healthy boundaries can both help us protect and take care of ourselves and increase connection. Bob’s girlfriend habitually dropped by his house without warning. But he hesitated to tell her that he wanted her to call first when she planned to visit. He was afraid that she would withdraw or break up with him if he expressed his wishes. This feeling was reminiscent of his fear of his mother’s disapproval if as a child he were to tell her he did not want to sit on her lap. As he worked on setting a boundary in therapy, he decided to maintain physical closeness with his girlfriend by looking into her eyes and holding her hand as he told her that he preferred that 459

she call before she dropped by. To his surprise, when he was finally able to set a clear boundary in this way, she did not withdraw. She instead apologized for not realizing that giving notice was important to him, and she said that she would be glad to call first. To Bob’s astonishment, setting a clear boundary in a loving way actually increased their connection; he felt closer than ever as his girlfriend honored his boundary. You too might have difficulties sensing or reading your body’s signals that tell you that you need a boundary, or you may remember times when you overrode these signals. Or, perhaps your attempts to set boundaries have not been respected, or have created too much distance in your relationships. Developing a somatic sense of boundaries necessitates that we learn to tune into signals and convey our preferences clearly with our bodies as well as with our words. When the stance and movement of our bodies is congruent with our words, we are able to send a definitive, clear message. With mindful practice, you can learn to read your body’s signals to better understand your needs and preferences and to communicate your boundaries clearly. In the worksheets that follow, you will learn to identify the signals in your body that indicate the need for boundaries and explore how to set them through physical movement, body language, voice tone, eye contact (or lack thereof), and other kinds of nonverbal communication. You can draw on the somatic resources you have already learned to support your setting healthy boundaries. Centering, containments, grounding, and alignment resources can all help you set your boundaries clearly and effectively.

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A Somatic Sense of Boundaries NONVERBAL B OUNDARY SETTING

Purpose: To try out physical actions that signal a boundary; mindfully notice what thoughts, emotions or memories are stimulated; and assess which actions are familiar, which ones feel good to you, and which ones do not. Directions: Try these boundary-setting actions with your therapist or someone you trust, adding any additional boundary-setting actions of your own in the empty polygon. Take your time to be mindful of what thoughts, emotions, sensations or memories arise, and write them in each polygon. Then, complete the prompts below. Use your facial expression—frown, sneer, scowl, or grimace Avoid eye contact Make a “stop” sign with your hands Narrow your eyes or glare Cross your arms in front of your chest Tighten your jaw Clench your fists Lean back and away Walk away Say “no” with your body Push away with your hands Retract your head—move it backwards Turn away 1. Which of the actions felt familiar to you? Which felt unfamiliar? 462

2. What situations in your past or present do the familiar actions remind you of? 3. Which actions felt good? Which did not? Are there any actions that felt more aligned with the person you are today, rather than with who you were in the past? If so, which ones?

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A Somatic Sense of Boundaries AWARENESS OF P HYSICAL B OUNDARIES

Purpose: To identify situations in which your physical boundaries were crossed, describe your body’s response to these boundary violations, and reflect on how you might handle such situations in the future.

Directions: Think about your experiences with physical boundaries as a child and adult. Read through the lists below that describe boundary violations and add any. Check the box next to any that you have experienced and add any not listed in the empty boxes. Choose three boundary violations to explore, then describe each situation, your body responses, how you handled it, and how you might handle it differently in the future. Physical Distance Boundary Crossed Being stared at Being looked at in a sexual way Being looked at in a threatening way Someone standing too close to you (e.g., in line at the store) Someone talking or yelling too close to your face Someone sitting beside you when you didn’t want him or her to be that close Someone talking “at” you in a derogatory or threatening tone Someone making threatening or insulting facial expressions to you Someone making obscene gestures at you 465

Physical Contact Boundary Crossed Someone brushing up against you Being hit or pushed Being held down Forced physical contact (e.g., being coerced or made to hug, kiss, or sit on someone’s lap) Someone grabbing your wrist or arm Being touched in a car, room or corner where you couldn’t escape Someone demanding, or forcing sexual contact Someone touching you when you don’t want to be touched, or in a way you didn’t want to be touched Being tickled when you didn’t want it

Situation Body Response

How You Handled It

How You Might Handle it Differently in the Future

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A Somatic Sense of Boundaries INTERNAL B OUNDARIES Purpose: To explore how having a good internal boundary might affect interpersonal conflict, and to help you acknowledge differences in thoughts and feelings between yourself and others without sacrificing your own internal boundary or violating those of others. Directions: Answer the questions below to gain insight about your own internal boundaries. 1. Think about a time when you had a conflict with someone you care about because he or she shared a different or opposing opinion, belief, or feeling to yours. Describe the conflict here. 2. How did the conflict affect your body? How does remembering it affect your body right now? 3. Imagine having a good internal boundary and acknowledging that you both have the right to your own thoughts, opinions, feelings, and beliefs. What happens in your body? Describe the somatic sense of a good internal boundary. 4. Imagine how this sense of internal boundary could affect the conflict, and describe below. 5. List three possible future conflicts with others in which the somatic sense of good internal boundaries might be helpful.

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A Somatic Sense of Boundaries VERBAL AND NONVERBAL B OUNDARIES Purpose: To discover the differences of verbal and non-verbal communication of a boundary and explore synchronizing your verbal communication with the nonverbal communication. Directions: Practice saying “yes” and “no” with words and with your body, and follow the prompts below. 1. Describe what happens in your body when you say “yes” aloud. Say it several times, noticing the changes in your body. Then try communicating “yes” with just your body. What changes in your breath, tension, movement, or posture? (e.g., My body opens up and relaxes, my chin lifts, my chest expands, and I take a deep breath.) 2. Describe three situations in which you would like to be able to say “yes.” (e.g., I would like to say yes to my kids when they want to play, rather than saying I have to work.)

3. Describe what happens in your body when you say “no” aloud. Say it several times, noticing the changes in your body. Then try communicating “no” with just your body. What changes in your breath, tension, movement, or posture? (e.g., My muscles tighten and pull inward, especially my shoulders; my jaw is set, I frown, and I feel like I dig in my heels.) 4. Describe three situations in which you would like to be able to say “no.” (e.g., I would like to say no to my friend when she asks me to babysit.)

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5. Choose one situation in which you would like to say “yes.” Practice taking on the body posture of yes, and describe what happens when you imagine that situation. 6. Choose one situation in which you would like to say “no.” Practice taking on the body posture of no, and describe what happens when you imagine that situation.

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A Somatic Sense of Boundaries TANGIBLE B OUNDARY EXERCISE Purpose: To create a tangible boundary that you can see and touch, in order to increase your somatic sense of having a boundary. Directions: Sit on the floor or in a chair. Then construct a tangible and symbolic boundary around your body using string, ropes, scarves, pillows, or other objects with your therapists guidance. Take the time to place the rope or objects around your body at the distance and in the shape that feels right for you. Make the boundary as thick or thin as you want by adding or taking away objects. If there are any areas (your back, chest, or one side) add more rope or objects to that part of your boundary.

After creating a tangible boundary, take a few minutes to sense “your space” within the boundary you defined, and then answer the following prompts. 1. Describe the tangible boundary you created. What did you use to construct it? Was it close to or far away from your body? Describe its shape and thickness. 2. How does your body respond to your tangible boundary. Does your breathing, tension, or posture change? 3. What thoughts, emotions, or memories emerge from constructing a tangible boundary? 4. How can you use the somatic sense of a tangible boundary in your life? For example, if you felt more solid in your body with a tangible boundary, how could you recreate that sense of solidity in situations where you need to have a boundary?

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A Somatic Sense of Boundaries B OUNDARIES:RESPECTED AND B REACHED Purpose: To identify times in your life when other people have respected your boundaries and when they have disrespected or breached your boundaries, and to assess how your building blocks are affected in each case. Directions: Take your time to remember an incident when your boundaries were respected and an incident when your boundaries were breached. Write a brief description of each incident and then contrast how your building blocks were affected in each situation. Boundaries Respected

Boundaries Breached

Describe the incident:

Describe the incident: Thoughts Emotions

Five-Sense Perception Movements Sensations Reflect on your experience of each of these incidents and discuss with your therapist.

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CHAPTER 20

Developing Missing Resources THERAPISTS’ GUIDE TO CHAPTER 20

Purpose of this Chapter This chapter identifies and explores resources that are undeveloped, weakened, or missing altogether. Resources may fail to develop for a variety of reasons, including family values (e.g., esteeming art but not sports), insufficient financial means to support a talent, lack of opportunities (e.g., a dry climate that does not support a child’s interest in swimming), parental blind spots or ignorance (e.g., their failure to recognize the need to encourage a particular ability such as reading or physical activity), disability (e.g., a dyslexia that makes it difficult to read or enjoy reading), family stressors (e.g., illness of a parent or sibling), as well as traumatic and adverse attachment experiences. The chapter provides a context for understanding how some resources fail to develop and encourages clients to acquire these missing resources.

Clients Who Might Benefit This chapter has particular benefits for clients whose progress in therapy has stalled due to missing resources such as the ability to connect to body sensations or emotions or to implement healthy boundaries. This material will also be useful for clients who have verbalized the need for particular resources currently unavailable to them, reporting, for example, “I wish I were more artistic,” or “I wish I could stand up for myself,” and for clients who have interpreted the absence of such skills as personal liabilities and shortcomings. Those who are actively exploring their own growth and development will be motivated by the new possibilities that developing their missing resources offers. Clients who struggle with shame and self-blame can gain particular benefit from contextualizing their difficulties by being reminded of how they came to lack particular resources and then helped to develop the missing resources. 476

Suggestions for Clinical Use You have been guiding your clients to experiment with resources of all kinds through the work of this book so far, but this chapter focuses particularly on identifying and developing the ones whose absence interferes with therapeutic progress. Helping clients understand the variety of reasons for the failure of resource development will help them reframe what they might believe to be inadequacies as missing resources. In traumatic environments, animal defenses, shame, and fear thwart the development of competencies. When young children in safe environments are learning such skills as asserting themselves or verbalizing their needs, some of our traumatized clients were learning automatic obedience or shutting down and “disappearing” instead. Regulatory capacities, such as being able to tolerate an emotion or feel an impulse without acting on it, are often missing resources as well. When clients lack confidence or self-assertion, are intolerant of their mistakes, or are apprehensive of new situations, professional success, or close relationships, you can help them reflect on how the absence of these capacities relates to their history. As clients realize that these resources could not have developed in their early attachment or traumatic environments, you can emphasize that these abilities can be developed at any time in their lives and then practiced until they become increasingly automatic and available without effort. For many clients, the idea of developing missing resources will be appealing, and they will be excited about the work of this chapter. For others, although the theme might be of interest, the ability to concentrate, process, and integrate this information might itself be a missing resource. Returning to the exercises of Chapter 6 “Paying Attention: The Orientng Response” on orienting to new information might be useful in these cases. But, if your client has learned to habitually neurocept danger and threat and still does not feel safe, the prefrontal areas of the brain governing attention and concentration may be inhibited and thus so is new learning. As van der Kolk (2009) asserts: “Our brains will continue to take in new information and construct new realities as long as our bodies feel safe. But if we do not feel safe, we become fixated on the trauma. Our ability to take in new information is lost, and we continue to construct and re-construct the old realities.” In these cases, the primary missing resource, that of feeling safe, must be addressed, often by returning to practicing the regulatory actions and somatic resources described in previous chapters. Some clients may benefit from your reminding them that developing new resources creates a new experience and thus can help the brain to change maladaptive patterns learned in childhood. Cozolino (2002) states: The slow development of the brain maximizes the influence of environmental factors, increasing its chances to survive. . . . That so much of the brain is shaped after birth is both good and bad news. The

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good news is that the individual brain is built to survive in a particular environment. . . . In good times and with good parents, this early brain building may serve the child well throughout life. The bad news comes when factors are not so favorable . . . the brain is then sculpted in ways that can become maladaptive. (p. 12)

Knowing that neuroplasticity allows the brain to change even in adulthood can mitigate clients’ discouragement about the resource development they have missed.

Introduction to the Worksheets The worksheet AN INTERRUPTED RESOURCE asks clients to identify a positive resource that was interrupted by trauma or stress and observe the changes in the body when they remember it. For some clients, this worksheet may bring up grief, necessitating your support and empathy. Others may report that nothing good ever happened prior to the trauma, and they will need your guidance to uncover a resource that was interrupted by their particular circumstances. Providing a menu of possible resources may spark their ability to identify one. You might say something like, “Perhaps you were learning a skill, like reading, or sports, or art, or enjoying a particular relationship, or sensing a growing capacity in yourself, like independence or working as a team with others.” EXISTING & MISSING RESOURCES asks clients to describe both existing and missing resources connected to a difficult event. It makes the point that no environment leaves us completely without resources or provides us with an opportunity to develop all possible resources. With your help clients can think about why a resource was undeveloped and thus unavailable during this difficult event, and how they could develop it in present time. In TACKLING FUTURE CHALLENGES, there are several concepts for clients to integrate: anticipating future challenges, predicting their reactions to them, and preparing for these challenges by identifying missing resources that might be useful, and finally predicting the effect of using these resources. This worksheet might alleviate fears of anticipated challenges and build confidence in the possibility of handling them well. Using the many different categories of resource as a guide, two worksheets, DEVELOPING MISSING INTERNAL RESOURCES and DEVELOPING MISSING EXTERNAL RESOURCES, provides the structure for clients to identify missing resources in each category and devise a plan for developing them. If the task of working with all the categories proves too daunting for your client, ask clients to pick just three categories, or even one, as a start, and then if the result is positive, they can choose additional categories to explore.

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Adapting this Material for Dissociative Clients The complaints and crises of dissociative clients naturally provide you with an opportunity to introduce this chapter on missing resources. Statements than validate the complaint and suggest that they can learn new resources are helpful, such as: “Yes, it’s so hard when people disappoint or fail you—you never had a chance to develop resources to help you with the feelings that come up or with not taking things personally. Let’s look at resources that can be developed to help you.” Or: “It’s overwhelming just having to get up and go to work and manage everything day to day—especially without the kinds of resources you should have learned in your family. Let’s find out what new resources you can use to manage all of this.” When you frame the task of identifying missing resources and beginning to develop them as part of recovering from trauma, clients’ motivation to work on these capacities typically increases. They learn that this endeavor is not about their failings but about recovering from difficult circumstances and the failings of others to support them. Missing resources for clients who have dissociative disorders often pertains to a loss of continuous awareness—an inability to stay present and aware across time and to choose which aspects of themselves to bring forward consciously, and which are more private, not to be shared with others. Depending upon your client’s recognition of these challenges, you might need to identify them as phenomena that you have noticed and invite discussion about what missing resources might be developed to help with these problems. Although clients may switch because something in their environment or a relationship has triggered them, they may also switch due to conflicts between dissociative parts of themselves. The reasons for switching should be explored and missing resources developed to help resolve them. You may want to vary the worksheet assignments to fit the unique perspective of clients who have dissociative parts. You can ask clients to notice each part’s most important existing and missing resource, and help them find ways to share both old and newly learned resources across parts. You and your clients may discover that occasionally what is missing in one part may be found in another part, so that apparently missing resources are not truly absent, but sometimes are “kept safe” or “hidden” by particular parts. As clients learn to accept and trust all parts of themselves as their own, these resources may be incorporated more systemically into the whole person.

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CHAPTER 20 Developing Missing Resources We can never have too many resources. The more resources we have, the better equipped we are to deal with stress, tolerate our emotions, and live healthy, happy, and productive lives. We can all learn to broaden our resource repertoires by reinstating resources that have been lost or forgotten, exploring new ones that were never learned, and supporting those that are weak, undeveloped, or underused. This chapter clarifies how resources come to be lost, weakened, or absent and how to develop them. We will focus on developing “missing” or underdeveloped resources that can provide additional skills and competencies to support you in leading the life you want to live rather than a life circumscribed by the effects of the past.

How Resources Develop Inner resources are acquired over our growing-up years. When we are children, knowing that we have at least one safe, supportive person who appreciates our talents, is committed to our well-being, and provides opportunities for our growth will maximize our resource development. Each stage of childhood affords opportunities to cultivate specific age-appropriate resources. For example, infants need to feel cared for and safe to form a secure sense of themselves in relationship with others. These capacities are foundational for all other resources. Later, after we learn to walk and use language at around age 2 we develop the ability to say “no,” with words, to assert our will and follow our own interests, at least some of the time. We learn to negotiate for what we want and also tolerate disappointment when we do not get it. However, all kinds of resources may fail to develop for any number of reasons. If our needs and wants are denied, ignored, or used against us, we might fail to develop the internal resource of sensing what we want and being able to go after it. We might have learned to automatically do what others want instead. If we have grown up with adults who expressed pride in our accomplishments, we develop confidence, but if they criticized us we become fearful of making mistakes and lose “confidence” as a resource. When our attachment figures fall short of providing basic emotional contact and age-appropriate opportunities, we adapt by developing habitual strategies, relationship patterns, and beliefs—survival resources that 481

compensate for the limitations of the environment. These might include withdrawing from or clinging to relationships, fear of healthy risk-taking and change, self-criticism, inability to recognize our own needs or go after what we want, and lack of confidence in our worth or abilities. Later in life, creative resources become harder to develop because we have entrenched survival resources that were necessary in the face of difficult circumstances. Our family values, financial resources, life circumstances, and parental blind spots can also limit our resource development. If, as a child, you would rather draw than read but grew up in a family that valued reading and education over the arts, you may not have been given opportunities to develop your artistic talent. Perhaps your family did not have the financial resources to support your talents through music lessons or sporting equipment. Maybe you grew up in a warm climate that offered no opportunity to fulfill your passion for snow skiing. Or, if your parents did not recognize your interest in dance or soccer, you may not have been offered dance classes or opportunities to join a soccer team. When talents or interests are overlooked, belittled, neglected, or ignored altogether, we are not able to develop certain resources that might have come naturally to us. But once you identify resources that you wish you had, you can take the steps needed to develop them. If our early environment is generally supportive, we naturally develop the somatic resources described in previous chapters. But as we have learned, we all form procedural habits to make the best of less than optimal circumstances. Mary’s posture was not slumped. Her chin and chest were slightly lifted, which had helped her feel a sense of identity, power, and determination, in a family when she needed to stand up for herself against criticism and sometimes emotional abuse. However, her body was constricted, and her legs were spindly, seeming out of proportion to her thick torso, and her knees were locked. She complained of easily being “thrown off” and scattered; she was missing a sense of her legs supporting her fully. Mary tended to stabilize herself through tension and rigidity rather than through a flexible, integrated body with good grounding support through her legs. She found that using some of the resources in Chapter 16, “Grounding Yourself,” and unlocking her knees helped her hold her ground, quiet her busy mind, and focus her attention. Mary’s habit of crossing her arms in front of her torso helped her feel safe, a survival resource she had needed in childhood. However, this position also made her feel closed off to others, which went along with not being able to make friends easily. She complained that when she went to a bar, no one talked to her. With her therapist’s help, she realized that she first needed good boundaries to feel safe enough to “open up,” and she practiced using her arms to make a pushing motion. Her therapist noticed that Mary’s inhalation was deep, but she did not exhale fully. Many mindfully practiced “letting go” on the exhalation, which helped her chest relax and feel more open. Mary found that these three missing resources— 482

developing a somatic sense of boundaries, becoming more grounded, and relaxing the tension in her chest by emphasizing the exhale—were key supports in her newly developing abilities to meet goals she set for herself.

How Resources Are Interrupted When trauma or stress occurs, existing resources are often interrupted, especially those that are not yet well developed. A stressful situation demands that we devote our available energy to coping with it, which detracts us from putting energy into learning new resources or further developing the ones we have. For example, an adverse experience for a school-age-old child may interrupt the developmental task of becoming more independent and venturing out into the world without her parents. She may become shy and dependent after a stressful event, perhaps even schoolphobic or fearful of sleepovers with other children. When resources in the process of development are curtailed, we may automatically abandon them in the future. We may avoid engaging certain capacities or skills associated in some way with difficult experiences of the past. Janie was 11 when her grandfather molested her after picking her up from dance class. She had been an assertive, outgoing child who was full of laughter, loved to dance, and was proud of becoming increasingly independent. After the abuse, Janie changed and many of her existing resources were lost to her. No longer fun-loving or gregarious, she became fearful and wanted to stay home after school and on weekends. Her laughter no longer filled her playdates—in fact, she was resistant to making playdates—nor did she want to continue her dance classes. Years later, as an adult, Janie remembered how playful she had been before the abuse and how much she enjoyed dancing as a child. She decided to cultivate the resources that had been interrupted by her traumatic experiences. She enrolled in an adult dance class and consciously made it a point to see the humor in every situation, reclaiming the laughter that had been dampened by the betrayal and the trauma of being abused by her grandfather. Sometimes, like Janie, we lose the connection to resources after such painful and distressing experiences. A good way to start reclaiming interrupted resources is to think back to something positive that was occurring in your life just before the stressful events. Even in the most threatening environments, most of us have had some normal or even pleasurable experiences before or in-between the difficult ones. Perhaps there was a time when you were learning a new skill, such as sewing or woodworking or a sport, or discovering a new capacity in yourself such as a newfound independence or love of the outdoors. Margo reclaimed the excitement of beginning to date as an adolescent—a positive time in her life that was cut short by the sudden death of her father when 483

she was 16. Afterwards, consumed by grief and family upheaval, she lost the sense of excitement and the pleasure of becoming interested in boys. In therapy, she began to discover and reclaim this interrupted resource by focusing on the memory of the time period prior to her father’s death and getting in touch with the feeling of adventure and exhilaration she had felt about dating as a teenager. For Margo, the memory of her excitement in discovering the opposite sex was remembered, reexperienced, and developed as a resource. Along with reclaiming interrupted resources and developing new ones, you can also develop a broader range of resources by utilizing “future templates” and rehearsing future challenges. You might think of anticipated real-life situations and then be mindful of your reactions. As you bring to mind an image of a challenging situation, an old habit or reaction might be evoked, giving you an opportunity to practice using your repertoire of new resources imaginatively before you are faced with an actual challenge in real life. You will be more successful incorporating your newfound resources into daily life after practicing them in your mind first. Each time we inhibit an old pattern and imagine or rehearse a new pattern, the new resources become a little stronger and more easily available to us. The worksheets following this chapter will help you reflect on missing or weak resources you would like to develop, identify when they may be of use to you, and learn how to acquire them.

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CHAPTER 20

Developing Missing Resources AN INTERRUPTED RESOURCE Purpose: To identify a resource that was not developed fully because it was interrupted by a stressful or traumatic event(s), and to make a plan to reclaim the resource. Directions: Think of a difficult, stressful, or traumatic experience. Then think back to something positive that was occurring in your life before or in-between the difficult, stressful or traumatic experiences, and complete the prompts below. 1. Describe the positive experience here. It could be a time in which you were learning a new skill, playing a sport, or discovering a new capacity in yourself. (e.g., I was 16 and beginning to explore relationships and feeling confident flirting with boys when my father died suddenly. I never regained that confidence.) 2. Use the graphic below to embody the positive experience described above. Begin in the center circle and then move around the outer circles. Write notes around the circles describing what you notice in your body. Do you feel lighter, more solid, or better in your body? Does your breathing change? Do you take a deep breath? Does your chin lift? Do your shoulders go back or relax? Take the time to remember the positive experience and notice what happens in your body. What movements change or what impulses do you have? Do you feel more grounded or is your posture more aligned? What else do you notice in your body? 3. How can you reclaim that interrupted resource from your past and use it in your life today? Maybe you could practice the physical effect of the resource, or 486

maybe you could recreate the resource or look for opportunities to use it in your current life. (e.g., I could look for opportunities to flirt and practice flirting by making eye contact, smiling more, and initiating conversations.)

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CHAPTER 20

Developing Missing Resources EXISTING & MISSING RESOURCES Purpose: To identify existing resources that you used during a challenging event, as well as missing resources that you did not use, and to consider how to develop the missing ones so that they can become available in the future. Directions: Think back on a traumatic or challenging event to determine what resources you used, and what resources were not available to you that might have been useful. Then follow the prompts to explore why those resources were missing and how you might develop them today. Describe a traumatic or challenging event below. Existing Resources: Describe three existing resources you used and how they affected your body. Missing Resources: Describe three resources that were missing or that you did not use fully. Reflect on why you were not able to use the three missing resources and describe below. How can you develop those three missing resources? Describe how using them might affect your body.

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CHAPTER 20

Developing Missing Resources TACKLING F UTURE CHALLENGES Purpose: To anticipate potential upcoming challenges and rehearse resources in your imagination in order to prepare you to readily draw on them when you face a challenge in the future. Directions: In the first column describe two situations for which you anticipate you will need resources. Then describe your predicted reactions to the upcoming situation, describe missing resources you could use in each situation, and predict the effect of using them.

Example

Anticipated Predict your initial challenging thoughts, emotions, situation and body reactions without the use of a resource

Describe the missing resources to experiment using

Predict the effect of practicing the missing resource on your thoughts, emotions, and body, and on the situation

When I go visit my mother, she will criticize something like my clothes or my job or not being married.

I will go for a walk, remind myself that I am good enough and that I don’t need to please my mother. I will call my best friend to talk with her instead of yelling.

I will feel calmer and better about myself. My shoulders will relax.

I may feel sad and dejected, like I did when I was younger. I may start to think that I’m not good enough and that nothing I do is right for her. I may hold my breath, tense my shoulders, and I might yell at her or withdraw to my room.

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I will avoid a fight and be able to

I will remind myself to breathe and relax.

enjoy my visit with my mother more.

Anticipated Challenge #1 Anticipated Challenge #2 Discuss with your therapist how to implement your plan during future challenges.

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CHAPTER 20

Developing Missing Resources DEVELOPING MISSING INTERNAL RESOURCES Purpose: To develop missing internal resources by identifying one in each category that you want to focus on, design a plan to develop it, and practice it until it is welllearned and increasingly easy to access. Directions: In each category below, list an internal resource that has been missing for you and that you want to develop. Describe a plan for how to practice and develop each of those missing resources. Relational

Somatic

Emotional

Missing Resources

Missing Resources

Missing Resources

Plan

Plan

Plan

Intellectual

Artistic/Creative

Material

Missing Resources

Missing Resources

Missing Resources

Plan

Plan

Plan

Psychological

Spiritual

Nature

Missing Resources

Missing Resources

Missing Resources

Plan

Plan

Plan

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CHAPTER 20

Developing Missing Resources DEVELOPING MISSING EXTERNAL RESOURCES Purpose: To develop missing external resources by identifying one in each category that you want to focus on, design a plan to develop it, and practice it until it is well-learned and increasingly easy to access. Directions: In each category below, list an external resource that has been missing for you and that you want to develop. Describe a plan for how to practice and develop each of those missing resources. Relational

Somatic

Emotional

Missing Resources

Missing Resources

Missing Resources

Plan

Plan

Plan

Intellectual

Artistic/Creative

Material

Missing Resources

Missing Resources

Missing Resources

Plan

Plan

Plan

Psychological

Spiritual

Nature

Missing Resources

Missing Resources

Missing Resources

Plan

Plan

Plan

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SECTION FOUR

PHASE 2

Addressing Memory

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CHAPTER 21

Implicit Memory and Your Resource Repertoire THERAPISTS’ GUIDE TO CHAPTER 21

Purpose of this Chapter This chapter marks the beginning of Phase 2 work as outlined in Chapter 12, “Three Phases of Therapy.” To review, from a Sensorimotor Psychotherapy perspective, effective treatment of memory focuses primarily on the effects of what happened, the nonverbal implicit memory, rather than on explicit memory content. A primary goal of this chapter is to help clients begin to shift their awareness from verbal descriptions of events to the implicit memories that comprise the legacy of those events. This orientation prepares clients for directly and deliberately eliciting state-specific memories of trauma and attachment failures in the subsequent chapters in this section. In this chapter, clients learn to identify the presence of implicit memories by recognizing when they are in a mental, emotional, and physical state that is similar to the one they had experienced during trauma and attachment inadequacies. They will also develop a resource repertoire drawn from the resources learned in the previous section that will help them change these states as needed or desired and gain confidence to address state-specific memories in subsequent chapters.

Clients Who Might Benefit Clients who are stable but still phobic or avoidant of their traumatic or attachment memories stand to gain from this chapter because their fear is likely to abate as they learn to identify their implicit memories and utilize their resource repertoires. Other groups of clients for whom this chapter should be a priority are those troubled by chronic or frequent intrusion of implicit memories or who are sensitive to reminders of the past and easily dysregulated. For them, creating a resource 498

repertoire and practicing those resources will mitigate the effects of implicit memory on present experience. Clients who unwittingly repeat unsatisfactory relational patterns or find themselves at the mercy of procedural actions—such as tightening when confronted, or collapsing when they feel their needs—might discover that these patterns reflect early implicit relational memories of how to be with others. Those clients who are chronically destabilized and unable to process memories without further destabilization will find it helpful to work on a resource repertoire. Identifying triggered implicit memories, especially those that precipitate periods of destabilization, will help them differentiate nonverbal remembering and procedural learning from normal reactions to everyday stimuli.

Suggestions for Clinical Use Because many therapy approaches emphasize the narrative memories of events and do not prioritize work with nonverbal implicit memories, you or your clients may equate memory work with detailed autobiographical recall. It is essential that you both understand the meaning of working with the effects of the memory as triggered in present time, rather than with the memory content. Even when clients do remember and describe a past event, it is the effect of talking about the memory— which stimulates mental, emotional, and physical states similar to those of the past —that becomes the focus of memory work. You might refer back to Chapter 5, “The Language of the Body: Procedural Learning,” to review how childhood experiences affect the body and to help clients understand that the effects of memories endure over time and can cause dissatisfaction, distress, or dysregulation. It will be helpful to emphasize that the past itself cannot be changed, but the effects of the past can be brought to awareness and changed. Clients will need your support to identify physical reactions such as numbing, trembling, muscular tension, and autonomic dysregulation; physical patterns such as stiffening of the back, neck, or shoulders; pain; or the somatic components of a defensive subsystem (e.g., the constriction associated with freezing) as implicit, body-based memories. Intrusions such as panic, rage, images or sounds, nausea, and shivering can also represent implicit memories that disrupt the present moment and catapult clients out of the window of tolerance. Some will realize the presence of implicit memories as they find themselves repeating the same negative patterns in their relationships without knowing why. You might explain to your clients that implicit memories are often “situationally accessible,” activated in present time by both internal and external stimuli reminiscent of the past (Brewin, 2001). Understanding the influence implicit memories of a past that they do not explicitly remember has on their present-day confusing and often distressing symptoms and patterns can be reassuring. 499

Making the connection between their day-to-day distress and implicit remembering will support clients’ motivation to identify the implicit memories that are most troublesome for them and then develop a resource repertoire to manage these implicit memories. To ensure that this goal is met, you can ask clients to refer to their homework sheets from the previous section and review together which resources are the easiest and the most helpful, as well as which resources are needed but still missing. Clients may need your help to identify the most effective resources to address implicit memories as they embark on Phase 2 work. Keys to this chapter include your ability to track your clients’ here-and-now reactions indicating implicit memory, facilitate their mindful awareness of these reactions, and help them practice resources to create a different experience. In session, implicit elements of memories will emerge as clients begin to talk about the past, which usually stimulates the mental, emotional, and physical state that they had experienced during the event itself. At these moments, you might ask clients to mindfully notice the building blocks that are evoked by remembering and then experiment with resources until they regain feeling calm or confident or centered. And of course, implicit memories will also be evoked within the therapeutic relationship, as clients orient toward features in you that unconsciously remind them of past relational encounters, and vice versa. As an enactment (cf Chapter 1, “Essential Principles of Sensorimotor Psychotherapy”) develops, you may “feel” that something is occurring between the two of you but not understand what that something is. At these moments, therapists often try to make meaning of these implicit dynamics, often to reduce their own discomfort with the relational unknown. However, it is important to keep in mind that understanding enactments is neither required nor possible at first, and how to approach what is going on between you and your client emerges from within the relationship. The meaning is not comprehensible on your own; it will be discovered jointly with your client as each of you shares your respective experiences. Bromberg (2010) wisely advises that at these moments, you might share what is going on for you, in some version of: “I’m feeling something as I’m listening to you that isn’t quite part of the topic but has a kind of life of it’s own. It’s almost as if we have another channel of communication that is more about feelings than about ideas. I’m sharing this with you because I’m wondering whether, if you let yourself look inside, you might be able to feel anything similar in yourself—something you may be feeling while we are talking that can’t find words but which might connect us in an even more direct way if we can each share them.” (personal communication, February 13, 2010)

This opens up the possibility for you and your client to relationally negotiate the enactment and co-construct the meaning and a new relational experience together. Although it is necessary to challenge clients to do more than they believe they can do, you will also need to ensure their sense of control over the pacing, activation, and emotion. Implicit memories inevitably involve a degree of loss of control over time, place, boundaries, and resources, so the experience of 500

integrating memory must include a felt sense of regaining control. The best indicator of when it is appropriate to move on to more deliberate accessing of memory will be your clients’ responses to this chapter and its worksheets and their ability to utilize their resource repertoire effectively. As clients utilize their repertoire of resources for regulating the impact of memory on present experience, their windows of tolerance expand and they are better able to navigate the challenging territory of integrating the past.

Introduction to the Worksheets The first worksheet, IDENTIFYING IMPLICIT MEMORIES, applies the concept of implicit memory by instructing clients to describe times when they embody states reminiscent of the ones they were in when past events occurred. It helps clients identify the emergence of implicit memories in the form of dysregulation and/or unresolved defensive responses, emotional reactions, or automatic behaviors in their life or in therapy sessions. Many clients are confused about identifying their implicit memories and will need your help to recognize them. In such cases, it will be best to fill out this worksheet together. YOUR PERSONAL RESOURCE REPERTOIRE requires clients to reflect on re- sources in each category that have or could help them when implicit memories are triggered. YOUR SOMATIC RESOURCE REPERTOIRE focuses on identifying somatic resources that clients can practice inconspicuously to regulate when implicit memories are triggered by difficult situations or people. RESOURCE AND REACTION BALANCE provides an opportunity for clients to list reactions to implicit memories triggered in current relationships and determine the resources from their repertoire that are most useful. In this way, they can assess if they have sufficient resources to balance the reactions or if they need to focus on developing more resources.

Adapting this Material for Dissociative Clients Although you might hope that processing memories will help stabilize your dissociative clients, the nature of implicit memory and dissociation suggests that the reverse is often true. Implicit memories of trauma are often contained in dissociative parts, so when various memories are activated, dissociative parts are also activated. Often the adult part of the client may express a desire to work with traumatic memories, but then is unable to cope with the activation of dissociative parts that are overwhelmed and stuck in “trauma-time” (van der Hart, 2012), either too hyper- or too hypoaroused. Once such parts are activated without stabilization 501

skills, they are quite difficult to contain, and thus may continue to intrude upon the client’s experience, keeping the client’s arousal outside his or her window of tolerance. It is essential to first help dissociative clients expand the window of tolerance to withstand the difficult work of integrating the effects of traumatic memory, which involves getting to know dissociative parts, increasing communication among them, and strengthening the part(s) that can function best in daily life. Otherwise, Phase 2 is likely to prove more dysregulating and will catalyze a greater number of dissociative symptoms, decreasing the client’s functioning in daily life. You can anticipate that a focus on implicit memory will pose challenges for this group of clients and will require your diligent support to help them work effectively with this chapter’s material. However, this chapter can also provide opportunities to increase clients’ integrative capacity as they learn to identify and consistently utilize their repertoire of resources in the face of implicit memory activation. One approach that can minimize the degree to which this material is triggering involves first focusing only on developing the resource repertoire and practicing how to use these resources to regulate their reactions, putting aside any connection between the triggered implicit memories and the events that generated them. For clients with dissociative disorders, it may be helpful to keep in mind that each part will “remember” in unique ways, display different procedural learning, show sensitivity to different triggers, and manifest different implicit memories. The implicit memories of a part that desperately tried to win positive feedback from parents will be very different from the implicit memories of an angry or ashamed or frozen part. Each will most likely benefit from different resources. The ashamed part might experience a shift when you and the client experiment with lengthening the spine; the part whose separation anxiety intensifies fears of abandonment might respond to the client’s hand over his or her heart; an angry part might be regulated by a boundary gesture such as the “stop” movement. Alternatively, you might find that clients with dissociative disorders benefit more from resources that decrease intrusion of parts or outright switching, such as grounding. It is helpful to identify some resources that can be used across various parts and to facilitate overall regulation when implicit memories are stimulated. Dysregulated and dissociative clients are more likely to experience intense dysregulating explicit memories, as well as implicit, and therefore stand to benefit from developing and strengthening a resource repertoire.

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CHAPTER 21 Implicit Memory and Your Resource Repertoire We may have different, or even conflicting, feelings about dealing with the memories of what happened in the past. We may be afraid that memory work will not help us, or that we will not be able to remember what we need to. We may be reluctant to delve into the emotional pain of early relationships, filled with apprehension of becoming upset by revisiting the memories, or dread at the possibility of “reliving the past.” We may shut memories out or shut ourselves down so that we don’t think about them. Or we may want to confront, head on, the most painful memories, hoping that by doing so, we will find relief or make the changes we desire in our lives. Neither extreme—avoiding the memories or jumping right into them—is optimal because neither will help us integrate them. Effective integration of memories can only occur when our resources remain available to us as we address a painful past, and when we do not just relive the original events but resolve their enduring effects on our lives today. It is important to emphasize that our symptoms and difficulties are due to the effects of past experiences as relived nonverbally through procedural learning, patterns of relating, dysregulated arousal, painful emotions, and negative beliefs. Therefore, the goal of memory work, as previously described in Chapter 12, “Three Phases of Therapy,” is to identify and integrate the effects of these memories—the impact of them on your well-being and your current life—rather than to reexperience or describe them. This first chapter on addressing memories sets the stage for the therapeutic tasks of this section. Building on previous chapters, especially Chapter 5, “The Language of the Body: Procedural Learning,” this one will continue to explore the nonverbal effects of the past that strongly influence us in present time. We will describe the nature of memory and help you understand why neither avoiding nor reliving troubling memories is the best option. Developing a “resource repertoire” from all the resources identified in the previous chapters will support you to effectively address the effects of the past as you embark on the work of integrating memories in the rest of this section.

The Presence of the Past 504

Memories can be remembered in two different ways, or in some combination of the two—explicitly (as coherent verbal descriptions of events we can consciously recall) and implicitly (in nonverbal, nonconscious forms such as habits, images, emotions, physical patterns, and beliefs, often related to events we cannot recall). Thus, past events may be remembered and described, only partially remembered, or only implicitly remembered. Implicit memories are best thought of as somatic and emotional memory states that are not accompanied by an internal sense that something from the past is being remembered. These memory states also called “state-specific memories,” show up in different ways and affect our daily experience. In moments of mysterious intuitive” feelings, we might be implicitly remembering something. Our immediate sense of liking or disliking another person might be based on implicit memories of previous interactions with someone else. The happy, expansive feeling we get from being in the country might be an implicit memory of early experiences of parks, green spaces, or open skies. The calm, centered feeling we have when someone had kind eyes might be because they remind us of the eyes of a grandmother who lovingly babysat us when we were infants. A feeling of aversion elicited by close contact with other people in an elevator might be related to an implicit memory connected to abuse or embarrassing experiences with others that we do not explicitly remember. By identifying these feeling states as reminiscent of those we experienced during significant events in the past, we are recognizing the presence of implicit state-specific memories in current time. Our earliest implicit memories influence our future relationships and our view of how to be in the world. In infancy, we learn about which behaviors are accepted by our parents or by other people who are important to us, and which behaviors are disapproved of or punished. The implicit memories of these relationships are all the more influential because we cannot recall the interactions that shaped them. Thus we cannot describe them or reflect on them with thoughts and words. They are “remembered” in relational patterns, emotional biases, beliefs, and physical habits that are often exacerbated by relationships in our current lives. They are remembered when we find ourselves in a certain state in a current relationship that is similar to a state we were in during early relationships that we do not remember, or do not remember clearly. We might find ourselves responding to specific people with aversion, irritation, neediness, fear, defensiveness, sadness, or anger without knowing why we feel that way. Ashton did not remember much of his childhood clearly, but he vaguely knew that his patterns in relationships were shaped by an early childhood fraught with abandonment and loss. His need for nurturing and support had not been met during infancy and childhood, leaving him in a state of desperation for contact and care, and he tearfully reported that everyone he loved in his current life left him because he was too needy. Donna complained that she could not “keep” a boyfriend. Having 505

grown up with a father who disdained vulnerability, she had learned to dislike and disown her own tender feelings. Unconsciously she had become overly assertive and even aggressive in interactions with men, unwittingly driving away potential partners.

Identifying Implicit Memories Implicit memories of attachment experiences emerge through relational habits in which we experience a mental, emotional, and physical state in the present that is similar to that of a past relationship. Because these implicit memory states often do not remind us of anything specific, we cannot think about them like we can an explicit memory, and we may feel we cannot change these states even though we would very much like to do so. To identify implicit attachment memories, we can reflect on our early relationships and look for similar patterns, or opposite patterns, in current relationships. When Ashton thought about how his present-day internal state was similar to what he felt as a child he felt even needier. He remembered the forlorn boy that he had been, often left to fend for himself without anyone to turn to for comfort or help. When he thought of his childhood, the energy seemed to drain from his body; he felt sadness and grief, he was acutely aware of a hollow feeling in his chest, and he thought, “No one is ever there for me.” These unfulfilled needs had left a wound of empty loneliness that he re-experienced in his adult relationships. Dylan had had a similar childhood but responded by becoming tough and avoidant of ever depending on anyone but himself. Donna first discovered her implicit memories when her best friend told her she had an arrogant attitude that made it hard to be emotionally open with her. Her boyfriend also complained that she was “closed” emotionally. However, to her dismay, when she expressed her wish to be more open and vulnerable to him, Donna noticed that her body tightened, her chin lifted in an aloof attitude, and she felt defended and even more closed. Although she had a conscious desire to be more open, her implicit memories led her in the opposite direction. After trauma, we may or may not remember, or only partially remember, what happened to us, either because the trauma occurred before the acquisition of language or because fragments of the memories are split off or dissociated from conscious awareness. We tend to remember trauma through reliving nonverbal elements of the event such as intrusive images, disturbing body sensations, shame, dysregulated arousal, and inflexible animal defenses (e.g.: fight, flight, cry for help, freeze, or feigned death/shutdown). Anita had undergone many years of therapy focused on retrieving memories of chronic childhood abuse. But the difficulties that had brought her to therapy did not 506

abate. She still “remembered” what had happened when she found herself in a state similar to the state she had been in during her trauma. This state had beliefs (“I’m not safe”), emotions (fear, shame, and self-loathing), and physical components (tension, shallow breathing, and hypervigilance) to it. If you have suffered trauma, you will probably implicitly experience the memories in dysregulated arousal, as Anita did. In order to integrate your implicit memories, you must first identify them by recognizing the elements of your current state that are similar to the elements you experienced when the actual events occurred. You might ask yourself questions such as, “Am I numb? Am I overwhelmed or hyperaroused? Are my reactions out of proportion to what is occurring? Is my arousal outside of my window of tolerance? Could the state I am in be similar to a state I experienced in the past when I was in danger?” Intense emotional reactions, or a lack of emotions when we would expect them, are good indicators that implicit memories are triggered, provided that we are not experiencing immediate danger. Panic and terror, numbing, rage, or the inability to move are all states that tend to be related to and triggered by implicit traumatic memories. Actions such as feeling strong impulses to run, freeze, collapse, hide, hurt ourselves, or hurt someone else are generally implicit traumatic memories as well.

Your Resources Repertoire The triggering of implicit memories, either by reminders of the past in our current lives or by talking about what we do remember, is usually automatic. When we find ourselves in a state reminiscent of what we experienced in the past, we need to be able to change that state if we wish by having at hand a repertoire of resources upon which we can rely and use effectively. Otherwise, our lives and our wellbeing can be strongly impacted by our implicit memories. Because we are all unique, each of us will develop our own “toolbox” of resources to best mitigate the effects of the past. Anita’s repertoire of resources included quiet time in the morning and evening during which she mindfully tracked her thoughts, feelings, and body sensations and practiced noticing them instead of reacting to them. Different resources helped her in different states of implicit recall. If she noticed that she was spacey and disconnected from herself, she would take a few minutes to press her feet into the ground. Incorporating deep breathing exercises became her favorite way of responding to states of hopelessness and dread that she knew were implicit memories of how she had felt as a child. Because her present-day life was safe and stable, she also found it helpful to bring up visual images of the beautiful home she’d made with her husband and daughters. The feelings of lightness and warmth in her body that occurred when she visualized 507

her family sitting around the kitchen table were “safe space” resources, especially when implicit memories of fear and bleakness typical of how she had felt in her childhood home emerged. When memory work became too triggering in therapy, Anita used the mindfulness skills she had learned. She focused on orienting to the external environment through each of her senses by looking at all the visual details that told her where she was in time and space, listening to sounds, sniffing for smells, and so forth (see Chapter 7, “Mindfulness of the Present Moment”). If that wasn’t enough to help her center herself, she would concentrate more precisely on what she noticed. Rather than only note the picture on the wall, for example, she would notice its fine details and describe them to herself: “There is a background of trees —lots of shades of green and some blue and yellow—sunlight shining through the leaves.” Orienting to and naming these details in her environment calmed her arousal, changed her state, and kept her aware of the present moment. Ashton and Donna both discovered specific somatic resources that helped them restrain the effect on their daily lives and relationships of their implicit memories of childhood attachment wounds. Ashton found out in therapy that if he executed a gentle “push” motion from the top of his head upward and the bottom of his feet downward, he experienced a better sense of the core of his body. He immediately felt less needy and more competent. Ashton practiced this push motion as he and his therapist delved into his emotional pain around abandonment and loss. Donna had discovered that her dislike of her tender feelings was reflected in the defiant lift of her chin, which she realized was off-putting to others. The lift of her chin had helped her avoid disappointing her father, who did not accept her vulnerability, but it did not support her desire to be close with her friends and boyfriend. In therapy, Donna’s therapist suggested she practice deeper breathing to soften the tension and try lowering her chin slightly by lengthening the back of her neck in order to ease the posture of arrogance and aggression. These somatic resources changed Donna’s state so that she could experience more vulnerable tender feelings with others. Daniel, on the other hand, found boundaries, posture, and centering resources to be the most important ones for him. His implicit memories at his enmeshed intrusive family emerged in his being easily overwhelmed by other people, and he often avoided group activities and relationships in general. His resources, practiced before going to work in the morning, were to stand quietly for a few minutes, lengthen his spine, lift his chin, and draw a big circle around himself with his arms and hands. He took a few moments to sense the feeling of solidity in his body as he did so, placing one hand over his heart and the other over his abdomen (a centering resource). These actions were his somatic reminders that he had energetic boundaries that differentiated him from others, that their feelings were not his feelings, and their attitudes were not a danger to him because they were outside 508

his boundary. In therapy, as he explored his painful childhood memories, he remembered to lengthen his spine and sense his boundary. He also practiced the centering resource of placing his hands on his torso whenever he felt that he needed to be more centered. These resources mitigated the effect of implicit memories and helped him interact with others more comfortably. As you approach the work of addressing your memories, you can begin to identify your implicit memories by recognizing when you are in a state similar to what you experienced during trauma and attachment inadequacies of the past. Having confidence that you can use the resources you have learned in the previous chapters to manage triggered relationship patterns, emotions, and physical habits of implicit memories is crucial. Using the following worksheets, you will identify current states that are, in fact, implicit memories and develop an individualized catalogue of resources to support your efforts to change those states. With practice using your personal resource repertoire when implicit memories emerge, you will be better prepared to access these resources as you embark on the next stage of memory work.

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Implicit Memory and Your Resource Repertoire IDENTIFYING IMPLICIT MEMORIES Purpose: To identify when your distress, emotional reactions, or automatic habits of behavior are influenced by implicit memories that are triggered in your daily life, and to identify resources to use at those times. Directions: Reflect on any implicit memories—somatic or emotional reactions— that affect you in your current life. Describe past experiences of trauma and attachment inadequacies that you think relate to the implicit memories. Record your emotional state and resources you used or could use to regulate the distress of the implicit memory. Implicit Memory

Past experience to which it might pertain

Resources that could change your experience of the implicit memory

I get really upset when people are not there for me exactly when I want them to be.

As a child, I was left on my own a lot, and neither of my parents really supported me.

•Containment–hug myself •Call a supportive friend. •Hand on heart, hand on belly

Implicit Memory

Past experience to which it might pertain

Resources that could change your experience of the implicit memory

I don’t remember this, but I was in an incubator when I was a baby and had a lot of hospitalizations up until 4 years old.

•Sit up straight and focus on sounds. around me to quiet the negative thoughts. •Take my best friend with me when I have to

Example 1

Example 2 I dread going to the doctor and I freak out at hospitals. I have nightmares about people in white clothes.

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take my kids to the doctor. •Meditate before I go. 1. Implicit Memory

Past experience to which it might pertain

Resources that could change your experience of the implicit memory

2. Implicit Memory

Past experience to which it might pertain

Resources that could change your experience of the implicit memory

3. Implicit Memory

Past experience to which it might pertain

Resources that could change your experience of the implicit memory

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Implicit Memory and Your Resource Repertoire YOUR P ERSONAL RESOURCE REPERTOIRE Purpose: To develop your personal resource repertoire by identifying resources in each category that you can draw on to regulate the effects of implicit memories. Directions: As you discover or remember resources that regulate your arousal and emotions, record them here. Write down the way in which they have helped you in the past and ways they might be useful when implicit memories come up in the future. Category

Resource How It Helped

Future Situations in Which It Might Help

Somatic

I took deep, full breaths very slowly.

I can use it when my partner has that certain tone of voice that I hate, to prevent the awful fights we get into (which is an implicit memory of when my dad tried to tell me what to do).

Breathing calms me and helps me regulate rather than just react.

Psychological Emotional Intellectual Relational Spiritual Creative Nature Material

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Implicit Memory and Your Resource Repertoire YOUR SOMATIC RESOURCE REPERTOIRE Purpose: To identify and practice somatic resources that can help with current relationship difficulties and other problematic situations that trigger implicit memories. Directions: Think of three situations or people that are difficult for you and that you think trigger implicit memories in your current life. 1. One at a time, describe three different situations or people that trigger implicit memories and then describe how you react to thinking of this trigger—note your thoughts, emotions, and especially your body reactions in each “BEFORE” section. 1st Situation/person that triggers implicit memory:

2nd Situation/person that triggers implicit memory:

3rd Situation/person that triggers implicit memory:

BEFORE

BEFORE

BEFORE

Thoughts

Thoughts

Thoughts

Emotions

Emotions

Emotions

Body

Body

Body

2. Look over the somatic resources listed below, and add others you think might be helpful in the empty spaces. Then try one or more of them and describe the changes in your thoughts, emotions, and body in each “AFTER” section. Use your breath

Connect with the back of your body

Push your feet into the floor

Align your spine, tighten your TVA

Self-soothe (hug yourself or Use a containment rock) resource

Hand on heart, or hand on belly 1st Situation/person

2nd Situation/person 516

3rd Situation/person

AFTER

AFTER

AFTER

Thoughts

Thoughts

Thoughts

Emotions

Emotions

Emotions

Body

Body

Body

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Implicit Memory and Your Resource Repertoire RESOURCE AND REACTION B ALANCE Purpose: To identify enough resources to ensure you can regulate your unwanted reactions related to implicit memories when they are triggered in current relationships. Directions: Select a recent relationship dynamic that triggers an implicit memory of a past traumatic experience or distressing attachment relationship, causing you to feel upset or dysregulated. Then, follow the prompts below. 1. Describe the current relationship dynamic that triggers an implicit memory. (e.g., When my partner has a beer, I get very upset because it reminds me of my father, who was an abusive alcoholic; When my wife doesn’t call to let me know she is late, I start to feel anxious. I relate this to when my mother would leave for a trip without telling me when I was a child.) 2. In the rectangles on the left, write down your reactions (thoughts, emotions, and body responses) to this current relationship dynamic. 3. In the rectangles on the right, write down the resources you have available to regulate your arousal and emotional state when these reactions come up. 4. Finally, draw a line from each resource to the reaction for which you may be able to use it.

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Resources should be at least as many or greater than reactions to create balance. If you feel you need more resources to balance your reactions to implicit memories, discuss how to develop more resources with your therapist.

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CHAPTER 22

Reconstructing Memory: Finding Resources in a Painful Past THERAPISTS’ GUIDE TO CHAPTER 22

Purpose of this Chapter Explicit memory retrieval is a kind of “memory modification” instead of an exact recall of what happened (Siegel, 2003). As an “active and constructive” process, it is subject to revisions based in part on the associations made during recall (van der Kolk, 1996b). The purpose of this chapter is to help clients take a step toward reorganizing memory by encoding new, positive information alongside the old information in such a way that subsequent remembering is less overwhelming or less painful. To this end, memory work can include intentionally discovering positive elements or resources that were used before, during, and after a painful event. When you encourage clients to seek out resourced moments surrounding a memory, they often discover external resources or personal strengths that they had not been aware of before. After discovering a previously overlooked moment within a painful memory in which they were able to use a resource, and then focus on that moment and embody it, their internal experience often shifts dramatically. This process can add new associations to the memory to better integrate it (Breuer & Freud, 1895/1955; Janet, 1925) and possibly change the way the memory is stored in the brain. As Siegel (2006) states: “Experience can create structural changes in the brain. Often these changes take place at the finely tuned microarchitectural level: for example, when we make new associations within memory” (p. 31).

Clients Who Might Benefit Clients who repeatedly focus on the most disturbing parts of their memories, who reexperience their trauma in the form of flashbacks, or who remain fixated in terror, 521

shame, rage, painful loneliness, freeze or shut down responses may find that as they pay attention to less disturbing elements of their memories, they way they remember the trauma changes. Clients who feel unrealistic blame, shame, or guilt for what happened can benefit from a focus on discovering internal resources surrounding the traumatic event(s). Clients whose recall of attachment experiences evokes strong emotions and negative beliefs about themselves, others, or the world can also benefit from finding and embodying the resources that brought them excitement, confidence, or comfort surrounding these painful memories. Clients who feel powerless when they think of the past often feel less helpless and more capable when they discover personal resources they had used to handle what happened. Those who feel there were few external resources available to them often realize that there were many things and people that helped them through painful times, which can change their tendency to emphasize a lack of support.

Suggestions for Clinical Use Phase 2 work with memory can be conceptualized as an opportunity for the “reconstruction of past experiences and impressions in the service of present needs, fears, and interests” (Schachtel, 1947, p. 3). Your confidence in the existence of resources within and surrounding a painful event and your ability to offer psychoeducation to support the focus of this chapter are crucial ingredients in helping clients make meaningful use of this material. Some clients may be confused by how memory is stored, and it will be important for you to clarify that the brain is selective in what is remembered; and that memory recall is not factual. Some details are elaborated, and others discarded (Janet, 1928; van der Kolk & van der Hart, 1989), and details of resources they used may have been forgotten. Some clients may perceive that this chapter discounts their pain, or the negative impact of the past, by asking them to find resources used in the midst of an adverse experience. Your ability to emphatically validate their concerns, reassure them that there will be time to delve into the painful past (see Chapter 24, “Sliver of Memory”), and convey how reconstructing memory by adding new associations might benefit them will be critical. Most clients have encoded the fear, powerlessness, hurt, anger, hopelessness, disappointment, or loneliness along with the accompanying thoughts and physical patterns of a painful memory, rather than the external and internal resources that helped them during that time. Asking them, “How did you survive? What helped you cope? What got you through that awful time?” can stimulate recollection of resources they had forgotten. Helping clients find both internal and external resources in the various categories can facilitate recall. You might provide a menu of possibilities to spark 522

clients’ recall of resources they used by saying something like, “Maybe there was a person who supported you, or maybe you turned to your favorite TV program or to sports or some other activity to feel better.” You can also refer back to the material from Section Three to review resources and spark recall. Understanding the importance of memory revision fosters clients’ willingness and perhaps even enthusiasm to explore the resources surrounding a memory. Going over the chapter in session will give you the chance to reinforce this new concept. Challenging clients to be curious about finding resources and positive experiences surrounding memory, along with attuned empathic support and psycho education for any hesitation or confusion they might express, will assure their success.

Introduction to the Worksheets The three worksheets on POSITIVE ELEMENTS OF A DISTRESSING EVENT guide clients to remember and embody positive elements that occurred before, during, and after a painful memory. Searching for resources before or after the event might include the seconds or minutes surrounding the memory, or the days and weeks adjacent to the memory. Most clients, especially those who might be drawn repeatedly to the most painful elements of memory or who have difficulty finding resources, will benefit most from completing these worksheets in session, with your guidance. Those who are already regulated can complete them between sessions after you review their purpose together in session. You and your clients can review the example of Adanich in the chapter to illustrate the worksheets. It is essential that you help your clients focus diligently on recollecting the positive elements rather than on the painful ones, assuring them that there will be time to explore the painful aspects in future sessions. They may need your encouragement to take plenty of time to bring to mind even the smallest positive elements. If they are having trouble, you can expand on the menu provided in the worksheet, ask them what got them through that time, or what helped them cope. You also can remind them that they would not have survived if there had not been some positive elements or some accessible resources. Using FOCUSING ON YOUR RESOURCES expands on the positive elements discovered in the three previous worksheets. Together during a session, you can help clients direct their mindfulness to the frame-by-frame experience of these elements that were intact before, during, and after the painful event. Determining the category each resource fits into and whether it was an internal or external resource will further help to define each one. Embodying the memory of the resources they used, or the positive elements that occurred, alongside how painful the experience was, will help them form different associations with the memory. Clients also will determine whether they still use a version of these resources in their lives today, or 523

whether they were put aside due to these, or later, events. Those resources can then be called upon again when needed or may be added to the clients’ repertoire of resources to develop.

Adapting this Material for Dissociative Clients Accessing memory will be much more complicated in clients presenting with issues of dysregulation and dissociation, both of which interfere with encoding, accessing, and retrieving memory. Clients often experience memory gaps in which they might remember the event itself, often the worst aspects, but not what happened before or after. They may remember what happened just before or after without any memory of the event itself, or recall only disjointed fragments of the event. In addition, accessing memory in these clients often triggers increased dysregulation, dissociation, animal defense-driven reactions, and a loss of mindfulness. First and foremost, with this group of clients, remember to slow the pace, take very small steps and evaluate the client’s response, then readjust the pace accordingly so that mindfulness can be maintained. Intense emotions often occur when working with traumatic memory, but if they become overwhelming, resources must be implemented to bring arousal into the window. If dissociative clients switch during work with discovering resources or positive elements of a traumatic memory, by definition, their arousal has exceeded the window of tolerance. Some parts who are fixated in the pain of memory may find exploring positive elements threatening. In session, all parts may appear to have worked in a regulated way with the material of this chapter, but the client may return to the next session reporting flashbacks of the same memory, indicating that not all parts of the client were able to integrate the material. If the material in this chapter exceeds your client’s window of tolerance, it can be skipped and returned to at a later date, after your client learns more stabilizing resources and is able to maintain mindfulness during memory recall. Or it can be used as a starting place to ask, “What helped you survive? Could we begin to understand together how each part of you helped you cope and survive?” The resources you discover can then be connected to the body and other building blocks when possible, so that the experience of resources is integrated. Integration is also fostered as each part becomes aware of the resources of other parts, and how these resources interface with one another.

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CHAPTER 22 Reconstructing Memory: Finding Resources in a Painful Past Many people are surprised to learn that, although memory refers to real experiences, it is also subjective, reflecting an individual’s personal perspective, not just “facts.” That is why two people often have different accounts of what happened when they remember and discuss a past event. Each of us orients to different elements of the same situation, which directly affects what we take in and what we leave out. We remember bits and pieces and then put them together in a manner that makes sense to us, which then becomes our “memory.” Often we remember only the most disturbing and painful, or the most wonderful and exciting, bits and pieces because those elements were the most vivid and intense. Our memory retrieval is therefore not an exact recall of what happened in an objective sense (meaning, as if a neutral person were simply filming the event), but a recall of those elements that we selectively oriented toward and registered at the time. This chapter will describe the “reconstructive” nature of memory and explore changing how you remember by intentionally discovering positive elements or resources that you used but may have forgotten or not focused on before, during, and after a painful memory.

Changing How We Remember When we recall something, the neural networks associated with that particular memory are strengthened. The bits and pieces of the memory that we recall become even more vivid each time we remember them. As we recall the past, the details we find essential to the memory’s main points are elaborated, whereas other details are discarded, minimized, or become part of the subtext. Sometimes we remember positive experiences with our caregivers that help us preserve our good feelings and attachment to them, essential for a child’s well-being. Laurie remembered and elaborated upon the nurturing moments with her dad, recalling few memories of emotional abuse. But her sister, Jean, highlighted and remembered the emotional abuse whenever she thought of their childhood. She recalled little of the warmth remembered by Laurie. Even when they discussed the same memory, such as a family vacation, Laurie remembered the fun of swimming with her dad, while Jean remembered their dad yelling that he would give them something to cry about if they didn’t stop crying after he refused to let them go to the county fair with their friends. 526

Memories are subject to revisions and distortions because they are modified when we think about or talk about them. Our ability to reconstruct our memories is helpful when we elaborate something joyful, peaceful, or heartwarming because then we feel those good feelings even more. But remembering a painful, humiliating, or frightening memory over and over causes us to re-experience our painful feelings and can worsen our symptoms. However, if we deliberately think about or talk about an adverse experience in a different way (e.g., by focusing on positive things or resources that helped us cope during that time), we create an opportunity to add new information to existing memory storage and lay down new neural pathways. This deliberate refocus of attention is very different from revisiting what we already habitually recall. If we think about the past or describe it in the same words or with the same feelings, images, smells, sounds, or tastes every single time, we cannot alter its impact on us. The way we remember does not change. But if we widen our focus to include new or previously obscure elements of the event in our recollection and description of what happened, we can begin to change how that memory is stored. Each time we think or talk about the past, we have an opportunity to broaden our memory of what happened rather than to further engrave the memory in our brains in the same way. We change how we remember the past by directing mindful attention to the features of the memory that we have not focused on before. When we do so, our brains will automatically modify the stored memory to include the previously absent features. Thus, we have a chance to reconstruct our memory every time we tell the story silently to ourselves or out loud to others. The purpose of reconstructing a memory in this way is not to condone what happened, minimize it, forgive it or try to change what happened. The intention is to transform our relationship to the memory by deciding to also focus on the less painful, neutral, or even positive elements surrounding the event that we may have forgotten or not attended to before.

Resources Before, During, and After One of the most useful ways to experiment with the idea of reconstructing an upsetting memory is to practice consciously strengthening our recall of the resources we used before, during, and after the painful experience. This process both reduces the distressing effects of remembering and alters how the memory is stored. Many of us are automatically drawn to the most terrible moments of the past, haunted by the images, tastes, sounds, emotions, and sensations of those painful events. We might even become frightened of recalling the past when we only remember the vivid features that are distressing or dysregulating. We may have lost sight of the fact that we coped and survived because we drew upon a variety of 527

resources. Without resources, we may have perished or emerged not nearly as intact as we are today. Every time we focus on remembering the resources that got us through, neural pathways in our brain associated with these resources are laid down and strengthened. Although we can never change what happened, how we remember it can be revised, edited, and altered no matter how long ago the painful experience occurred. In short, we have a wonderful opportunity to modify how we remember and hold distressing events, hurtful interactions with attachment figures, and traumatic experiences in our minds and bodies.

Finding Resources It might seem counterintuitive, but no matter how sudden, devastating, or horrific your past experiences have been, you undoubtedly called upon resources to get you through those times that you can rediscover and reclaim now. Sometimes positive things that occurred in the midst of the negative event can be recalled as well. Consciously remembering your resources or any positive elements will help you form new associations to the painful past memory that are not distressing. Adding these new associations to what you already remember can not only alter your relationship to the memory but also promote feelings of competence, capability, and even pride in your resourcefulness. Adanich accidentally fell through a glass door and nearly died from the injuries when she was 5 years old. She suffered from intrusive images of blood and hospital equipment for years following the event. As a young adult, her therapist encouraged her to search for and remember the resources that had been available to her during the time of her accident. First, Adanich tried to remember the “good things” that had occurred prior to the accident, and she recalled the wonderful feeling of rough-andtumble play with her older brother in the living room. As Adanich remembered the fun she’d had roughhousing, she experienced several building blocks of that experience. She heard the sounds of their childish laughter, saw the image of herself playing, and felt the joy and alive feeling in her body as she and her brother wrestled together. Before the accident, Adanich had been a very physical child, but this changed after the incident—she became timid and much less active. But by consciously deciding to direct her mindful attention exclusively toward the memory of her enjoyment of rough-and-tumble play, and taking the time to savor these remembered good feelings, she began to reclaim the pleasurable, joyful, exuberant emotions and vibrant body sensations she experienced at that time, but had long forgotten. With the help of her therapist, Adanich then turned her attention to the accident itself, not to relive it, but to discover what had supported her and how she had 528

coped during the accident. She remembered that immediately after she had fallen through the glass window, her father had rushed to pick her up in his arms with a frightened and worried expression on his face. This was a particularly important recollection for Adanich because his expression told her how much she meant to him. She had few memories of being held by her father and even fewer memories of feeling his love for her. As she remembered seeing the love in her father’s eyes and face in her mind’s eye, she felt warm inside. Capturing the feeling of being held and loved by her father gave her a physical sense of security that she had rarely experienced. Anadich had been rushed to the emergency room and had remained hospitalized for several days. Her family had brought her a giant teddy bear, which proved a soothing resource for her while in the hospital, and she remembered touching the soft “fur” and squishy body of her bear. Her feeling of being loved and secure deepened as she remembered hugging her bear, appreciating that her family had understood that she needed something soft to hold on to as she lay alone in her hospital bed. It is important to emphasize that Adanich had forgotten about these three resources until her therapist suggested that she focus on the “positive” elements surrounding her accident. In her mind she had gone over and over many of the horrible images associated with it: the shattering of the glass, the blood on the floor, the screeching sound of the siren, and the strange, scary hospital. But, after remembering her three resources, Adanich felt that the memory would never be the same. When she thought of the accident, she still remembered the horrible elements but now she also remembered how much she loved playing with her brother, the warmth in her heart as she felt her father’s love for her, and her big teddy bear and how holding it soothed her at the hospital. Sometimes the intense feelings of fear and helplessness overshadow our sense of having had any resources at all at the time of traumatic events. However, if we remember that survival in the moment of threat requires resources, and we stay curious and keep asking ourselves how we survived what happened, we will discover them. For example, not only were Bob’s mother and alcoholic father both physically abusive to each other, but they were also physically abusive to him when they were drunk. Once Bob suffered extensive injuries from the abuse. At first Bob couldn’t imagine having had any resources whatsoever at the time. But somehow he survived, and as Bob went back to the memory of the moments just before and after the violence, asking himself how he did survive, he realized that he had lain very, very still afterwards. Somehow he instinctively knew that holding still would help minimize his injuries and cause his parents to lose interest in beating him, even though he couldn’t think clearly at the time. As he remembered staying so still, he felt greater confidence in himself and his body. It was true that he couldn’t prevent 529

the abuse, but he was able to help ensure that he survived it. Our nontraumatic but nonetheless distressing memories also contain forgotten resources that we can discover. George remembered his usually even-tempered father being furious at him for accidentally scratching his brand new car. His father’s anger surprised and confused George, who felt that he “never quite recovered” from the impact of this event. Banished to his room, George cried for what seemed like hours. Searching for resources in therapy, he remembered the family dog scratching at his bedroom door to gain entrance. As he recalled Milo licking his tears away, he remembered the comfort of the dog’s warm body and doleful eyes, and he felt less distraught. He also remembered his mom putting her arm around his shoulders in a wordless gesture of comfort when he was finally allowed out of his room. These two resources, both of which communicated empathy and understanding to George as a small boy, eased the negative impact of the memory for him. Although we can never change what happened, how we remember it can be revised, edited, and modified no matter how long ago the events happened. You can learn to orient toward and focus attention not only on the negative but also on the positive aspects of painful experiences. Doing so will help you face the distressing, painful parts of the memory in the work of the chapters to come. By discovering, acknowledging, and embodying the resources you were able to use, as well as the positive elements surrounding a painful memory, you are rewriting the story you have remembered over and over in a particular way up until this point, and this can change your brain’s memory of what happened. The worksheets that follow will help you to remember internal and external resources alongside disturbing aspects and upsetting emotions you felt during the distressing event. This brings balance to a painful memory and supports our sense of confidence and mastery.

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Reconstructing Memory P OSITIVE ELEMENTS OF A DISTRESSING EVENT, P ART 1 BEFORE THE EVENT Purpose: To remember and embody a positive experience that occurred before a painful event. Directions: Under the guidance of your therapist, select a painful past event or period of time to explore in this three-part worksheet. Recall how old you were when this event occurred, how long it lasted (e.g., a moment, a day, a whole summer, or a longer period of time), where you were, where it occurred, and what you were doing at the time. Once the event is clear in your mind, direct your mindfulness to a time before it happened and complete the prompts below. 1. Focus on any positive experiences that were occurring before the painful event or during the time period leading up to the painful event. Perhaps you were learning to read, paint, or dance. Maybe you were in the midst of developing a certain skill —learning how to be independent, or discovering something interesting. Or perhaps you enjoyed a special relationship with a friend, teacher, pet, or relative. Stay focused on remembering the positive elements that occurred before the painful event and choose one to describe in as much detail as you can in the box below. Example: Adanich recalled the joy of rough-housing with her brother before her accident. She remembered the sounds of laughter, the good physical feeling of their wrestling, and the warm feeling of closeness. 2. Focus all your attention on remembering the positive experience that you described above. See if you can re-experience the physical feeling of this positive element right now. •What movements or sensations do you notice now as you embody that positive experience? •How does your posture or the tension in your muscles change? •What happens to your breathing? •What else changes in your body? 3. What good thoughts or emotions go along with the positive element you described above? 532

4. Now, think of the memory of the event again, remembering the painful elements while also focusing on the positive experience you described. What is different when you remember both elements rather than only the negative?

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Reconstructing Memory P OSITIVE ELEMENTS OF A DISTRESSING EVENT, P ART 2 DURING THE EVENT Purpose: To remember and embody a positive experience that occurred or resource that you used during a painful event. Directions: Using the same memory of the distressing event that you used in the previous worksheet, again gently tune into that time in your life, the age that you were when the event occurred, and where it occurred. Direct your mindfulness to the time when the event happened and complete the prompts below. 1. What happened during this painful event or difficult time in your life that felt positive or empowering? Perhaps you used a survival resource or a somatic resource such as breathing or being still. Perhaps someone came to help you, or you turned to a beloved pet. Perhaps you could “leave” your body, or felt you could call on an imaginary friend. Describe one resource you used or positive experience that occurred right in the midst of the negative event in as much detail as you can in the box below. Example: Adanich recalled her father rushing to her side and the look of worry and on his face. She remembered being held by her father and how loved she felt. 2. Take your time to focus on remembering the resource or positive experience that you described above. See if you can re-experience the physical feeling of this resource or positive element right now. •What movements or sensations do you notice now as you embody the resource that positive experience? •How does your posture or the tension in your muscles change? •What happens to your breathing? •What else changes in your body? 3. What thoughts or emotions go along with the positive element you have discovered? 4. Now, think of the memory of the event again, remembering the painful elements while also focusing on the positive elements you described before and during the event. What is different when you remember positive elements rather than only the 535

negative?

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Reconstructing Memory P OSITIVE ELEMENTS OF A DISTRESSING EVENT, P ART 3 AFTER THE EVENT Purpose: To remember and embody a positive experience that occurred or resource that you used after a painful event. Directions: Using the same memory of the distressing event that you used in the previous two worksheets, again gently tune into the painful event or time in your life, the age that you were when it occurred, and where it occurred. Direct your mindfulness to the time after the painful event happened and complete the prompts below. 1. What happened after this painful event or period in your life that felt positive? What resources did you use to cope afterward? Did you call upon anyone for help? Did you take steps to get help for yourself, such as going to physical therapy? Did you read, draw, paint, or turn to nature? Were there people or pets that helped you through this difficult time? Describe one resource you used or positive experience that occurred after the negative event in as much detail as you can in the box below. Example: Adanich recalled the huge teddy bear that her family gave to her in the hospital for her, and it reminded her of their love and support. She recalled the softness of the fur as she hugged the bear. 2. Take your time to focus on the resource that you used or positive experience that occurred after the painful event. See if you can re-experience the physical feeling related to the resource or positive experience right now. • What movements or sensations do you notice happening as you embody that positive experience? • How does your posture or the tension in your muscles change? • What happens to your breathing? • What else changes in your body? 3. What thoughts or emotions go along with the positive element you described above? 4. Now, think of the memory of the event again, remembering the painful elements while also focusing on the positive elements that occurred before, during, and after 538

the event. What is different when you remember positive elements rather than only the negative?

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Reconstructing Memory F OCUSING ON YOUR RESOURCES Purpose: To link positive elements of a distressing event to resources that you can reclaim, develop, or call upon now when you need them in your current life. Directions: Below, note the positive elements before, during, and after the event that you discovered in the three previous worksheets entitled POSITIVE ELEMENTS OF A DISTRESSING EVENT, and then complete the prompts. 1. In the rectangles below, write the resources or positive elements that you discovered in the previous three worksheets, and determine the category or categories of resource that fits each one. Write down whether each was an internal or an external resource. For example, Adanich remembered rough-housing with her brother before the trauma—an external, relational, and somatic resource. During her trauma, her father holding her was an external, relational, and somatic resource. And afterward, the teddy bear was an external, material, and somatic resource.

2. Do you use any resources now that are the same or similar to the ones you described above? Explain below. 3. Were any of these resources put aside or interrupted due to the distressing event or repercussions of the event? Describe below. 4. Make a plan to mindfully call upon or develop the resources you noted and describe below. How do you think using these resources will affect your body?

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CHAPTER 23

Dual Awareness of Past and Present THERAPISTS’ GUIDE TO CHAPTER 23

Purpose of this Chapter Whether clients are challenged by the avoidance of, preoccupation with, or reliving of painful memories, effective resolution of the past is dependent upon their ability to experience the state they were in at the time of the event (“the state-specific memory”) while maintaining awareness of the present moment. Without reexperiencing, to some degree, the state they were in when the event actually occurred and was encoded into memory, clients will remain detached and will not be able to process the effects of the past. But without awareness of the present, clients run the risk of reliving instead of processing and integrating the effects of their memories. This chapter defines and explains the importance of dual awareness that, in addition to accessing their resource repertoires, will help clients address the effects of painful memories while remaining firmly rooted in the here and now.

Clients Who Might Benefit Clients who push themselves to remember, move too precipitously into memory work, or believe that they cannot resolve the past unless they relive it or remember everything will benefit by understanding the importance of dual awareness. Those who are preoccupied with their memories to the extent that they cannot stay focused on the present moment need to learn dual awareness. Clients who are phobic or avoidant of memory, fearing emotional upheaval or that they will relive the past, will be encouraged to learn how dual awareness can alleviate dysregulation. This chapter is especially important for clients who have recurrent intrusive memories that threaten their stability and flood them with painful emotions and for those whose implicit memories strongly impact their current relationships. Dual awareness will help clients who fear their feelings and sensations, or who panic or 542

dissociate when they try to connect to memory. On the other hand, clients who complain of being detached from their memories and emotions will benefit from learning dual awareness to more fully embody the state they were in when the events occurred, and still remain grounded in the present moment.

Suggestions for Clinical Use The material in this chapter will be used differently depending on your clients’ regulatory capacity, window of tolerance, and whether they are dysregulated by or detached from their memories. Many will be at risk for reliving the past, but some will have difficulty connecting experientially with what happened. The first group will need more focus on maintaining mindfulness of the present while remembering, whereas the second group will need more focus on embodying a state-specific memory. Although the didactic material in the chapter will be helpful to both groups, you play an important role in ensuring their success in memory processing by capitalizing on your social engagement system to evoke their social engagement. Your use of facial expressions, prosody (intonation, pitch, inflection, volume, tone of voice, tempo, and so forth), and body language to interactively regulate clients’ anticipatory anxiety will support their dual awareness skills and increase their confidence in addressing memories. Your interactive regulation will support clients at risk of reliving by helping them stay in the present moment with you as they remember. It can also support those who are detached from embodying the statespecific memory to appropriately experience the emotional pain associated with it. You might begin by saying something like the following to promote dual awareness during memory recall, and then refine your directed mindfulness questions depending upon your client’s needs: “What do you notice as you go back to that day? Maybe you see certain images, or your body changes. You might have an emotional response, or a thought. Just stay with it and tell me what you notice happening right now as you begin to remember.” The subsequent directed mindfulness questions you ask should reflect whether your client needs to embody the state-specific memory more, or not so much. If more, you can focus on elements of the memory that evoke the state—the emotion, the painful image of an attachment figure, tone of voice that was so wounding in the past. If clients need to regulate and focus less on the event and more on the present moment, your mindfulness questions can be directed toward the less evocative, or even stabilizing, moments of the memory. When memories emerge spontaneously in therapy sessions, you can encourage clients to pause, notice, and name the statespecific elements (i.e., building blocks) that arise spontaneously as they remember. If clients are not dysregulated and can tolerate more fully embodying the state they 543

were in during the past event, you can ask them what emotions, thoughts, movements, sensations, or images emerge. If clients lose dual awareness and become dysregulated, they need to put the memory aside and practice their resources until arousal returns to the window of tolerance. As they learn dual awareness skills, many clients will be reassured that they do not need to relive the past but simply be willing to notice the effect of remembering on their present experience and employ resources whenever they need to regulate. This approach helps them maintain control of remembering, and thus often increases their willingness to approach memory work. Clients will learn to refrain from becoming immersed in their reactions, which represent intrusions of implicit memories, and use their mindfulness skills to identify the building blocks that comprise these reactions. You can positively reinforce their ability for dual awareness, saying something like, “You’re doing great telling me what happens inside as you remember”—a statement that also supports social engagement, reinforces time orientation to the present, and supports differentiation of past and present. Clients who are detached from their memories and emotions will need your help to experience the effects of what happened, not just report the facts or discuss the event. You can help them discover and then inhibit the physical elements that go along with detachment, such as tension, held breath, or a particular body posture. Encouraging them to slow their narrative pace to pause and describe the building blocks evoked by the content can help clients embody the state-specific memory. Your prompting to describe the sights, sounds, and smells of the memory more clearly, to find the moments in the memory that are emotionally meaningful to them, and to become aware of, and perhaps even exaggerate, those physical reactions that deepen the emotions can help clients more fully experience the memory state. It may be helpful to review this chapter’s example of Darius together with your client to clarify some ways to support embodying the state specific memory.

Introduction to the Worksheets YOUR UNIQUE STYLE OF REMEMBERING can help clients develop their dual awareness skills in a less triggering way by noticing and comparing what happens in the present moment when they recall a negative versus positive event. They will discover whether they tend to remember certain building blocks more than others, or whether different ones stand out in each memory. Some clients will report more images, some only intense body sensations without a visual context, some have more emotions than thoughts about what they remember, and some remember the events cognitively. Even positive events can be triggering to recall for traumatized individuals, so if your client is triggered by the exercise, validate that this is a 544

normal phenomenon for many survivors. Dysregulated clients can practice with less intense state-specific memories, such as a neutral memory instead of a “good” one, and a mildly disturbing recent event, instead of past abuse, for a “bad” one. Noticing patterns of remembrance helps to keep the emphasis on dual awareness and implicit memory. You can emphasize that it is not the events themselves, but how the client’s mind and body encoded those events that are important to address. The second worksheet, EMBODYING A STATE-SPECIFIC MEMORY & BEING MINDFUL, asks client’s to embody a state-specific memory and then use mindfulness to remain in the here and now and observe present moment experience while continuing to embody the memory. For nearly all clients, especially dysregulated ones, this worksheet is best completed with you in session where you can provide interactive regulation and adjust the worksheets specifically to your client. The worksheet, DUAL AWARENESS OF RECENT INTERPERSONAL CONFLICT, helps clients deconstruct the memory of a current relational disagreement into its component building blocks. It also asks them to reflect on whether the current situation reminds them of earlier ones, helping them understand how past conflicts impact current relationships. The following worksheet, DUAL AWARENESS OF AN UPSETTING CHILDHOOD MEMORY, can be copied and used to practice mindful deconstruction of a graduated intensity of events. You can first explore a mildly upsetting memory and then work with increasingly challenging memories. The final worksheet, DEEPENING THE STATE-SPECIFIC MEMORY, is intended for clients who are detached and need your help to deepen into painful emotions sufficiently to experience the state-specific memory. Clients will benefit from your guidance in session, step by step, to focus on their internal experience. You can pace the exercise according to your client’s ability to balance accessing the state-specific memory with being aware of the present moment. After you guide your client through the steps delineated in the worksheet, the two of you can fill it out together as a reflective exercise meant to further integrate the experiential component.

Adapting this Material for Dissociative Clients Although exposure to memory is challenging and often destabilizing for dissociative clients, practice maintaining dual awareness counteracts their tendencies toward dissociation, and hyper- or hypoarousal. Therefore, an emphasis on the dual awareness skills in this chapter that encourage mindfulness of the present moment will be more valuable and stabilizing than an emphasis on embodying state-specific memory. For clients with dissociative disorders, there are innumerable opportunities to 545

practice dual awareness. For example, dysregulation, switching of parts or intrusions of sensations, images, thought, or emotions from dissociative parts, are all moments when dual awareness could be invaluable. However, dual awareness often requires greater integrative capacity than clients with dissociative disorders might currently possess. Various parts may have full, partial, or no awareness of other parts or of the building blocks. Thus, some parts may be able to hold dual attention more effectively and fully than others. It is important for you to assess with clients whether dual awareness is possible with most or all parts. If not, further work to promote awareness of the building blocks corresponding with different parts and acceptance between parts must occur first. Various parts of the client may be able to support and help other parts to increase awareness of the present, fostering more sustained capacities for dual awareness. It can increase symptoms and exacerbate dissociation to proceed with memory work before all parts of the client have at least some capacity for dual awareness. Until then, clients need to practice using resources from their repertoire when memories are triggered. Once parts are adept at using resources when memories involuntarily emerge, you might then attempt dual awareness by seeing if the client can embody a neutral memory while being mindful of the building blocks. Eventually dual awareness of the present moment and of the effects of voluntarily stimulating the states that are reminiscent of when the trauma occurred may become possible.

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CHAPTER 23 Dual Awareness of Past and Present As discussed in previous chapters, whether we consciously remember the details of what happened, partially remember, or implicitly remember, our past experience has shaped who we are in the present. In memory work, we seek to change the negative effects of what happened that still impact our lives today, using our resource repertoire as needed. However, even with resources, working with memory can still be challenging. One moment, we can be thinking about a past trauma or an upsetting experience with an attachment figure and, the next, we might be experiencing the present moment as if something unpleasant, dangerous, or upsetting were happening again. For many of us, working with memory in therapy catalyzes reexperiencing the past, which interferes with our ability to integrate and resolve it. But some of us have the opposite difficulty. We remember intellectually what happened, but feel distant from it and cannot connect with the body sensations or emotions that go with the memory. When we recall the past as simply a cognitive description, divorced from our bodies and the emotions connected to it, we might gain insight but do not transform the experiential effects of what happened. To integrate the effects of the memory we must activate the same parts of the brain and body that were activated during the event, which means reexperiencing, to some degree, the state we were in when the event occurred. The solution to both challenges—reliving the memory or feeling distant from it —is dual awareness. Our awareness must be in two places no matter whether we remember consciously, partially, or implicitly. We must remain aware of the present moment and our surroundings as we talk about or remember the past. As we do this, we will reexperience (to a manageable degree) an internal state similar to the one we were in when the event(s) occurred. As we embody the state we were in back then, called a “state-specific memory,” we must also be mindful of and describe how our building blocks change in the here and now. We have one foot in the past and one foot in the present, so to speak. Dual awareness is a particular form of directed mindfulness applied to work with memory and this chapter will teach you how to achieve it. You will learn that as you think about, talk about, or implicitly remember the past, you can become aware of how remembering is affecting your internal state. By deliberately focusing your attention inward. While you are remembering, you will notice the building blocks as they unfold moment by moment across the screen of your awareness.

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In Two Places at Once Rob reported that his parents had insisted on obedience. He felt that they had controlled his every move, which had made him angry as a child, although he was unable to express it then. As an adult, he implicitly remembered his childhood by being quick to anger and quick to feel controlled by his wife when she asked him to do something or even suggested an activity they could do together. In therapy, he worked with a memory of when his parents had refused to listen to what he wanted to do and had insisted that he do what they wanted instead. As he described this memory, mindful dual awareness enabled him to remember what happened and simultaneously to notice the anger he felt in the present as he remembered. Rob also noticed the other building blocks that were stimulated by the memory: the tension in his jaw and shoulders, a sensation of heat, angry thoughts, and impulses to yell back at his parents. With dual awareness, Rob was in two places at once—experientially back “in” the memory, reexperiencing (to a degree) the state he was in as a child, aware of how his building blocks changed as he embodied that state, and also aware of his current surroundings: where he was, whom he was with, and the sounds, sights, and smells of his immediate environment. When we can activate a state-specific memory and also remain aware of the here and now, we can transform the effects of what has happened to us. However, it is essential that we experience a kind of control now that we did not have then so that we are not simply reliving the past. Working on a painful memory naturally evokes emotions and can be dysregulating, but the effects of the memory cannot be integrated if dysregulation is excessive. In dual awareness, as you are talking about a past event with your therapist and also noticing how you are responding in the present moment, you may notice your arousal escalating or intense emotions coming up. Then you can put aside the memory to become mindful of the effects of remembering—your experience of your building blocks in the present moment. And your resource repertoire is your safeguard that will bring your arousal into the window if you become too dysregulated, or if you want to change the state you are experiencing.

Practicing Dual Awareness Amanda came to her Sensorimotor Psychotherapist following retraumatizing experiences in her previous therapy that had focused on memory retrieval and reliving trauma. Not only did thinking about her early memories lead to hyperarousal, but thinking about memory work itself had become triggering to her. It was at times hard for her to stay connected to her present moment experience because her bodily reactions were so intense, driving her arousal out of the 549

window of tolerance. Amanda first needed to develop a repertoire of resources and practice using them when implicit memories provoked an internal state similar to what she had experienced during past trauma. Gradually, she increased her confidence in her ability “stop” the implicit memories and regulate herself by using her resources. Feeling more in control, Amanda found the courage to address her memories directly, but in a different way. Amanda and her therapist decided that the first memory to focus on would be a date rape from her teenage years. Practicing dual awareness, Amanda began to think about the memory and stay mindful of her present experience of her building blocks. She immediately noticed feeling shaky inside. Her therapist asked her to notice where she felt the shaky feeling and then to discover what other building blocks went with it. Amanda noticed emotions of shame, a feeling of revulsion in her stomach, and the thought, “This is all my fault.” Her breathing became shallow, and she felt her heart pounding. Amanda’s arousal was at the upper edge of her window of tolerance, and she did not want it to increase. She and her therapist then decided to put aside the images, thoughts, and emotions and direct her mindful attention exclusively to a grounding resource from Amanda’s resource repertoire until her arousal settled down. Through using her resource, her body calmed and she felt more centered. Then she returned to dual awareness of remembering the memory of the rape and noticing her present moment experience as she remembered. Whenever remembering caused her arousal to approach the limits of her window of tolerance she learned to use her resources and put aside other elements of the memory until her arousal settled. Amanda began to overcome her fear of processing memories as she developed the new habits of implementing resources when remembering triggered her. Dual awareness is used to stimulate the effects of the memory in present time, but when those effects are too intense to integrate, then resources are used. If you are not becoming dysregulated as you recall the past, you can continue to use dual awareness to remember even more painful moments of the memory and mindfully focus simultaneously on how remembering affects your building blocks in present time. Darius was not afraid of reliving his memories—he was afraid he was too “in his head” to “connect” to them emotionally. He could not get in touch with the emotional pain he intellectually knew that he had felt as a child. Growing up with a single dad who worked two jobs to make ends meet and was “not the most nurturing,” Darius had developed a strategy of self-reliance. It was hard for him to depend on others, receive support, or stay connected to his emotions. In therapy, Darius could sense the lonely and sad child he had been for a moment or two, which made him feel sad in the present moment, but then he quickly detached from the feeling, Unlike Amanda, Darius’s difficulty was not that he became dysregulated when 550

he remembered his past. His difficulty was that he wanted to be in touch with the emotions and needs he had pushed away, but he could not stay with them long enough to experience them. In therapy, Darius could see a fleeting image of himself as a boy alone in a dark apartment, not knowing when his father would return. In dual awareness, he noticed his impulse to tighten up and “shield my heart” when he saw the image. With his therapist’s help, Darius deliberately softened his chest to inhibit his usual pattern of detaching from his emotions. He then used dual awareness to remember more painful moments—curling up on the sofa, hugging his teddy bear for comfort, the hard look on his father’s face as he failed to recognize Darius’s need—while also mindfully describing the building blocks that were evoked. His therapist helped Darius embody the state he had been in as a child by guiding him to recall more specific details. She asked him to describe the colors and furniture of the dark room, to see the boy’s expression and posture when his father came home with that hard look on his face, ignoring Darius’s need, and how that felt to this small boy. Darius reported that he felt sad, but quickly came the thought, “I should not be sad, I should be strong”—and again the impulse to tighten up, to protect his heart, which he inhibited. As he continued to focus on the memory of himself in the darkness, he took a breath to open his chest and refrained from tightening his muscles. By doing so, he was able to embody the painful state of the child more fully in the present. He felt the sadness and hurt in his chest, a softening in his usually rigid posture, the impulse to curl up into a ball, and the thought, “There is no one here to help me.” Darius wept as he reexperienced the emotional pain of the lonely, sad, and forlorn child he had been, reconnecting with a part of himself that he had pushed away because there had been no one to comfort him when he was small. Dual awareness helped Darius challenge the patterns that contributed to his automatic avoidance of his emotions. He could use dual awareness to inhibit the tension, remember the pain of his childhood more fully and express emotions he could not express before, while remaining connected to the present moment and to his therapist, whose empathy provided what he had missed as a child. For Amanda, dual awareness helped her notice the effect of remembering so that she could be aware of the building blocks that signaled her dysregulation, and then practice her resources so that she could maintain control and prevent herself from reliving the memory. For Darius, dual awareness helped him contact the painful elements of the memory so that the emotions could be processed with his therapist. The worksheets that follow will help you learn to track the moment-bymoment building blocks that are stimulated as you remember painful past events and develop the confidence that recalling the past is manageable. They will also help you practice dual awareness as you remember current interpersonal conflicts. Even though you reexperience, to a degree, the state you were in when the event or 551

the conflict happened, you remain mindfully aware that the past is not happening now. Being aware of the building blocks as they unfold in the present moment while recalling the past takes some practice in the face of the intensity that a painful memory can evoke. Being able to embody the state of the past can also take practice, especially when habits of feeling detached from the felt sense of the memory come into play. But the reward is that we can successfully process and integrate the effects of our memories when we use dual awareness to keep one foot in the present and one in the past.

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Dual Awareness of Past and Present YOUR UNIQUE STYLE OF REMEMBERING Purpose: To practice dual awareness, compare how remembering a good memory and a bad memory stimulate your building blocks, and explore your style of remembering. Directions: First follow the prompts for #1, then for #2. Afterwards fill out the remaining prompts below. 1. Recall a good memory and describe it in the box below. Practice embodying that memory and being mindful of your experience. Check the box next to each building block that you notice as you recall the memory, and describe the building blocks you remember. Your Good Memory Building Blocks of Your Good Memory Five-sense perceptions: Body sensations and movements: Emotions: Words/thoughts: 2. Recall a distressing memory and describe it in the box below. Practice embodying that memory and being mindful of your experience. Check the box next to each building block that you notice as you recall the memory, and describe the building blocks you remember. Your Bad Memory Building Blocks of Your Bad Memory Five-sense perceptions: 554

Body sensations and movements: Emotions: Words/thoughts: 3. Is there a pattern to your general style of remembering? (e.g., You might remember the facts—words or thoughts—but not the emotions; you might remember emotions but not the images; or perhaps you remember the physical feeling, but not the details.) 4. Did your style of remembering differ between your good memory and your bad memory? (e.g., You might remember the images of the bad memory, but the emotions and body sensations of the good memory.) 5. How might you use what you learned when you want to recall something difficult or something positive? (e.g., To direct mindfulness toward sensations and physical impulses and less on images when remembering a bad memory in order to regulate arousal; to focus more on the images, emotions and pleasant body sensations when remembering a good memory in order to deepen the positive experience.)

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Dual Awareness of Past and Present EMBODYING A STATE-SPECIFIC MEMORY & B EING MINDFUL Purpose: To practice dual awareness by embodying, to some degree, the state you were in when a disturbing event actually occurred (i.e., state-specific memory) and then mindfully notice how remembering affects the building blocks in the present moment. Directions: With your therapist, select a distressing memory to explore. Read through the rest of the worksheet together for an overview of the exercise, then follow the numbered prompts with your therapist’s guidance. NOTE: If you start to become dysregulated, what resource can you use? OR If you have trouble embodying the state-specific memory, which building blocks can you focus on that might help you embody it more? It might be helpful to refer to #5 on YOUR UNIQUE STYLE OF REMEMBERING worksheet. 1. Embody the state specific memory. Take your time to embody the memory and what occurred to a degree. Think about how old you were and what happened. Remember the images and sounds of the event, what you were doing, who was with you, and how they acted. Sense the emotions you experienced when it occurred. Remember how you felt at that time, the actions and movements you made, and anything else significant in the memory. 2. Become mindful Pause and use mindfulness to notice how embodying this memory affects your present moment experience of each building block. 3. Describe the building blocks you experience right now as you continue to be mindful and embody the state-specific memory. Sensations Movements and Impulses Five-sense Perceptions 557

Emotions Thoughts 4. Describe how embodying the state-specific memory in #1 compared to being mindful of your building blocks as you embody the memory in #2 and #3.

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Dual Awareness of Past and Present DUAL AWARENESS OF A RECENT INTERPERSONAL CONFLICT Purpose: To practice embodying a disturbing memory of a recent interpersonal conflict to the degree that it affects your building blocks, and then mindfully describe each building block you experience as you remember. Directions: Think of a recent conflict with another person that upsets you and feels unresolved. Note: If you become dysregulated, call upon a resource to bring your arousal into your window of tolerance. 1. Focus on the recent conflict until you experience a significant change in your building blocks in the here and now. Write down the building blocks you experience in the boxes below when you both embody the state specific memory and are mindful. The emotions I experience are: I see images of, I hear, taste, or smell: I have these thoughts: I noticed that my sensation changes in these ways: The movements I make or want to make are: 2. Did you feel dysregulated or upset when you embodied the state-specific memory and were mindful? Do you feel dysregulated or upset now? If so, identify a resource from your resource repertoire that you can use right now and describe the effects of using it. If you do not feel dysregulated or upset, move on to # 3. 3. Describe your experience of dual awareness of both embodying the statespecific memory of the conflict and being mindful of the building blocks that emerged in the present moment as you do so. What did you learn? 560

4. Reread your descriptions of the building blocks above, and notice if they remind you of any past relationships. Describe one or more earlier interpersonal conflicts that are similar to this current conflict.

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Dual Awareness of Past and Present DUAL AWARENESS OF AN UPSETTING CHILDHOOD MEMORY Purpose: To practice dual awareness by embodying the state you were in when a distressing childhood event occurred, while mindfully observing your building blocks at the same time. Directions: Read the numbered prompts with your therapist and select an upsetting childhood memory to explore. Then, complete the worksheet to practice dual awareness of the memory. Remember, if you become too dysregulated, use a resource from your resource repertoire to bring your arousal into the window of tolerance. 1. Describe the piece of the memory that causes you to become upset. (e.g., My mother being mad at me when I brought home a poor report card.) 2. Recall enough of the memory so that you can embody the state you were in then in this present moment, but not so much that you become too dysregulated. As you experience the effects of embodying the memory, describe what happens. Example I start to feel really bad about myself, and my breathing changes. My body starts to feel heavy. I frown, and I start thinking that my mother should have been kinder to me. She treated my brother better than she treated me. I think she always liked him better. He was her favorite. He got good grades. She was always hugging him 563

and she looked happy and proud of him. My body is starting to get tight and my shoulders are pulling in. It makes me mad, and I feel like telling her off. But then I think telling her off would only make things worse. 3. Be mindful of the building blocks you experience as you embody the memory and complete #2. Draw a line from each internal experience on the left to the corresponding building block below as you maintain mindfulness. Then, write anything else you notice from being mindful under the appropriate building block. Thoughts: I’m not good enough for her.

Emotions: I actually feel really hurt under the anger.

Five-Sense Perceptions: I see this little kid that I was, trying to be tough and not cry.

Movements: My chest tightens, my head comes down, and I sigh.

Sensations: The tension in my chest is acting and I feel a lump in my throat. 4. Last, take a few minutes to look around your environment and orient to your surroundings. Then describe how using mindfulness as you embodied the memory changes your experience of it. (e.g., I realized that as I became more mindful, I experienced the hurt that was under the anger.) 5. Discuss with your therapist any situations in your life today that you experience similarly to this childhood memory or that remind you of this memory.

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Dual Awareness of Past and Present DEEPENING THE STATE-SPECIFIC MEMORY Purpose: To use dual awareness to practice embodying a state-specific memory or an upsetting interaction or event that you feel emotionally detached from or avoid and also notice your building blocks. Directions: Review the example of Darius in the chapter. Then, under the guidance of your therapist, select an upsetting childhood memory involving another person or persons that you feel you detach from or avoid. Then follow the prompts below. 1. Focus on the memory and describe ways you might avoid experiencing the emotions of that memory (e.g., tighten, distract yourself, hold your breath, minimize the emotional pain, self-talk, such as “what good would it do?”). 2. Do the opposite of the impulses you recorded in #1 (e.g., Relax your muscles, focus on your body when you get distracted, breathe deeply, acknowledge the emotional pain). Describe your experience. 3. Focus on the sensory elements of the memory that are the most painful to you— describe the colors and surroundings, the people, the sounds of voices, facial expressions and eyes, and movements of the other person or people that upset you. Colors, Surroundings

People Sounds of Voices

Facial Expressions, People’s Eyes Movements

4. Identify and focus on the painful element—the images, sounds, movements— and describe what impulses you have physically. 5. Continue to focus on the painful element and exaggerate slightly what you notice physically to explore if doing so helps you more fully sense the emotions connected to this memory. (e.g., If you feel an urge to curl up or turn away, do it physically.) Describe your experience. 6. Take your time to notice the effects of this exercise, and describe the changes in 566

your building blocks below. Thoughts

Emotions

Images

Movements

Sensations

Note: If you feel dysregulated after completing this exercise, discuss with your therapist what resources you can use.

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CHAPTER 24

Sliver of Memory THERAPISTS’ GUIDE TO CHAPTER 24

Purpose of this Chapter Memory work in Sensorimotor Psychotherapy emphasizes the importance of selecting a particular piece, or sliver, of a memory to focus on, rather than attending to the entire memory at once. It is important to choose a sliver that, when recalled, will activate an internal state similar to the one experienced when the event occurred, so that the building blocks are clearly affected in the present moment. When memory is retrieved in small doses, or “slivers,” and clients practice both dual awareness and the use of their resources, they will not become unduly dysregulated—which would prevent integration of the effects of the memory. This chapter teaches clients how to select appropriate slivers of the memory, focus on the building blocks activated by the sliver, maintain connections to the here and now using dual awareness (cf. Chapter 23, “Dual Awareness of Past and Present”), and regulate arousal through the use of clients’ resource repertoire (cf. Chapter 21, “Implicit Memory and Your Resource Repertoire”), as needed.

Clients Who Might Benefit Clients who are easily overwhelmed when they intentionally recall traumatic events will get significant relief by learning to select “slivers” and then use their resources to regulate themselves until their arousal settles. Doing so will increase their felt sense of confidence and control. Clients who easily narrate events but whose hypoarousal prevents their actually connecting somatically or emotionally to their experience will benefit by carefully selecting a specific moment of a memory that can bring the memory alive without triggering spikes in hyperarousal or exacerbating hypoarousal. Equally, for clients who fear escalation into hyperarousal, limiting their recall to a carefully selected manageable sliver of memory helps decrease their fear. 568

Another group that often shares the same fears is comprised of those clients who function well in daily life but who are afraid that addressing painful memories will lead to a loss of functioning, too-intense emotions, or an exacerbation of symptoms. Their avoidance of memory can be addressed by the emphasis on titration and by ensuring that exposure to memory is always accompanied by access to resources and use of dual awareness. When they are encouraged to select a sliver of a memory that is not too arousing and integrate the skills taught in the previous two chapters, these clients can build confidence in how these approaches work. Thus, their conviction that they have only the two choices of avoidance or flooding can be challenged. Clients who are not traumatized or prone to dysregulation but are still troubled by upsetting memories with attachment figures can benefit from this chapter in a different way. Finding the sliver that shaped negative core beliefs and has the most meaning and emotional “charge” for them can add precision to the processing of the memory. The attachment-related emotions that come up can be expressed and empathically regulated within the therapeutic relationship. Clients who are not dysregulated but who are detached from a painful past or who want to be able to feel more emotionally connected to themselves and others can also benefit from being able to focus on a potent sliver of past memory that will help them experience their emotions more fully.

Suggestions for Clinical Use If a narrative style of therapy is more familiar to you and your clients, this way of working with memory may be challenging because the focus is not on the memory’s content or the event itself. It is on what changes in clients’ here and now experience of the building blocks when they remember a specific sliver of the memory. Once this approach becomes as natural as the more familiar methods used previously by you or your clients, the benefits your clients experience will hopefully encourage both you and your clients to continue to work with “slivers” of memory rather than address the entire event. The first task is to select an appropriate sliver. An appropriate sliver will send clients’ arousal to the edges of the window. For some clients this will occur with the smallest, least potent sliver, and for others this will occur only when the most painful moment of the memory is used for the sliver. The more potent the sliver of memory, the greater the effect on clients’ current experience, and the more challenging it will be for some clients to maintain dual awareness and regulate arousal. For that reason, the sliver of memory is carefully chosen to appropriately challenge clients’ integrative capacity. If clients have a narrow window of tolerance, the sliver should be less provocative to assure successful processing. 569

For clients with anxiety, fears, or phobias of memory based on hyperarousalrelated flooding, exposure to just the smallest slivers of memory (the date of the accident, the moment before an event, a single, more neutral, image) can help develop confidence and desensitize them to memory exposure. If clients tend to become hypoaroused or numb, it will probably be most effective to first work with movement resources so that these are readily available when needed. Then you can experiment with eliciting slightly evocative slivers of the event to activate a statespecific memory, staying aware that if doing so exacerbates dysregulation, resources will be needed. For other clients who have more integrative capacity and a wider window, a more disturbing sliver can and should be stimulated at the outset. For clients who are not prone to dysregulation, you can stimulate and stay with a sliver that evokes more emotional pain. Selecting a sliver of an original attachment injury that has the most intensity for the client provides an opportunity for the client to experience the unresolved emotions with you there for support and regulation (cf. Chapter 30, “Making Sense of Emotions”). Finding a potent sliver can also elucidate the meaning the client made at that time about him- or herself, others, and the world (cf. Chapter 29, “Beliefs and the Body”). Some clients may have no explicit memory of an event but may have been told what happened, or may just know that something happened. This knowledge itself can stimulate a similar state to the one experience during the event. Implicit memories emerging in present time also evoke these states. In such cases, the current implicit memory, remembering being told, or simply the knowledge about what happened can replace the sliver. After you help clients select an appropriate sliver of memory, remember to facilitate dual awareness of being here in the moment with you and encourage them to describe the impact of remembering the sliver on their building blocks. Some clients’ internal state will shift the moment they turn their attention to the sliver. Others will need your help to focus on and describe the sliver in more detail before they are able to notice an internal shift. As always, the directed mindfulness questions you ask once you select a sliver of memory should be appropriate to your client’s integrative capacity. Clients whose arousal threatens to exceed the window will need questions that guide them to be aware of the building blocks that will not cause arousal to escalate further. Those whose arousal does not reach the edges of the window, who easily detach from a felt sense of the effects of the memory, or who tend to remain cognitive rather than access their emotions may need questions that guide them to be aware of the more painful building blocks associated with the memory. It is important to keep in mind that for this intervention of working with a sliver of memory to be successful, previously learned skills must be integrated. Dual awareness of the internal state similar to the one experienced during the original 570

event, and simultaneously tracking the sensations, movement, perceptions, emotions, and thoughts evoked by it, and resourcing when needed, will assure mastery.

Introduction to the Worksheets Even a tiny piece of memory can potentially be dysregulating. Thus for most clients, completing these worksheets in therapy is best because of the need for the interactive upregulating or downregulating of arousal. CHOOSING SLIVERS OF A DIFFICULT MEMORY assists you and your client in identifying five different slivers of one memory and deciding which one is most appropriate to begin with. The key is to encourage clients to challenge themselves to find the sliver that activates “just enough but not too much”—which will depend on the width of their window of tolerance and their integrative capacity. The companion worksheet, IDENTIFY RESOURCES FOR ADDRESSING A SLIVER OF MEMORY, anticipates the need for resourcing, teaching clients to choose three resources they can use from their resource repertoires for a particular sliver from the previous worksheet. A SOMATIC RESOURCE FOR A SLIVER OF MEMORY again works with a distressing sliver, but this time incorporates the use of a somatic resource to observe its effect while accessing the sliver. OSCILLATING BETWEEN SLIVERS OF MEMORY AND RESOURCES is similar to the concept of pendulation, or contacting a difficult sensation and then finding an opposite one (Levine, 2010). Clients will need your guidance with this worksheet so that they can learn to become mindful of their internal experience as they focus first on the effects of a distressing sliver of memory and then on the effects of a positive sliver of memory. Shifting focus back and forth between dysregulation and regulation is thought to increase overall regulatory capacity. The final worksheet, SLIVER OF ATTACHMENT MEMORY FOR WORK WITH EMOTIONS, is for clients who are able to tolerate strong emotions and should be explored in session. This worksheet addresses a sliver from childhood that evokes emotional pain and helps clients explore the physical, mental, and emotional state that is stimulated. This worksheet will be most successful if you empathically guide your client through the described steps, adjusting the steps according to his or her experience. Afterwards, you and your client can fill out the worksheet together.

Adapting this Material for Dissociative Clients The more fragmented or easily activated the client is, the more challenging it is to 571

access a sliver of memory that will not exacerbate dysregulation. Any access to memory may prematurely break down dissociative barriers and result in flooding. When clients are exposed to memory, dysregulation, attempts to avoid memory, dissociative switching, or shutdown are often triggered. Dissociative clients should learn how to contain their memories and work toward communication and cooperation among parts first. Only then, if there is a wide enough window of tolerance for all parts, should the “sliver of memory” approach be used for the more painful elements of the past. Until then, it might be possible to explore choosing a neutral or positive sliver that all parts can tolerate, and practicing dual awareness, using resources as needed. For those clients with sufficient tolerance, working with a sliver of painful memory can be a helpful way to decrease the impact of memory intrusion. If a dissociative client has some capacities and resources, and a flashback occurs, you should use resources from the client’s repertoire to return to the here and now and ask him or her to connect with you. Then, you might ask the client to put aside the memory for the moment, and just focus on what’s happening in the body. If the client is able, you can look at the sliver in a different way that is more manageable. For example, you might ask: “Can you connect with me and just notice that one little piece of the memory from a distance, as though you are watching it on a small TV screen all the way across the room?”; “Can you let yourself feel just a little tiny bit of what happens inside from that—maybe 1% or just a teaspoon full?”; “Can you let yourself feel what happens in your body for just 15 seconds?”; “Can parts share together just a tiny bit of that feeling or image?” Often, your narrowing clients focus with specific directions to notice just one building block or to notice a sliver or building block connected to the memory for just a few moments helps them regulate arousal so that the memory exposure can be tolerated. It is important to remember that clients with dissociative disorders not only have difficulties with dysregulation but also struggle with internal conflicts among parts that exacerbate the tendency to either avoid or overexpose themselves to memory. A vicious circle can ensue. Avoidance of memory can result in stuckness, whereas overexposure threatens stability, ultimately resulting in stuckness as well. Because of the risk of sudden flooding, these clients should be discouraged from completing worksheets on their own. And even in therapy sessions, this client group might do best focusing on the worksheet entitled IDENTIFY RESOURCES FOR ADDRESSING A SLIVER OF MEMORY. By stressing resources for regulating activation and emotion triggered by slivers of memory, we can better ensure that our more dissociative clients continue to expand the window of tolerance rather than become increasingly dysregulated.

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CHAPTER 24 Sliver of Memory As we have learned, the two parallel tasks of reexperiencing a state-specific memory and remaining present in the here and now are essential to memory work. In the last chapter, we explored how mindful dual awareness helps us keep one foot in the present while the other is in the past. In this chapter, we will learn to work with a single, selected element—or “sliver”—of memory rather than the entire memory all at once. A sliver of memory is an important moment in the memory that, when we remember it, changes our here and now experience of the building blocks so that we experience an internal state similar to the one we experienced when the event occurred. As we remember the sliver, the effects of what happened emerge spontaneously in the present moment as sensations, five-sense perception (images, smells, tastes, sounds), movements, emotions, and thoughts. We carefully choose the sliver of past memory to focus on so that the effects of remembering—our internal reactions—can be processed and integrated. The sliver chosen should stimulate emotions or catalyze our arousal to approach the upper or lower edges of the window of tolerance without excessive dysregulation or loss of dual awareness so that we can remain aware of the present moment and integrate what arises. Kara’s sliver was remembering the loud sound of the car bombing she witnessed in Iraq. The effect of remembering the sound was instantaneous. Her heart rate quickened, and she began to tremble. Jonathan’s sliver was the image of the displeasure in his mother’s eyes and the expression on her face when she saw his poor report card from the third grade. The effect of seeing this image in his mind’s eye was also immediate. His head lowered, and the thought “I’m not good enough” came to mind, along with a feeling of shame. These significant moments, or slivers, of memory are used to stimulate the old reactions of the past that are still with us today. The building blocks that are activated by remembering the sliver become the grist for the therapeutic mill. It is essential to remember that we are not working with the actual memory itself, which cannot be changed, but with how we react to the memory, which can be changed. To repeat what we have learned in previous chapters, resolving the past means working to integrate the effects of whatever happened to us that impinge on our well-being in our current life.

How to Choose a Sliver of Memory 574

Any number of components of a memory can be chosen as a sliver to create a statespecific experience of the past in the here and now. It could be a specific image, the look on someone’s face, a particular word that was uttered, the movement of someone turning away or coming towards you, a smell, the sound of footsteps, someone yelling at you, or any other element you remember. Any piece of a memory that stimulates arousal to the edge of the window of tolerance (but not so far over that we lose dual awareness) or specific moment in a memory in which we felt emotional pain as children when our needs were not met qualifies as a “sliver.” Sometimes, we might want to focus on a sliver of a recent memory rather than one from childhood. Sometimes we do not have an explicit memory of what happened, but we know that something happened because someone told us about it, or because we just know. If this is true for you, then thinking about what you know happened can replace the sliver of memory. When choosing a sliver to work with, we want to remember a piece of the memory, or a reminder of it, that is vivid enough to stimulate traces of the emotions, perceptions, physical reactions, or thoughts that we experienced at the time the event occurred, but not so vivid that our ability to stay in the here and now is threatened. In other words, the sliver should help us experience just enough of the state we had been in during the event, but not so much that we become too dysregulated and lose dual awareness. Sometimes, especially if the event was traumatic, we might experience a state similar to the one we were in when the event occurred just by talking about it, or even by “thinking about thinking about” what happened. When this happens you must call upon your resources to maintain dual awareness. Kara’s sliver was the loud noise associated with the sound of the car bombing—the backfiring of a car, a firecracker, or even the unexpected loud bark of her neighbor’s dog. All were slivers because they catalyzed the same internal reactions associated with the car bombing. As you have already discovered through the exercises you have completed, some memories can be regulating and resourcing. Kara remembered that one of her resources from her resource repertoire was the memory of seeing the image of a beautiful sunrise, and it became a regulating sliver that she turned her attention to when she became dysregulated during memory work. If arousal does not approach the limits of the window of tolerance, but remains within the middle (e.g., in flat emotional states or mild fear and anxiety), the opportunity to regulate and integrate the effects of the past can be hindered because we do not experience the effects with sufficient intensity. Recalling a “just right” sliver of memory and then noticing what happens internally enables us to reexperience the effects of the memory in small doses, rather than all at once. Once these reactions are stimulated, the sliver has served its purpose, and we can then turn attention to our internal reactions.

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A Sliver of Traumatic Memory Jennifer had suffered severe abuse growing up. Talking about what had happened made things worse. She alternated between agitated hyperarousal states accompanied by anxiety attacks to hypoarousal states in which she just wanted to sleep. When Jennifer came to therapy, she was eager to learn the somatic resources necessary to regulate herself, and she worked hard to develop a resource repertoire. But she became frightened when her therapist suggested that she might be ready to address her memories. She could understand the value of working with memory intellectually, but she still had trepidation because talking about what had happened had only increased her dysregulation in the past. However, after practicing her resources when she “thought about” memory work, Jennifer felt willing to try to work with a sliver from the past. She and her therapist decided the first sliver would be an image of herself as a 6-year-old, trying to “not be noticed” before an abusive incident. As Jennifer remembered that sliver, tears started to burn in her eyes, and she could feel the fear and freezing and an impulse to sink into a ball with her arms over her head. The sliver of the image proved to be too frightening for Jennifer, so her therapist asked her to “pause and just put the memory aside for a moment.” The therapist then helped Jennifer to turn her mindful awareness toward her favorite resources: lengthening her spine and putting her hands over her heart. Once Jennifer’s arousal returned to the window of tolerance, they decided to work with the same sliver again, this time with Jennifer maintaining the resources of an aligned spine and her hands over her heart. Jennifer was able to stay with the sliver for a few more minutes before she felt dysregulated. She returned to focusing exclusively on her resources for another few minutes. When Jennifer again accessed the sliver, this time her therapist helped direct her mindfulness to just her physical state—shaking and rapid beating of her heart. At first, Jennifer was frightened of these sensations, but with her therapist’s help, she was able to maintain dual awareness and notice that when she used directed mindfulness to focus only on her body, and not the image or the emotions, the shaking subsided, and her heart rate slowed down. Several minutes later, Jennifer again brought to mind the image of herself as a child, and this time, although she felt tearful and sad for the child she had been, she was able to stay in the here and now while also embodying just a small amount of the painful emotional state she had experienced as a child. This first session on working with a sliver along with her resources gave Jennifer the confidence to begin to address her memories without flooding and becoming overwhelmed. As long as they could address just one little piece at a time, and then work with the effects of remembering just that sliver, using her resources as needed, Jennifer felt that her memories were not too big for her to tackle. To resolve events that were dysregulating, arousal must be stimulated so the 576

effects of the past on our bodies and physiology can be processed. But to ensure the success of memory work, it is essential to use titration techniques: that is, to begin by carefully and slowly calling to mind only a small sliver of the memory, always followed by tracking the building blocks evoked by the sliver and deliberately maintaining dual awareness. When dysregulation exceeds our capacity for integration, embodying a resource from our resource repertoire or practicing mindful awareness of only the body, putting images, emotions, and thoughts aside, can helps us regulate. Each time we access a sliver of memory we once always pause to notice how our building blocks change. Going at a slow pace and working with a manageable sliver enables our arousal to approach the edges of the window of tolerance without remaining in the hyper- or hypoaroused zones. This “just right” level of arousal allows us to describe the experience without becoming immersed in the memory, and facilitates integration of the effects of the past.

A Sliver of Attachment Memory We can also use slivers of upsetting memories of recent or childhood relationships that are distressing but do not evoke the extreme dysregulation of life-and-death survival responses as Jennifer’s slivers did. Jonathan was repeatedly upset by what he called his wife’s continual “nagging.” The sliver of this recent memory for him was the tone of her voice. In therapy, he focused on the quality of her voice when she asked him about washing the car, and was mindful of how his building blocks changed. Jonathan saw an image of himself at 10 years old, feeling badgered by his mother to practice the piano, a formative memory for him, similar to the memory of the disappointment on his mother’s face when he brought home a poor report card that had given him the message that he was never enough. With attachment wounds such as Jonathan’s, the sliver of the memory to work with is usually a moment in the memory when we feel terribly hurt in some way by an attachment figure. Such a sliver enables the emotions that were not resolved to be experienced. For Jonathan, different moments of memory became slivers: seeing the displeasure on his mother’s face as she looked at his report card, the nagging quality in his wife’s voice, and the tone in his mother’s voice and her facial expression when she asked him to practice the piano. These all became significant slivers because they had a strong effect on his building blocks in the present moment and provided the opportunity to work with effects of his past that were not resolved. Jonathan and his therapist decided to focus on the tone of his mother’s voice and the look of displeasure on her face when she asked him to practice the piano. With this sliver, Jonathan’s emotional arousal rose to the edge of the window of tolerance, and his therapist helped him to stay with these emotions. He 577

reexperienced the hurt he had pushed aside as a child and recognized that the meaning he had made from this experience was that he would always be a disappointment to those who loved him. This meaning and the emotional charge were superimposed on the more recent memory of his wife asking him to wash the car, which implicitly reminded him of the original hurt. In therapy, Jonathan cried hard as he sensed that small child who felt like such a disappointment, but he was able to maintain his awareness of the here and now and receive the support of his therapist. He felt that such empathic support for his feelings had been absent when he was a child. This experience helped Jonathan integrate the emotions of the past for so that he could relate to his wife’s requests differently. He realized that he was not a disappointment to his wife, that her intention was not to nag him, and that his reactions to her had to do with the old feeling of disappointing his mother.

Social Engagement with Your Therapist Maintaining social engagement with your therapist is essential when working with memory. However, at times you may lose social engagement with your therapist. You might notice dysregulation, difficulty speaking, loss of eye contact, or an impulse to pull away. Or you might feel upset with your therapist or that he or she is critical of you, or has other negative thoughts about you. This could mean that some early relational issues are coming up between you and your therapist, which provides an opportunity to talk about them together. For example, at one point Jonathan thought he was a disappointment to his therapist, too, and he began to withdraw, but he was able to reestablish social engagement when he and his therapist became aware of this and discussed it together. The loss of social engagement could also be a sign that the work is moving too quickly, stirring up too much traumatic memory, too much emotion, or dysregulating implicit memories. At those moments, we need to draw on our resources to help us reconnect to the present by grounding ourselves, feeling the support of the chair, and sharing our experience with our therapist. By discussing together, you can reestablish social engagement, and the safety needed to continue memory work. In the worksheets that follow, you and your therapist will have the opportunity to practice choosing a sliver of memory with which to work. As you continue your memory work, the worksheets will help you maintain dual awareness, track your body, and call upon your resources. You will select a sliver that sends your arousal or emotions to the edge of your window of tolerance and at the same time, track what unfolds in dual awareness. Then, with your therapist’s guidance, as you experience your arousal coming back into the window—and possibly the resolution of old, emotional pain—you will begin to experience a sense of completion and integration of the effects of the past. 578

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Sliver of Memory CHOOSING SLIVERS OF A DIFFICULT MEMORY Purpose: To identify several slivers—moments, images or sounds—of a difficult memory and assess the effect of each sliver on your arousal. Directions: Think about the memory you want to explore and choose five different slivers of the memory. Write down each sliver in a segment of the circle below. Use the “Key to Intensity of Sliver” scale to mark the intensity of each sliver. Then determine which slivers activate just enough arousal that is high enough to reach the outer edge of the window of tolerance but does not escalate to an unmanageable level. Key to Intensity of Sliver 5

Hyperarousal

(-1)- Tolerable lower arousal (within (-3) the window of tolerance)

4

High arousal (upper edge of the window of tolerance)

(-4)

Low arousal (lower edge of the window of tolerance)

(-5)

Hypoarousal

3- Tolerable higher arousal (within 1 the window of tolerance) 0

Optimal arousal

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Sliver of Memory IDENTIFYING RESOURCES FOR ADDRESSING A SLIVER OF MEMORY Purpose: To identify and practice three resources from your resource repertoire that you could use when a distressing or dysregulating sliver of memory is activated. Directions: Select a sliver of memory from the previous worksheet, CHOOSING SLIVERS OF A DIFFICULT MEMORY, that causes your arousal to approach the upper or lower edges of your window. Focus on remembering that sliver for a moment, and notice your reactions, especially the emotions and sensations that let you know your arousal is approaching the one of the edges of your window. Select three resources from your resource repertoire that would be useful to regulate your emotions and arousal when this sliver is activated. Try each one out and describe how it helps. Describe the sliver of memory. Whole Memory 1. Identify the first resource, try it out, and describe the effect on your body and arousal. 2. Identify the second resource, try it out, and describe the effect on your body and arousal. 3. Identify the third resource, try it out, and describe the effect on your body and arousal.

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Sliver of Memory A SOMATIC RESOURCE FOR A SLIVER OF MEMORY Purpose: To select a dysregulating sliver of memory, embody the state you were in at the time it occurred, and find a somatic resource that helps you regulate your arousal. Directions: With your therapist, select one sliver of a disturbing memory—an image, a smell, a sound, a person—that increases your arousal but not so much that you become too dysregulated. You can use a sliver from the worksheet CHOOSING SLIVERS OF A DIFFICULT MEMORY or you can choose a sliver from a different memory. Then follow the prompts below. 1. Describe the sliver of memory: 2. Practice dual awareness: remember and embody the state you were in at the time the event occurred, Describe how your building blocks change when you embody that sliver. Thoughts Emotions Five-Sense Perceptions Sensations Movements 3. Choose and practice a somatic resource (alignment, grounding, a breath, containment, centering, or another one of your choice) as you embody the state again, and describe the difference in your building blocks. Thoughts Emotions Five-Sense Perceptions Sensations Movements

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Sliver of Memory OSCILLATING BETWEEN SLIVERS OF MEMORY AND RESOURCES Purpose: To practice oscillating between awareness of a distressing sliver and awareness of a resource from the same memory. Directions: Select a painful memory you want to explore. Identify a distressing sliver and a resource from the same memory. Then follow the prompts below. 1. Describe a distressing sliver (e.g., When I was a teenager, I had a car accident on an icy road, and the person in the car I hit got hurt. I was driving a little too fast, and it was my fault. Every time I think of it, I feel awful.)

Describe your cognitive, emotional, and physical response to the sliver of a distressing (e.g., I start to curl up in a ball, and I feel like crying. I feel ashamed, really sad and full of remorse, like I should not show my face. I keep thinking if only I hadn’t been driving so fast.) 2. Describe a positive sliver/resource (e.g., I remember the doctor at the hospital telling me that this could have happened to anyone, and not to blame myself.)

Describe your cognitive, emotional and physical response to the sliver of positive stimulus. (e.g., I take a deep breath, my chin lifts a little, and I still feel sad but don’t feel so ashamed. I have the thought that my doctor must know what she is talking about, when she told me this could happen to anyone.) 3. Practice oscillating between focusing on the distressing sliver and focusing on the positive sliver. First focus on the positive sliver, sensing your body, and then on the negative sliver, 587

sensing your body. Oscillate back and forth several times and then describe what you experience emotionally and physically. (e.g., The whole thing starts to lose some of its charge. My body is a bit more relaxed, and I have the thoughts, “These things do happen to everyone,” “Everyone makes mistakes,” “I don’t need to be so ashamed,” and “I was young and didn’t understand how slippery ice could be, and the person did fully recover.” I start to feel better. I feel sort of tender toward myself that I had to go through this.)

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Sliver of Memory REMEMBERING A P AINFUL ATTACHMENT EXPERIENCE Purpose: To explore a sliver of memory with an attachment figure that is emotionally painful and to express these emotions with your therapist. Directions: Under the guidance of your therapist, choose a sliver of memory with an attachment figure that causes you significant emotional distress (e.g., you might feel hurt, angry, sad, disappointed, or another painful emotion). Your therapist can guide you through the steps below. Afterward you can complete the prompts together. 1. Describe the sliver—a moment of emotional pain. 2. Take your time to embody the emotional state you were in at the time the event occurred. Immerse yourself in enough of the state so that your emotional arousal reaches the upper edge of your window of tolerance. Describe what happens as you immerse yourself in this emotional state. 3. What changes in your body when you focus on this sliver and re-experience the emotions? What impulses do you have? 4. If you find yourself detaching from, inhibiting, or minimizing your emotions, notice how your body participates (e.g., your body might tighten up or pull back, your breath become shallow or held), and try to do the opposite. Then try refocusing on the sliver that increases emotion and describe below. 5. What thoughts about yourself, others, or the world take you deeper into the experience of painful emotions? 6. Repeat any steps as you wish, and take all the time you want to be with and share this experience with your therapist. Then describe how you feel afterwards.

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Restoring Empowering Action THERAPISTS’ GUIDE TO CHAPTER 25

Purpose of this Chapter Building on the material of Chapter 4 (“The Wisdom of the Body, Lost and Found”) about instinctive physical defenses designed to protect us from harm, this chapter has two important goals: first, to help clients understand their innate animal defenses and, second, to help them both explore more empowering defensive actions that were inhibited in the past and to integrate defensive actions that are dysregulated. Clients will learn that all mammals, including humans, are equipped with a cascade of defensive reactions in a hierarchical system designed to protect them against threat, from mild to severe (Cannon, 1953; Fanselow & Lester, 1988). Both traumatic threat and relational strife can stimulate animal defenses of immobility (freeze, feign death) or action (cry for help/fight/flight). When triggered by current stresses or reminders, clients are more likely to use the animal defenses that they habitually employed during past events. Using this chapter, you can help them to better understand their dysregulated animal defense as instinctive protective actions that have become altered in ways that are not integrated or adaptive to current situations (Herman, 1992). By exploring these actions somatically, clients will learn to mindfully execute new, integrated actions that can change procedural patterns, replacing feelings of being out of control or helpless with feelings of empowerment and control.

Clients Who Might Benefit Clients whose hyper- or hypoactive animal defenses continue to be triggered in present contexts and who are unaware that impulses toward more empowering or regulated responses are often present, too, or are just below the surface of their awareness, can benefit from this chapter. For such clients, past experiences have resulted in faulty neuroception and dysregulated defenses that arise unbidden in 591

current situations. This group includes agoraphobic clients whose sense of the world as a dangerous place precludes engagement in activities of normal life, clients with anger management issues, chronically passive or repeatedly victimized clients, and clients with overactive “flight” responses who tend to flee precipitously. Any client whose habitual faulty neuroception of danger contributes to relational strife or to symptoms such as night terrors and inability to sleep will find this chapter useful. Clients whose symptoms of panic and anxiety are traumabased, or who use addictive substances to self-medicate and regulate arousal, may also benefit. For all these clients, such difficulties may reflect dysregulated animal defenses.

Suggestions for Clinical Use Clients with dysregulated animal defenses experience difficulties in relationships because their ability to neurocept safety is diminished. Psychoeducation about these defenses challenges the automatic shame and self-blame clients so often experience. Porges (2011) reminds us: “To effectively switch from defensive to social engagement strategies, the mammalian nervous system needs to perform two important adaptive tasks: 1) to assess risk, and 2) if the environment is perceived as safe, to inhibit the more primitive limbic structures that control fight, flight, or freeze behaviors” (p. 279). When we educate clients about the instinctive nature of animal defense responses and how our neuroception of safety versus life threat biologically determines what actions we take, we are helping them to reframe their instinctive responses as life-saving rather than shameful. When introducing this material, you might discuss the relationship of empowering actions to client’s aims and goals by saying something like this: “I know that you are tired of feeling too scared to go out,” or “You wish you could stop frightening your wife with your anger,” or “You are tired of giving in and then feeling ashamed for giving in.” “Is this something you would like to work on?” Difficulties like these might reflect habitual use of certain animal defenses that could be helped by the restoration of regulated, empowering action. Since the reptilian brain, the seat of our instincts, governs animal defenses, they are often impervious to “top-down” resolution via insight or even through emotional expression. Teaching clients to work with them “bottom-up” through mindful physical action can be a new and empowering way to address dysregulated animal defenses. For these interventions to be effective, clients must use mindful dual awareness to witness and embody the felt sense of empowering impulses for action. You want to ensure that clients are within the window of tolerance or at the outer limits and able to sustain dual awareness. Toward this end, you can first ascertain that they 592

fully understand the didactic material in the chapter and are curious about how it applies to their circumstances. Curiosity and the hope that this way of working will help free them of stuck patterns (e.g., long-term depression or shame, anger and reactivity, fear and freezing or emotional volitility in relationships) are the best motivators for encouraging clients to experiment with action. From there, you can help them discover the sliver of memory in which an empowering defensive action might have been available so that they can experience the impulse physically, as described in the chapter.

Introduction to the Worksheets The worksheets in this chapter provide an avenue for clients to experiment with the connection between memory, habitual animal defensive reactions, and the potential for practicing more empowering and regulated actions. Most clients will benefit by using the worksheets in the session so that you and they can gauge how triggering these interventions are while you are there to help them maintain dual awareness, remind them of their resources, and interactively regulate them. As a way of increasing interest in restoring empowering action, the worksheet on RECOGNIZING ANIMAL DEFENSES builds awareness of automatic habitual animal defenses and how those impact the client’s body and relationships. The pair of worksheets entitled ANIMAL DEFENSIVE RESPONSES & THE BODY offers clients the opportunity to imagine and execute actions of animal defense in an empowering and regulated manner. It is critical that clients stay mindful of and connected to their bodies, so you may need to remind them to go slowly and mindfully as they explore executing these physical movements. As always, modeling the actions yourself can decrease self-consciousness. When clients have fears of making an empowering defensive action such as pushing away, they may say, “I could never do that—it wouldn’t feel safe—just thinking about it is scary.” Educating clients that their reactions reflect the degree of danger that active defenses would have posed in the past and reframing their reluctance as a survival resource, can help alleviate some of their fears: “Maybe it would have been too dangerous to say ‘stop’ or push him away—was that true in the past?” For clients whose habitual defensive responses have been to freeze or to shut down and become hypoaroused, REPLACING AN IMMOBILIZING DEFENSIVE WITH A MOBILIZING DEFENSE provides an opportunity to find a sliver of memory in which mobilizing defenses were available. Once that sliver is found and the physical impulse is felt physically in the present moment, clients can experiment with following the body’s impulse to execute a more active, empowering defense. Your coaching to help them sense their bodies and find the action that “wants” to happen will support them to pinpoint the most satisfying action for them. It might be 593

helpful to remind them to just sense how the action feels in the body in the present moment, and to not think about the past. REGULATING DYSREGULATING MOBILIZING DEFENSES will help clients regulate hyperaroused, hyperactive fight-and-flight responses that lead to aggression or disconnection in relationships by executing these actions slowly and mindfully. By now, clients should be familiar with somatic resources from their resource repertoire, and they can use those if they become dysregulated during these exercises. If clients freeze or shut down, you can ask them to stand up or help them embody somatic resources that they have found useful in the past (e.g., alignment or grounding) that mitigate immobilizing responses. You can also help them orient to their current environment by saying, for example, “Let’s take a moment to orient . . . . Slowly look around the room. What do you notice?” Often, as clients orient to the external environment, they can neurocept safety again. Reestablishing social engagement with you might free clients to explore what their bodies want to do rather than focus on what their bodies are afraid to do.

Adapting this Material for Dissociative Clients Movement, evocation of memory, and active defensive responses can all be intensely triggering for dissociative clients. If your client has had difficulty with “slivers of memory,” is unable to contain traumatic memories, cannot sustain dual awareness, or struggles with switching or a narrow window of tolerance, you may want to go back to earlier chapters on dual awareness or on developing a resource repertoire. If your client benefits from psychoeducation but is dysregulated by physical interventions and movements, then you may just want to read and discuss the material together instead of moving into it experientially for the time being. It can be helpful to ask the client what various internal parts find difficult about this material, so that together you can help each part gain further understanding, resilience and skills. Since the RECOGNIZING ANIMAL DEFENSES worksheet asks only that clients notice and report patterns of reaction, it is less likely to trigger dysregulation. The ANIMAL DEFENSIVE RESPONSES & THE BODY worksheets could simply be vehicles for helping clients notice which active defensive movements he or she would like to perform or could imagine performing, and which not, or whether different parts prefer different defensive movements. If even that is too triggering, the inquiry could focus on what beliefs, fears, concerns, or inner conflicts between parts interfere with effective action or physical responses. The worksheets could be used to track the parts that are connected to different habitual defensive responses and clarify which parts might want to or feel capable 594

of executing each action and which parts might be afraid or ashamed to perform that action. If there are parts that would like to execute an action, then they could participate in the exercises while other parts are asked to watch from a safe distance. If there are parts that want to participate but are afraid to try out any of these actions, you might find out which resources they would need to be less afraid and whether other parts could be of assistance.

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CHAPTER 25 Restoring Empowering Actions We learned in “The Wisdom of the Body, Lost and Found” (Chapter 4) how instinctual physical responses designed to protect us from harm are stimulated when we feel threatened. These responses fall into two general types: mobilizing actions, such as crying for help, fighting, and fleeing, and immobilizing actions that keep us from moving when the mobilizing ones are ineffective, such as freezing and shutting down or feigning death. These instincts are called animal defenses because they are innate capacities in most animals. Though no single animal defense is “better” than another, in the face of a particular situation, one defense is usually more adaptive and effective. Freezing or feigning death would be more successful than crying for help, fighting, or fleeing in situations when the abuser could easily overpower us if we tried to fight, catch us if we tried to run, or when there was no one to aid us if we called for help. If an older, wiser, or stronger person is available to protect us, crying for help would be effective. Running would work if we could run faster than an attacker. Fighting back might be the best choice if we were stronger and had a good chance of winning the fight. In the moment of threat, we do not have time to reflect on the best choice of animal defense, and so the brain inhibits activity in the prefrontal cortex and increases activity in the subcortical (mammalian and reptilian) brain (see Chapter 9, “The Triune Brain and Information Processing”). These subcortical structures are responsible for implementing instinctive survival responses very quickly. Ideally, the subcortical areas of the brain instinctively select the defense that works the best for each situation. But when we have repeatedly been subjected to threat, the same defense(s) is usually activated over and over. Although all of the animal defenses are instinctive in nature, the one that we use the most is encoded in procedural memory and becomes our default defense. We then may lose our ability to use the other animal defenses. For example, when Jay was mugged and beaten, he froze, and his body continued freezing in later situations, even when fighting back or leaving a situation would have been more effective. Mateo grew up in a family that expected him to be tough and stand up for himself. Because of this, he developed a propensity to fight that was reinforced when his fight defense was activated over and over during his military service. When he came back from the war, the slightest traumatic reminder would stimulate his fight response, and he would instinctively lash out. Fighting had become his default defense when he was threatened, which sabotaged his relationships. 597

The pathways in our brains that relate to the animal defenses used most frequently become well traveled and sensitized to threat-related stimuli. It takes conscious intention to develop new pathways. When the effects of memories that turned certain animal defenses into habits have not yet been resolved, the same defense is triggered over and over. This chapter describes the various animal defenses and explores how to find the sliver of memory that will help you rediscover actions you may have instinctively abandoned in the past. With these new actions now rediscovered, you will be able to use a greater array of instinctive animal defenses more appropriately. By reviving and engaging empowering defensive actions, you will create a new experience for yourself and facilitate the growth of new neural pathways necessary for neuroplastic brain change.

Mobilizing Defenses The cry for help, flight, and fight defenses are called mobilizing defenses because, powered by high arousal, they propel us to take action. The cry for help is an attempt to get help from someone stronger, older, or wiser. Infants and children cry for their attachment figures when distressed, but the cry for help also is used in adulthood when we seek out others in times of stress and threat. Flight is a common response to threat when escape is likely to be successful. Flight can include both running away from danger and running toward a person or place that can provide safety. Flight responses include other forms of “getting away” as well, such as twisting or turning away or backing away. We use the fight response when fighting back is expected (as in combat or street gangs) or when it might be successful, such as when we seem to be stronger than the attacker. It goes without saying that if the perpetrator has a weapon, such as a gun, the wisest defensive choice for survival is usually to comply with his or her wishes. During nonrelational trauma, such as falls or car accidents, we also use procedurally learned mobilizing actions that have become instinctive from repeated use, like slamming on the brakes or turning the steering wheel to avoid an accident, engaging the righting reflexes during a near fall, raising an arm for protection from a falling object, avoiding a rock in a downhill ski run, and so on. All these illustrations highlight the reflexive body movements that take place when versions of mobilizing defenses are stimulated by a threatening situation.

Immobilizing Defenses The mobilizing defenses instinctively give way to immobilizing ones when the former would be ineffective. When action would make things worse—for instance, 598

if an abuser is bigger and stronger, has a gun, or can run faster, if we cannot escape, or if no one is around to help—then not moving is the best strategy. There are two types of immobilizing defenses: the freeze response and the shutdown (feigned death) response. The freeze response is characterized by high sympathetic nervous system arousal and hyper attentiveness, combined with a feeling of being unable to move. Tense muscles accompany this “alert immobility,” and we might feel anxious, paralyzed, terrified, or agitated. In contrast, a shutdown defense, or “feigned death,” is powered by the dorsal vagal branch of the parasympathetic system that renders us immobile in a different way. Instead of being hyperaroused, we are hypoaroused; instead of muscles becoming tense, they become flaccid or “floppy”; instead of heart rate increase, heart rate decreases. Sometimes this can even lead to fainting, or feeling like we will faint. This shutdown defense is an instinct that occurs as a “last resort” when the other defenses are not effective.

Inflexible Animal Defenses To repeat, we develop habits of animal defense from their repeated use in the face of threatening experiences. Because our sense of safety depends on attachment figures in childhood, and because we are genetically programmed to neurocept cues in others that might signal danger and threat (e.g., an angry face), animal defenses may be aroused if our attachment figures exhibit these cues. We may develop immobilizing defenses in the face of parental criticism, rage, rigid rules, and punishments. We may develop mobilizing defenses not only during trauma but also in the face of expectations that we be tough, unemotional, and defensive. Mateo had an overactive fight defense, developed first in his family and reinforced in the military. He had chronically tense arms and jaw, was easily provoked, and often felt irritated, angry, and ready to argue. Someone with an overactive flight defense might have tense legs that feel ready to run, often feel trapped, fearful, or terrified, and want to “get away.” When the cry for help is predominant, we may feel desperate for someone to rescue us or simply to be with us. Our eyes may have an imploring quality, we may feel clingy in our relationships, and be afraid of being alone especially when stressed. A habitual freeze response can include hyperalertness, panic, fear, or muscle tension combined with feeling paralyzed and unable to act. The shutdown defense might be experienced in flaccid, weak muscles and in a difficulty with staying “present.” We might feel spacey, numb, blank, or just “not there,” and we may feel detached from our emotions and not be able to feel our body. Habitual defenses can become default behaviors that can override other, more adaptive actions. Mateo’s habitual fight response was fueled by a quick-trigger 599

anger, and he easily got into physical fights. Trish’s flight response led to feeling restless and closed in, and she would “flee” from apartment to apartment, never staying in one place. Meg’s desperate wish for others to rescue her was evidence of a cry for help left over from a childhood in which her need for protection was not met. Betty experienced the chronic shutdown/feigned death response, and she often found herself “spacing out.” Jay, who had frozen when he was mugged, had trouble mobilizing himself to be active and often felt “stuck.” An adaptive flexibility in our animal defensive responses is necessary so that we can instinctively call upon any of them as needed, rather than be stuck using only one type. Mateo and Trish needed to address their overactive mobilizing defenses and modulate their impulses to fight or flee. Meg needed to integrate her desperate need for help from others so that it was appropriate to her current adult relationships. Betty and Jay needed to find their long-lost mobilizing defenses.

Integrating Animal Defenses Whether we are conscious of these responses at the time or not, our bodies instinctively react to threat initially with sympathetic mobilization and then, based on environmental conditions, automatically adapt our defenses intuitively to the situation. Both Betty and Jay could find slivers of memories of wanting to fight back but not doing so because that would have made things worse. As over time, they lost impulses to resist, instead encoding beliefs such as “I don’t deserve to defend myself” and a feeling of helplessness (for Betty) and agitated panic (for Jay). But both Betty’s and Jay’s impulses to defend and protect themselves still existed as instincts in their bodies, but the mobilizing defenses had been inhibited and gone undercover because they had not been effective in the past. DISCOVERING “FIGHT” AND “FLIGHT” DEFENSES

When Jay was mugged, he had felt paralyzed—his feet felt stuck to the ground, and his arms felt too heavy to move. With the help of his therapist, he discovered his mobilizing defenses of both fight and flight. Jay’s therapist asked him to focus on a particular sliver of memory—the image of the mugger walking toward him, before he froze—inviting him to notice any action his body wanted to make. Jay felt himself beginning to tense and freeze, but he also noticed indicators of mobilizing defenses. He reported that his legs were tensing up and becoming restless with the impulse to run away. Jay also noticed a slight tightening in his jaw. His therapist asked him if this muscle tension extended upward or downward, and Jay noticed that it traveled from his jaw down the neck into his shoulder and arm. As he concentrated on the tension in his arm, Jay became aware of a physical urge to push away. 600

As he recalled the sliver of memory in therapy, the mobilizing defenses that Jay could not act upon at the time of the mugging arose spontaneously as physical impulses, allowing him to finally feel the power and strength of taking action to defend himself. It is important to note that the instinctive impulse to push away emerged from Jay’s awareness of his body as he focused on the image of the mugger coming toward him, and not as an idea, concept, or thought that he “should” defend himself. Jay’s therapist encouraged him to execute both the fight and flight actions. First, Jay mindfully used his arms to push out against a cushion held by his therapist, following the impulse of the tension in his arms to fight back. Second, Jay followed the impulse in his legs to run by standing up and running in place. As he performed these actions of fight and flight, Jay felt a new sense of strength and competence. He felt empowered by the physical experience of having discovered and executed the physical actions that had been stimulated when the mugging occurred, but could not be acted upon at that time. Betty had been severely abused throughout childhood by multiple perpetrators. Her best option then was to shut down until it was over, and this became her default defense. She often found herself “not there,” unable to focus or will herself to move. With her therapist, Betty learned to become aware of how her building blocks began to change when she started to shut down—a slight numbing and heaviness in her body, feeling helpless, and thinking “It’s no use.” As she recognized these antecedents, her therapist asked her to stand up and take a few steps, putting aside any memories. Her therapist encouraged her to keep walking around the ofiice so she could sense how her legs could now “run away.” Betty realized that through mindful awareness, she could recognize when she was beginning to shut down and could interrupt it before she became completely immobile by standing up and walking around, sensing that her legs could now move (the action of a flight defense). Like Jay, she also found many slivers of memory in which she experienced a fleeting tension in her muscles that indicated she had wanted to fight back. With her therapist, Betty explored putting her hands in front of her body to protect herself, and finding the words “No” and “Stop.” Gradually, practicing these mobilizing defenses over time, her shut down defense lessened and she was able to be more present in her life. REGULATING A “FIGHT” DEFENSE

Mateo learned to track the signals in his body that would suddenly propel his dysregulated fight responses. The sliver Mateo chose was the seductive behavior of a stranger toward his girlfriend that had led to a fist fight. Mateo noticed the somatic precursors to lashing out. His eyes narrowed, his arms and hands got tense, and his arousal increased. He learned to regulate his arousal and overactive fight response in two ways. One, he found that if he placed one hand on his heart and one hand on his belly (a somatic resource described in Chapter 15, “Somatic 601

Resources”), his arousal would decrease. He practiced this resource over and over at home until he began to feel mastery over his escalating arousal. Next, in therapy, as he mindfully experienced tension in his arms and hands right before he felt the urge to lash out, he tried making slow-motion actions of hitting out against a pillow held by his therapist, while reporting to his therapist exactly what he felt in his body sensation. Since mindfulness has been shown to be effective in activating parts of the cortex that regulate instincts and emotions, being mindful helped Mateo regulate the fight defense and the rage he felt. Mateo felt empowered and “in control” as he executed the usually explosive aggressive action in a mindful, controlled manner rather than chaotically in a fit of rage. Eventually, Mateo felt that his fight response was no longer so easily triggered in his life, presumably because executing it mindfully had prevented his subcortical instincts from overriding his thinking brain, the neocortex, and helped his three brains work better together. REGULATING A “FLIGHT” DEFENSE

Similarly, Trish reported that she had relied on her ability to escape, moving from apartment to apartment, or even from town to town, fleeing any situation or person that was uncomfortable. She grew up with an alcoholic father who drank nearly every night, verbally venting his frustration on Trish and her mother. In therapy, she remembered that even as a small child she spent as much time as she could away from home to avoid witnessing her father’s “rage attacks” and her mother’s submissive, cowering response. As she became a teenager, Trish “ran away” by spending most nights with friends, alternating houses so that she did not wear out her welcome. In therapy, she remembered a sliver of memory in which she saw her mother wince, cower, and fall silent as her father began his verbal tirade. She felt her legs tense up in readiness to run away. Her therapist asked her to stay focused on the feeling of tension in her legs, and to see what else she noticed in her body. Trish became aware that she wanted to say, “Leave us alone! You have no right to yell!” and she experienced an impulse to put her hands in front of her body in a defensive gesture. These protective words and gesture would not have stopped her father’s rage at the time—in fact his anger would have escalated, which is why Trish had abandoned any assertive action in favor of the flight defense. Learning that she had a right to “stand her ground” and defend, as well as experiencing these “fight” responses physically, helped to regulate Trish’s overactive flight response. REGULATING A “CRY-FOR-HELP” DEFENSE

Meg’s desperate fear of being alone interfered with her relationships. Her friends told her that she was too clingy, and that her desperation drove them away. As a child, Meg had been sent to boarding school, where she had been bullied by the older children. Too small to protect herself, she had cried pitifully for help but had 602

no allies. In therapy, her first sliver was remembering driving with her father to the school when she was 8 years old. She focused on the image of her small self crying uncontrollably, clinging to her father and begging him not to leave her. But he only told her she was a big girl and would be fine. Embodying this sliver, Meg reexperienced the frantic feeling and the belief that she could not survive without someone to protect her. She realized that, in her current life, she similarly clung to her friends because she still felt she could not survive alone. Through the work with her therapist, Meg realized that her frenetic desire to be with another person reflected the cry for help, a desperate need for protection that had not been met in her childhood. Her empowering actions were to reach out to the part of herself that felt so desperate. She learned to soothe and reassure herself by using a somatic resource of wrapping her arms gently around her body and communicating to that terrified child she once had been that she was no longer in the same situation, that she was safe now with contact and comfort available from trusted friends to whom she did not need to cling. INTEGRATING DEFENSIVE RESPONSES

Instead of leaving your future to the prescribed patterns of animal defense left over from the past, you can use mindful awareness of the signs of what your body once wanted to do as an avenue for transforming immobilizing or overactive mobilizing defenses into adaptive actions. When you practice these new physical movements with focused concentration and enjoyment until they become easy to execute or even automatic, you have harnessed your brain’s neuroplastic ability to change. Until Jay could experience the satisfaction of performing his active defensive actions fully, he repeatedly failed to defend himself, and his future seemed to hold only further abuse and disempowerment. Until Mateo could experience his impulse to fight with mindful action-taking instead of impulsive acting out, he envisioned his future as full of disputes, violent encounters, arrests, and broken relationships as it had been since the war. Until Trish could experience the capacity of her legs to “get away,” she could not prevent this distorted flight defense from prompting her to move from place to place. And until Meg could herself reassure the part of her fixated in the cry for help defense, she could not engage in a satisfying way with her friends. The worksheets that follow will help you learn to become consciously aware of animal defenses and how they feel in your body, to explore new actions that perhaps were previously unavailable to you, and to regulate dysregulated defenses. Beyond insight alone, it is the actual experience of a variety of defensive options, executed with conscious intention and awareness, which helps to restore empowering action and a felt sense of protection.

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Restoring Empowering Actions RECOGNIZING ANIMAL DEFENSES Purpose: To help you recognize the animal defenses that are familiar to you and that you use more frequently than others.

Cry for Help

Fight

Flight

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Freeze

Feign Death/Shut Down Directions: Read through the examples of each animal defense in the chart below and then follow the prompts. 1. Check the box next to each kind of animal defense that you have experienced or that arises when you think of something from your past or in your current life that causes you to feel unsafe or in danger. 2. Underline any example that is familiar or that you use more often when threatened or stressed. Add any other defensive actions that you’ve experienced in each category in the space provided. 3. In the box below each animal defense, describe the situation(s) in which you have used that type of defense in the past, how it felt in your body, and how others responded Cry for Help: make noise, yell, Fight: push away, shove, Flight: flee, scream or call out for help, attack, hit, kick, yell “stop” run away, cling to or seek close proximity or “no”, verbally attack, back away, to others strike out leave, escape Other: Other: Other:

Freeze: hyper-alert but can’t

Feign Death/Shut Down: go numb, limp, 606

move, hide, stiffen up, feel paralyzed Other:

collapse, play dead, “not be there”, fall silent Other:

4. Reflect on which animal defenses you use more frequently and which ones you don’t use as often. Why do you think that is? Discuss with your therapist.

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Restoring Empowering Actions ANIMAL DEFENSIVE RESPONSES & THE B ODY, P ART 1 Purpose: To explore and try out animal defensive actions to discover how each defense feels physically. Directions: With your therapist, follow the directions below, exploring one animal defense at a time. 1. In the first box next to each defense, describe what happens when you think about or imagine executing actions related to that animal defense (e.g., do you think it would feel good, triggering, comfortable, unfamiliar, scary, empowering, or confusing, or something else?). 2. In the second box, describe what happens when you mindfully execute actions related to the animal defense, staying focused just on your body sensations and movement. Put any images, thoughts, memories, or emotions aside in order to pay attention exclusively to your body and learn how the defense feels. Cry for Help: scream, yell, call out, cling to others, or seek close proximity for safety

What happens when you imagine making noise, yelling or screaming or crying/asking for help?

Try mindfully for help, saying to your therapist, “I need help,” or clinging to a pillow or something else as if for safety. Stay focused on your body and describe how this defensive action feels physically.

Fight: shove, push away

What happens when you imagine shoving or pushing someone or something away?

Try mindfully and slowly pushing against the wall, a pillow, or a big therapy ball held by your therapist. Stay focused on your body and describe how this defensive action feels physically.

Fight: hit, kick, strike out

What happens when you imagine striking out, hitting, or kicking?

Try mindfully and slowly kicking or hitting a pillow or a big therapy ball held by your therapist. Stay focused on your body and describe how this defensive action feels physically.

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Restoring Empowering Actions ANIMAL DEFENSIVE RESPONSES & THE B ODY, P ART 2 Purpose: To explore and try out animal defensive actions to discover how each defense feels physically. Directions: With your therapist, follow the directions below, exploring one animal defense at a time. 1. In the first box next to each defense, describe what happens when you think about or imagine executing actions related to that animal defense (e.g., do you think it would feel good, triggering, comfortable, unfamiliar, scary, empowering, or confusing, or something else?). 2. In the second box, describe what happens when you mindfully execute actions related to the animal defense, staying focused just on your body sensations and movement. Put any images, thoughts, memories, or emotions aside in order to pay attention exclusively to your body and learn how the defense feels. Flight: run away, back away, leave

What happens when you imagine backing away or running away from something, or leaving a situation?

Try backing away or running in place. Or just walk and sense your legs carrying you away. Stay focused on your body and describe how this defensive action feels physically.

Freeze: hyperalert but can’t move, hide, stiffen up, feel paralyzed

What happens when you imagine feeling hyperalert but not able to move, or when you imagine freezing, or hiding?

Try slowly and mindfully tightening your muscles and be very alert, but do not move, as if you are paralyzed or hiding. Stay focused on your body and describe how this defensive action feels physically.

Feign Death/Shut Down: go limp, numb, collapse, play dead, “not be there”

What happens when you imagine shutting down, collapsing, playing dead or not being there?

Try slowly shutting down just a little in a mindful and voluntary way. What do you do inside yourself to begin to go numb or “not be there?” Stay focused on your body and describe how this defensive action feels physically.

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CHAPTER 25

Restoring Empowering Actions REPLACING AN IMMOBILIZING DEFENSE WITH A MOBILIZING DEFENSE Purpose: To discover and mindfully execute empowering, mobilizing defenses that you might have wanted to use in the past, especially if you tend to freeze or shut down when threatened. Directions: Under the guidance of your therapist, select a sliver of a memory in which you felt threatened but became immobilized and did not take action, then follow the prompts below. Note: If this exercise is too dysregulating, use your resources. 1. Recall the event and immobilizing defense. Describe the event in which you felt threatened and became immobilized. Describe which immobilizing defense you used and how it felt physically (i.e., Did you freeze and stiffen up or shut down, feel limp, and go numb?) stiffen up or shut down, feel limp, and go numb?) Describe your sensation and arousal level. 2. Take your time to search for a sliver of the memory before you became immobile in which you wanted to take action (e.g., run, fight back, leave, scream, or get help). Describe the point in the memory when you wanted to take action. (e.g., Right when I saw the look in my brother’s eyes as he was coming towards me, before he started beating me up, I wanted to run but I didn’t move.) 3. Because muscles tense right before taking action, any tension can be a sign of an mobilizing defense. Take your time to focus on the sliver you described in #2 and notice any tension or impulses you experience (e.g., tension in your shoulders and arms and impulses to push away or hit, tension in your chest or throat and impulses to yell for help or scream, tension in your legs and impulses to run or kick).

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Describe any tension you experience and impulses to action you want to make. (e.g., I felt my legs start to tense up and an impulse to turn to the left and run.) As you notice the physical impulses of a mobilizing defense, what happens when you slowly and mindfully execute those movements or allow them to happen? Try to let the movement your body wants to make come from your awareness of your physical experience and not from your thoughts, and describe below. (e.g., As I feel the impulse to run, I slowly stand up, follow the tension that is telling me to turn to the left, and then I run in place for a few minutes. I can feel strength in my legs, and it feels really good to not be stuck and to feel that I could get away. My breath deepens and afterwards I feel relieved.)

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Restoring Empowering Actions REGULATING DYSREGULATING MOBILIZING DEFENSES Purpose: To slowly and mindfully execute the actions of the mobilizing defenses of fight or flight that have previously been unmanageable, chaotic, or dysregulating. Directions: Under the guidance of your therapist, select a sliver of a memory in which you reactively lashed out at someone, got in a fight, ran away, or left a situation impulsively or prematurely. Then answer the prompts below. 1. Describe the situation that triggered fight or flight responses and what actions you took. (e.g., This guy outside the bar made a sexual comment about my girlfriend, and I shoved him. He hit me, and I hit him back really hard without even thinking, and I kept hitting him. I was really out of control.) 2. Take your time to focus on the sliver of your memory just before you lashed out or ran away and see if you can sense those impulses in your body. Be sensitive to any slight tension you might experience as you remember. Describe how you physically experience the impulses in the arrow to the right. • (e.g., I can feel my chest expanding, a really deep breath starting, and a tingly feeling—my arousal is shooting up. My fist clenches and my right arm starts to move back to wind up to hit him. It feels hard to slow it down. My eyes get wide and I grimace in anger.) • • • 3. In slow motion, with mindful attention, begin to execute those actions. Let the impulse come from your body rather than from your thoughts. • Find a way that feels “good” or “right” to very slowly and mindfully execute the action. • While you slowly execute the action, describe to your therapist what you experience in your body. 4. Repeat #2 and #3 until the action feels complete to you. 5. Sense your experience after executing the action. Describe what you experience in your body, emotions, and thoughts. Body

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Thoughts

Note: If you feel unsettled or dysregulated after this exercise, practice a somatic resource from your resource repertoire.

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CHAPTER 26

Recalibrating Your Nervous System Sensorimotor Sequencing THERAPISTS’ GUIDE TO CHAPTER 26

Purpose of this Chapter Resolving past trauma is not an act of will. It is the felt sense that the trauma or threat is over. To experience a sense of having survived rather than a sense of anticipatory threat requires autonomic and physical recalibration. Trauma first and foremost impacts autonomic arousal to mobilize protective action. When past traumas are explicitly or implicitly activated, heightened arousal may emerge and be experienced as rapid heart rate, a tingly feeling, trembling, shaking, or jerky movements. These physiological changes are viewed as a “discharge” of the immense energy that was mobilized to fuel survival behavior (Levine, 2005; Ogden et al., 2006). If we cannot help traumatized clients to “reset” (Levine, 1997) their dysregulated nervous systems they will be unable to adaptively neurocept safety, no matter how safe their circumstances may be because their bodies will continue to signal “danger.” When we therapists understand the neurobiological concepts underlying the felt experience of hyperarousal, it will be much easier to communicate to our clients why it is usually best to work with hyperarousal from the bottom up, using “sensorimotor sequencing:” mindfully following the sensations of hyperarousal in the body until they settle. The purpose of this chapter is to support clients to differentiate and “uncouple” (Levine 1997) the involuntary physical sensations and movements associated with traumatic memory from the events themselves, and even from the emotions or meaning-making connected to those events, so that the sensations themselves can return to baseline instead of escalate.

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Sensorimotor sequencing is an intervention for trauma-related hyperarousal. It is not a technique to use with attachment-related emotions that need to be experienced. Recalibrating the nervous system through sensorimotor sequencing can be valuable for all traumatized individuals who are prone to hyperarousal. However, in order for sensorimotor sequencing to be successful, clients need to have confidence in their body’s intelligence and in bottom-up interventions because the technique requires the ability to tolerate involuntary movements and sensations, such as trembling. Provided that clients have developed such confidence in the body from the work of previous chapters, especially Chapter 1, “The Wisdom of the Body,” Chapter 10, “Exploring Body Sensation,” and all the chapters on somatic resources in the previous section, those who will benefit the most are those whose emotions or quality of life are limited by hyperarousal. You might recognize these clients by the manifestations of their undischarged energies: for example, a tendency for arousal to escalate quickly, and to experience tingling sensations, shaking, and trembling under stress, when implicit memories emerge, or during explicit recall. Clients who chronically struggle with hyperarousal symptoms such as anxiety, panic, nightmares, flashbacks, feelings of being “driven” (e.g., “I can’t stop moving”), restlessness, or involuntary movements (e.g., startling, trembling, tics, jerks) might also benefit if undischarged or uncompleted energies of hyperarousal contribute to these symptoms. Another group of clients that also stands to gain from this chapter comprises individuals with biphasic reactions; that is, those who are constantly triggered back and forth from hyperarousal states to hypoarousal states and then back to hyperarousal again. These clients stand to benefit from learning sensorimotor sequencing, provided they have developed confidence in working with the body and are comfortable with involuntary sensations and movements that go along with hyperarousal.

Suggestions for Clinical Use For your work with this chapter to be successful, both you and your clients need to understand the purpose of bringing awareness to involuntary sensations and movements. It might be helpful to discuss the technique of sensorimotor sequencing with your clients prior to assigning the chapter. Together you might read the examples in the chapter that illustrate how mindfully tracking the involuntary sensations associated with hyperarousal, without addressing the emotions or memory content, can lead to a resolution. As Levine and Frederick (1997) state, “Once you become aware of them, internal sensations almost always transform into something else” (p. 82). Using sensorimotor sequencing, the tingling sensation might change from affecting only the hands to involving the arms, which might begin 619

to tremble, then gradually quiet and soften, and the accelerated heart rate might also returns to baseline. It is best to begin by teaching clients to notice their body sensations and movement as distinguished from other building blocks. You might mindfully direct their attention to a sliver of memory and then ask them to notice the effect on their body, building on previous chapters. You will want to refer back to the sensation vocabulary list that was studied in Chapter 10, “Exploring Body Sensation,” to refresh clients’ memory of words to describe physical sensations. It is critical that clients describe their sensations as they experience them because doing so stimulates areas of the neocortex which can shut down during trauma or when trauma is reactivated (cf., Chapter 9, “The Triune Brain and Information Processing.”) With your help, clients can discover that for each significant thought, emotion, image, sound, smell, or taste related to the memory, they will experience a physical sensation. Directed mindfulness questions like the following will facilitate their awareness of this correlation: “When you see that image, what happens in your body?”; “How does your sensation change when you think of the combat?”; “When you sense that anger, what happens in your body sensation?”; “Can you just feel the panic as body sensation?”; “What happens in your body when you have the thought, ‘It’s not safe here’?; “See that image in your mind’s eye, and notice what happens in your body.” It is important to understand and convey to clients that for sensorimotor sequencing, stimuli (such as images, emotions, or thoughts) are used to evoke body sensations and involuntary movements. Then the stimuli are put aside, and mindfulness is directed exclusively toward the body. LeDoux (2003) reminds us: “In order for the amygdala to respond to fear reactions, the prefrontal region has to be shut down . . . . [Treatment] of pathologic fear may require that the patient learn to increase activity in the prefrontal region so that the amygdala is less free to express fear” (p. 217). Sensorimotor sequencing is used when arousal approaches the upper edge of the window of tolerance. This can either occur spontaneously or by selecting a specific sliver of memory. For sensorimotor sequencing to be successful, arousal can be neither too high nor too low. The key is to stimulate enough arousal that strong sensations are experienced but also to ensure that clients’ prefrontal cortex remains engaged through focused attention, and verbal description of, the physical sensations and movements as they progress through the body. When clients who have unresolved trauma experience a clear sensation of their arousal approaching the upper limits of the window of tolerance, sensorimotor sequencing can be used. The thoughts, emotions, images, and other elements of the content of the memory must be uncoupled from the body sensation. Clients are taught to direct mindful attention exclusively to tracking the sensation as it “sequences” through the body. Your job is to support clients in sustaining directed 620

mindfulness solely on the sensations, such as tingling, vibration, involuntary tics, trembling, and changes in temperature that emerge when focusing on a sliver of traumatic memory or traumatic reminder. Instructions like, “Just put the fear aside; don’t think about what happened. Just focus all your attention on your body,” can help clients direct mindfulness exclusively to the body. Verbal encouragement, as reflected in your tone of voice, attitude of curiosity, and confidence in sensorimotor sequencing and the ability of the nervous system to recalibrate itself, will tend to keep the client more focused and therefore more regulated. You can prompt clients by drawing their attention to the details of their physical experience and to the moment-by-moment progression of the sensations through the body. For example, you might say something like “Yes, there’s a lot of tingling in your right arm, isn’t there? Where does it begin and end? Does it include your shoulder, or spine, or your hand? OK, so it seems to be moving down from your shoulders through your arms into your fingers. Great—just sense it moving into your fingers. What happens next in the tingling? Does it start to settle or get stronger?” Helping your clients track their sensation by asking the important question “What happens next?” both reassures them that there will be a “next,” and the sensation will not stay the same, and also cues them to focus more on the movement of the energies and sensations than on the content. If the tiny movements, jerks, shakes, and energies cease, we might restart the sequencing by saying, “Notice what is happening now in your body—and then notice what happens next.” If the sequencing stalls, a somatic resource, such as pressing the feet into the ground, aligning the spine, or self-touch can sometimes help the sequencing continue and complete. Or you can return to the original sliver that caused hyperarousal and start again. It is essential that, in spite of experiencing somewhat involuntary sensations, clients know that they are always in control. It is helpful to say, “As long as you are comfortable, just allow that sensation” or “You can stop any time if this doesn’t feel right to you.”

Introduction to the Worksheets Because sequencing requires sustaining mindfulness while arousal is at the upper edge of the window of tolerance and tracking how sensations change, it is best to complete these worksheets in-session, rather than allow clients to attempt sensorimotor sequencing at home. NOTICING BODY SENSATIONS OF HIGH AROUSAL helps clients take that first step of becoming mindful of sensations that are experienced when they think of something even slightly dysregulating. Clients will need your guidance to select an appropriate sliver, and also to find the words to describe their sensation. The worksheet also requires clients to choose a resource to practice that will help their arousal return to baseline and to assess the 621

difference in how they feel afterward. This step is important because it emphasizes that clients can always change their sensation if they wish by using resources. SENSATIONS SEQUENCING THROUGH THE BODY helps clients trace how sensations travel from one area of the body to another until they settle. For clients who struggle with triggering, involuntary movements, activation, or flashbacks on a daily basis, this worksheet may prove to be a good way to get through these occurrences. You can help your client learn to sustain mindful focus when tracing their sensations on the drawing of the body on the worksheet until arousal settles. Your guidance especially with the question, “What happens next?” will be essential in helping clients notice how their sensations travel sequentially through the body. The slowness of this microprocessing, along with the physical action of drawing the sequence of sensation on the paper, encourages dual awareness and along, with maintaining social engagement between you and your client, helps to keep the experience safe and manageable. SENSORIMOTOR SEQUENCING & THE WINDOW OF TOLERANCE may be especially helpful to clients who have trouble maintaining arousal within the window and need the structure of the worksheet and your direction to help them stay focused. The experience of successfully tracking how sensations change as they approach the upper edge of the window, and then continue to change until they settle, helps clients gain control over their dysregulation and feel present. You should use this worksheet in session, guiding clients through the sequence of sensations until they settle, and writing down their descriptions of the sensations on the worksheet, then fill out the last question together. The final worksheet, SEQUENCING ONE AROUSAL CYCLE AT A TIME, provides the opportunity for you to guide clients in sequencing one sliver of a memory three times. By processing one arousal cycle at a time, you can help clients learn experientially that if they repeatedly use sensorimotor sequencing with one sliver, they may no longer become triggered by that sliver or by the memory. Their nervous system has recalibrated itself. Most clients will benefit from sequencing the same sliver three times, and each time the arousal stimulated by the sliver should be a little less, until the sliver no longer provokes arousal. However, occasionally, after sequencing only one cycle, the sliver may no longer stimulate arousal. After the first cycle, you can assess whether the same sliver still stimulates arousal or not. If it does, you can sequence that sliver again; if not, you can sequence another sliver of the same memory. Other clients may need to sequence the same sliver more than three times, and if that is the case, you can continue until the sliver no longer triggers arousal. As always, the worksheets should be adapted specifically to the client.

Adapting this Material for Dissociative Clients 622

The intentional recall of a memory that causes arousal to escalate will be overwhelming to clients with dissociative disorders and to those who are already dysregulated. Thus stabilization and containment skills are best for these clients until they gain a sufficiently wide window of tolerance and ability to regulate and maintain dual attention. Slivers of memory can quickly evoke shaking and trembling, chronic fear, and uncontrolled fluctuations in arousal and flashbacks— all manifestations of a dysregulated nervous system. When arousal is high, as it often is for dissociative clients they can benefit from having their attention directed exclusively to the physical sensations rather than to the beliefs, images, emotions, or other memory content that might otherwise be their focus. If clients are able to put aside all images, emotions, and thoughts and direct mindfulness to the body until arousal settles, then this technique will be helpful, even if they cannot yet make use of the technique. They can shift benefit from the explanation in the chapter about why shaking, jerky movements, and other involuntary physical reactions often occur after trauma. However, in order to utilize sensorimotor sequencing successfully, it is essential that clients have developed the resources to prevent further dysregulations and that they are able to uncouple memory content from sensation and exclusively turn their mindful attention toward the body. They also need to have developed confidence in bottom-up processing, the ability to focus on the body’s involuntary responses and the capacity to remain oriented to the present moment. Although this orientation does not immediately alleviate fixation in animal defenses, it does provide the foundation to utilize the dual awareness necessary for further work with the slivers of memory that cause dysregulation for different dissociative parts. Clients must learn not to fear or be ashamed or disgusted by the involuntary movements that may occur when these parts are experienced. Understanding why involuntary movements occur will help them embrace these experiences with compassion. Whether triggered reactions reflect different parts of clients and their survival responses, or are generated by heightened autonomic arousal of the whole person, being able to treat sensations as “just sensations” is an ability that needs to be slowly cultivated. Only then can sensations be facilitated through their natural sequences until there is a sense of resolution. For this client subgroup particularly, the ability to sequence arousal and movement often takes time and is learned in small increments, using sensorimotor sequencing first for the arousal generated by mild reminders and eventually for arousal associated with slivers of traumatic memory. It is helpful to facilitate communication among parts that are comfortable with involuntary sensations, or at least can accept and tolerate them, with those that cannot yet do so. You and your clients can also explore different parts’ degree of comfort and confidence in allowing involuntary physical sensations and movements without evoking a flashback or further dysregulation. 623

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Chapter 26 Recalibrating Your Nervous System: Sensorimotor Sequencing We have learned that, in the face of trauma, animal defenses are instinctively mobilized to assure our survival. Under threat, the sympathetic nervous system prompts the adrenal glands to release adrenaline that gives us the burst of energy we need to be fully prepared to fight or flee or get help. Traumatic reminders and slivers of traumatic memory can both stimulate the same surges of energy, usually experienced as uncomfortable body sensations such as sweating and trembling. As we have pointed out, since these sensations result from autonomic nervous system arousal, they are often impervious to resolution by talking about them or working with their emotional components. These energies need to be addressed and processed on a bodily level. In much the same way that people with unresolved grief can identify and experience the grief, we can identify and experience these instinctual energies physically. In order to do so, it is necessary to distinguish body sensations and movements from emotions and thoughts, as you learned to do in Chapter 10, “Exploring Body Sensation.” This chapter will further the work of that chapter by teaching you how to put emotions, thoughts, images, and memory content aside when you are working with a memory in which your arousal begins to exceed the upper edges of the window of tolerance into the hyperaroused zone. You will learn sensorimotor sequencing, a technique of mindfully and exclusively attending to the physical sensations of hyperarousal until the sensations settle down by themselves. Through sensorimotor sequencing, you can work with the strong energies connected to hyperarousal and defensive responses on a physical level and resolve the sensations they cause when the past is activated deliberately in therapy or triggered by reminders.

The Neuroception of Danger The adrenaline released when we neurocept danger has many effects. Our heart rate speeds up and strengthens, causing increased blood pressure; our pupils dilate for wider vision; our bronchi also dilate to increase our intake of oxygen; our digestion slows as blood vessels in our internal organs constrict. These changes enable greater blood flow to our muscles, which contract to support whatever drastic 626

action might be needed to survive. We experience the rush of adrenaline as an increase in energy, focus, and muscle tension, and often as trembling, shaking, tingling (often in hands and feet—the areas of the body involved in fight or flight defenses), sweating, nausea, increased heart rate, dizziness, hyperventilation, or shortness of breath. If you have ever seen a dog tremble after being frightened by a clap of thunder, you have witnessed one of the effects of adrenaline. When adrenaline is stimulated and we start to become hyperaroused, we can learn to put aside any images, emotions, or thoughts and direct mindful attention exclusively to the body—to the sensations of tingling, buzzing, trembling, temperature changes, and so forth. We can then follow or track the sequence of these sensations as they progress through the body. This is what we call sensorimotor sequencing. Over many years of therapy, Cate had worked with the memories of a terrible traumatic event, but her symptoms of panic and hyperarousal, alternating with depression, had not resolved. When Cate was 17 years old, her sister had lost her life in an act of murder–suicide by her sister’s husband. Cate had been sent by her parents to the morgue to identify her sister’s body. For nearly 40 years afterwards, Cate felt she relived the event whenever she tried to address the memory. Even the thought of what had happened caused panic, trembling, pounding heart, and thoughts of “what if” and ”I wish I had died instead.” In a session, as she and her therapist began to focus on the first sliver—“thinking about thinking about” what happened the day her sister had died—Cate learned to put her panic and thoughts aside to focus all her attention exclusively on her sensations. She noted the tingling in her body that occurred along with the shaking and the slight acceleration in her heart rate before it started pounding. With the help of her therapist, Cate learned to mindfully follow the sequence of these sensations as they progressed through her body, until the shaking stilled and her heart rate returned to normal. For the first time since this terrible event, she had a way to remember a tolerable sliver of memory, rather than relive what had happened, and to quiet her arousal through sensorimotor sequencing. Cate repeated sensorimotor sequencing with several slivers of this memory until the event felt “finished” and thinking about it no longer provoked hyperarousal. When we choose a sliver that stimulates arousal to the upper edge of the window of tolerance we can use the technique of sensorimotor sequencing to direct mindfulness exclusively to spontaneous body sensations and movement that emerge instead of focusing on the images, emotions, and thoughts associated with the sliver. Sensations can vary in intensity from tingling to a slight tremble and even progress to strong tremors. We must allow the energies of unresolved trauma to slowly and steadily dissipate in a controlled way. Think of a pressure cooker whose buildup of pressure has to go somewhere or it remains energized and unstable, just as our bodies sometimes do after trauma or stress. If we open the pressure cooker too 627

quickly, there will be a burst of unregulated energy and the pressure cooker might blow its lid, so we have to let a little bit out at a time. When we begin to experience these powerful energies as they approach the upper edge of the window, but just before they escalate to dysregulated hyperarousal, we can mindfully follow the progression of the spontaneous sensations and movements that accompany very high arousal. Cate noticed trembling in her spine and even her mouth as soon as she thought of what had happened, but she stayed with these sensations and observed them just as a feeling in her body, putting aside the memory contents. Since she was attending only to body sensation, excluding emotions, cognitions, images, and content, the amount and intensity of what she had to pay attention to in the moment was tolerable for her. The sensations began to move or “sequence,” and the trembling gradually subsided.

Sequencing One Arousal Cycle at a Time Martin came to therapy to get rid of his nightmares and resolve his hyperarousal. He had tried to address combat memories in a treatment center for veterans but found that the therapeutic approach in which veterans acted out their memories exacerbated his symptoms. Afterwards, he avoided his memories. With his new Sensorimotor Psychotherapist, he understood that working with traumatic memory would not necessitate reliving the trauma. Martin agreed to call up a memory of his first day of combat and worked with sensorimotor sequencing one arousal cycle at a time. The first cycle began with the first sliver as he thought about working on what had happened. This caused his body to tighten, his breath to constrict, and his arousal to escalate. As soon as he began to experience these sensations, his therapist helped him focus his attention solely on them rather than on the fear, thoughts, and images of combat. He used resources of grounding and self-touch until his body relaxed, he was able to breathe deeply, and his arousal returned to a window of tolerance. The second cycle started with another sliver: talking about the part of the memory just before the combat. He told his therapist that he “knew it was not the right place to be.” This time, Martin experienced trembling in his legs, and he followed the trembling sensations until they settled and his arousal again returned into a window of tolerance. The third cycle started with the sliver of a moment in the memory where Martin “knew someone was aiming” at him, and the fourth sliver was when he had heard a fellow soldier screaming. Each time, Martin’s therapist helped him to direct his mindful attention toward his body, and simply track these sensations of arousal as they changed, or “sequenced.” Each time Martin found that the sensations themselves spontaneously transformed into ones that were more 628

tolerable. See Figure 26.1 for an illustration of sequencing one arousal cycle at a time. By processing one arousal cycle at a time, Martin began to trust that if he put his mindful attention exclusively on the moment-to-moment changes in his body sensation, his arousal would not escalate beyond control as it had before. By putting aside emotions of panic and terror, images of the combat, and repetitive thoughts that he was going to die, he was able to prevent the escalation of his arousal. Instead, he found that his arousal returned to the window. For those who wonder how we could process trauma without making meaning of what happened, it is important to understand that we cannot make accurate meaning of trauma until our bodies experience the physical sense that the danger is over. After his arousal returned to a tolerable level and stayed there, Martin could then look at the emotions and meaning of his war experience and process them without undue dysregulation. Prior to that, the feelings he experienced (terror and rage) or meanings he could attribute (“You can’t trust anyone,” “I’m going to die,” and “I was stupid to enlist”) were biased by his dysregulated arousal. After sensorimotor sequencing, Martin no longer felt the terror and rage as his nervous system recalibrated and became regulated. He could then make a different meaning. He recalled joining the army because he was young and idealistic. He realized that not everyone was untrustworthy; some people in the world could be trusted. Even more importantly, he could feel compassion for himself as a teenager exposed to so much violence at such a young age.

FIGURE 26.1

Note that through sensorimotor sequencing, the mind is harnessed to support the sequencing of the sensations associated with arousal rather than to manage or 629

control them. Martin and Cate both experienced their sensations and movements as if they were happening by themselves, without their intention or control. At first, not being in control of the sensations was a bit disturbing and uncomfortable. But as they learned to allow these sensations rather than try to control or suppress them, and to find the words to describe their qualities such as shaky, jerky, and quivery, they noticed that the sensations began to change and resolve without effort. However, it is important to know that you are always in charge of your body and of sensorimotor sequencing. If, at any point, you were to find that the sensations were not settling the way you would like, or if you want to stop the process of sequencing, you can simply focus on a voluntary somatic resource from your repertoire—grounding, lengthening your spine, standing and walking, or pushing away. You can choose resources to either facilitate the sequencing to progress or help it cease, whichever you prefer. If you decide to stop the sequencing, you can return to it later if you wish. Working with beliefs and emotions (see Chapters 29, “Beliefs and the Body” and 30, “Making Sense of Emotions”), although indispensable in healing certain aspects of memory, does not directly address the resolution of the instinctual physical and physiological effects of trauma and stress in the same way that working directly with the body does. Through sensorimotor sequencing, many people find that they experience more regulated arousal and a sense of mastery. Cate reported that for the first time ever she was able to talk with her adult son about her sister’s murder without getting dysregulated. After learning sensorimotor sequencing to process his memories, Martin said, “I feel really easy in my body— that’s new these days although I’ve done lots of [therapy]. I’m able to go back and think about [combat] and not really get activated.” Sensorimotor sequencing takes intention and practice, but with experience, you can develop confidence that your hyperarousal will settle if you just follow the sensations that you experience. With the help of your therapist and the worksheets that follow, you can explore mindfully tracking the sequence of physical sensations and movements as they progress through your body and to temporarily disregard the emotions, images, and thoughts that arise. These sensations and movements will then have the chance to resolve naturally, without your trying to control them. Over time, with repeated iterations of sequencing, your nervous system can recalibrate, as Cate’s and Martin’s did, so that you are no longer so triggered into hyperarousal by your memories.

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Recalibrating Your Nervous System NOTICING B ODY SENSATIONS OF HIGH AROUSAL Purpose: To become mindful of the sensations (e.g., tingling, buzzing, trembling, temperature changes) you experience when you think of something that causes your arousal to increase and then practice a somatic resource. Directions: With your therapist, select a sliver of memory that causes your arousal to approach the upper edge of your window of tolerance but is not too dysregulating or overwhelming. On a scale of 0-5, where 0 elicits no change in arousal and 5 greatly exceeds your window of tolerance, aim for about a 4. (e.g., The sliver could be losing your car keys when you are already late for an important appointment, speaking in front of a group, or the last time you had an altercation with someone.) 1. Describe the sliver of memory that stimulates your arousal. 2. Take your time to focus on this sliver until you experience the physical sensation of your arousal rising. If you cannot sense your arousal escalating, take time to remember more clearly the specifics of the sliver: sounds, images, who was there, and so forth. If you still cannot sense your arousal escalating, choose a more intense sliver, perhaps from a different memory. 3. Circle the sensations you experience when you think of this sliver. If the sensation you notice is not on this list, write it in an empty space in the chart. achy

chills

damp

flaccid heavy

moist

airy

churning

dense

flushed hot

nauseous quivery

suffocating

bloated

clammy

dizzy

fluid

numb

sweaty

blocked

clenched

dull

fluttery jerky

electric

floaty

jumbly pins and needles

shivery

fuzzy

knotted prickly

shuddering tight

breathless congested

itchy

bubbly

constricted empty

burning

cool

energized goose- light bumps

buzzy

cold

faint

quaking

radiating

paralyzed sharp

puffy

sore

stiff

tense thick

tickley

4. After you have found the words to describe the sensation of your arousal rising, 632

select a resource from your repertoire that you enjoy and that helps your arousal return to an optimal level—breathing, grounding, moving around, or something else. After you have practiced your resource, put a check next to any sensations you notice in the chart above. If the sensation is not on the list, add it on the bottom line. 5. Describe your experience below. How do you feel after allowing your arousal to increase to the upper edge of your window and then using a resource to bring it down again?

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Recalibrating Your Nervous System SENSATIONS SEQUENCING THROUGH THE B ODY Purpose: To practice experiencing body sensations related to high arousal, track how they move through your body, and find the words to describe their qualities, until the sensations begin to change and resolve. Directions: With your therapist, select a stimulus or a sliver of memory that triggers high arousal for you. Take your time to remember the sliver and allow it to affect your present moment experience. Notice the sensations of your arousal increasing and approaching the upper edge of your window of tolerance (e.g., a tingling or buzzy feeling, a rapid heart rate, vibrations, or trembling). You may wish to refer back to the VOCABULARY FOR SENSATIONS list in the previous worksheet to find the words that describe your sensation. Then complete the prompts below. 1. Describe the stimulus or silver of memory that triggers high arousal. Notice the sensations that occur in your body when you focus on it. 2. Take a pen and put a mark on the figure where you feel the sensation or sensations. If you feel them in two places, such as tingling in both arms, mark them both. 3. Direct your mindful attention toward the sensations triggered by the sliver or stimulus. Note: If they have gone away, think about the trigger again to restimulate your arousal and sensations. 4. On the figure to the right, place the tip of your pen on the mark you identified in #2. If you made more than one mark, choose one sensation to sequence. 5. Ask yourself “What happens next?” and use your pen to trace how the sensation moves or changes, or sequences through your body. 6. Take your time to be mindful of your sensation and continue to use your pen to trace how your sensation sequences until you feel it settling. 7. Describe how your body feels once your arousal has settled and you no longer experience the sensation of arousal.

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Note: If at any time you feel uncomfortable or want to stop, you can practice a resource from your resource repertoire to help your arousal settle.

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Recalibrating Your Nervous System SENSORIMOTOR SEQUENCING & THE WINDOW OF TOLERANCE Purpose: To select a sliver of memory that stimulates arousal just over the upper edge of the window of tolerance and then to mindfully notice how the sensations sequence in your body until they settle. Directions: Under the guidance of your therapist, select a sliver of memory that causes your arousal to increase just over the upper edge of your window of tolerance. Focus on the sliver until you experience your arousal rising, and write the sensations that tell you your arousal is increasing in box #1 on the lower left of the page. Then direct your mindful attention to the sensations and follow the numbered prompts around the curve. Return to the sliver if the sequencing stalls before your arousal reaches the upper edge of your window. Note: If you feel uncomfortable or too dysregulated, use a resource from your resource repertoire. Window of Tolerance 1. What are the first sensations that tell you your arousal is increasing? 2. What happens next in your body? What sensations tell you your arousal is getting higher? 3. What happens next? What sensations tell you your arousal is a little over your window? 4. Notice what happens next and follow “A” or “B” below. A. If your arousal is returning to your window, describe the sensations that tell you so in #5. B. If your arousal is not settling, experiment with a somatic resource (grounding, breath, lengthen your spine) until your arousal begins to settle, then move on to #5. 638

5. Describe the sensations that tell you your arousal is settling. 6. Describe the sensations you feel as your arousal returns to an optimal level and you complete the sequence. How could you use this skill of sequencing in other situations in which you get triggered?

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Recalibrating Your Nervous System SEQUENCING ONE AROUSAL CYCLE AT A TIME Purpose: To select a sliver of memory that causes your arousal to increase to the upper edge of your window of tolerance and to sequence three cycles of arousal, one at a time. Directions: With your therapist, select an activating sliver of memory. As you recall the sliver, pause and direct your mindful attention to the sensations of arousal in your body. Record the first cycle of sequencing under the first curve, using the example below as a guide. When the first cycle is complete, focus on the same sliver, and repeat for the second cycle, and then again for the third. MOVING UP THE CURVE (Arousal Increases)

MOVING DOWN THE CURVE (Arousal Decreases)

• Sensation of tingling in core

• Trembling is moving through arms and out my fingers

• Tingling turns to trembling in core

• Trembling in my arms and fingers is slowing down

• Heart rate goes up, and breathing gets • Breathing is fuller, more relaxed, core more shallow is completely calm • Trembling seems to be getting more intense–feels scary

• Body feels warmer and heavier now

• Put the fear aside and just notices sensations

• Sensations are definitely quieting–heart rate going down

• Core is calmer, trembling moving into arms

• Body is feeling calm and relaxed

Arousal Cycle 1

Arousal Cycle 2

Arousal Cycle 3

Window of Tolerance AROUSAL CYCLE 1 MOVING UP THE CURVE

AROUSAL CYCLE 2 MOVING UP THE CURVE

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AROUSAL CYCLE 3 MOVING UP THE CURVE

MOVING DOWN THE CURVE

MOVING DOWN THE CURVE

MOVING DOWN THE CURVE

Reflect how your arousal changed with each arousal cycle, and whether your sensations lessened and became more tolerable. If your arousal did not return to within your window, use a resource from your repertoire to regulate.

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CHAPTER 27

Emotions and Animal Defenses THERAPISTS’ GUIDE TO CHAPTER 27

Purpose of this Chapter Clients often come to therapy complaining of a range of intense emotions that disrupt their work, home, relationships, and even the therapy. As we encourage them to express their emotions or to access emotions previously unavailable to them, the results can be different from our expectations. Rather than feeling relief or a deeper connection to themselves, clients might find that expressing intense emotions leaves them exhausted, overwhelmed, or confused—or may bring immediate relief without any longer-term resolution. The reason for this might be the relationship between threat-related emotions and animal defenses. When we are threatened, animal defenses typically precede the emotion, as Hobson (1994) clarifies: “We react automatically, and only later (even if it is only a split second later) do we realize there is danger and feel afraid” (p. 139). Actions are immediately followed by the brain’s appraisal to determine the meaning of the sensation, action, and situation, and only then are the sensations interpreted as a sense of peril (Siegel, 1999). This chapter’s goal is to help clients understand that the evolutionary goal of emotions related to animal defense is to fortify a particular defense in order to ensure its efficacy. Once danger is assessed, emotional arousal, such as terror or anger, serves to support instinctually driven animal defensive strategies (Frijda, 1986; Hobson, 1994; Rivers, 1920). Differentiating these circular “vehement emotions” (Janet, 1909) that accompany trauma, stress, and severe attachment failure from those that add motivational coloring to experience and fuel actions other than animal defenses (see Chapter 30, “Making Sense of Emotions”) will help clients make good use of this chapter. Clients will understand that when the vehement emotions related to trauma and animal defense are interpreted as data about present-moment events, perceptions of these events are distorted.

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Clients Who Might Benefit For traumatized clients who suffer from the consequences of dysregulated emotions that do not resolve, this chapter will be invaluable. It speaks particularly to those whose emotions feel out of control or wreak havoc on professional and personal relationships, as well as to those who cannot access emotion, disconnect, or automatically become numb in response to emotions of any kind. Other clients for whom this chapter will be beneficial are those who have trouble with specific emotions such as: fear of their own rage, chronic shame responses, prolonged terror or despair, paralyzing anxiety. For these clients, too, the chapter can help to normalize their difficulties and make sense of them. Clients who experience sudden surges of intense “unreasonable” emotions that are out of proportion to the context will find a possible explanation for this. Clients who have repeatedly been encouraged to express intense emotions but who find no relief, and sometimes find that their dysregulated emotions only increase, will benefit by learning why emotional expression has not been effective. Those who think abreaction and catharsis are the only way to resolve emotions will understand the use of bottom-up approaches to work with animal defense-related emotions effectively.

Suggestions for Clinical Use Dysregulated, vehement emotions recur in a destructive cycle in the lives of many of our clients. They “impair the capacity to think, feel, and act in a purposeful, unified way” (van der Kolk & van der Hart, 1989, p. 1538). Faulty neuroception of danger and life threat evokes vehement emotions, internally confirming the sense of danger, which then exacerbates the dysregulated emotions. It is essential for clients to understand that these emotions are best addressed through bottom-up processing, not emotional processing. Either executing empowering actions or sensorimotor sequencing are effective interventions for working with them. Distinguishing dysregulated emotions from other kinds of emotions is the first step in utilizing the material in this chapter. As emotions come up, you might ask yourself and your clients: “Is this emotion outside of the window of tolerance? Is it driven by a neuroception of danger or life threat? Is it connected to an animal defense? Does the root of it seem to be dysregulated arousal? Do the emotions strongly dysregulate the client?” If the answer to any of these questions is affirmative, the emotion is most likely associated with animal defenses. The window of tolerance will help you and your clients in your assessment because if emotions are outside the window, accompanied by extreme hyper- or hypoarousal, they are likely to be related to animal defenses. It might be helpful for you and your clients to review the arousal zones in Chapter 11, “Neuroception and the Window 644

of Tolerance” to refresh their memory about the signs of dysregulation. Traumatized clients often present with narratives describing whatever has been most stressful or problematic for them since their last appointment. In talking about these stories, clients may either have strong emotions (related to animal defenses of cry-for-help, fight, flight, or freeze) or they may become numb and shut down (related to the animal defense of feigned death). This pattern provides ample opportunity for you to apply the information from this chapter and to integrate it into treatment. You might verbalize what you notice using psychoeducation from the chapter. Often, when you reframe an emotion as a survival response, it elicits clients’ curiosity (e.g., “This anger you feel isn’t just anger—it goes with a fight response”). Your own understanding and ability to convey to your clients why expressing these emotions would not be a good therapeutic strategy without their feeling that you are not empathic or that you refuse to or are unable to handle their strong emotions is essential. You might ask them if expressing their emotions has helped them in the past. Usually the answer is to the contrary, or that any relief has only been temporary. You can use directed mindfulness to guide clients to notice what happens physically as they become aware of dysregulated emotions. They might report a tightening in the jaw as they talk about their anger, impulses to flee after a negative experience at work, wanting to curl up into a ball accompanied by a desperate sadness or terror and impulses to defend coupled with feeling unable to move. Dysregulated hyperaroused emotions such as rage and terror are often experienced either as impulses to action or as strong sensations. If clients experience sensations of tingling, trembling, vibrating, or buzzing, you can use sensorimotor sequencing, as described in the previous chapter. Otherwise you can help them track their physical impulses to discover the movements that want to happen. You or your clients may notice “preparatory movements,” such as a lifting of the fingers in preparation to push away, which are dependent upon the planned or voluntary movement for the form they take (Bouisset, 1991). Physical tension is often indicative of a preparatory movement and can be a precursor to a larger action, such as tension in the legs as preparatory to the impulse to flee, or tension in the arms as preparatory to fighting back. You can ask questions that evoke preparatory moments, such as, “When you feel that sense of terror, what happens in your body?”; “When you sense that rage coming up, what impulses do you have?”; “When you feel so tight and frozen, what action would your body want to make if you could move?” Often, impulses begin to manifest through a tightening or clenching in the jaw, neck, shoulders, arms or hands, back, legs and feet, as well as through small movements such as twisting of the spine or pulling back with an arm. As clients notice these preparatory movements, you can encourage them to mindfully follow their impulses to execute the action. If clients feel hypoaroused, physically weak or limp, “flat” or detached from 645

emotion, they might be experiencing a shutdown defense. They may not experience any impulses to move and may not be able to feel the body. In such cases, voluntary movement such as standing up together, pushing against a pillow, or moving the head and neck to orient to various items in the room are probably the best options. Voluntary defensive action is usually an antidote to this version of immobility, and often other movements will then emerge spontaneously. In these cases, it also might be useful to spend more time with the embodiment of animal defenses, especially the mobilizing ones in Chapter 25, “Restoring Empowering Actions,” to establish a physically felt sense of these defenses. Another option is to carefully choose a sliver of memory in which an active defense might have been stimulated, as described in Chapter 24, “Sliver of Memory,” and then direct clients’ mindful attention to body sensations and movements.

Introduction to the Worksheets These worksheets should be explored in session so that you can help your clients understand the material, and regulate arousal as needed. The pair of worksheets entitled EMOTIONS, DEFENSES, AND BEHAVIOR guides clients to better identify emotional responses that accompany animal defenses. Connecting the animal defense to the emotions that drive them helps clients appreciate that these are not “ordinary” emotions, but more dysregulated and more likely to lead either to strong defensive action or an inability to act. You can help clients explore assessing the behavior that accompanies these dysregulated emotions and the resources that they might use to help change their behavior. The second pair of worksheets, EMOTIONS, HIGH AROUSAL, AND HYPERAROUSAL and EMOTIONS LOW AROUSAL, AND HYPERAROUSAL, encourage clients to identify dysregulated emotions that exceed the window of tolerance, differentiate them from those that occur at the upper and lower edges of the window, and find resources for both. They will probably need your guidance to discern the somatic signs of arousal at the edge of the window in contrast to the signs when arousal exceeds the window. As an alternative to expressing a dysregulated emotion, you can encourage your clients to work with DYSREGULATED EMOTIONS & THE BODY to describe undesirable behaviors they have used in response to dysregulated emotions, and identify alternative behaviors. You will want to support them to follow through on implementing alternative behaviors and possibly identifying resources that would help assure success. The final worksheet, RESOURCES FOR DYSREGULATED EMOTIONS, helps clients reflect on their triggers for dysregulated emotions, the associated animal defense, and resources that regulate both the emotions and defenses. Your help to recognize the connection among these elements—triggers, emotions, 646

defenses, and resources—will consolidate this chapter’s teachings.

Adapting this Material for Dissociative Clients By definition, dissociative clients struggle with dysregulated emotions related to animal defenses on a frequent basis and can therefore benefit from the material in this chapter. However, their challenge will be to sustain directed mindfulness in the face of these emotions and to prevent dissociative switching or intrusions. You might also encounter specific parts of the client that are organized by particular animal defenses and their accompanying vehement emotions. For example, an angry part may insist that fighting is a justified reaction to a situation, whereas an ashamed child part is unable to understand shame as related to an animal defense response of being frozen in terror and unable to respond. You might suggest that an adult part of the client offer inner reassurance and clarification to other parts about their emotional reactions. You may also reframe the material in terms of what can be understood in the context of each part’s belief system as related to intense emotions. For example, an angry part can be reassured that indeed anger is helpful when in danger, and that you would like to find a way to decrease the sense of danger right now. You might also ask that other parts inside help this part understand more about what is happening in the present moment, and realize that there is currently no danger. For this client group, the worksheets could provide the structure needed to mindfully notice the vehement emotions inside them. EMOTIONS, DEFENSES, AND BEHAVIOR, for example, could be modified to encourage clients to connect specific emotions and animal defenses with particular parts, thus helping them understand themselves better and increasing their ability to have self-compassion. The worksheet on resources for trauma-related emotions might also be particularly useful for this group of clients. After working on it in the therapy hour, you can keep it handy to help triggered clients understand the emotions that have been stimulated, which animal defenses they could be related to, and remind them of the possible resources they can use to help with that activation. This increases the possibility of their regaining a sense of mindfulness and grounding, and decreases the chance of their being overwhelmed by the content of trauma. Since clients with dissociative disorders are prone to flooding because some parts are fixated in animal defenses and their vehement emotions, it will be important to integrate resources that they have learned to support containment, regulate arousal, and prevent switching. Venting emotions is not helpful in such instances, and parts that do so must learn the value of reflecting. Those that are afraid to express any emotion need more support in adaptive expression of emotion (cf. Chapter 30, “Making Sense of Emotions”). You can assist clients to work 647

bottom up with dysregulated emotions by helping them track their body to discover the preparatory actions of animal defensives (e.g., pushing or getting away) fueled by these emotions. You will need to adjust your pacing so that it is slow enough to invite different parts to voice their reactions to making the action, so that parts and conflicts are not overridden. If parts become threatened or frightened by the action, you can pause to gather information from these parts about what is needed to make the action acceptable or what they are worried might happen if the action is completed. You can also help dysregulated parts by encouraging the support of other, more stable parts when working with these emotions and actions.

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CHAPTER 27 Emotions and Animal Defenses If we have experienced trauma or attachment relationships in which we felt unsafe, we might be left with intense emotions such as rage, hatred, fear, terror, dread, shame, desperation, panic, or helplessness. Or, we may experience the opposite, feeling “nothing,” cut off from our emotions, detached or numb. We may even alternate between these two extremes. Sometimes we might feel embarrassed or confused because we experience these extreme emotions in response to current situations that we know do not warrant such intensity. These emotions make sense if we understand them as related to animal defenses that come up to protect us when we feel unsafe. Each animal defense (cry for help fight, flight, freeze, and feigned death/shutdown) is accompanied by corresponding emotions that support the function of that particular defense. Panic and desperation accompany the “cry for help” defense. Emotions of fear and terror fuel a flight defense, and anger and rage fortify a fight defense. A freeze defense may be accompanied by panic or other extreme emotions coupled with an inability to move. Emotional numbness, detachment, helplessness, and despair often respond with the shutdown defense. All these emotions are adaptive in the moment of immediate peril and stress because they support the function of the particular animal defense that is the best option at that time against that particular threat. Attempts to talk ourselves out of emotions like these are generally ineffective. Expressing them usually just leads to more dysregulation, and at best only helps us feel better for a little while. This chapter addresses the relationship between these extreme emotions and animal defenses and how the body participates in creating and sustaining these emotions. Since they do not usually resolve by expressing them or by talking about them, physical ways to work with these emotions that you have learned in previous chapters will be illustrated.

Enduring Emotions Related to Animal Defenses Emotions related to animal defenses are completely natural responses to threatening or scary situations, but after the danger is over, they can linger. We may continue to feel terrified (even when we know rationally that we are no longer in danger), desperate for someone to rescue us and make us feel safe, experience outbursts of rage or panic or overpowering shame or despair, feel flat or detached from our 650

emotions, or feel powerless to manage them. Some of us may “feel nothing” even when we are in dangerous situations, despite our rational mind telling us that we should be afraid. Other people might tell us that our emotions or reactions are “unreasonable” or “out of proportion.” We ourselves may feel critical of, embarrassed by, ashamed of, or disgusted by our strong emotions, not understanding that they make sense in terms of animal defenses. Sometimes we may try to cope with them in ways that are not helpful in the long run, such as hurting ourselves or others; erupting in uncontrollable emotional outbursts; avoiding the feelings or trying to talk ourselves out of them; attempting to regulate them with food, alcohol, or drugs; or by withdrawing from situations and people that stimulate extreme emotions. We may also feel detached from emotions. Marcy told her therapist that she did things that would seem dangerous to most people, such as driving too fast on her motorcycle, having unprotected sex with strangers, venturing into dangerous areas of town alone, and even going to a bar that was notorious for violence and criminal activity. The absence of fear when she knew intellectually that she should be afraid left her wondering why that was. In addition, Marcy was bothered by out-of-control emotional reactions. She was triggered when others rejected her or did not give her the attention she felt she needed. In such situations, she experienced uncontrollable fury or panic-driven outbursts. Afterwards, she felt embarrassed at her “tantrum” and promised herself not to overreact the next time—only to find that she continued to have the same reactions to the same triggers. Though she was not aware of it, Marcy was reliving the emotions related to the animal defenses she had needed during childhood trauma. The numbing and detachment (related to a “feigned death” response that was the last resort for Marcy during abuse) was triggered through the high-risk activities. The rage she felt was related to a “fight” defense, and the panic had to do with a desperate need for others to help her (cry for help defense).

Feeling “Too Much” and Feeling “Too Little” If we have grown up with people who abused or neglected us, our emotions become even more complex. Relational trauma creates intense internal conflicts between our need to seek others for support, connection, and safety, and our need to protect ourselves against further neglect or abuse. Our caregivers may have provoked extremes of numbing (as in neglect) or overly intense emotions (as in abuse) that we could not regulate then and that affect our emotional responses now. Figure 27.1 shows where the dysregulated emotions corresponding with each animal defense occur in the hyper- and hypoarousal zones of the window of tolerance. 651

When we do not have adults to regulate or soothe us when we are small, we may vacillate, like Marcy did, between hyperarousal (feeling too much) and hypoarousal (feeling too little). As adults later on, we may still suffer from rapid, dramatic, exhausting, and confusing shifts of the intense emotions that go along with animal defenses. We may experience emotions as urgent calls to explosive, dysregulated action, or complain of depression, inaction, and lack of motivation, or alternate between bouts of impulsive action and feeling unable to act.

FIGURE 27.1

Some people report that they live in a chronic state of arousal and fear. The desperate need for another person that is ordinarily a characteristic of a young child’s cry for help from their caregivers may persist into adulthood. We may not be able to feel safe unless someone who can protect us is nearby, and we may feel distressed and frantic when we are alone. Fear and terror that fuel a flight defense may become chronic, repeatedly triggered by traumatic reminders. We may have recurring impulses to leave social situations, flee when someone approaches, or even run out of the room during meetings when something triggers us. The anger and rage associated with a fight defense could become chronic or out of control, and we may find that triggers evoke uncontrollable bouts of rage, destructive behavior, or impulses of violence against our own body or toward others. 652

Both immobilizing defenses of freezing and feigned death/shut down are characterized by a feeling of helplessness. Agitation and extreme anxiety or panic combined with feeling paralyzed are the hallmarks of freeze. When no other defense is effective, the last resort is a version of feigned death/shutdown, accompanied by feeling detached from emotion. Sometimes it can be a relief not having to feel the feelings, but often those who experience detachment and numbing have a sense of defectiveness or become angry at themselves for not feeling normal feelings like most people do, which only aggravates their feelings of inadequacy and despair. They do not understand that a lack of emotion is most likely the result of a shutdown, or feigned-death, animal defense.

What to Do with Trauma-Related Emotions When emotions arise in our daily life, we feel more comfortable expressing and experiencing them if we know that doing so has a beginning, middle, and an end. If we feel sad, for example, and express it through weeping, afterwards we usually feel better (see Chapter 30, “Making Sense of Emotions”). However, it is important to know that expressing the intense emotions related to animal defenses do not have the same effect of bringing relief and closure. These kinds of emotions are intended to fuel animal defensive actions and are typically circular, endlessly repetitive, and exacerbated rather than resolved when expressed. You may have experienced cathartic rage or panic, like Marcy above, only to discover you felt worse afterwards or that any relief was only temporary. Understanding that threat first and foremost affects our bodies may help explain why these emotions do not resolve or abate if we express them. When we are threatened, our most immediate instinct is physical, not emotional. First arousal escalates and we feel the impulse to run, and only afterwards, even if it is only a split second afterwards, do we feel afraid. Or we feel the urge to protect ourselves or strike out, then we feel angry. Here is a simple example: If you start to fall down the steps, you instinctively grab for the railing before you realize you are afraid or have time to think about what is happening. Our physical instincts, the purview of our reptilian brains, are designed to protect us without having to assess danger with our conscious minds (neocortex), which would take extra time, slowing down our survival defense. Because the first response to threat is physical, it makes sense to address trauma-related emotions that fuel these instincts first on a body level. Instead of expressing them on an emotional level, we can complete the actions related to these emotions on a bodily level, which usually resolves these dysregulating emotions. This is called “bottom-up” processing (see Chapter 9, “The Triune Brain and Information Processing”). 653

To do this, we must differentiate emotional processing from sensorimotor, or body, processing and become familiar with the language of each as described in Chapter 10, “Exploring Body Sensation.” Effective emotional processing involves experiencing, articulating, expressing, and integrating emotions at the edges of the window of tolerance (see Chapter 30, “Making Sense of Emotions”). The problem with the emotions related to animal defenses is that they exceed the edges of the window and cannot be integrated by expressing them. But they can be worked with bottom-up through the body. Sensorimotor processing, in contrast to emotional processing, refers to experiencing, describing, and integrating body sensation, physiological arousal, and movement impulses. A direct, exclusive, or even primary focus on emotional processing is of little benefit when we are experiencing an overwhelming flood of emotions, a lack of emotion, or the same emotion over and over. Expressing emotions in these cases can even make things worse. Instead we can address them through bottom-up physical interventions.

Marcy’s Therapy with Emotions and Animal Defenses Here are three examples from Marcy’s therapy of working with her emotions physically rather than emotionally. Marcy had told her therapist she either felt rage or panic, or else she felt nothing. With her therapist, Marcy decided to work first with the rage associated with a fight defense. She described how her shoulders were always tight and that she thought the tension was holding back rage. Marcy had always believed she had no right to fight back or even be angry with her abusive father. Over several sessions with her therapist, working with the anger through movement helped her resolve her rageful outbursts. Marcy focused on a particular sliver of memory: her father saying it was time for her to go to bed with a certain look in his eye, which Marcy knew meant that he was going to come into her bedroom in a few minutes and abuse her. Marcy’s therapist coached her to notice what happened in her body as she remembered her father saying, “It’s time for bed.” Marcy reported a tightening all over, clenching of her jaw, and then more tightening in her arms. Her therapist asked her to be aware of both the anger and the tightness in her arms and notice what movement that tension wanted to make. Marcy followed an impulse to slowly raise her arms, with her palms out in a “stop” or pushing gesture. Her therapist asked her to see what happened if she gradually and mindfully made the pushingaway motion. “See if it feels bad or good,” her therapist said. Marcy was taken aback at first, questioning how rage could feel good. Also, she knew that if she had confronted her father then, the abuse would have gotten worse. But as she followed the instruction to just notice the action, rather than thinking about what the 654

movements meant or what her father might have done, she found that it did feel good to push against a pillow held by her therapist. She felt strong, determined, and self-protective. Marcy realized that her anger was originally meant to fuel a “fight back” defensive response that she could not act upon during the abuse by her parent. When she mindfully made the fighting back motion of pushing, Marcy found that her rage had a good, empowering (but not dysregulated) action to go with it instead of being stuck or exploding. Marcy had told her therapist that she often felt numb and detached from emotions especially when she engaged in high-risk behavior. As she focused on a sliver of seeing herself walking into the dangerous bar, she noticed that she could barely feel her body. Another sliver of memory then emerged of being very small, and she remembered that as a child, she felt helpless. Then Marcy began to lose connection with her body as she had during the abuse. She said that she felt “nothing,” no emotion whatsoever, and no sensation. The absence of emotion is common with a feigned death/shutdown, defense. It was hard for Marcy to stay present because her arousal had plummeted to outside of the lower edge of the window of tolerance. She remembered “being a robot” and doing exactly what her father wanted. Marcy was reexperiencing the state she had been in when the abuse happened, the shut down and compliant behavior that helped her survive the abuse. As an adult, she had relived that state of robotic compliance and numbness when she engaged in high-risk behavior. Her therapist asked Marcy to stand up and walk together through the room, and, with the movement and social engagement, Marcy began to feel her body again. She learned to recognize the first signals of this shutdown defense, which she described as a glazing over of her eyes and feeling like a block of wood. When she began to sense this signal, she knew her best resource was to move around, before the numb detachment got stronger. Still later in her therapy, when Marcy recalled a particularly triggering sliver of memory, she experienced panic and began to tremble. Her therapist asked her to put the panic aside and just focus on the trembling sensations in her body and describe them in detail. Marcy reported that the sensations felt like a vibration in her spine, but that as long as she disregarded the panic and focused on her body, the vibration itself was not unpleasant. Marcy was surprised to find that as she became mindfully aware of the trembling and just directed her attention to it, it slowly began to change. Through sensorimotor sequencing, the trembling settled eventually, by itself. Marcy was able to use sensorimotor sequencing with several triggering slivers to recalibrate her nervous system. In each of these sessions, Marcy capitalized on bottom-up processing: first using her anger to find an empowering physical fight action (the pushing), using movement to mitigate the absence of emotion and robotic behavior that accompanied the immobilizing defense, and eventually working with the panic by putting the emotions and thoughts of the panic aside and using sensorimotor 655

sequencing to follow the vibrations in her body until they settled. These somatic interventions can help to resolve the intense emotions related to animal defenses that occur too far out of the window of tolerance to integrate and pave the way for future efficacious processing of emotions (see Chapter 30, “Making Sense of Emotions”). The worksheets provided in this chapter can help you recognize, understand, and find resources for the emotions that relate to animal defenses. They will also give you and your therapist insight into your experience of any of these emotions so that you can determine physical ways to work with them.

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Emotions and Animal Defenses EMOTIONS, DEFENSES, AND B EHAVIOR, P ART 1 Purpose: To identify the emotions that correspond to different animal defenses, reflect on situations in which you have experienced these emotions, assess your behavior at those times, and consider resources you could use when these emotions emerge in the future. Directions: Reflect on the animal defenses below and identify emotions that correspond to them in the circles. Then describe a situation in which you have experienced each defense and accompanying emotions, and reacted in a way you later regretted (e.g., “fight” was driven by anger, leading to pushing someone away when you really want more closeness). Animal Defense

Corresponding Emotions

Fight: push away, shove, attack, hit, kick, yell “stop” or “no,” verbally attack, strike out

Situation and Behavior –––––––––– –––––––––– –––––––––– –––––––––– ––––––––––

What resources would help you regulate these emotions so that you could take the action of your choice rather than behave in a way you might later regret? (e.g., Use my breath and grounding resources to calm down and ask my partner to sit and hold hands with me and discuss the difficulty between us.) Discuss with your therapist physical ways (through action or sensorimotor sequencing) to address these emotions. Animal Defense

Corresponding Emotions

Cry for Help: make noise, yell, scream or call out for help, cling to or seek close proximity to others 658

Situation and Behavior –––––––––– –––––––––– ––––––––––

–––––––––– ––––––––––

What resources would help you regulate these emotions so that you could take the action of your choice rather than behave in a way you might later regret? Discuss with your therapist physical ways (through action or sensorimotor sequencing) to address these emotions.

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Emotions and Animal Defenses EMOTIONS, DEFENSES, AND B EHAVIOR, P ART 2 Purpose: To identify the emotions that correspond to different animal defenses, reflect on situations in which you have experienced these emotions, assess your behavior at those times, and consider resources you could use when these emotions emerge in the future. Directions: Reflect on the animal defenses below and identify emotions that correspond to them in the circles. Then describe a situation in which you have experienced each defense and accompanying emotions, and reacted in a way you later regretted (e.g., “flight” was driven by fear, leading to running away or leaving prematurely; “freeze” was driven by terror, leading to not moving when you wanted to). Animal Defense

Corresponding Emotions

Freeze: hyper-alert but can’t move, hide, stiffen up, feel paralyzed

Situation and Behavior –––––––––– –––––––––– –––––––––– –––––––––– ––––––––––

What resources would help you regulate these emotions so that you could take the action of your choice rather than react in a way you might later regret? Discuss with your therapist physical ways (through action or sensorimotor sequencing) to address these emotions. Animal Defense

Corresponding Emotions

Flight: flee, run away, back away, leave, escape

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Situation and Behavior –––––––––– –––––––––– –––––––––– ––––––––––

––––––––––

What resources would help you regulate these emotions so that you could take the action of your choice rather than behave in a way you might later regret? Discuss with your therapist physical ways (through action or sensorimotor sequencing) to address these emotions.

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Emotions and Animal Defenses EMOTIONS, DEFENSES, AND B EHAVIOR, P ART 3 Purpose: To identify the emotions that correspond to different animal defenses, reflect on situations in which you have experienced these emotions, assess your behavior at those times, and consider resources you could use when these emotions emerge in the future. Directions: Reflect on the animal defenses below and identify emotions that correspond to them in the circles. Then, describe a situation in which you have experienced each defense and accompanying emotions, and reacted in a way you later regretted (e.g., “feigned death/shut down” was driven by a feeling of helplessness, so you didn’t speak up for yourself when you could have). Animal Defense

Corresponding Emotions

Feign Death/Shut Down: go numb, limp, collapse, play dead, “not be there,” fall silent

Situation and Behavior –––––––––– –––––––––– –––––––––– –––––––––– ––––––––––

What resources would help you regulate these emotions so that you could take the action of your choice rather than react in a way you might later regret? Discuss with your therapist various physical actions that would address these emotions. 1. List the three emotions related to animal defenses that you would like to regulate. 2. Describe future situations in which each of these emotions might emerge and identify the resources, especially somatic resources, you could use in each of those situations to regulate.

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CHAPTER 27

Emotions and Animal Defenses EMOTIONS, HIGH AROUSAL, & HYPERAROUSAL Purpose: To differentiate emotions accompanied by hyperarousal that pertain to animal defenses of cry for help, fight, flight, or freeze (and occur outside the window of tolerance) from emotions accompanied by high arousal (and occur at the upper edges of the window) and identify resources for each kind of emotion. Directions: Reflect on the difference between emotions you have experienced that were accompanied by high arousal and those accompanied hyperarousal related to animal defenses. Then complete the prompts below. 1. Think of different times when you experienced the emotions below, accompanied by hyperarousal related to animal defenses. Write any other relevant emotions on the last line. Describe how your body feels when you experience each emotion. Panic________________________________________________________________ Terror_______________________________________________________________ Rage_________________________________________________________________ Other________________________________________________________________ Hyperarousal High Arousal 2. Think of different times when you experienced the emotions below, accompanied by high arousal. Write any other relevant emotions on the last line. Describe how your body feels when you experience each emotion. Your Window of Tolerance Frustration_________________________________________________________ Apprehension/fear___________________________________________________ Anger_______________________________________________________________ Other_______________________________________________________________ 3. Identify two resources that might help you allow yourself to experience emotions accompanied by high arousal, or prevent them from escalating into the hyperarousal zone. 4. Identify two resources that would help you regulate emotions accompanied by hyperarousal. 666

Discuss with your therapist which physical action (e.g., pushing, running, or another action) or if sensorimotor sequencing would be useful to work with hyperaroused emotions related to animal defenses.

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CHAPTER 27

Emotions and Animal Defenses EMOTIONS, LOW AROUSAL, & HYPOAROUSAL Purpose: To differentiate emotions that pertain to the feigned death/shut down animal defense (and thus occur below the window of tolerance) from emotions that occur at the lower edges of the window and identify resources for each kind of emotion. Directions: Reflect on the difference between emotions you have experienced that were accompanied by low arousal and those accompanied hypoarousal related to animal defenses. Then complete the prompts below. Your Window of Tolerance 1. Think of different times when you experienced the emotions below, accompanied by low arousal. Write any other relevant emotions on the last line. Describe how your body feels when you experience each emotion. Disappointment______________________________________________________ Sadness_____________________________________________________________ Boredom_____________________________________________________________ Other_______________________________________________________________ Low Arousal Hypoarousal 2. Think of different times when you experienced the emotions below, accompanied by hypoarousal related to the animal defense of feigned death/shut down. Write any other relevant emotions on the last line. Describe how your body feels when you experience each emotion. Shame_____________________________________________________________ Despair___________________________________________________________ Absence of feeling________________________________________________ Other_____________________________________________________________ 3. Identify two resources that might help you tolerate emotions accompanied by low arousal, and prevent them from dropping into the hypoarousal zone. 4. Identify two resources that would help you regulate emotions accompanied by hypoarousal. 669

Discuss with your therapist what physical action or actions (e.g., standing, pushing, running, or another action) would be most useful to work with these emotions.

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CHAPTER 27

Emotions and Animal Defenses DYSREGULATED EMOTIONS & THE B ODY Purpose: To identify dysreglated emotions related to animal defenses that you have experienced in the past and describe how they felt, how you responded to them, and how you would want to respond in the future when these emotions emerge. Directions: Think about when you might have experienced dysregulated emotions related to animal defenses and then answer the prompts below. 1. Circle the emotions you have experienced that were dysregulated and that took your arousal out of your window of tolerance. Write in any other emotions that you experienced as dysegulating. aggression

frenzy

mortification

agony

fury

neediness

anguish

gloom

panic

apprehension

grief

rage

degradation

helplessness

revenge

depression

hopelessness

shame

despair

horror

terror

desperation

hostility

torment

dread

humiliation

2. Select three emotions you circled in # 1 that you feel you expressed in a negative or unsatisfying way and list them below. Describe what each feels like in your body (e.g., Tense, jittery, held breath, rigid posture, collapsed posture, fast heart rate, slow heart rate, or numb). 1. 2. 3. 3. How did you react to each emotions? (e.g., I got critical, angry, disgusted, 672

ashamed, embarrassed, self-blaming, confused.) 1. 2. 3. 4. How did you express or manage these emotions? (e.g., I withdrew, lashed out, apologized, hurt myself, went to bed, smoked marijuana, drank alcohol, watched mindless TV.) 1. 2. 3. 5. List three alternative behaviors in the chart below and describe how you think you would feel if you engaged in these behaviors. Alternate Behaviors

How You Would Feel

6. Work with your therapist to practice implementing these alternate behaviors.

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Emotions and Animal Defenses RESOURCES FOR DYSREGULATED EMOTIONS Purpose: To identify triggers for dysregulated emotions, describe the emotions that are triggered, identify the related animal defenses, and list resources you can use to regulate. Directions: Take your time to think about people, situations, or events that trigger dysregulated emotions at both extremes of the window of tolerance and then follow the prompts below. 1. List your triggers for emotions that are accompanied by hyperarousal and draw a line to connect each trigger with one or more of the emotions in the column in #2. 2. Draw a line to connect each emotion on the left with one or more of the animal defenses on the right that you experience when the emotion is triggered. Fear/Terror Fight: hit, kick, strike out, push away, verbally attack Anger/Rage Cry for help: scream, make noise, cling to or seek close proximity to others Panic

Flight: run, back away

Other:

Freeze: hyper alert but can’t move, feel paralyzed, crouch down, hide Other:

3. List resources you can use to regulate these emotions. Hyperarousal Window of Tolerance Hypoarousal 4. List your triggers for emotions that are accompanied by hypoarousal and draw 675

a line to connect each trigger with one or more of the emotions in the column in #5. 5. Draw a line to connect each emotion on the left with one or more of the animal defenses on the right that you experience when the emotion is triggered. Shame

Shut down, go numb

Despair

Collapse, go limp

Helplessness

Be a “robot,” automatically comply

Other:

Curl into a ball, go to sleep Other:

6. List resources you can use to regulate these emotions.

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SECTION FIVE

PHASE 3

Moving Forward

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CHAPTER 28

The Legacy of Attachment THERAPISTS’ GUIDE TO CHAPTER 28

Purpose of this Chapter Through both positive and negative affect-laden interactions with their primary caregivers, children acquire “implicit relational knowing,” in other words, “how to do things with others” (Lyons-Ruth, 1998, p. 284). Encoded in procedural memory, the legacy of attachment constrains the meaning we make of each moment and reflects nonconscious strategies of both affect regulation (Schore, 1994) and relational interaction. The purpose of this chapter is to elucidate further how early caregiving can leave an enduring imprint on relational capacities so that clients might be better able to understand their relational proclivities as learned patterns and work to change those that are problematic. In helping your clients learn to observe their interpersonal patterns with curiosity instead of criticism or shame and name them as learned through attachment dynamics, self-judgment often spontaneously diminished, leaving clients more willing and able to address outdated attachment legacies.

Clients Who Might Benefit This chapter will benefit any clients who experience difficulties in relationships. It will be equally useful for those who do not understand why their relationships tend to be unstable and volatile and those who have stable relationships but experience a sense of dissatisfaction. The chapter should be recommended both to clients whose triggered responses lead them to avoid others and isolate themselves, and to those who maintain frequent contact with others but have problems navigating certain kinds of relationships (e.g., with their bosses, children, parents, or partners). Client who have difficulty in particular kinds of interactions with others, such as when someone criticizes them, asks them for something, expresses a need, and so forth, will also benefit. Those whose relationships go well during the early 678

stages and then become increasingly problematic (or vice versa) may glean insight into the role their attachment histories play.

Suggestions for Clinical Use Phase 3 work puts primary emphasis on understanding how early relationships influence current ones—an understanding cultivated not only through insight but also through awareness of habits of movement, gesture, expression, and posture. The cognitive understanding that, for example, “I was treated harshly as a child at times and ignored at others, and that’s why I withdraw and keep relationships at a distance,” can decrease clients’ judgments about their habitual reactions. But insight and understanding do not necessarily change the procedural relational patterns, such as pulling in, shallow breathing, avoidance of eye contact, and so forth. These patterns both reflect and sustain implicit relational knowing. As clients appreciate why they are the way they are in relationship, and understand how their physical patterns contribute, they can start to develop new interpersonal behaviors. Since the legacy of attachment is evident in clients’ current relationships, you can help them identify early relational knowing through noticing what happens in their bodies when they remember recent relational difficulties. Building on Chapter 21, “Implicit Memory and Your Resource Repertoire,” recent examples of difficult interactions can provide the slivers of memory to explore. Clients can learn to appreciate the implicit legacy of attachment that takes hold long before they have the words to explain it to themselves. For example, perhaps harsh treatment as a child does not just provoke emotional distress or a belief that they do not deserve to be treated gently, but also causes the body to tense up and pull away from contact in relationships today. As clients notice their physical responses to current relational dynamics, they often remember their childhood adaptations to failed or inadequate caregiving. The connection between their history and current relational patterns of withdrawing, fading into the background, becoming angry or compliant becomes clear. Although implicit relational knowing was once an adaptation to particular contexts, some parts of it may be ill-suited for current relationships, exacerbating present-day dissatisfaction and eliciting unwanted responses from others. For example, learned patterns such as withdrawing might result in not being seen by others; distancing might feel rejecting to others; needing to be “tough” or “right,” or needing not to make mistakes, may be intimidating and push people away in clients’ current life. You can help clients notice these sequences and the physical patterns that contribute to them with a curiosity and interest generated by their understanding of an attachment perspective. Doing so presents opportunities to experiment with new patterns that can improve their current relationships. 679

Because relationships are such a sensitive topic for so many clients, the didactic material in this chapter can provide a less triggering context for a discussion of how the legacy of attachment affects them. Conveying that all of us learned ways of relating that no longer serve us will help clients be receptive to this material. Emphasizing that this chapter has something to offer that will support their goals may also help to offset any reluctance, shame, or defensiveness that might arise. The emphasis on collaboration is especially important because clients so easily feel ridiculed or ashamed with regard to the topic of their relationships. Communicating that everyone is affected by some degree of inadequate caregiving, even in the best of families, and perhaps providing some examples, can help to normalize their relational difficulties. Since attachment histories shape transference and countertransference, this chapter can shed light on how therapists inadvertently trigger clients, and viceversa, or how both are caught up in a more prolonged or complex enactment. As we view clients’ transferences and our own countertransferences as legacies of attachment in the form of implicit relational knowing, we may find ourselves becoming curious about, rather than interpreting, the relational challenges between us as a problem. For example, a therapist’s relational knowing that “It’s important not to keep secrets” might lead her to pressure a client into disclosing more than is therapeutic, or to have a strong reaction to the client’s fear that disclosing his thoughts, feelings, and opinions could lead to humiliation or punishment. When your clients respond to a steadily deepening therapeutic relationship with abandonment fears, criticism of your skill, or with reactive fight or flight responses, you will have a context for showing curiosity about these patterns as early attachment imprints, reflecting clients’ “knowing,” such as, “It isn’t OK to be close—to depend on—to trust—anyone because I will be abandoned, criticized, or betrayed.” If you yourself react to your clients by feeling rejected or incompetent, you can become aware of your own relational patterns as well, and how they interact with those of your client. Holding in mind that transference, countertransference, and therapeutic enactments stem from implicit relational knowing rather than conscious intention is essential to remaining curious about the impact of your own attachment history, as well as that of your client, on the therapeutic relationship. At these moments, safety in the relationship may be threatened or even lost. But this is not cause for undue concern for the therapist who is interested in learning about his or her own participation in what takes place beneath the words. In fact, the real magic and healing power of clinical practice often comes from negotiating the implicit impact of therapist and client upon one another, a process which can temporarily compromise social engagement, but in the end yield great reward (Ogden, 2013). As Bromberg (2006) states: The [therapist’s] ability to provide a safe environment is not in itself the source of therapeutic action. While the [therapist] must indeed try not to go beyond the patient’s capacity to feel safe in the room, it is

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inevitably impossible for him to succeed, and it is because of this impossibility that therapeutic change can take place. (p. 24)

A well-negotiated therapeutic enactment holds more possibility for therapeutic change than if the enactment had not occurred. Interactive repair following collisions can lead to growth and alter the legacy of attachment for both parties.

Introduction to the Worksheets The worksheets link early attachment experiences to current relational patterns, positive and negative. Most clients, no matter how unsafe or rejecting their early environments, had some positive relational experiences with parents, grandparents, teachers, neighbors, or parents of friends. A POSITIVE RELATIONAL EXPERIENCE asks clients to revisit their positive, adaptive “relational knowing”—what they learned and internalized from past relationships that strengthens current ones and enhances their fulfillment in interactions with others in their lives today. The worksheet will help them to break down their positive relational knowing into beliefs, thoughts, emotional reactions, and body responses. Building further on the first worksheet, HARNESSING A SOMATIC RESOURCE FROM A POSITIVE RELATIONAL EXPERIENCE helps clients to further develop and embody their positive relational knowing by delving more precisely into its somatic components so that it can become a conscious somatic resource. A NEGATIVE RELATIONAL EXPERIENCE brings up negative past experiences, but completing this worksheet after the previous two will make it more tolerable. It asks clients to notice the beliefs, emotions, and body responses connected to relational knowing from less than positive early attachments and also to track fluctuations in autonomic arousal connected to this relationship. By helping clients to reflect on how the relational knowing from this negative experience is still influencing them today they can then discover the resources to mitigate the effects of negative attachment history. Especially in long-term treatment, these first two worksheets can be used to explore positive and negative experiences clients have had with you over time. This provides a clear structure to discuss your relationship. THE LEGACY OF ATTACHMENT IN DIFFICULT RELATIONSHIPS helps clients make connections between early relationships, the distorted relational knowing associated with them, and a present-time difficult relationship, ending with defining resources that might be useful in the current difficulties. You may find it useful to discuss with your clients how their negative relational knowing affects the relationship between the two of you. The final worksheet, THE LEGACY OF ATTACHMENT IN POSITIVE RELATIONSHIPS, focuses on the resources that clients can consciously harness—both those resources they have gained and those 681

connected to early relational knowing—to enrich their current relationships. If your client has difficulty remembering any positive relationships from childhood, an alternative use of this and other worksheets would be for the client to examine the relational knowing connected to the therapeutic relationship. In fact, with some clients, many of the worksheets for this chapter may be best adapted to explore their relationship with you.

Adapting this Material for Dissociative Clients Dissociation is itself a kind of attachment disorder and is most often triggered by actual or perceived disruptions in current relationships, including those with you. When the legacy of early attachment has included chronic experiences with “frightened and frightening caregiving” (Lyons-Ruth & Jacobvitz, 1999; LyonsRuth, Dutra, Schuder, & Blanchi, 2006), clients have been left with dissociated intense impulses to “cry for help,” coupled with equally intense dissociated animal defense responses of fight, flight, freeze, and shutdown. This chapter provides the opportunity to better understand their past relational experiences, profound ambivalence about relationships, and approach–avoidance conflicts. However, the risk that clients with dissociative disorders will be triggered by this material is high, so it may be most helpful to introduce the material with that challenge in mind —that is, bit by bit, using their resource repertoire to regulate, pacing the work at an even slower speed when clients are triggered, or titrating the work into smaller segments. In addition, work with this chapter will be complicated by the fact that different parts of the client may have dramatically different attachment patterns. You might experience these different attachments in relationship to you: a “cry for help” part might be strongly attached to you with intense separation anxiety, whereas a hypervigilant part questions your integrity and caring, and a fight part pushes you away with anger. A submissive part might be automatically compliant for fear of disappointing you, but another part dismissively complains, “Working with you is not helping me.” If your clients’ attachment-related responses are fragmented in this way, then the work of this chapter can be furthered simply by inviting them to notice the shifts in their relationships with you, and identify the relevant parts that hold different patterns. Both of you can track how different parts are triggered by interpersonal stimuli and then trigger other internal reactions and other parts. One of the goals of Phase 3 for clients with dissociative disorders is increased connection and integration among parts, and this chapter offers an opportunity to meet this goal by using the umbrella of attachment to explain and explore the responses of different parts to the material.

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CHAPTER 28 The Legacy of Attachment Our most joyful and pleasurable relationships are usually with those to whom we are attached—in other words, those closest to us, our families and friends. These same relationships are generally the source of the most distress and emotional pain as well. Attachment reflects a biologically driven need for affiliation with other humans that begins in infancy and continues throughout our lifespan. Forming and sustaining attachment relationships is essential to our survival. We would perish without someone to care for us and protect us when we are small, and we instinctively call upon the “cry for help” animal defense to bring another person to our aid when we are frightened. However, along with the need for safety and protection, all of us have fundamental human needs for emotional connection, physical contact, companionship, support, and a sense of belonging. We will not thrive and may not survive unless our intangible emotional and relational needs are met by our family and friends, our attachment figures. We all have varying capacities to form and maintain attachment relationships. This chapter focuses on how our capacity for attachment—for developing enduring emotional bonds—is developed, distinguishes relational defenses from animal defenses, and explores how we learn how to be in relationships. We hope that this chapter will give you a better understanding of and compassion for the patterns you have developed in relating to those close to you and also spark some ideas about how you might improve your capacity for attachment.

Our Early Attachments Relationships vary in their duration, intensity, and meaning. We form associations with others through work, school, sports, and other social activities, but an “attachment bond” is a special relationship colored by strong emotion and a lasting connection. Because we are born fragile and dependent, unable to survive without the care of another person, we have an innate biological drive to attach to those who care for us. Under normal circumstances, those who care for us will have a corresponding innate drive to attach to us, too, and meet our physical and emotional needs. Early in life, our needs are primarily body-based. We need food, physical contact, warmth, and soothing, and safety. The implicit meaning we make of how 685

our caregivers tend to these needs physically with their touch, movement, and tone of voice is our introduction to the nature of human relationships. If this genetically driven dance between infant and parents goes well, the parents will experience a desire to touch, rock, and hold their baby and tend to his or her needs. The baby will snuggle, smile, and coo in response, internalizing the experience that the world is a safe, loving place. Thus, our sense of ourselves in relationship to others is first and foremost a body sense, experienced through the sensations and movements of our own bodies in interaction with others when we are small. The dance of reciprocal attachment behavior between a parent and infant, including misattunements and reconnection, is meant to occur again and again. These experiences foster an internalized template of safe relatedness that prepares us to encounter frustration, disappointment, and hurt feelings and then to recover without lasting ruptures in our relationships. However, if our caregivers abuse or neglect us, our natural instinct to seek out others for care, protection, and emotional connection is damaged. When people, especially those to whom we are attached, frighten or ignore us, we may learn to mistrust others and avoid depending upon their support, suspicious of their intentions. Or we may start to feel that other people are the only hope of rescue or protection even though they are also dangerous and scary. As a result of this legacy of traumatic attachment, we are likely to become easily dysregulated in relationships, which no longer feel like the sources of support and enjoyment they could be. We become vulnerable to being repeatedly triggered by interactions with others, especially those people closest to us.

Animal Defenses and Attachment Animal defenses and their emotions, as we discussed in Chapters 25, “Restoring Empowering Action,” and 27, “Emotions and Animal Defenses,” are attempts to protect and defend ourselves, but they also interfere with attachment when they take over unnecessarily in relationships. Jillian’s volatile emotions disrupted her connection with her husband. She had married a mild-mannered man, Tim, who usually went along with her decisions and choices, and when he did so, she was a loving, nurturing partner. But on those occasions when Tim disagreed with her or opposed her wishes, Jillian’s animal defenses were triggered, and she found herself reacting in a succession of ways. First, she would try to convince him that her opinion was “right,” but when he wasn’t convinced, she erupted with rage, threatening to leave him if he refused to agree with her. In therapy, Jillian became aware of the roots of her reaction. Her mother had herself experienced relational trauma, which sabotaged her innate nurturing instincts. She responded to Jillian’s normal childhood needs with anger. As a child, 686

Jillian would try to please her mom when she “flew off the handle,” in an attempt to keep herself safe and maintain the attachment bond. She pushed aside her own angry reactions to her mother’s rage because she intuitively knew that expressing her anger would only make things worse. Though she had inhibited her impulses to rage back at her mother, she implicitly remembered this inhibited rage years later in conflict with her husband. Jillian learned in therapy to recognize that the tension in her jaw was the first signal that she was about to erupt in rage, and she learned to pause, take some deep breaths, relax her jaw, and wait until her arousal calmed before continuing to talk with her husband. In this way, Jillian used resources to quiet her defensive “fight” response and restimulate her social engagement system. If you have suffered attachment trauma like Jillian, becoming sensitive to the first physical signs of the emergence of animal defenses in your attachment relationships, and then inhibiting that response and practicing a resource instead, can help quiet them when they are not needed. You might also work with your therapist to find the actions your body wants to make when you experience intense emotions. Pushing motions and words like “stop” gave Jillian’s rage empowering actions that replaced the outbursts. Using sensorimotor sequencing to address the sensations of hyperarousal can also be effective. Using sensorimotor sequencing helped to reset Jillian’s nervous system and over time she found that she rarely experienced dysregulated rage.

Relational Knowing As we have seen, how and to what degree our relational needs were actually fulfilled and how misattunements were resolved in childhood affects our future relationships. Through both positive and negative interactions with our early attachment figures, we acquire knowledge about how to interact with others—what kinds of sounds, facial expressions, or actions will be welcomed or rejected by them, and what we can expect in our relationships. Once we have acquired this “relational knowing,” the sounds, expressions, and behaviors that produce the most desirable response from the people close to us become automatic, and, conversely, we inhibit behavior that provokes adverse or unwanted reactions. We no longer think about what we are doing or how we are interacting with those close to us. Our postures, facial expressions, gestures, and even emotional responses have become procedurally learned habits. If our parents respond to our distress with kindness and sensitivity, we learn that we can count on others to support us when we need it. Our innate need to connect then remains strong and becomes more sophisticated over time as we grow up. If our parents put aside their activities to respond to our needs, we learn that we matter and deserve attention. If our parents encourage us to try new things and are 687

generous in their praise when we attempt difficult tasks, then we will probably be excited and curious when faced with challenging new activities and move forward to engage with the world and with others. If they help us deactivate our defenses when they are unnecessary, then we learn to meet challenges with courage. For example, parents can support a child who is afraid of dogs to slowly approach and pet a friendly dog and teach the child to read the cues that tell whether a dog is friendly or not. These positive exchanges teach us to expect satisfying, enjoyable interactions with others and help our brains to develop in such a way as to increase our capacity to form healthy attachment bonds that can last a lifetime.

No Parent Is Perfect It is important to understand that no parent is perfect. All have deficits in their parenting as a result of their own blind spots, childhood experiences, current stress, and life circumstances. Even if we have not been neglected or traumatized, we have all had childhood experiences with attachment figures that caused us some degree of emotional distress. Our parents might have been good parents in general but still did not give us quite enough attention or the kind of attention we most needed. They might have been inconsistent or critical in how they treated us. Perhaps they were just unaware of our needs or too focused on work demands or other stressors to tend to us satisfactorily. All parents welcome, confirm and respond positively to some aspects of their children, as well as deny, disconfirm and respond negatively to other aspects. Whatever less than optimal attachment experiences we had, it is likely that we adapted by maximizing ways of relating that helped us to get the best possible connection with our parents while avoiding their rejection and disapproval. If our parents were critical, we might have learned to make an extra effort to do things right and try to avoid mistakes in order to win their approval. These efforts might result in bodies that are tense and anxious. If our parents responded positively to our achievements, welcoming the parts of us that were competent, we might have developed patterns of high-energy, goal-focused behavior designed to excel. If our parents were threatened by or put down our achievements, we might have learned to hold back our enthusiasm and competitive impulses. If our parents were stressed, we might have put aside our own needs to try to comfort or help them. If they were too busy to pay attention to us, we might have become self-reliant and given up on needing their attention.

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LaVonne grew up in a loving, close-knit family and had many happy memories of cozy evenings watching TV, going for walks together, and playing with her siblings. But LaVonne’s parents did not always support her interests. LaVonne wanted to play sports; her parents insisted on ballet classes instead. When she wanted to be a vegetarian, her parents required that she eat meat. Through repeated situations in which her wishes were thwarted, LaVonne began to sense that her interests were not acceptable to them, and she started to put aside her own impulses in order to do what her parents wanted. Instead of sticking up for her own wishes and convictions, she responded by acquiescing to their wishes to keep the peace and fit in with her family. Her body reflected this acquiescence in a slightly sunken chest, limp arms, low energy, and somewhat shallow breathing. It eventually became difficult for LaVonne to mobilize enough energy and confidence to voice her own opinions or assert herself in her marriage. LaVonne’s husband, David, had been a “latchkey kid,” often left to fend for himself as a child. He remembered the lonely, boring hours waiting for his single mother to come home from work, hoping she would not be too tired from her long day to do something fun. David’s most precious memories of his childhood were the exciting, joyful times he spent with his mom, from going to amusement parks to making up stories, but these times were few and far between. Much as he had longed for more fun times with his mother, David longed for more engagement from LaVonne. He suggested they try couples therapy because he wanted an “equal partner” who would come up with ideas for vacations and dates and spark interesting conversations at mealtime. At the same time, he did not know how to invite LaVonne to engage with him but rather waited for her to take the initiative just as he had waited for his mother to come home and attend to him. He became critical and aggressive, saying that LaVonne refused to “meet” him. Neither LaVonne or David reported that they had suffered from trauma—in fact, both remembered their childhoods as generally positive—but they both were recapitulating early negative relational dynamics in their marriage. It was important for LaVonne and David to understand that both their procedurally learned patterns reflected implicit relational knowing acquired in their original families. Once they understood that their relational difficulties would not change through criticism or self-judgment, but through challenging their implicit relational knowing, they could better work on their difficulties. LaVonne discovered that she collapsed and “tuned out” when David asked her what she wanted to do on their weekly date, a response originally designed to avoid the disappointment she had felt when her interests were unsupported by her parents. David tightened up and aggressively insisted that she come up with some ideas, which only made her anxious. In therapy, David learned to soften his body and lower his voice, express curiosity about what LaVonne might be interested in, and refrain from pressuring 689

her. LaVonne learned to take a deep breath, lengthen her spine, and reclaim some of the interests with David she had foregone as a child, such as playing tennis together. When they discussed their date options, they practiced social engagement by making eye contact, sitting side-by-side on the sofa, and holding hands. They supported each other and themselves to change how their histories “lived” in their bodies, and were gradually able to move beyond their early attachment conditioning and enjoy more intimacy in their marriage. Our early attachment relationships leave us with both positive and negative legacies. The relational knowing and procedural patterns learned from our positive relational experiences can be harnessed and deepened into resources to support our current relationships. Discovering the relational knowing and procedural patterns learned from our negative attachment experiences can help us understand our current interpersonal difficulties. The worksheets that follow will help you get in touch with your own implicit relational knowing and how the effects of early attachment relationships have shaped your beliefs, emotions, and body. You can learn how to reclaim and deepen your positive attachment legacy as well as discover and transform the attachment imprints you want to change.

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Legacy of Attachment A P OSITIVE RELATIONAL EXPERIENCE Purpose: To explore the positive, adaptive “relational knowing” that you acquired from your early attachment relationships that contributes to the satisfaction you experience in your relationships today. Directions: Think about positive experiences with a childhood attachment figure (parent, aunt, uncle, grandparent, sibling, teacher, family friend, or peer) and select one to explore. You may also have had unpleasant or negative experiences with the person, but just focus on a positive one for this exercise.

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1. Describe your positive relational experience. 2. Imagine that person is in the room with you right now just as he or she was during the positive experience. Take your time to envision that he or she is with you, maybe sitting beside you or across the room. Reflect on the triune brain model and about how each of your three brains might respond to the positive experience. Describe the thoughts, emotions, and body sensations and movements that come up when you imagine this person in the room with you.

Thoughts/Beliefs:

Emotions:

Body Response: Sensations & Movements:

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Legacy of Attachment HARNESSING A SOMATIC RESOURCE FROM A P OSITIVE RELATIONAL EXPERIENCE Purpose: To draw on a positive relational experience to develop somatic resources that can help you regulate your arousal, mood, and emotions in current dysregulating or challenging relationships. Directions: Explore one of your body responses from the last worksheet, LEGACY OF A POSITIVE RELATIONAL EXPERIENCE and determine how you can turn that response into a resource. 1. Choose a body response that you identified in #2 of the worksheet, LEGACY OF A POSITIVE RELATIONAL EXPERIENCE, that reflects relational knowing. My breathing slows and I feel a sense of calm throughout my body. 2. What relational knowing is reflected by your physical reaction? When my grandmother took care of me when I was sick, I felt that I deserved love and that people could depend on one another. 3. How can you turn this relational knowing into a somatic resource that you can use today? “I can remember to breathe more slowly, especially when I am having an argument with my wife I can remind myself that we can depend on each other.” 4. How can you use your somatic resource to regulate the negative effects of remembering upsetting experiences with an attachment figure? “When I feel dysregulated when thinking about how my father left us when I was a child, I can remember that my grandmother cared for me, and breathe slowly.”

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Legacy of Attachment A NEGATIVE RELATIONAL EXPERIENCE Purpose: To explore a negative experience with an early attachment figure that has influenced your relational knowing in a way that limits your fulfillment in your current relationships. Directions: Think about negative experiences with early attachment figures (parents, aunts, uncles, grandparents, siblings, teachers, family friends, or peers) and select one to explore. You may also have had pleasant or positive experiences with the person, but just focus on a negative one for this exercise. Note: If you think this exercise could be especially dysregulating, be sure to complete it under the guidance of your therapist, or save it for later. 1. Describe a negative experience you had with an early attachment figure. 2. Imagine that person is in the room with you right now as he or she was when the negative experience occurred. Take your time to envision that he or she is with you, maybe sitting near you or across the room. Reflect on the triune brain model and consider how each of your three brains might respond to this negative experience. Write down thoughts that you have, the emotions that come up, and how your body reacts. Thoughts/Beliefs:

Emotions:

Body Reactions:

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4. Describe the relational knowing you received from this individual. What did he or she teach you about relationships? 5. How do you think the relational knowing you learned from this person affects your relationships today? 6. Identify any people in your life today who remind you of this relationship. 7. What body reactions and emotions do you experience with the people you identified in #6 that are similar to those you experienced as a child? 8. What resources can you use to regulate arousal or lessen the effect of this negative relational knowing?

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Legacy of Attachment THE LEGACY OF ATTACHMENT IN DIFFICULT RELATIONSHIPS Purpose: To identify a current difficult relationship dynamic that evokes implicit memories (i.e., mental, emotional, and physical states) that are similar to those you experienced in an previous attachment relationship. Directions: Think of a difficulty you are having in a current relationship and complete the prompts below. 1. Describe a current relationship in 2. Describe the thoughts, emotions, and which you experience difficulty in the body responses that come up when you circle below. think about this difficulty. Thoughts/Beliefs Emotions Body response

3. Consider similarities between these body responses, emotions, and beliefs and those you experienced in your past. Describe any difficulties in early relationships that feel similar to the current difficulty you described above.

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4. Identify three resources you can use to help you separate past from present and regulate your experience in this current difficulty and describe them below.

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Legacy of Attachment THE LEGACY OF ATTACHMENT IN P OSITIVE RELATIONSHIPS Purpose: To identify two enjoyable and supportive current relationships and explore how they pertain to relationships with early attachment figures. Directions: Think of two current relationships that are enjoyable most of the time in which you experience positive emotions. In the two charts below, describe the ways in which the relationships are positive and how being with each person affects your thoughts/beliefs, emotions, and body responses. 1. Describe a current, positive relationship. Thoughts/Beliefs Emotions Body Responses 1. Describe another current, positive relationship. Thoughts/Beliefs Emotions Body Responses 3. Do the thoughts/beliefs, emotions, and body responses remind you of elements of your childhood relationships? Or do they remind you of elements that were missing from your childhood relationships? Describe below.

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CHAPTER 29

Beliefs and the Body THERAPISTS’ GUIDE TO CHAPTER 29

Purpose of this Chapter As young children, we interpret what we experience through our bodily and emotional responses. When a baby melts into her mother’s arms, the melting indicates that she has made meaning our of being held, such as, “I’m safe—I can relax.” The toddler seeks his mother for comfort when hurt has made a different meaning than the one who falls down and cries but avoids his mother and instead rocks himself from side to side until he stops crying. Meaning-making goes hand in hand with expectations of the future. Our prediction of what will happen is based on the meaning we make, and we often behave as if what we expect is exactly what will occur again. Tronick (2009) has pointed out that meanings are made from different realms ranging from verbal and explicit to nonverbal and implicit (cf. Chapter 1, “Essential Principles”). In Sensorimotor Psychotherapy, the meaning-making that takes place without awareness, beneath the words, through the body is a primary interest. Since they are implicit, such meanings cannot be consciously reflected upon or revised, and thus may be more significant in determining behavior than the meanings we make with language (Ogden, 2011). By the time a child reaches the age at which cognitive schemas can be verbalized, years of implicit meaning-making have already occurred. The purpose of this chapter is to help your clients identify their core beliefs that predict the future and bias their behavior. The power of cognitive schemas, or limiting beliefs, such as “I’m worthless” or “I don’t deserve anything good” or “It was my fault,” to inhibit initiative, energy, hopefulness, and drive is directly related to the impact of these beliefs on our bodies, and vice versa. Beliefs reinforce procedural tendencies and in turn, procedural patterns reinforce beliefs. Clients will begin to challenge these beliefs by understanding how they are formed, how they are either reinforced or upgraded with experience, and how they are reflected and sustained by procedural habits. They will learn to differentiate attachment703

related beliefs from trauma-related beliefs and explore a few ways to address each kind of belief in therapy.

Clients Who Might Benefit Clients whose cognitive schemas have curtailed their experience and constricted their lives will benefit the most from the material in this chapter. Traumatized clients whose beliefs pertain to physical survival and threat—for example, “I’ll never be safe” or “All men are dangerous”—can discover the overlap of these with beliefs that do not necessarily have to do with danger or physical survival—such as “I must work hard to be loved” or “The world is not supportive.” Clients who are beset by negative thoughts might discover the underlying core belief that drives such thoughts. Those whose beliefs hold them back in particular areas or prevent full engagement with life can also learn from exploring beliefs and the body. For example, clients may enjoy being home and caring for their family but have beliefs that prevent mastery in school and work settings, such as “I’m not smart,” or “I’m incompetent.” Others may enjoy their professional lives but have beliefs that interfere with their ability to enjoy family life, such as, “Work is more important than family,” “People will always betray me in the end.” Clients who have successful careers might discover beliefs that prevent them from enjoying the same satisfaction in relationships; others find beliefs that cause them to sabotage themselves just as their efforts are about to come to fruition. Clients who have particular goals in their life that they have trouble achieving can learn from discovering the beliefs that hold them back. Because these cognitive schemas were constructed in the context of attachment relationships, both safe and unsafe, exploring them with clients can evoke strong transference and countertransference responses and generate enactments. As therapists, we need to track not only the client’s body and verbalizations but also our own. We may feel a sense of urgency or internal pressure to convince the client to change a limiting belief. We may feel hopeless in the face of the client’s constricting or self-punitive belief system. Our somatic and emotional responses are the best indicators of potential enactment when the client’s belief has evoked core beliefs or attachment patterns in us.

Suggestions for Clinical Use Llinas (2001) asserts that when our brains compare present-moment data with past experience, “an ‘upgrading’ [should occur] of the internal image of what is to come to its actualization into the external world” (p. 38). But often upgrading does not 704

occur. Many clients have identified themselves by their limiting beliefs, which feel like truths rather than beliefs, and might feel apprehensive about having them challenged. The work of this chapter does not require that clients give up their beliefs or redefine them based on current reality. Instead, you can focus on increasing their curiosity by asking questions such as these: “How might the belief that feels ‘absolutely true’ have helped you survive?” or “What would it have been like in your family if you hadn’t believed it?” By stimulating their curiosity about the inception of beliefs that seem true to our clients, we challenge these schemas while also validating their origins as adaptive. You will find it useful to integrate this material on beliefs with the client’s moment-to-moment experience. If, for example, a client has trouble making eye contact, you can bring this difficulty into the open by saying, “Yes, you learned at an early age that it wasn’t good to look other people straight in the eye . . . and it’s happening here right this minute—it’s still with you.” Often, when you make the connection to how a belief helped clients cope with early relational dynamics, it is easier for clients to address the memories that formed the belief, experience the emotions associated with them, and be able to upgrade the belief to fit with current reality. You can help clients discover the physical patterns that correspond with beliefs by drawing attention to them, perhaps saying, “When you speak of others criticizing you, your chin seems to lift.” Or “Your head seems to pull into your shoulders as you talk about never being able to follow your dream.” Often memories emerge as you address these limiting beliefs, and Chapter 24, “Sliver of Memory” on finding a sliver of memory for attachment can be useful in these instances. The most emotionally painful slivers of childhood memories usually have to do with the formation of a limiting belief. A boy who thinks he is stupid may grow into an adult client whose sliver of memory is the look in his father’s eyes when he made a mistake or could not understand a math problem. These slivers in which beliefs were formed or confirmed are fraught with strong emotions that need to be accessed and experienced with your acceptance and regulation before the beliefs can be upgraded (cf. Chapter 30, “Making Sense of Emotions”).

Introduction to the Worksheets The worksheet BODY READING FOR CORE BELIEFS provides an entry point into the topic by asking the client to analyze and imitate the drawings of bodies with different procedural patterns and speculate how each communicates a different core beliefs. For many clients, this might be an easier, less triggering start than exploring their own beliefs. The goal of this worksheet is to increase curiosity and awareness of how cognitive schemas are experienced and communicated through the body. 705

Participating in this exercise with clients gives you the chance to emphasize how the body both reflects and sustains beliefs. Once your client and you have identified a core belief you can experiment with the opposite posture to illustrate how a different posture makes it difficult to maintain the belief. DISCOVERING A CORE BELIEF FROM YOUR BODY instructs clients to identify a tension pattern in their body, and then, through mindful awareness, translate the language of the tension to discover what belief it might reflect. Your guiding clients through this exercise, refining the mindfulness questions, and contacting their response will help them discover a belief. If clients discover a painful, formative memory, they will need your empathy to process the emotions that are likely to come up. UPSETTING SITUATIONS & CORE BELIEFS asks clients to select a particular sliver of a recent upsetting incident. You can help them identify the particular sliver that is the most upsetting to them. The worksheet then asks clients to make connections between distressing or triggering experiences; core beliefs that might have been formed about self, others, and the world; thoughts, emotions, and physical reactions; and past experience. Clients reflect on how these beliefs are kept “alive”: how the body and emotions make the beliefs feel true, even though they are more relevant to the past than the present. UPSETTING SITUATIONS & CORE BELIEFS is designed to identify the beliefs about self, others, and the world that might have influenced a recent upsetting situation. It helps clients think about whether these beliefs have their roots in childhood, and whether they are accurate perceptions of the current upsetting situation. The worksheet entitled NEGATIVE THOUGHTS & CORE BELIEFS helps clients become more sensitive to the negative chatter in their minds about a particular situation, identify the various thoughts that reflect beliefs about the self, others, and the world, and describe the effects of these on their body and emotions. It concludes with exploring how to interrupt one of these beliefs and support a new one. COMPASSION FOR YOURSELF reminds clients that core beliefs were not formed by the person they are today, but by a younger version of themselves who had to deal with difficult circumstances. The goal of this worksheet is for clients to develop compassion instead of judgment for themselves as children who formed certain beliefs that served an adaptive purpose in that family at that time—a goal that will be supported as you demonstrate compassion for the pain they experienced in the original circumstances and still experience today. From an attitude of selfacceptance, new beliefs more appropriate to present-day circumstances can be considered. EXPLORING BELIEFS THAT HOLD YOU BACK helps clients discover a belief that inhibits achieving something they currently desire, whether it is to get a new job, to be married, or to have more friends, and then identify and practice a small movement or posture that challenges that belief and encourages a new one that will support them in achieving their goals. As always, your reminders 706

to practice the new movement will help them reap the most benefit from the worksheet.

Adapting this Material for Dissociative Clients Dissociative clients will be faced with additional challenges in working with this chapter because some of their beliefs pertain to a sense of life-or-death survival, not just inadequate attachment. Their cognitive schemas are likely to be deeply influenced by the chronic tendency of certain dissociative parts to neurocept danger in most, if not all situations. It is impossible for these parts to develop and sustain positive and balanced beliefs in the face of constant neuroception of danger and even life threat. Persistent dysregulation makes it difficult for clients to develop a capacity to reflect on and be curious about their beliefs and how they impact the moment-to-moment experience. It will probably be triggering for such clients to consider new beliefs that would have been unsafe or led to more trauma or neglect in their early attachment environments. Therefore, it will be necessary to alternate work on orienting and resourcing with work on these cognitive schemas. For example, if the belief “I’m stupid and can’t learn this stuff” generates hypoarousal and shutting down so that the client cannot focus on the tasks of chapter, then resources that increase arousal enough to facilitate curiosity or orienting to the here and now learning experience may allow the client to continue. For clients with dissociative disorders, different dissociative parts will have very different cognitive schemas that often conflict with each other. A young part of the client with abandonment fears may believe “I’m not lovable—I’ll be left alone and might die unless someone cares about me,” whereas a hypervigilant part might believe “I’m only safe if I’m alone,” and an ashamed part is thoroughly convinced of being unworthy of care and attention. You will want to work slowly with such core beliefs, acknowledge the fears and concerns of each part as well as the survival functions of their beliefs, and try to maintain social engagement with these clients and their parts to increase their ability to neurocept enough safety to explore their beliefs. When possible, the veracity of the beliefs should be questioned and challenged in ways that help clients to change. However, dissociative clients and their parts are often so entrenched in their beliefs that they experience them as irrefutable facts, such as “I’m bad.” “I always get hurt.” “Nothing good ever lasts.” “All people are dangerous.” When beliefs are strongly fixed, it is generally not helpful to challenge them. Instead empathize with what it must feel like to “believe so completely that you are unlovable,” or “believe that no one can ever be trusted,” identify the survival function of the belief, and identify the body responses that 707

accompany those beliefs. Eventually parts that have developed more adaptive beliefs can be helpful to those whose beliefs are fixated in the trauma.

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CHAPTER 29 Beliefs and the Body Human beings are meaning makers. We make meaning every moment not only with words, but through a range of automatic, nonverbal capacities. As we observe, infer, and compile data from environmental stimuli and from our internal reactions to stimuli (i.e., changes in our building blocks), we make meaning. Our brains promptly assimilate the effects of external stimuli on our sensations, movements, perceptions, emotions and thoughts, and, in a millisecond, compare all this data to our past experience. By comparing the present to the past, we make sense of what is occurring almost instantly, and from this usually implicit meaning, we forecast the future and respond based on that forecast. If a certain kind of experience is repeated often enough over time, the meaning we make of it might also be repeated and eventually become a somewhat inflexible core belief. Picture a child who seeks her father when she is frightened of new experiences, such going on a playdate to a friend’s house, and the father repeatedly comforts her and provides the support she needs to overcome her fear and engage in the new activity. The child then learns to associate being frightened of something new with the availability of someone to comfort and encourage her. This might result in beliefs such as “When I’m scared, someone will be there to help me” or “I can count on other people’s support.” or “It’s ok to try new things.” We all form some positive beliefs like these, but trauma and painful attachment experiences also lead us to form core beliefs that are negatively biased and erroneous. Beliefs such as “I’m bad,” “It was my fault,” “No one will ever love me,” and “I’m never good enough” remain powerful determinants of our behavior long after the experiences that shaped these beliefs are over. And, as we have discussed, they are reflected and sustained in the procedural patterns of the body. In Phase 1, developing resources, we learned to be mindful of thoughts and beliefs, as well as the emotions and physical elements, that went along with resources. We learned resources to regulate arousal and increase our sense of mastery and self-esteem. In Phase 2, working with memory, we practiced “bottomup” interventions for beliefs related to animal defenses by following the sensation or movement of our bodies, and we put thoughts and beliefs aside if they interfered with the movement our bodies wanted to make. A major goal in Phase 3 and in this chapter is to directly address the core beliefs we formed through our interactions with attachment figures. Learning to identify and understand core beliefs and how they are formed, and discovering how they are reflected and sustained in your body 710

are goals of this chapter. From there, you can challenge these limiting beliefs and explore constructing more realistic or positive beliefs that can help you move forward in your life today.

How Beliefs Are Formed Our beliefs originate in childhood and develop and change over our lifetimes through the new experiences we have. Even as infants and young children, we make meaning through our emotions and body experience. Sometimes these meanings can turn into pervasive negative or positive beliefs we express through our behavior as well as in words. If, as babies, our mother comforts us when we cry or cling to her, we will repeat those actions. Without words, we have implicitly predicted the future by making the meaning that she will respond if we cry and cling. If she is responsive to us more than not, over time, we may develop positive and realistic beliefs about others and the world, such as, “Others will usually respond to my needs” or “The world is basically supportive.” We may also make meaning in relation to ourselves: for example, “I’m worthy of attention,” or “I deserve to have my needs met.” On the other hand, if we are not attended to and comforted fairly consistently, we probably learn to detach emotionally and physically when we need support from others. If a parent continues to be unresponsive time after time, whatever meaning we make, whether it is about others (“She doesn’t like me,”; “She is too busy for me”), the world (“The world is not a supportive place”), or ourselves (“I’m not good enough”; “I don’t deserve attention”), turns into pervasive negative beliefs about others, the world, or ourselves. These beliefs are communicated to us and to others through our posture, tension patterns, and the way we move.

Types of Beliefs Beliefs can be realistically positive (“Most people will treat me kindly”), unrealistically positive (“All people will always treat me kindly”), or unrealistically negative (“All people will always treat me unkindly”). Similarly, beliefs about ourselves can be realistically positive (“I’m good enough just as I am”), unrealistically positive (“I’m better than other people”), or unrealistically negative (“I’m stupid and always mess up”). Following is a chart of examples of realistic positive beliefs and unrealistic negative ones. Which ones resonate with you? Positive

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“I deserve to be loved.”

“I’m unlovable.”

“I can usually do what I want.”

“I always have to do what others want.”

“I can get my needs met.”

“My needs will never be met.”

“I can count on others.”

“I can only count on myself.”

“I’m good enough.”

“I’m not good enough.”

“Whatever I feel is OK.”

“My feelings are not OK.”

“It’s OK to make mistakes.”

“I always have to do everything right.”

Our negative or limiting beliefs usually involve global generalizations (no one, all people, or everyone) and feel like facts or “absolutes.” Words such as always, only, or never accompany these absolute beliefs; for example, “No one will ever love me;” “I will never get what I want;” “This world is only full of heartache.” These beliefs and the painful memories, emotions, and physical patterns that accompany them all together form a repetitive, negative cycle.

Upgrading Our Beliefs Although we begin to develop these beliefs early in our lives, they can be modified over time as we are exposed to new and different experience that challenge the beliefs. What we take in through our senses is continually compared to both past and present experience, and through this automatic process of comparison, we have an opportunity to revise or upgrade core beliefs based on new experiences. But often this does not occur fully because the old beliefs and their emotional and physical correlates impose the old meaning on new experiences. New meaningmaking is constrained by the old meanings made of earlier experiences, even in childhood. The little boy with the downcast eyes and collapsed chest who believes he is stupid has been unable to take in new information that could upgrade his meaning-making. With his head down, looking at his feet instead of making eye contact, he cannot see his teacher’s smiles, and he has missed her encouraging body language. With his chest collapsed, his breathing shallow, and his body heavy and numb, his teacher’s positive words feel empty and he cannot absorb them. Nate’s parents did not pay attention to their own or Nate’s emotions. He remembers dinnertime as full of intellectual conversation, but no one ever asked him how he felt. Nate learned to tighten his body, hold his breath, and keep his facial expressions blank so that his feelings would not show. He developed the limiting beliefs, “My emotions are not interesting to others,” “I should keep 712

whatever I feel to myself,” and “My feelings are not OK.” However, as an adult, his best friend, who came from a family that expressed emotions easily to one another, often asked Nate how he felt. Through this friendship, Nate had an opportunity to upgrade his old beliefs, and he began to challenge his limiting beliefs with more realistically positive ones, such as, “My friends care about how I feel.” But, even though Nate’s limiting beliefs were challenged, he still had a difficult time opening up to his friend. He implicitly remembered the early imprint of his parents’ disinterest in his emotional life and how his attempts to communicate his feelings had brought only indifference and disapproval—very hurtful to him as a child. The possibility of testing out if his old belief was still accurate by opening up to his friend felt frightening because Nate unconsciously associated the pain he had experienced from his parents’ rejection of his emotions with opening up to another person. He did not want to take the chance of reexperiencing the same hurt he had experienced with his parents. Keep in mind that such beliefs and related procedural learning are not conscious. They are implicit strategies designed to minimize the recurrence of painful relational experiences. Nate’s implicit learning told him that it was safer to believe that no one would be interested in his emotions than to take the risk again of hoping that they would be and then being profoundly disappointed if they were not. When his friend would ask him how he was feeling, Nate’s body tightened and his breath constricted automatically, implicitly signaling to him that he should keep his feelings to himself. His core belief was not upgraded because it had become a procedural habit. Instead, Nate overly oriented to any evidence of others being disinterested in his emotions. If Nate’s friend looked away, was slightly distracted, or furrowed his brow, Nate unconsciously interpreted these behaviors as proof that his friend was not interested in his emotions and that his limiting belief was correct. His body tightened and pulled back a little more at these moments. In this way, our beliefs become inflexible, and, like Nate, we repeat actions that were adaptive in the past, even though they are no longer needed or useful in present time. Ideally, beliefs should be flexible, changing with new experiences and geared to the needs of the present rather than to the past. Our actions and the way we approach life should expand through development, maturation, and learning gained from interactions with others so that we have increasingly satisfying lives and relationships. But, when our core beliefs feel like the “truth,” it takes intention, courage, and diligence to change them. Nate took several steps to challenge his core belief. He became aware of his procedural learning—the tension and constricted breath—and he made an effort to relax his body and take deep breaths, especially when he was with his friend. This helped him be receptive to a new experience. He also decided to talk with his friend about his desire to change his pattern, and to ask his friend’s help, and the 713

two friends set about challenging Nate’s belief. They decided together that when Nate started to interpret his friend’s behavior as disinterest, Nate would ask openly if that were true (which, according to his friend, it never was). They also decided to have an evening once a month to discuss their feelings about their lives and relationships, and Nate learned from his friend’s openness and receptivity at those meetings that showing emotions was OK. In therapy, Nate revisited one especially painful sliver of memory, tearfully remembering how he had cried as a young boy after being bullied, only to be told by his father to grow up and be a man. Reconnecting to the emotions he had pushed aside to fit into his family was critical in changing Nate’s belief.

Trauma and Attachment-Related Core Beliefs The beliefs related to trauma are accompanied by emotions that arise with animal defenses such as panic, rage, terror, and despair, as we learned in Chapter 27, “Emotions and Animal Defenses.” The roots of these feelings and beliefs are connected to survival needs in the face of danger and life threat, and when we experience them, our arousal exceeds our windows of tolerance. Although they overlap, trauma beliefs can be distinguished from the limiting ones we develop in our nontraumatic attachment relationships and later, with peers and others who were important to us. These limiting beliefs are accompanied by painful emotions such as sadness, grief, loneliness, anger, frustration, and fear. Usually when we feel them, our arousal goes to the edge of our window, but not too far out unless traumarelated emotions and animal defense come up too. Following are some examples of each kind of core belief: Trauma Beliefs

Attachment Beliefs

“I’ll die if I’m left alone.”

“I’ll always be alone.”

“The world is a dangerous place.”

“I can’t count on anyone.”

“I have to perform or I will perish.”

“I should please others.”

“I must fight to survive.”

“No one cares about me.”

“I’m completely helpless.”

“My needs are not important.”

“I have to comply to survive.”

“I’m not loveable.”

If we have suffered relational trauma, the distinction between trauma and attachment beliefs can be blurred. Often the two overlap in such circumstances. We 714

can work with our trauma-related beliefs through bottom-up interventions, developing resources and working with traumatic memory as described in previous chapters. For example, Sue, who suffered ongoing sexual abuse in childhood from a nonfamily member, had developed trauma-related belief, “I am a weak, incapable person.” Since this belief was associated with the danger she experienced during the abuse and with being too little to defend herself, she and her therapist addressed it using somatic resources and reinstating empowering physical defenses. Sue learned how her rounded shoulders, collapsed posture, and the lack of tone and energy in her arms reinforced these beliefs. She began to practice alignment of her spine, lifting her head, and strengthening the “pushing away” muscles of her arms by lifting weights under the instruction of a trainer. As she worked with her therapist to resolve her traumatic memories, she discovered the long-lost ability to push away and defend herself. This changed her trauma-related belief to “I am capable. I can protect myself.” On the other hand, nontraumatic attachment beliefs are fraught with emotions (see Chapter 30, “Making Sense of Emotion”) that need to be experienced and expressed. John had formed the attachment belief, “I have to be a high achiever to be loved,” which grew out of being raised in an extremely accomplished family that insisted upon excellence in all endeavors. John’s body, mobilized for action, reflected this belief through overall tension, high, shallow breathing, and quick, incessant movements. Even when he was sitting, some part of his body was in motion. His leg jiggled, and he squirmed in his chair. These physical patterns contributed to his need to stay active and achieve at all costs, which prevented relaxation and drove him to workaholism. John began to develop the new belief, “I can be loved for who I am,” by learning to slow down and relax his body, and to have compassion for the little boy he used to be who kept performing for fear of losing the love and attention of his parents. The painful emotions of feeling that he would not be loved for himself also needed to be experienced and accepted by another person. With his therapist’s compassionate support, John, like Nate, was able to express the deep sadness on behalf of his young self and for all the years spent working so hard to win approval. His agitated movements lessened and his breathing deepened as he cried softly. Gradually, over time, John was able to exchange his limiting belief of only being loved if he achieved for “I’m loveable as I am, not for what I achieve.” It is important to know that when we are working with attachment-related beliefs, we often re-experience the emotional pain of disapproval, rejection, or lack of support from those who were most important to us growing up. The compassion both you and your therapist can convey to the young child you once were who needed to form these beliefs to cope with childhood circumstances will help you experience the healing grief that can resolve the past and change your core beliefs. The worksheets that follow can help you explore your core beliefs, how 715

they relate to your body, and to begin to understand the circumstances that led you to form them.

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Beliefs and the Body B ODY READING FOR CORE B ELIEFS Purpose: To practice body reading in order to discern the core beliefs, both positive and negative, that might be reflected and sustained by different procedural patterns. Directions: Look at the pictures below of four different people. Review the example of #1 and then imitate the posture. Cross out what you did not experience, and add anything else that you did experienced as you imitated this posture. Imitate the remaining postures and write down your experience for each. #1

1. Imitate this posture, then describe your experience of the posture and alignment of the body. (e.g., My chin and head are forward. My neck feels like it is sticking out. My shoulders are rounded. My spine is collapsed and I can’t breathe very well. My stomach is sticking out and my arms and legs feel weak. 2. What positive or negative beliefs do you think this person has about himself? (e.g., “There is no use trying;” “It’s OK to be peaceful and non-aggressive;” “I can be close with others;” “I don’t have enough support.”) 3. How do you think he feels about himself? (e.g., low self esteem, disempowered) What childhood experiences may have contributed to this belief? (e.g., Maybe 718

his parents always put him down, or made him feel bad about himself. Maybe he didn’t do well in school.) #2

1. Imitate this posture, then describe your experience of the posture and alignment of the body. 2. What positive or negative beliefs do you think this person has about himself? 3. How do you think he feels about himself? What childhood experiences may have contributed to this belief? #3

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1. Imitate this posture, then describe your experience of the posture and alignment of the body. 2. What positive or negative beliefs do you think this person has about himself? 3. How do you think he feels about himself? What childhood experiences may have contributed to this belief? #4

1. Imitate this posture, then describe your experience of the posture and alignment of the body. 2. What positive or negative beliefs do you think this person has about himself? 3. How do you think he feels about himself? What childhood experiences may have contributed to this belief?

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Beliefs and the Body DISCOVERING A CORE B ELIEF FROM YOUR B ODY Purpose: To translate a familiar tension pattern into words in order to discover a limiting core belief. Directions: Take your time to become mindful of your body and aware of any tension that feels familiar. Select an area of tension that you would like to explore (e.g., a small area such as one side of your neck, a knee or the area around your heart, or a larger area such as your shoulders, pelvis, or chest). Then answer the following questions. 1. Describe the tension.

Describe the qualities of the tension (e.g., tight, dense, achy, dull, sharp, congested, hard, blocked, rigid, painful, knobby).

Where exactly is the tension? Is it a big area or How is the tension pulling (e.g., if your shoulder is tense, does a specific point? the tension pull up, in, forward, down, back, diagonally)? Where does it begin and end?

2. Exaggerate the tension. Exaggerate the tension slightly, if possible. What happens when you increase the tension just a little—how does the rest of your body change? 3. Experiment with tensing and relaxing. Exaggerate the tension, and then relax it. Go back and forth several times very slowly, being mindful of the contrast. Describe the difference: Tense Thoughts Emotions Images/memories Body Responses 722

Relaxed Thoughts Emotions Images/memories Body Responses 4. Find the belief. Exaggerate the tension once more and search for a belief associated with it. Explore what the tension might tell you about yourself, others, or the world. Ask yourself the following questions: • If this tension could talk, instead of tighten up, what would it say? (e.g., The tension in my shoulders says “Don’t let your guard down,” or, “Others will criticize you if you show who you are,” or “The world is not on your side.”) • If this tension could say one sentence about you, what would it be? (e.g., “I’m a loser.”) 5. Refine. Say a belief you discovered about yourself out loud while you exaggerate the tension—see if the words and the tension say the same thing. If not, find new words to fit the tension. 6. Identify a somatic resource. Describe a good somatic resource for this tension and belief.

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Beliefs and the Body UPSETTING SITUATIONS & CORE B ELIEFS Purpose: To discover core beliefs about yourself, others, and the world that are stimulated by a recent, upsetting experience. Directions: Describe a triggering or upsetting experience you’ve had lately. Study your thoughts, emotions, body responses, and beliefs that are evoked, following the prompts below. 1. Describe the upsetting experience and identify a sliver of that memory to focus on. 2. Describe how your body responds when you focus on that sliver (e.g., changes in movement, posture, tension, location of tension, how tension is pulling). 3. Describe your thoughts and emotions when you focus on that sliver. 4. Stay with your thoughts, emotions, and body responses that are activated by the situation or person. Identify negative beliefs about yourself, others, and the world that this experience seems to confirm: • Yourself? (e.g., “I can never get it right.”) • Others? (e.g., “Others are out to get me.”) • The World? (e.g., “Things always turn out badly.”) 5. Reflect on the beliefs you discovered. Can you connect them to memories from your childhood? Evaluate if the beliefs are accurate and fitting for this current situation. Describe below.

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6. Think about how you want to respond to this situation in the future and identify one somatic resource that would support you in this situation. Describe below.

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CHAPTER 29

Beliefs and the Body NEGATIVE THOUGHTS AND CORE B ELIEFS Purpose: To identify the thoughts that often go on unnoticed when you are faced with a difficult or challenging situation and explore how these thoughts affect your body and reflect core belief(s). Directions: Think of a situation that causes you to have negative thoughts about the world, others, and yourself and write them in the “Situation & Negative Thoughts” boxes. Take your time to notice the effects of the thoughts on your body and emotions and write them down in the “Effect on Your Body and Emotions” boxes. Finally, identify and write down the core beliefs that might underlie your negative thoughts and emotions in the “Core Belief(s)” boxes. Read the examples first. The World

Others

Yourself

Situation & Negative Thoughts Effect on Your Body & Emotions

Core Belief(s)

Example: Going to a party. “If you’re not ‘in,’ you’re out. There’s no point in going to parties. It will be awful like it was in high school.”

“The world is a cruel, unfair place. Life is always so hard.”

My body tightens and pulls back and my eyes cast downward. I feel sad.

Situation & Negative Thoughts Effect on Your Body & Emotions

Core Belief(s)

Example: Going to a party. “Everyone will have fun but me. They’ll think I’m boring. No one will talk to me.”

“Others are not interested in me. No one likes me.”

I want to curl up and cover my eyes. I feel dejected and more sad.

Situation & Negative Thoughts Effect on Your Body & Emotions

Core Belief(s)

Example: Going to a party. “I

“I don’t

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My head comes

don’t have anything interesting to say. I won’t have any fun. I’ll just feel awkward. I should stay home and watch TV.”

down. My body tightens and pulls in. I feel ashamed and afraid.

belong. I don’t matter. There is something wrong with me.”

Identify beliefs about the world, others, and yourself that you would rather have and describe how you could change your body to interrupt each old belief and support the new belief. (e.g., The belief I would rather have is, “There is nothing wrong with me.” I could relax my shoulders, lift my chin, make eye contact, breathe, and engage my TV A muscle a little.) The World Others Yourself

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CHAPTER 29

Beliefs and the Body COMPASSION FOR YOURSELF

Purpose: To explore how negative core beliefs helped you cope in the past, and imagine conveying compassion to yourself, especially to the part of you that formed these beliefs in order to cope with difficult experiences. Directions: With your therapist, choose two negative core beliefs you want to explore. You can choose a core belief that you discovered in one of the previous worksheets for this chapter, or choose a different one. Reflect on the childhood experiences that caused you to form them, and how they helped you cope with these difficult experiences. Then fill out the boxes below. Negative Core Belief

Difficult Childhood Experiences

How the belief helped you cope

Negative Core Belief

Difficult Childhood Experiences

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How the belief helped you cope

Take a moment to remember yourself as you were during the situations when you formed one of these core beliefs. Find a gesture (e.g., a hand over your heart, rocking, gentle self touch) that expresses compassion for yourself and especially for the younger “you” who had to deal with painful circumstances. Then try out the gesture with the intention of conveying compassion toward yourself and describe your experience.

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Beliefs and the Body EXPLORING B ELIEFS THAT HOLD YOU B ACK Purpose: To discover and challenge beliefs that hold you back from achieving something you want in your life, and to practice a movement or posture that challenges that limiting belief. Directions: Think of something in your life that you want to accomplish that eludes you. Maybe it is success at work, being in a committed relationship, going back to school, or building a good support system. Use this worksheet to identify the beliefs that hold you back and explore movements and thoughts that might help to change those beliefs. 1. Describe something you want in your life that eludes you. (e.g., I want to have more friends.) 2. Identify a belief that holds you back from achieving what you identified in #1. (e.g., I don’t matter.) 3. Describe the childhood situation(s) that led you to form that belief. (e.g., Parents divorced; lived with Mother and she was always off doing things with other people. She never had time for me.) 4. How did the belief help you in that situation? (e.g., Believing, “I don’t matter,” led me to stop wanting attention from her. I avoided disappointment and learned to be on my own.) 5. How does your body reflect the belief now? (e.g., My shoulders tighten and come up, I duck my head, and my knees lock. My stomach feels tight.) 6. Explore a small change you could make in the way your body holds the limiting belief. (e.g., I lift my chin a bit and drop my shoulders a little.) 7. Identify what this small change might communicate to the part of you that had formed the old belief. (e.g., You deserve attention.)

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8. Say those words that you discovered in #7 to yourself or aloud. Be aware if there is any part of you that does not believe these words. If so, change the words so that they are believable. What happens? (e.g., My stomach tightened when I said the words, “You deserve attention.” The words that are more accurate and believable are, “You deserve attention, but sometimes you will be disappointed. But that does not mean you have to always be on your own.” Then my stomach relaxes and my knees let go a bit. These words make it easier for my chin to lift and my shoulders to relax.) 9. Continue with this movement and the new thought, and think about what you want that you described in #1. Describe your experience.

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CHAPTER 30

Making Sense of Emotions THERAPISTS’ GUIDE TO CHAPTER 30

Purpose of this Chapter Although it is well established that patterns of emotional expression are learned in childhood, it is a newer concept to many therapists and clients to consider these patterns as influenced by how our bodies have come to support certain emotions and prevent or inhibit others. Neuroscience has taught us that emotions and the body are mutually dependent and inseparable in terms of function (Damasio, 1994; Frijda, 1986; LeDoux, 1996; Schore, 1994). “All emotions,” writes Damasio (1999), “use the body as their theater [via the] internal milieu, visceral, vestibular and musculoskeletal systems), but emotions also affect the mode of operation of numerous brain circuits” (p. 51). That is, emotions are affected by body sensations and movements, and vice versa, and both influence meaning-making, beliefs and behavior. Emotional processes are central to psychopathology and thus to psychotherapy practice (Dorpat, 2001; Fosha, 2000; Goleman, 1995; Schore, 1994/2003b; Schore & Schore, 2008). Most current treatment models emphasize expressing unresolved emotions of painful past experiences and expanding affect array. In contrast to the trauma-related emotions explored in Chapter 27, “Emotions and Animal Defenses,” attachment-related emotions are the result of “both the relational processing in intense affective experiences and the long-term consequences of internalizing the dyadic handling of such experiences” (Fosha, 2000, p. 42). This chapter primarily explores painful attachment-related emotions. Positive emotions are the focus of Chapter 34, “Play, Pleasure and Positive Emotions.” The material in this chapter teaches clients to be mindful of their habits of emotional expression or inhibition as data about their attachment histories, rather than judging their emotions as “bad” or “good,” “true” or “untrue.” Instead of venting habitual emotions that might have once served to maximize the resources of attachment relationships in the past, this chapter helps clients discover the relationship between the body and emotions, the function of emotional patterns, and 735

from there, to explore the underlying authentic or “core” emotions (Fosha, 2000) that reflect a deep contact and comfort with the self and the self in relationship with others. The ability to mindfully study these patterns and then to connect to and experience painful emotions previously disowned or disconnected can help expand clients’ affect array and foster a richer emotional life. This endeavor was started in Chapter 23, “Dual Awareness of Past and Present,” and is further expanded in this one.

Clients Who Might Benefit This chapter will be of benefit to clients who are sufficiently stable and have enough resources to explore their attachment-related emotions without becoming unduly dysregulated. No client is immune to inadequate childhood attachments that leave emotional limitations or constrictions that affect not only their well-being but their relationships. It is extremely rare for any client to be able to comfortably connect to and express the full range of painful emotions, from sadness, to anger, to hurt, to disappointment, and so on. And, it is also the rare client who has learned to experience the full range of intensity of such emotions from mild irritation to full blown, grounded anger, for example. Clients likely to gain most from this chapter include those whose limited access to emotions deprive them of important abilities, such as clients who cannot access anger and who therefore cannot set boundaries; clients for whom all emotions end in grief and feeling depleted, depriving them of energetic participation in life; or clients whose anger keeps others at a distance and who have difficulty expressing the vulnerability that would instead draw others closer. If clients become dysregulated by this chapter’s material, or if emotions that fuel animal defenses are coupled with attachment-related emotions, they can still benefit from the psycho-education of this chapter. It will help them make sense of their complex emotional reactions.

Suggestions for Clinical Use Bowlby asserts that “many of the most intense emotions arise during the formation, the maintenance, the disruption, and the renewal of attachment relationships” (1980, p. 40). Because revisiting painful attachment-related emotions in therapy is accompanied by a similar intensity, clients need to be able to both tolerate this intensity and appropriately regulate it and receive interactive regulation from you. Developing “affective competence” includes “being able to feel and process emotions for optimal functioning while maintaining the integrity of self and the 736

safety-providing relationship” (Fosha, 2000, p. 42). For this work, a crucial element is your own tolerance for emotions, which will determine the kinds, strength, and variety of emotions that are expressed or denied within the alliance between you and your clients (Schore, 2003b). This chapter seeks to differentiate “core” emotions from “patterned” emotions. Core emotions reflect a deep contact and comfort with the self and the self in relationship, such as: the experience and expression of emotional pain unmasked by defensive emotion, and the joy, pride, love, and deep resonance in the dyadic context. Core emotions are supported by corresponding physical actions. For example, adaptive anger is supported by increased alignment of the spine and a degree of physical tension; joy by an uplifting of the spine and expansive movement; empathy by a softening of the face and chest, and perhaps a gentle reaching out. Patterned emotions are “learned, dysfunctional responses that interrupt the process of resolution. These patterns often serve to thwart or defend against a primary emotional response” (Engel, Beutler, & Daldrup, 1991, p. 175). These emotional biases serve to minimize affects that are either frightening or aversive (Fosha, 2000; Frijda, 1986; Ogden, 2009). They can be thought of as relational defenses (distinguished from animal defenses) that limit the negative impact of painful emotions that evoked inadequate or inappropriate regulation and empathy from attachment figures. However, they limit emotional competence: Attachment related [patterned emotions] mask or suppress a deeper [core] emotion, recapitulate early affect-laden interactions with caregivers, and limit affective experience, array and expression. These emotions have a repetitive quality, and often disguise and defend against a deeper level of feeling, having been formed as successful strategies for meeting needs where direct authentic emotional communications proved unsuccessful. (Ogden, 2009, p. 228)

Emotions are commonly described as critical motivators of action and as signals that orient us to important environmental stimuli (Krystal, 1978; van der Kolk, McFarlane, & Weisaeth, 1996). However, it is important to help clients become aware of emotional patterns as procedural learning and other forms of implicit memory that prime them to orient toward particular cues that confirm these emotions. For example, if a patterned emotion is anger, cues that relate to anger will be noticed. Helping clients recognize these orienting habits and changing patterns of orienting can be useful in changing emotional biases (cf. Chapter 6, “Pay Attention: The Orienting Response”). Discovering how procedural patterns support certain emotions and keep others at bay will facilitate clients’ awareness of how these physical habits predispose them to experience certain emotions. Chronic tension around the eyes, jaw, shoulders, or chest may support angry feelings but prevent sadness, grief, or other more vulnerable feelings. A sunken chest, downward head, and deep sighs may support grief and hurt, but not anger or assertion. Instead of venting these patterned 737

emotions unawares, clients are helped to discover their function and experience the underlying core emotions. Postures, facial expressions, and gestures outwardly express internal emotional states, communicating these states to others. Damasio’s (1999) “dispositional tendencies” appear similar to Bull’s (1945, 1962) “motor attitudes” that communicate emotions. Through this chapter, we want to help clients become aware of the sequences in interpersonal relationships that are propelled by their emotional patterns and the related physical tendencies. Perhaps the client who never gets angry is unable to share much with her husband or is cut off not only from anger but from other emotions as well, reflected in a tight, unexpressive body —the result of which is that her husband feels unimportant. Or the client who never cries but suffers from performance anxiety accompanied by constrained upper chest breathing and quick, anxious movements might have a difficult time relaxing enough to enjoy playing with her children. Often clients question their emotion, asking, “Am I right to feel this way? Would other people feel this way?” By stimulating their curiosity and interest in emotional biases and the physical patterns that support them, we can disrupt clients’ identification with them as “just how I am” and challenge evaluations of emotions as “right” or “wrong,” “bad” or “good.” As you encourage clients to be nonjudgmental and mindful of patterns of emotional over- and underexpression that complicate their relationships, you will spontaneously encounter opportunities to work with particular slivers of memory that lend themselves to emotional processing. You might say, “Let’s go back to that moment when you looked around the auditorium and saw that your mom wasn’t there” or “Can you connect to that time you were crying and then saw your father’s face harden? Do you see his face now?” When you ask clients to direct their mindfulness back to a sliver of memory that is fraught with unexpressed painful core emotion, whether it is the recent past or many decades ago, you evoke the state-specific experience of that affect-laden moment. Clients can often connect to the feelings that were available but not expressed at that time. Where there has been an underuse of some emotions (due to disconfirmation of parents, and their aversion, rejection, or punishment) and the overuse of others (due to confirmation of parents), there might be a feeling of relief as well as grief when the client is finally able to connect to and experience them. Maroda (2002) advises that “helping our inhibited, cooperative, and wellbehaved patients to be more emotional should be as important as helping our overemotional patients to contain themselves” (p. 75). Clients need to experience their core emotions fully and effectively in a way that expands their affect array, brings closure to past encounters, and reclaims emotions that have been dissociated, devalued, or suppressed. However, it is important to assess the nature or source of a client’s emotional arousal e.g., whether it is a patterned, habitual emotion 738

stemming from attachment or trauma history, or an authentic emotional response to the present moment or a past situation. Sometimes therapists have learned that either containing and resourcing all dysregulated emotions or expressing and abreacting all strong or dysregulated emotions is the priority in therapy. It is important to recognize that these extremes can equally prevent core emotions. Our own bias as therapists in regard to the role of emotions in psychotherapy can contribute to therapeutic enactments, for example, when we find ourselves pushing to help the client feel emotions or intervening anxiously to regulate client distress.

Introduction to the Worksheets Research shows that basic emotions have reliable, distinctive facial expressions across cultures (Eckman & Friesen, 1978). The worksheet EMOTIONS, EXPRESSIONS, & THE BODY depict drawings of seven faces that each express a particular emotion. Clients are instructed to use each expression to help them embody the emotion and discover their own particular physical elements that correlate with the emotion. By mirroring the emotion in each of these expressions and noticing how their bodies respond, clients discern which emotions feel most familiar and least familiar to them. This worksheet can be done in session so you can model embodying each emotion while reporting the details of the somatic components you experience in order to expand clients’ own awareness. You can also help clients become aware of how certain postures support emotional biases, and how changing the posture makes it more difficult to sustain the bias. FAMILIAR AND UNFAMILIAR EMOTIONS expands on the first worksheet by providing a structured way for clients to refine their awareness of how the body participated in expressing some emotions and holding back others and to expand their emotional repertoire by identifying an unfamiliar emotion to explore. The two worksheets, EMOTIONS & EARLY ATTACHMENT and EMOTIONS, BELIEFS, & THE BODY instructs clients to identify the high and low arousal emotions that were acceptable and unacceptable in their families and identify emotions they tend to minimize and maximize in their current lives. Keep in mind that any of the high arousal emotions listed may be low arousal ones for some clients, and vice versa. If this is true for your client, the emotion should be crossed out and added to the appropriate worksheet. You can assist clients in remembering childhood situations when certain emotions that were common and accepted in their families were experienced, and then discovering how each emotion is embodied. They will also need your support to reflect on how they learned to maximize or minimize emotions, and to find actions that can encourage a more adaptive way to relate to a high or low arousal emotion. 739

EMOTIONS, BELIEFS & THE BODY helps clients to clarify a negative feedback loop of emotions, thoughts, movements and sensations. A negative emotion can catalyze a negative thought, which in turn leads to physical responses that evoke more negative emotions, followed by more beliefs, followed by more somatic responses, and so on. Clients are asked to identify a resource that might help them interrupt this negative feedback loop. The final worksheet, EMBODYING AN UNFAMILIAR EMOTION, leads clients to identify an unfamiliar emotion they want to explore and embody. This worksheet’s material will need your guidance so it should be completed in session. As a sliver of a childhood memory with an attachment figure that induced an aversion to a particular emotion is addressed, clients will need your empathy and regulation. The intention of this worksheet is that clients will expand affect array by being able to more fully embody an emotion they had learned to avoid.

Adapting this Material for Dissociative Clients Connecting to attachment-related emotion tends to be dysregulating for clients with dissociative disorders, due to both a narrow, rigid window of tolerance and because attachment is usually coupled with trauma. Emotions related to attachment can occur simultaneously with those related to animal defenses, and both can feel frightening and out of control. Clients with dissociative disorders may notice that they automatically switch whenever strong feelings arise, or that certain parts tend to intrude on their emotional experience in the present. Those with phobias of emotion may find themselves inexplicably becoming numb or switching to an unfeeling or dismissive part. But even if your client cannot access or tolerate much emotion, the psychoeducation contained in this chapter can be valuable in and of itself. When you offer a conceptual overview to clients whose mammalian and reptilian brains tend to dominate their daily experience, and when you explain the logic of seemingly illogical and intrusive attachment-related emotions with which they get flooded, you might find that these explanations in and of themselves can be regulating. Contacting and expressing emotions requires that clients can utilize Phase 1 stabilization skills as needed. It will not be helpful to explore this chapter with dissociative clients until they have first achieved some control over the dysregulated arousal of their dissociative parts. Through completing the work of Phase 2, dissociative parts fixed in animal defensive reactions and the accompanying vehement emotions can become better regulated and develop a sense of the present. Many emotions will emerge in Phase 2 and can then be regulated through bottom-up approaches. With parts in better communication and more resourced, after completing Phases 1 and 2 work, you can determine if your client 740

is ready to work more directly with emotion as described in this chapter. Questions to ask yourself in that regard include these: Are all parts of my client able to tolerate emotion, at least to a degree?; Is there any remaining internal punishment or shame for the experience or expression of emotion?; Can all parts of my client work together, at least to a degree, on small steps forward?; Is my client able to step back and reflect on emotions, rather than being embedded in them? Some clients, or parts of clients, may insist on the temporary relief that uncontained catharsis, that is, the expression of intense emotions might provide even though doing so has no lasting benefit and can exacerbate dysregulation in the long run. At the same time, clients with dissociative disorders may be masterful at avoiding emotions, and will need sustained encouragement from you to appropriately experience attachment-related emotions, including grief for what they missed. Keep in mind that, as van der Hart (2006) notes, “Grief is experienced after every therapeutic gain. Grief is the bridge between past, present, and future.” It is helpful to ensure that clients have experienced positive emotions prior to grief work, by completing worksheets in previous sections on positive emotions. A reference point of positivity can support resolution and helps prevent a spiral into despair, loss, or rage. A purpose of the phases of therapy is to systematically build the capacity for deeper emotional work, step by step. If clients with dissociative disorder are still in crisis, are unable to maintain a relatively steady relationship with you, are still losing time, self-harming or switching, have trouble keeping an adult part in charge, or cannot remember some or all of your sessions, then the focus should remain on Phase 1 stabilization. If clients are struggling with vehement emotions related to animal defense, working with them via bottom-up interventions is probably your best option. You also might be able to read and discuss this chapter together, even noting what emotions are possible without further dysregulation, and which ones are not, and how these relate to early attachment patterns. But it will be critical to refrain from accessing painful emotions before clients have developed the capacity to do so in a way that is integrative.

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CHAPTER 30 Making Sense of Emotions Emotions add richness and complexity to our experience. Without them, our lives would seem flat and impoverished because the fullness and depth of experience that emotions make possible would be missing. Our emotional brain steers our attention toward certain cues, people, and situations that have meaning and value for us on a feeling level, and then the emotions we experience motivate our actions in response to these stimuli. Fear motivates us to move away from a source of anxiety or danger, enjoyment motivates us to continue whatever activity feels good, sadness or grief motivate us to seek out comfort, and love motivates us to pursue the company of those we care about. Our emotions can be confusing. They are constantly changing in response to our fluctuating internal and external landscape. We might experience emotions related to animal defenses and those related to attachment relationships at the same time. We can experience contradictory feelings toward the same person or stimulus. Sometimes certain emotions are aroused by reminders of past relationships rather than current ones. Emotions related to earlier attachment relationships usually need to be expressed as long as they are not dysregulating. Resolving the emotions that keep us stuck in repeating negative relationship dynamics of the past can help us respond to people in our current lives in new and adaptive ways. On the other hand, trauma-related emotions that fuel animal defenses are usually best addressed through sensorimotor sequencing, physical action, and somatic resources. This chapter will help you make sense of the difficult or painful emotional patterns and biases you developed in the context of early attachment, explore how to navigate them, and how to distinguish them from emotions connected to animal defenses. Note that we will discuss the pleasurable emotions more thoroughly in Chapter 34, “Play, Pleasure and Positive Emotions.”

Emotions and the Body Emotions are experienced as body sensations that help us know what we are feeling. Take a moment to think about the last time something embarrassing happened to you. You may have noticed a tight feeling in your chest or felt a warm rush of blood to your face that told you that you were embarrassed. Such signals are the body’s way of communicating our emotions. Butterflies in the stomach tell us 743

we are excited, a heavy feeling in the chest speaks of grief, tension in the jaw informs us that we are angry, and an all-over tingling feeling or a tightness in the chest indicates fear. These internal emotional states are also reflected in our movements and facial expressions, giving signals to others around us about how we feel. Sadness might be visible in the downward turn of the mouth and head, moist eyes, and general softening of the body. Disappointment may be communicated in hunched shoulders, held breath, and a pleading look in the eyes; hurt in a bracing or moving away from the person who hurt our feelings. Thus, the activation and deactivation of our various emotional states are felt as internal body sensations, but postures, facial expressions, and gestures outwardly express these emotions, visibly revealing them to others.

Emotions and Attachment Our most powerful, intense emotions are generated not only by traumatic events but also by the joys and hurts of attachment relationships. Our deepest emotional wounds are usually related to the people who mean the most to us. We learn very early in our lives which emotions are accepted or favored by these people, and which ones are not. As infants, we experience and communicate unrestrained “core” emotions spontaneously as they emerge. Core emotions are authentic and true to what we feel at the moment, unhindered by what we have learned is acceptable. However, we soon learn to keep at bay emotions that evoke undesirable reactions from others and try to express the emotions that elicit desirable reactions. When caregivers or other important people react with criticism, withdrawal, dismissal, anger, disappointment or disapproval, children then experience often excruciating negative feelings of shame, humiliation, rejection, confusion, fear, and so on. If caregivers consistently respond to particular emotions in a negative way, children begin to censor those emotions. They block or minimize the emotions that elicit a negative response and express or maximize those that elicit a positive response. For example, if your parents got upset when you were angry but comforted you when you were sad, you probably learned to hold back your anger but show your sadness. If they did not welcome expressions of excitement, joy, or happiness, you learned not to show these feelings—maybe you did not even feel them at all. When our attachment figures disapprove of a particular emotion, we often judge that emotion as “bad” and develop physical habits, such as shallow breathing or numbing or tightening of the body, to ward off these emotions if they start to come up. Sometimes parents are not receptive to emotions in general, so we 744

unconsciously keep all our emotions, positive and negative, under wraps. Even when we know intellectually that emotions are neither good nor bad, these automatic emotional and physical habits can persist.

Relational Defenses Our emotions and their bodily sensations and stances can occur in response to a current situation or to internal experience (e.g., thinking about someone who has disappointed us). They also can become a chronic, pervasive habit related to our history and beliefs rather than to the present. We can think of these habits as relational defenses that serve to minimize or block emotions that were frightening or aversive to our caregivers, and thus to us. These kinds of relational defenses and their functions are to be distinguished from animal defenses. The emotions associated with relational defenses are not focused on life-or-death survival. Instead, they form to avoid negative responses from our attachment figures, such as rejection, disapproval, or distancing. For example, if they disapprove of us when we’re irritated, we will automatically try not to be irritated in order to avoid their disapproval. We develop a relational defense against irritation, in favor of other emotions that our attachment figures accept, such as sadness or disappointment. For those of us with both trauma and painful attachment histories, relational defenses can be complicated by autonomic dysregulation and bodily cues that signal danger. For example, if expressing irritation led to abuse in the past, your belief might be “It’s not safe to get irritated.” In contrast, if you were not traumatized but grew up in a family that did not accept angry feelings, your belief might be, “I won’t be accepted if I get angry” or “It’s better to be sad than angry.” Relational defenses override, alter, or mask the core emotions in different ways. When caregivers or other important people in our lives ignore or react negatively to our emotions, we then might dismiss signals of internal distress inside us and minimize our emotional needs. If we have implicitly lost hope that our emotions will elicit comfort and empathy, we may fail to communicate emotions or even to experience them. We might learn to “overregulate” our emotions, which eventually reduces our capacity to experience both positive and negative emotion. If we have learned to forfeit a rich, emotional inner life in favor of being accepted in our families, we may as adults pay the price by feeling emotionally impoverished and unable to connect with others on a deep core emotional level. Having lost access to the richness of our emotions, as well as to a broad range of different types of emotions, we may blame ourselves for feeling flat and unemotional, without awareness that these are relational defenses, beyond our conscious control. In contrast, our attachment figures may have been undependable and 745

unpredictable, their comfort obtained only intermittently when we showed distress intense enough to capture their attention. When we can elicit needed attention and comfort only through being upset, we might learn to underregulate our emotions. We might experience uncontrollably strong emotional states that keep us at the mercy of our emotional intensity. And we might be anxious about whether our feelings will be attended to or not. Extreme emotional states come to feel normal. Even if our attachment figures did not cause us to form habits of over- or underregulation of our emotions, no parent is perfect. They may provide adequate regulation and repair, but nevertheless particular emotional responses are commonly favored over others even in the best of families. As a result, children develop emotions in predictable ways that lead to emotional biases, inadvertently limiting their access to a wide range of emotions. For example, having grown up in a family that minimized vulnerable emotions of sadness, hurt, and disappointment, but welcomed assertion and even anger, Jim habitually interpreted any painful emotions as frustration and anger. He had learned to narrow his range of emotions in order to “fit into” a family that “never showed weakness.” His core emotions of sadness and grief remained unacknowledged and unresolved, expressed as frustration and anger instead. In contrast, Jim’s partner Leslie had an affinity for sadness, avoiding core emotions of anger or outrage—a tendency he developed in a family that favored the more vulnerable feelings over more aggressive or assertive ones. To maximize the availability of caregivers who paid attention to him when he was sad, but chided him when he was assertive or angry, Leslie had suppressed these feelings. When anger was called for, he became sad instead. As an adult, he had trouble being assertive and would often acquiesce to the wishes of others.

Emotional Biases and the Body Emotional biases are accompanied and sustained by procedural habits in the body that limit the range of emotions we experience. Jim tended to hold tension related to anger in a set jaw and pulled-back shoulders. Leslie’s rounded shoulders and the downward turn of his head reflected and sustained sadness. In couple therapy, both became aware of these emotional and physical patterns and learned about the ways in which they impacted their relationship. Jim discovered that Leslie felt consistently pushed away by his anger, rather than drawn closer to him, which is what Jim longed for. Leslie said that when Jim clenched his jaw, he knew to stay away. Leslie perceived Jim as becoming easily frustrated with his sadness and making decisions for both of them. He could not counter Jim’s decisions when he did not like them because the emotional bias of sadness and collapsed posture, and the associated limiting beliefs (“It’s not OK to assert myself” and “My opinions don’t count”) kept him from being assertive. 746

In couple therapy, they could observe the patterns with curiosity and empathy for each of them having done the best he could to fit into their families of origin. Both Jim and Leslie were able to express the grief and hurt they had felt as children whose emotions were not accepted. Having worked with a well-tested, often used repertoire of resources upon which to draw, both felt ready to touch in to the emotions they had avoided. Over time, Jim worked to change the physical patterns that reinforced being “tough” by softening his jaw and his chest, especially the area around his heart, to connect with the core feelings of tenderness and vulnerability he had pushed away. In therapy Jim was able to reclaim the vulnerable part of himself, which he saw as a small, sad boy alone in his room, listening to the loud, aggressive voices of his siblings, feeling like he did not fit in with his family and had nowhere to go. In one moving moment in therapy, Jim placed his hands gently on his chest and imagined holding that small boy that he had been, a wordless communication of his acceptance and understanding that symbolically gave the vulnerable child the tenderness he needed. Leslie worked with a specific sliver of memory. As a child, he had been given a new pair of coveted Converse sneakers for his birthday. It was time for school, and he didn’t want to wear his boots—he wanted to wear his brand-new sneakers. His mother yelled irritably, “Don’t be silly. It’s just a pair of shoes. Just put your boots on—we have to go.” As he mindfully noticed the effects of remembering this sliver, Leslie could feel a wave of anger coming up through his body, and tension his legs and arms and jaw. He wanted to yell back, “No!” As he felt the surge of anger, Leslie could feel a stronger pull to tears, and as his body collapsed, the anger diminished. Leslie started to cry, saying “I couldn’t say ‘no’, she would have gotten really mad. It would have just made things worse.” His therapist understood how painful this was for the 6-year-old Leslie who could not say ‘no’ and have his mother’s love at the same time. Her emphatic understanding of how Leslie had to sacrifice his own assertion for his mother’s love led to more sad tears mixed with relief at being understood the sliver of memory in which Leslie heard his mother’s words, “Don’t be silly,” and again he felt the tension in his body and the wave of anger, a core emotion he had pushed aside to win his mother’s acceptance. His therapist encouraged him to stay with the tension and the angry feelings. He felt an impulse at the back of his throat, his shoulders, chest, and jaw tensed, and the words that came up for him were: “I’m not silly! You can’t tell me what I want!” The waves of emotion were strong as he connected to the frustration, anger, and then the grief of being that little boy who had to trade expressing his anger for connection to his mother. But this sadness felt different to Leslie. Instead of the defeated sadness of giving up his authentic emotions, opinions, needs, and desires, this crying felt like the grief of a boy who for so many years had kept his anger at bay in exchange for affection. But it was an empowering feeling for Leslie to finally express his anger and reclaim his self-assertion. 747

To reclaim the variety of core emotions that have been previously inaccessible because of our childhood relational defenses, we will need the support of a trusted other person. We also need a wide-enough window of tolerance and a repertoire of resources that keep our emotional feet on the ground. When we can access early attachment experiences through the body, we can often express the intense distress that we needed help with as children. Doing so helps us reclaim the core emotions that we had pushed aside. Since our patterned emotions developed in our early relationships, they can be transformed, rather than simply vented, in the context of an empathic relationship. This transformation is supported by dual awareness, when we experience ourselves here in present time as resourced adults and ourselves in past time in the state we were in as young children seeking emotional safety and acceptance. Within an attuned relationship, within which both people can attend to the hurt, wounded self, we can appropriately reexperience the old pain and emotions that we could not express then. Through this process, we learn to embody the physical expressions, postures, and movements that help us to feel and express a fuller range and richness of emotions. The worksheets that follow will help you explore the interface between your emotions and your body—and familiar and unfamiliar emotions—and perhaps re-experience the old pain with your therapist, and discover resources to interrupt cycles of negative, emotions, beliefs and procedural tendencies.

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Making Sense of Emotions EMOTIONS, EXPRESSIONS, & THE B ODY Purpose: To explore how you experience different emotions in your body. Directions: In a standing position, use each facial expression as a prompt to embody the emotion it represents. Then answer the following questions in the space provided for each emotion. • Describe how your body responds to imitating these expressions. (e.g., Your shoulders slump, your back stiffens, your knees lock, your buttocks tighten, or your chin lifts; maybe you feel a sense of lightness, tension, collapse, or a heavy feeling; you take a breath or hold your breath.) • Describe the thoughts or memories that emerge as you embody each emotion. Joy

Disgust

Fear

Sadness

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Surprise

Shame

Anger

Describe the emotions and postures that felt the most familiar. Describe the emotions and postures that felt the least familiar.

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Making Sense of Emotions F AMILIAR AND UNFAMILIAR EMOTIONS Purpose: To further identify familiar and unfamiliar emotions, reflect on how you learned to keep certain emotions at bay and freely express others, and explore how altering your body posture and movement might support experiencing unfamiliar emotions. Directions: Look over the emotions listed below. Circle those that are familiar to you and that you experience often. Underline those that are unfamiliar to you and that you do not experience often. Write in other emotions that you think of in the last row. Then follow the prompts below. afraid

contrary

downhearted grateful

indignant

loving

alarmed

crabby

embarrassed grieved

inspired

miserable

amazed

crestfallen

empathic

grim

infuriated

morose

angry

dejected

enraged

happy

intimidated mortified

annoyed

delighted

enthralled

hateful

irate

nervous

anxious

depressed

exhilarated

helpless

irritated

outraged

ashamed

despairing

fearful

hopeless

jovial

panicky

bitter

devastated

frightened

horrified

joyful

passionate

cheerful

disappointed furious

hostile

jubilant

pitiful

compassionate disgraced

glad

humiliated loathing

remorseful

cherished

disgusted

gleeful

humble

revolted

confused

distressed

1. List three emotions that are most familiar to you.

lonely

2. List three emotions that are most unfamiliar to you.

3. How does your body reflect or express each familiar emotion? (e.g., Cheerful: deep breath, open heart, aligned spine, smile; Dejected: rounded shoulders, head 753

down, tight chest, lower lip protrudes, knees turn inward.) 4. How does your body hold back each unfamiliar emotion? Do negative beliefs participate in suppressing them? (e.g., Hold back anger by not breathing, tightening my jaw, purse my lips, pull back. Beliefs: “Anger is not OK. Keep it to yourself.”) 5. Describe the relationship between the emotions you find familiar or unfamiliar and your family dynamics when you were a child (e.g., note if these emotions were accepted or common in your family, if and how a family member expressed them, or if you were chided for some emotions). 6. Choose one of the unfamiliar emotions that you want to experience more and imagine that it is acceptable to others. Describe what changes in your posture, sensation, or movement. (e.g., If anger were acceptable, I could express it and I wouldn’t have so much tension in my jaw, and I wouldn’t pull away from my husband when I’m mad.)

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Making Sense of Emotions EMOTIONS & EARLY ATTACHMENT Purpose: To identify the high and low arousal emotions that were common or accepted in your family, and those that were uncommon or were not accepted, and explore how these affect your body and how you relate to and express your emotions today. Directions: Follow the prompts below to explore high and low arousal emotions. You may experience some of these emotions with the opposite level of arousal (e.g., grief may be a low arousal emotions for you). If so, write them in the empty space in each list. 1. Circle those emotions that were familiar, common or accepted in your family when you were a child. Usually High Arousal Emotions Anger

Exasperation

Hostility

Anxiety

Fear

Outrage

Distress

Frustration

Worry

Embarrassment

Grief

2. Describe how the emotions you circled were expressed in your family. Were they expressed openly, indirectly, in a dysregulated manner, or were they hidden or held in? 3. Choose two high arousal emotions that you circled and describe how you experience each one in your body and how you express them when they come up. 4. Circle those emotions that were common or accepted in your family. Usually Low-Arousal Emotions Boredom

Disappointment

Melancholy

“Bummed out”

Discouragement

Sadness

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Defeat

Helplessness

Depression

Hopelessness

Shame

5. Describe how the emotions you circled were expressed in your family. Were they expressed openly, indirectly, in a dysregulated manner, or were they hidden or held in? 6. Choose two low arousal emotions that you circled and describe how you experience each one in your body and how you express them when they come up. 7. How could you draw on your body to relate to any of your high arousal or low arousal emotions differently? (e.g., Find an action to show compassion to the part of myself that is depressed instead of beating myself up for being depressed; find an action to resource it; reach out to someone I trust for support.) Note: If you circled any of these emotions, indicating that they become dysregulated for you, discuss with your therapist resources you might use to regulate them.

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Making Sense of Emotions EMOTIONS, B ELIEFS, & THE B ODY Purpose: To describe a negative feedback loop of emotions, thoughts, movements, and sensations that intensify your negative emotions, and to identify a resource to interrupt this loop. Directions: Study the example below. Then identify an emotion you experience that leads to a feedback loop. Write the initial emotion in the small white circle. Fill out the rest of the circles with the thoughts (light gray), sensations and movements (dark gray) and emotions (white) to describe your feedback loop. For example, a loop might go like this: “Lonely” is the initial emotion,

I feel lonely.

which leads to a belief,

I will never have a partner.

which causes a body movement. My posture starts to collapse. The body movement and belief intensify the original emotion,

I feel lonelier and sadder.

which intensifies the belief

I’ll always be alone; my future is dim.

and further affects the body’s movement.

My body sags more, and my head droops.

The emotions intensify more,

I feel lonely, sad, disappointed, hopeless.

the beliefs become even more negative,

No one in the world will ever be there for me; there must be something wrong with me.

and the movement develops, leading to isolation.

I want to curl up in a ball and hide from the world.

I feel: Last, describe one resource you could implement to interrupt the negative feedback loop you illustrated on the left.

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Making Sense of Emotions EMBODYING AN UNFAMILIAR EMOTION Purpose: To select an emotion that you avoid, push away, detach from, or that is unfamiliar to you, and to explore a sliver of memory in which that emotion was not welcomed. Directions: With the guidance of your therapist, reflect on what you have learned from previous worksheets on familiar and unfamiliar emotions. Identify a painful emotion that was not accepted or welcomed when you were a child. Then follow the prompts below. 1. The unfamiliar emotion I want to embody is: (e.g., sadness) 2. Describe what emotion(s) you tend to experience instead that is more familiar to you (e.g., rather than allow myself to feel sad and vulnerable, I get angry). 3. Think back to your childhood and identify three situations with an attachment figure in which the emotion you want to reclaim was not accepted. 1. 2. 3. 4. Choose a sliver from one of the memories in #3 to explore. Describe the sliver here and what happened that told you that emotion was not accepted (e.g., the look on my parent’s face, being ignored, what was said, the tone of voice, being sent to my room or punished). 5. Take your time to embody the state you were in when this sliver of memory occurred and describe: Your emotions (e.g., I feel sad but try not to). What happens in your body (e.g., lightness; shallow breathing; my heart feels closed; an impulse to pull away from others that goes with sadness). Your thoughts (e.g., I can’t be sad. I must be strong). 761

6. Identify any physical patterns that prevent you from feeling the emotion (e.g., tension in my shoulders, my heart feels hard, do not exhale fully) and explore inhibiting them to embody that unfamiliar emotion. Describe your experience. 7. Identify anything you need to know in order to experience the unfamiliar emotion (e.g., I need to know it’s OK to feel sad; my therapist will not pull away if I get sad; I won’t be rejected). Mindfully say those words aloud or silently a few times and describe what happens. (e.g., When I say those words inside, the part of me that could not show sadness is skeptical but relaxes slightly. I take a deep breath and feel an impulse to talk about what makes me so sad.) 8. Discuss with your therapist how you might challenge any beliefs that keep the unfamiliar emotion at bay and determine a somatic resource you could use to help you reclaim that emotion.

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CHAPTER 31

Moving through the World How We Walk THERAPISTS’ GUIDE TO CHAPTER 31

Purpose of this Chapter Many of us take walking for granted, but the bipedal walk is a complex function shaped not only by anatomy but by development and psychological context. Most clinicians rarely consider clients’ walking styles as targets of therapeutic intervention, yet gait can be extremely powerful for many clients to explore. Habits of walking, like all movement habits, offer an inroad to the difficulties that bring clients to therapy, and changing one’s pattern of walking challenges the beliefs that influenced how the pattern developed. The goal of this chapter is to heighten clients’ awareness of how habitual patterns of walking reflect personal history and can unconsciously reinforce trauma-related dysregulation, attachment-related beliefs and habitual emotions. Helping clients to track their way of walking and become aware of the relationship between their gait, their history, and how their style of walking might be one of the procedural patterns that keeps them from moving beyond their past creates a whole new level of awareness. From this awareness, experimenting with slight changes in walking, from lifting the head, to swinging the arms, to aligning the posture, can significantly support therapeutic goals.

Clients Who Might Benefit Both trauma and attachment affect gait, so this chapter can benefit all clients. Clients whose way of walking is not integrated biomechanically—the head is down, the feet come down hard, the spine is not aligned, the arms do not swing, the feet point out or in, the gait is awkward, jerky, heavy, or too light—can learn how these patterns might reflect and sustain attachment-related limiting beliefs and 763

emotions. Traumatized clients may notice that their dysregulated arousal or animal defensive responses automatically affects their way of walking. They might benefit first from exploring gait in a way that brings arousal into the window of tolerance and quiets the defenses and then for its correlation to beliefs.

Suggestions for Clinical Use If you are unaccustomed to incorporating gait into the therapy hour, it will be to your advantage to increase your own comfort level so that you communicate ease in exploring ways of walking as a treatment intervention. You might begin by reviewing the patterns of walking that are described in the chapter and think about which ones fit your clients. Consider what a particular client’s way of walking communicates and how it reflects core beliefs and attachment or trauma history. You can educate yourself by observing various walking styles in a public place and imitating them yourself. When you have achieved a level of ease with the material, explored your own walking pattern through completing the worksheets, and have become aware of vaious walking styles, you will be more successful in introducing the chapter to clients. If your office is small and restricts options for movement, you may want to plan in advance where you can walk with your clients, perhaps walking in a hallway, lobby, or another space where there is room to walk indoors, or perhaps walking outdoors. The material will be most beneficial if there is opportunity to take even a few steps together rather than just learning the information cognitively and through the worksheets assignments. Alternatively, or in addition, you might also ask clients to imagine waking in a way that feels good to them and report to you what kind of walk they visualize, keeping in mind the concept of mirror neurons and how visualizing images of walking in a new way can serve as practice. Clients often reference gait without awareness that they are doing so by using expressions such as “wanting to move forward” in their lives, “walking on eggshells,” feeling “down at the heel,” “treading on thin ice,” or “walking on air.” Sometimes these movement references are metaphors for something other than walking. Often they describe an observable pattern of gait that provides an inroad to introduce this material. When these phrases emerge in therapy, you have an opportunity to prompt clients to practice directed mindfulness: “Let’s pause for a moment and notice those words, ‘I want to move forward, but I can’t.’” You might suggest, “I wonder if we should explore that more? What if we both stand up and then you can try to take a step forward and see what happens?” Even a few steps is enough to tell you and your clients a great deal about how their movement patterns relate to their complaints. Your clients may quickly realize that their gait is connected to beliefs and emotions that they have explored in previous chapters. 764

Personal styles of walking have developed over many years of repetitive movement, sometimes for hours a day. They usually feel “normal” to the client. Experimenting with changing the pattern can feel awkward, strange, uncomfortable, “wrong,” and even frightening. As Franklin (1996) points out, “Unless you ‘evolve’ into new movements very slowly, change sends an alarm through the body” (p. 43). It is best to proceed gradually, with one slight intervention at a time. Even experimenting with small modifications of the normal walking pattern, such as pushing off with the toes of the feet, or lifting the chin slightly instead of looking at the ground, can make a profound difference for your clients. To slowly help them learn new ways of walking, you might decide to explore gait as an ongoing part of therapy, rather than in only a few sessions.

Introduction to the Worksheets The first worksheet, WHAT A WALK CONVEYS, is a nonthreatening way to begin because it asks clients to describe what they see in pictures of people walking in various ways. It can provide an engaging structure to explore together in session what different walking styles might convey. You might each imitate each person’s style of walking depicted on the worksheet and learn together about the style through experience. DIFFERENT WAYS OF WALKING is not about improving how we walk but rather comparing the impact of different ways of moving on mood and beliefs. You can encourage clients to take a playful or curious approach to the worksheet. It can also provide an enjoyable and illuminating way to explore walking styles together if you complete the worksheet in session. YOUR WALKING STYLE asks clients to practice discovering their own gait by noticing the fine details of their movements and body responses while they walk. Clients can benefit from your asking the questions on the worksheet while they are walking so that they can be mindful of their body. WALKING WITH SOMEONE SIGNIFICANT (Ron Kurtz, personal communications, 1976) provides an opportunity for clients to imaginatively study how attachment relationships impact their style of walking and possibly make connections between their early attachments and how they carry themselves today. MODIFYING YOUR WALK asks clients to experiment with changing their walk and should be introduced in a way that evokes interest rather than self-consciousness. This worksheet will help clients notice their walk, identify ways of altering elements of it, and choose one small modification to practice. If you can go for a walk with your clients, they can practice their new way of walking, and you can help them become aware of how the new walk affects them. You might instruct them to return to the old way of walking for a moment to sense the difference. PRACTICE WALKING MINDFULLY integrates orienting to the environment with mindfulness. If your 765

client wishes, he or she can practice chosen elements from the previous worksheet, staying aware of their body’s movements and sensations and of their surroundings.

Adapting this Material for Dissociative Clients On the one hand, exploring ways of walking can be an excellent avenue for regulating autonomic arousal and increasing connection to the body and to oneself. Feeling each foot touch the ground, feeling connected to the spine as well as to the extremities, experiencing increased control over or integration of the movements of walking are valuable interventions for this subgroup of clients. Hypoaroused clients especially can benefit from this material because physical movement can often spontaneously bring their arousal into the window of tolerance. On the other hand, this material can also be challenging or triggering for various parts of the client, especially for parts with a chronic tendency to freeze, shut down, or inhibit movement or who might be frightened of exploring their gait. You may want to take advantage of the probability that clients’ capacity to participate in exploring ways of walking may be at its highest when they first walk into the office, because they are still on their feet. Experimenting with walking may become more difficult after clients are seated, or as they begin to address their problems, can activate immobility responses. You might suggest that they tell you about their week while the two of you go for a walk or walk around the room together. From there, you can gently explore the different ways of walking suggested on the worksheets, or implement one small change in the way that they walk, discover how it affects various parts, and assess if it supports stabilization and integration. An opportunity to use this material might present itself from a feeling, body impulse, or trigger that arises in the session and is related to a particular dissociative part of the client. For example, if the client says, “I feel trapped—I want to get out of here,” you might bring the client’s attention to the body impulses by saying, “Notice how your body is telling you it wants to get out—how does it want to move?” If the client is aware of a part that wants to run, you can facilitate communication between the adult part of the client and this part, while simultaneously working with the physical experience. Usually clients will feel the impulses in their legs, which provides the opportunity to follow those impulses by both of you getting up and walking away together. You can remind the client that “You can indeed now get up and walk away. It’s important for all parts to notice that.” It is often valuable for some parts of the client to sense how their legs can now carry them away from situations or people, because during the trauma, that was not possible. Parts that have become immobilized or shut down can be included in these 766

exercises, so that they also can sense this capacity. When the client says, “I want to get up and go,” you can respond “Maybe you can check to see if all parts are listening and watching? Then let’s see what happens if you slow the impulse but keep following it—slowly rising, getting on your feet, taking a step or two forward. Notice how that feels . . . and how does the part that wants to run experience it? How about the part of you that is shut down?” It is essential, as always, for you to do the movement with your clients rather than only observe their movement, and to have as many parts of the client as possible participating actively or by “observing.” Because movement patterns tend to be evoked by triggers, it may be difficult to collaborate with clients to mindfully notice their walking patterns and experiment with new ones. But you can begin by simply walking together, helping all parts sense their capacity to walk away and walk toward, and over time discover how to intervene with walking in a way that supports the integration of parts.

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CHAPTER 31 Moving through the World—How We Walk The way we walk speaks volumes about who we are and how we feel. Whether we shuffle, stride, saunter, glide, traipse, or trudge with heavy footsteps, we are telling the world how we feel today, how we feel about ourselves and what we expect from others. We may plod along, dragging our feet behind us as if we have very little energy, giving the impression that we are tired or depressed. We may walk with a hurried, rushed gait, leaning forward, eyes focused straight ahead, giving the impression that we are preoccupied, busy, harried, and have no time to spare. If we feel afraid to be seen, we may walk cautiously and hesitantly; if we feel uncertain, we may slouch and shuffle with our eyes cast downward. We may stomp our feet with every step if we feel angry or bounce with a spring in our step if we feel joyful. Our gait changes with our mood, but our characteristic style of walking, like all our physical habits, is formed over time from a variety of influences. This chapter explores walking habits and styles, how we learned them, and what different ways of walking convey. It will also help you learn about the various components of your own gait and explore changing one or two of them to support new, less limiting beliefs and attitudes.

Walking Habits Walking is influenced by the strength and flexibility of the spine and surrounding muscles, which provide an axis around which we literally move through the world (cf. Chapter 17, “Core Alignment: Working with Posture”). When we are small, our legs develop through crawling, standing, and eventually walking and running. Our core, the spine, supports the movement of our legs through space and absorbing the shock of each footstep. We form patterns of walking as we imitate how our parents move, so if they walked proudly with heads up and shoulders down and back, with a gentle sway in the hips, we might follow suit, most likely giving an impression of someone who is confident, happy, and at peace with him- or herself. If our parents walked tentatively, as if on eggshells, we are likely to have imitated that way of walking, perhaps conveying the impression that we are unsure, timid, or lack confidence. Our emotional and psychological experience also shapes the way we walk. If we have limiting beliefs such as “I don’t deserve to be treated well,” “I have no 769

value,” or “I am incompetent,” our shoulders might slump in a posture of defeat, sadness, or fear. We may take small hesitant steps, heads down, with little swing in our arms. If we grew up without sufficient nourishment, whether it be food, affection, or attention, the way we walk—perhaps with arms hanging limply, spine collapsed, gait slow, with little energy—might go along with a belief that there’s no use in trying to get what we need. If our families expected us to be strong, avoid vulnerability, and be prepared for confrontation and fight back, we might walk with chests out, shoulders back, and a tough-guy, challenging swagger to our gait. If we grew up in a family where the members were supportive of one another and generally happy, we may bop along with a spring in our step, making eye contact with those passing, giving the impression that we trust that good things will come our way and that others will treat us well. Past trauma and dysregulated arousal can also affect the way we walk. Hyperarousal can result in gait patterns that are jerky, rigid, agitated, or too rapid to allow focus. Hypoarousal affects gait in almost the opposite way, usually resulting in slow, mechanical, numb, and disconnected movements. Lisa, a survivor of child abuse from a series of foster parents, had been unable to escape from danger and often felt trapped and incapable of leaving situations that were triggering or abusive. She walked stiffly and robotically, with little movement through her spine or arms. She reported that she often felt spacey and foggy and could not feel her legs. In therapy Lisa learned to walk with mindful attention to the sensations of movement through her feet, legs, pelvis, and spine, relaxing her neck and allowing a little swing to her arms. As she noticed her feet coming into contact with the ground and how with each step, her legs propelled her forward, she experienced the felt sense that she could walk away from situations and people when she wanted to. Lisa felt less spacey, more empowered and present in the here and now. The experience of her ability to move through space was something that Lisa returned to again and again because it mitigated the physical feeling of being frozen and trapped and helped her sense an effective “flight” defense. The way we walk not only reflects past trauma, chronic beliefs, and characteristic emotional biases but also our mood moment to moment. Our gait changes depending on how we feel, the environment, and who we are with. If we are with someone with whom we feel good and who treats us well, our gait may become more confident, arms swinging, posture more aligned, and head lifted. If we are walking with someone with whom we feel inferior or who treats us badly, we may walk with heavier footsteps, tense shoulders that prevent a free swing in the arms, head down to avoid orienting to the person. If we want to attract the attention of our husband or wife, or of a potential sexual partner, we may walk with more movement in our bodies and swing to our hips, increasing eye contact and sending a flirtatious “look at me” message. 770

Attuning to Your Walk We rarely notice how we walk, but when we do, we may be surprised. Alejandro often felt stuck and a little depressed, in spite of having realized his dream of earning U.S. citizenship along with many other accomplishments. With his therapist’s help, Alejandro was surprised to discover that his walking style reinforced the beliefs of his childhood. He walked slowly, with long strides, his arms hanging lifelessly by his sides. The back edges of his heels struck the ground hard with each step. As his therapist encouraged him to be mindful, he noticed a reverberating wave of force moving through his legs, pelvis, and into his spine every time his heel hit the ground. Each heavy step seemed to compress his spine, causing a slightly painful sensation in his lower back that, to Alejandro, went along with a feeling of hopelessness. Alejandro’s walking pattern accompanied the “all work and no play,” “life is hard” attitudes that he had embodied as a boy in his struggling, hardworking immigrant family that often suffered discrimination and, being undocumented, lived in fear of being sent back to Mexico. Alejandro’s life had changed, but his walk did not reflect the job he loved or the relaxed, happy home life full of the laughter of his two young children and jovial wife who always looked on the bright side.

Physical Elements of Walking Your walking style can be thought of as your posture in motion, and good walking starts with good posture (see Chapter 17, “Core Alignment: Working with Posture”). We may enjoy a walking posture that is aligned, oriented to our surroundings, in contact with the people and things that cross our path as we move through the world. Or we may have a collapsed or rigid spine, or lead with our heads, chest, or pelvis. The way our feet strike the ground is significant, impacting our legs, pelvis, and spine and even potentially causing physical pain. We may fail to land squarely on the flat of our heels but land hard on the edge. This interferes with shock absorption by the discs that separate each vertebrae of the spine and act like cushions, absorbing the shock each time our feet contact the ground. We may fail to roll from heel to toe, or to push off with our toes, losing the opportunity to propel ourselves forward by this simple action. We might take short, mincing steps that seem too small for our height, feet landing flat on the ground. Or we may have a stride too long for our height so that it looks and feels awkward, and causes us to land hard on the edge of our heels. Our gaze while walking may be oriented downward, which might communicate the compliant or withdrawn attitude of someone who does not feel empowered. Or, it could reflect being preoccupied or 771

unwilling to engage with others. We may focus several feet in front of us, or look around to take in our surroundings as we walk. Our feet may be turned out or in, rather than pointed forward. Our arms may be stiff and straight, hang limply at our sides, or swing vigorously side to side instead of forward and back in rhythm with each step. We can mindfully explore any of these elements of walking to discover their meaning. Since walking is a repetitive activity—the average person takes several thousand steps per day—one seemingly minor walking error can have a strong effect because it is repeated thousands of times per day. This can cause wear and tear on the muscles and joints, and eventually even pain, along with reinforcing the attitudes and self-concepts our style of walking might reflect.

Experimenting with Walking Alejandro’s parents had been too busy and too worried to notice his fears and feelings when he was growing up. He had learned to hunker down, not make waves, and do everything he could to alleviate his parents’ stress. In therapy, when Alejandro exaggerated his walking style slightly, he saw an image of himself at nine years old feeling ashamed and guilty after a bike accident. He had cut himself badly, but did not tell his parents for fear of adding to their troubles. When the cut became infected, his parents had to pay for medical care with money they did not have. Alejandro worked with a particular sliver of memory—an image of himself leaving the hospital, walking with his head down, “hating himself” for costing his parents money. As he saw this image in therapy, he felt sad for the boy he had been who believed that he was a burden and did not deserve good things. Alejandro cried in grief for having missed out on a joyful, lighthearted childhood due to his family’s hardships. Realizing that the way he walked only added to his depression and old belief about being a burden, Alejandro wanted to explore changing his walk to reflect his happy life in his adopted country. With his therapist’s help, he practiced aligning his posture, tightening his TVA muscle a little (cf Chapter 17, “Core Alignment: Working with Posture”), and unlocking his knees. He stepped forward with shorter strides to support landing on the heel of his foot rather than the edge, rolling forward onto the ball of his foot, and propelling himself forward by pushing off with his toes. He learned to swing his arms naturally in counterbalance to his leg motions, which added power and energy to his walk. Alejandro found that, with these changes, his depression lifted a little, and he felt more deserving and less like a burden. Alejandro said his new walk made him feel like he was living in present time with his current happy family instead of being stuck in the struggles of the past. Changing the way he walked helped him to move through the world with more 772

lightness and joy. Robert had come to therapy because he felt isolated, wanted to make more friends, and find a girlfriend. With his therapist walking alongside him, they noticed together the ways in which Robert’s walk reflected and sustained what he has learned growing up—mainly, to keep to himself, not get involved in other people’s business, and stay focused on the task in front of him. His shoulders hiked up, and he walked very quickly with his head forward of his body, looking down at the ground in front of him, with his arms slightly swinging but only from the elbows down. Realizing that his hurried, tense, walk did not support his goals for himself, Robert decided he wanted to practice a new way of walking. First he lengthened his spine and relaxed his shoulders, which allowed his arms to gently swing from his shoulders, bent slightly at the elbow. He paid attention to slowing down his speed, striking the ground gently and squarely with his heel, then sensing the pressure on the sole of his front foot as he rolled toward the ball, pushing off with his toes. He immediately noticed that he felt grounded but lighter, physically and emotionally. With his head lifted up and his chin parallel to the ground, he was more aware of his environment and the people in it. These changes, practiced over several months, challenged the old beliefs that were embodied in his walking style. With mindful attention Robert was gradually able to alter the way he walked so that his ability to orient to his surroundings and engage with others was enhanced as he moved through the world. When we walk, many parts of our body work together to produce our particular style—the arm swing, head carriage, movement in the shoulder girdle, pelvis, and through the joints; how we place our feet, how we push off with the balls of our feet, the resiliency of our spine. Together these body parts interact to create a distinctive pattern that might be recognized from a distance as a personal signature long before our features are visible. Unless there is an organic cause, our unique walking patterns reflect our histories, beliefs, and emotional biases. Because we take a few thousand steps per foot per day, we have many opportunities to either strengthen that pattern or to become aware of it and change it to support new ways of being. Like Lisa, Alejandro, and Robert, you can try out new ways of walking to help you change outdated psychological patterns that are reflected and sustained by your old way of moving through the world. The worksheets that follow will help you explore different styles of walking, discover your own style, and experiment with ways of modifying your sway of walking so that you can move through the world in a manner that supports your goals.

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Moving Through the World WHAT A WALK CONVEYS Purpose: To explore different ways of walking, analyze what meaning each walking style might convey to others, identify the emotions and beliefs it might reflect, and discover which style is most similar to your own walk and which one is most different. Directions: Study the pictures below of different styles of walking. Next to each style, answer the following prompts. • Describe how you think each person feels. • Describe what you think each walk conveys to others about the person. • Describe what you think might be difficult for each person (e.g., feeling vulnerable, happy, or angry, being assertive, having close relationships, playing with kids, being successful at work). • Circle the walk that is most familiar to you and make an “X” next to the one that is least familiar.

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Moving Through the World DIFFERENT WAYS OF WALKING Purpose: To try out and contrast different ways of walking, discover how each one feels physically and identify which way of walking is most like your own. Directions: First, read through each way of walking below. Make a preliminary check mark next to the way or ways of walking that you think would be familiar to you. Then try out each way of walking, noticing what each feels like physically and emotionally. Pause after you try out each way of walking to answer the prompts below. Then answer the questions at the end. Heavy

Bouncy

1. Walk in a plodding way, landing heavily on each foot, letting the weight of your body sink into the ground with each step.

2. Walk lightly, with a swing to your arms and a bounce in your step, as if you had springs in your shoes.

How does this walk feel in your body?

How does this walk feel in your body?

How does this walk feel in your body?

What does this walk feel like emotionally?

What does this walk feel like emotionally?

What does this walk feel like emotionally?

How do you feel about yourself when walking this way?

How do you feel about yourself when walking this way?

How do you feel about yourself when walking this way?

What belief might this walk convey about you?

What belief might this walk convey about you?

What belief might this walk convey about you?

How might other people respond to you?

How might other people respond to you?

How might other people respond to you?

Head Forward 4. Walk with your head thrust forward, leading

Rigid 3. Walk in a rigid way, with your shoulders back, your chest out, your back straight and tense, your abdomen pulled in, and your chin up.

Slumped 5. Walk with your spine slumped and collapsed, head 778

Swagger 6. Walk with a swagger, taking long

with your head in front of your body.

down, arms hanging limp, looking at the ground.

strides, swinging your shoulders and arms.

How does this walk feel in your body?

How does this walk feel in your body?

How does this walk feel in your body?

What does this walk feel like emotionally?

What does this walk feel like emotionally?

What does this walk feel like emotionally?

How do you feel about yourself when walking this way?

How do you feel about yourself when walking this way?

How do you feel about yourself when walking this way?

What belief might this walk convey about you?

What belief might this walk convey about you?

What belief might this walk convey about you?

How might other people respond to you?

How might other people respond to you?

How might other people respond to you?

7. Was your initial assessment accurate of which way or ways of walking were familiar? Which walk was most familiar? 8. Identify one physical element of the walking style that was most familiar to you that you would like to change (e.g., walking with my head down felt familiar, and I want to practice walking with my head up, looking around).

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Moving Through the World YOUR WALKING STYLE Purpose: To explore various components of your walking style, and speculate what your walking style might convey about you. Directions: Study the prompts below. Then go for a walk in a location with minimal distractions where you can focus on your walking style. Record what you notice about the way you walk below. If you don’t know the answer to a question, take another short walk to pay attention to that question and discover the answer.

How do your feet come into contact with the ground? Do you come down hard on your heels? Or on the flat of your heel? Is your weight more on the inside or outside of your feet? Notice joints in your feet, ankles, knees, hips, spine, shoulders, elbows and hands. Are your joints tight, or do they feel relaxed and loose? Do you roll from your heel to your toe with each step, pushing off with your toes? Describe the quality of your walk; hesitant, cautious, energetic, purposeful, or some other quality? Do you swing your arms a little, a lot, or not at all? Do you swing them from your shoulders or your elbows? Are your elbows bent of straight? Does one arm swing more than the other? 781

Is your body slumped over, rigid, leaning forward, or leaning backward? What is the rhythm of your walk? Fast, slow, staccato, flowing, disjointed? Can you tell which part of your body you lead with-your head, feet, chest, or pelvis? What is the position of your head—are you looking down at the ground, or several feet in front of you? Are you leading with your head? Are you looking around? What emotions are expressed by your walking style? What might your walking style convey about you? (e.g., My style expresses depression and grief about my past. It tells people that I am not a happy person.) What belief or beliefs might be conveyed by your walking style?

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Moving Through the World WALKING WITH SOMEONE SIGNIFICANT Purpose: To explore how your way of walking naturally changes when imagining walking with a person who is, or has been, important to you. Directions: Think of three people that are, or have been, significant in your life— they could be one or both of your parents, your partner, your child, a close friend, a teacher, or mentor. Write their names in the spaces below, then follow the prompts.

1. Select one of the people above and describe your relationship with him or her. 2. Imagine that the person you selected will join you for a walk. Review the prompts below, then go for a walk. Fill out the prompts after your walk. If you are unsure of the answer to a prompt, take another short walk to discover the answer. 3. As you begin your walk, take note of how you are walking. Then visualize this important person joining you. Take your time to imagine that her or she is walking beside you, on your right side or left. 4. Describe the first thing you notice about how your walk changes when you imagine that this person is walking beside you. 5. Circle below what else changes in your walk when you imagine the person beside you, writing down any additional changes you notice in the blank spaces. Walk faster

Walk slower

Spine slumps

Head tilts

Spine is rigid Look down

Spine lengthens

Swing arms less Eyes look up

Longer stride Shorter stride Shoulders sag Head lifts up Head down

Walk heavier Walk lighter

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Chest puffs up

Look at ground

Chin lifts up

6. How do your emotions change when you imagine this person walking beside you? Do you feel more joyful and happy, or disappointed, inadequate, on edge or nervous? How are your emotions reflected in your walk? 7. What thoughts or beliefs do you seem to have about yourself when you imagine this person walking with you? 8. What do the changes in your walk seem to tell you about this relationship and how this person has influenced you? 9. Think about how this person walking beside you affected your walk. How might what you learned influence the way you walk? (e.g., When I imagined my son walking with me, my walk became freer, my arms were swinging, and I walked lighter, and I want to practice these elements; When I imagined walking with my critical father, my head came down, and my body pulled inward. I want to try to do the opposite—lift my head, and relax!)

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Moving Through the World MODIFYING YOUR WALK Purpose: To explore elements of your walking style and experiment with modifying each element. Directions: Walk for a few minutes in your natural way, paying attention, one at a time, to the elements of walking listed in the first column. Then fill out the horizontal row of prompts pertaining to that element. Elements of a walking style

What do you notice about this element of your natural walking?

Exaggerate this element slightly. Describe the effect on your thoughts, emotions, and body.

Walk again, experimenting with the instructions below, making very small changes rather than big ones.

How your feet engage and land on the ground

• Relax the muscles of your feet and toes. • Point feet and knees forward. • Land on the flat of your heel rather than the edge. • Feel a rocking motion from your heel to toe. Think “heel to toe.” • Push off with your toes.

Speed and length of stride

• Make sure your stride is short enough so that you can easily land on the flat of your heel. • Slow down rapid walking. 787

Describe the effect of making these small changes on your thoughts, emotions, and body.

• Speed up slow walking by taking more strides, not longer strides. Posture

• Relax shoulders back and down. • Align neck with shoulders (not reaching forward or retracted). • Raise or lower your chin so that it is parallel with the ground. • Look ahead and around you rather than down. • Lengthen your spine and walk tall. • Hug your naval to your spine, engaging your TVA muscle. • Gently push up with your head and down with your feet as you walk.

Tension patterns

• Slowly scan your body from your feet to your head, noticing any tense areas, and relax them. • Relax the joints in your feet, ankles, knees, hips, spine, shoulders, arms and hands • Let your head gently lengthen upward. • Pay attention to your 788

breath and relax with each exhale. Arm swing

• Swing your arms freely from your shoulders. • Let your hands be loose. • Let the arm opposite your forward foot swing forward in rhythm with your walk. • Allow your arms to swing directly forward and back rather than cross the center line of your body when they swing.

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Moving Through the World P RACTICE WALKING MINDFULLY Purpose: To practice orienting toward your surroundings while simultaneously being mindful of your body, putting aside the thoughts or emotions that distract you. Directions: First, read through the “Guidelines for Mindful Walking” below, and then take a walk where you can be relatively undisturbed. When you return from your walk, answer the numbered prompts. Guidelines for Mindful Walking • As you walk, focus first on your body sensation and movement: how your feet land on the ground, the sensation and movement through your joints, the swing of your arms, or your breath. • Stay mindful of your body, but also orient toward and take note of your surrounding—the sights, smells and sounds, the feel of the air and the temperature on your body. • Notice any internal experiences that distract you, especially thoughts and emotions. Name them to yourself (e.g., “I’m having the thought right now that I should be working”), and return your focus to both your body and your surroundings. • Identify any external distractions that draw your attention away from your body, name them, and return your focus to both your body and your surroundings. 1. After mindful walking, describe what you sense in your body and how you feel. 2. During your walk, what sights, sounds, smells did you notice? Did you notice the wind, or the temperature? 3. During your walk, what did you notice about your movement and sensation? 4. Were you able to stay aware of both your body and your surroundings at the same time? 5. What thoughts, emotions, physical elements, or external distractions drew your attention away from mindful walking? 6. How and when might you use mindful walking as a resource in the future? 791

CHAPTER 32

Boundary Styles in Relationships THERAPISTS’ GUIDE TO CHAPTER 32

Purpose of this Chapter Helping clients to understand and develop adaptive relational boundaries is an essential focus in treatment (Boon, Steele, & van der Hart, 2011; Kepner, 1987, 1995; Levine, 2004; Levine & Frederick, 1997; Ogden et al., 2006; Rosenberg et al., 1989; Rothschild, 2000; Scaer, 2001/2012), especially in Phase 3 therapy. Attachment trauma is inherently a relational boundary violation, leaving clients with the felt sense of having little or no protection and a heightened vulnerability to future violations from others. Even in the absence of trauma, clients are likely to have developed implicit patterns of setting boundaries in childhood that contribute to problems in their current relationships. Clients come to therapy presenting with relationship difficulties that often reflect either a failure to set relational boundaries, a propensity to set boundaries that are too rigid, or a vacillation between too-loose and too-rigid boundary setting. Building on Chapter 19, “A Somatic Sense of Boundaries,” this chapter focuses on identifying four relational boundary styles acquired in the context of early attachment and addresses the effect of these styles on current relationships. Clients will have a chance to explore the procedural patterns of these styles as well as their psychological meanings and address how to change the way they set boundaries to enhance their relationships.

Clients Who Might Benefit This chapter will benefit clients who have problems saying “no,” maintaining their own opinions or identifying their own priorities and wishes with others, become enmeshed in relationships, or cannot differentiate themselves from others as reflected in statements such as, “He always makes me feel. . . .” Those clients who constantly feel victimized or let down by others will benefit from this chapter. 792

Their complaints are often indicative of an underbounded style that leads to giving too much, an inability to defend or protect themselves, difficulty screening what to take in and what to keep out or trouble buffering disappointment, rejection, or hurt feelings. Clients who experience alternating approach–avoidance tendencies (opens up too much, gets disappointed or let down, and then puts up walls and pushes others away; experiences alternating feelings of connection and loneliness), may also find this material enlightening. Clients who tend to set too rigid boundaries, experience chronic distrust, tense musculature, or tend to be distant and withhold personal information will benefit from this material. Clients whose distrust and guardedness are triggered by close relationships often feel challenged by friends and partners wanting “more” emotional connection. They have much to gain from seeing these issues as evidence of procedurally learned rigid relational boundary styles rather than as negative reflections of themselves or their significant others.

Suggestions for Clinical Use The first step in helping your clients with relational boundary issues will be to collaboratively explore the boundary styles described in the chapter. You might ask clients to review the boundary style markers delineated in the chapter and then reflect on which ones are most familiar to them. You can also use the markers in the chapter as a checklist in session by reading the different descriptors of each boundary style together and asking, “Does this sound familiar? Is this one you recognize as characteristic of you?” In collaboratively assessing your clients’ boundary styles, it is important to keep in mind that cultures differ in terms of accepted personal boundaries. In some cultures, it is normal to be more enmeshed and in others, it is normal to be more reserved and distant. As clinicians, we need to help clients to put their boundary styles in cultural context and avoid viewing culturally valued norms of boundary setting as unhealthy. Clients may need psychoeducation about the containing, screening and protective functions of boundaries, and how the body participates in these functions. Boundaries help us to think before we speak, contain emotions and thoughts, screen out toxic or unwanted input from others, and set protective limits. Many clients rehearse setting verbal limits only to have them ignored or tested, often because their body tells a different story—an experience both confusing and often triggering. You might experiment with asking these clients to notice what happens in the body when they think about, or try to say, “no” to you in session. Some clients might report a holding in the stomach or tightening in the throat, or the word “no” will be uttered tentatively, with hesitation, or aggressively with anger. 793

They might look away, unable to sustain eye contact. Others will say the word “no” definitively and even aggressively, often accompanied by a forward movement and tension in the jaw, arms, or shoulders. Similarly, for overbounded clients who are unreasonable inflexible around limits or cannot say “yes,” having a felt sense of appropriate containment, differentiation, and protection can allow some relaxation of their guardedness. Often, guarded clients are asked to relax their vigilance or tension prematurely, before they have developed adaptive boundaries. Such clients can benefit from making the physical boundary actions that engender a direct bodily sense of empowerment that naturally allow a counterbalancing relaxation of the tension that sustains a rigid boundary. Prematurely relaxing boundaries can elicit fear and vulnerability that, in turn, exacerbates rigid boundaries. Having established their boundary style or the mixture of styles found in pendulum or incomplete boundaries, the next step might be to ask your clients to observe these indicators in their relationships to see if a boundary style might contribute to a problem that they may have identified as “my fault” or “his/her fault.” In each case, the chapter material and exercises will be richer if the client’s expressed current relational difficulties, including those with you, are the context for this exploration.

Introduction to the Worksheets YOUR BOUNDARY STYLES is intended to clarify situations in which clients use particular boundary style and to identify a somatic resource that could support healthier boundaries. It can be revealing to use this worksheet to explore how clients employ different boundary styles in situations with you. The worksheet on SAYING “NO” IN A RELATIONSHIP may be a good next step for clients whose difficulties with others stem from an underbounded style or from ways of setting boundaries that are indirect, ineffective, or create adversity or distance in relationship. The worksheet on SAYING “YES” IN A RELATIONSHIP may be especially helpful for clients with an overbounded style to practice noticing physical ways of saying “yes,” some of which may feel unfamiliar to them. Clients who say “yes” when they need to say “no” may recognize ways in which they habitually convey a “yes” message. No matter their style, however, you may want to encourage clients to complete both of these worksheets in order to recognize which of the two comes easily and automatically versus which is challenging or even frightening. These two worksheets can also be used to explore clients’ relationship with you. Because the therapeutic relationship evokes the boundary styles of both therapist and client, we can use the relationship directly to explore boundary styles. 794

The worksheet on SETTING BOUNDARIES WITH ANOTHER PERSON (Marjorie Rand, 1981. personal communication). provides an especially effective interactive exercise for use in a therapy session. For some clients, it could also be assigned to use with a partner or friend. Its goal is to help clients increase their awareness of the responses dictated by their boundary styles when a boundary is breached, and then practice reestablishing their boundary. Exploring this exercise together in session will elucidate boundary issues within the relationship. For example, you and your client may discover that your client has difficulty saying “no” to you directly. Helping clients practice new adaptive ways of setting boundaries with you supports a greater sense of safety, trust, and collaboration in the therapeutic relationship.

Adapting this Material for Dissociative Clients Because the experience of trauma and traumatic attachment is inherently one of relational boundary violation, working with boundaries can be triggering for clients with severe dysregulation or dissociative disorders. Disorganized–disoriented attachment is highly correlated with dissociation, and people with this attachment pattern experience a conflict between defense and proximity seeking, which impacts how they set or avoid setting boundaries. Exploring boundary gestures relationally is likely to elicit the objections of proximity-seeking and “cry for help” parts, for example. What might seem like simple actions (bringing up the hands to make a “stop gesture, saying the word no) can trigger panic and frozen terror. For these clients, it is often useful if you describe the actions connected to a sense of boundary in neutral language (“make this gesture” rather than “make a stop sign” or “set a boundary”) and if you demonstrate it first. If the exercise is likely to be dysregulating, just watching your demonstration might trigger the client, who then has the opportunity to practice a resource to regulate arousal. With these clients, and with those who are afraid to move, a boundary gesture or movement can be broken down. Clients can lift their hand or even just their fingers an inch or two and mindfully notice their internal response, including the various reactions of different parts. Different parts of clients with dissociative disorders generally manifest different boundary styles. Internal conflicts about which type of boundary style is safe or safer can interfere with identifying the client’s overall style or can complicate exploring boundary exercises. Protector parts and those rooted in a fight defense are likely to be overbounded, guarded, reserved, mistrustful, and wary of disclosing too much. Submissive parts are likely to be underbounded, eager to please, or easily swayed and compliant. Proximity-seeking, cry-for-help, and many child parts also tend to be underbounded, seeking indiscriminate close connection 795

to, and enmeshment with, others. They usually are extremely sensitive to rejection, withdrawal, or disappointment. It can be helpful for dissociative clients to notice and identify the different boundary style of each part, validate the function of that style, and discuss how that style serves them, or fails to serve them, in their current relationships. Observing the stimuli that trigger a protector part’s tight boundaries or a shut down submissive part’s lack of boundaries is, in and of itself, a step toward differentiation and eventual integration. Reflecting on how a particular boundary style operates in their current life, and evaluating when it might be needed and when it might be overactive can pave the way for clients to develop more adaptive boundaries. If the boundary exercises are couched as protective in nature yet also as allowing safer relationships, all parts of the client are more likely to be willing to try them, rather than refuse or become triggered. You can explore inviting different parts to fill out a worksheet, and perhaps discover a boundary action that is acceptable to several parts. Working successfully with dissociative clients requires titrating and carefully integrating the material to ensure that any experience with boundary exercises reassures all parts of the client that it is safe to try out new ways of setting boundaries in relationships.

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CHAPTER 32 Boundary Styles in Relationships If we have trauma in our histories, or if we grew up in families where boundaries were overly rigid, enmeshed, nonexistent, or unpredictable, the opportunity to learn and practice healthy relational boundaries was greatly diminished. As a result, we pay a price in relationships, especially our closest relationships in which healthy boundaries are an important element of forming current attachments. As described in Chapter 19, “A Somatic Sense of Boundaries,” when we do not experience safe relational boundaries growing up, we may become too passive and fail to protect or assert ourselves. Or we might have problems saying “no,” or we might withdraw or aggressively defend against others, rather than set calm, appropriate boundaries. Or maybe we developed a pattern in which we vacillate between these two extremes of being passive and being aggressive. Some of us might find ourselves with good relational boundaries with some people in our lives, such as with our coworkers, but with inadequate boundaries with others, such as with our family members. The way we set, or do not set, our boundaries with others is neither “negative” nor “bad” but reflects adaptive responses to past circumstances that have become procedurally learned patterns. It should be noted that the way we set boundaries also reflects the culture in which we grew up. It is important to understand that different cultures have different perspectives on personal boundaries. For example, some cultures regard eye contact during conversation as disrespectful, whereas other cultures regard it as a sign of respect and connection. Some cultures prefer more distance between acquaintances during conversation, others more proximity. But no matter what our culture, we cannot learn adaptive relational boundaries if we are raised by caregivers who lack healthy boundaries themselves. In those kinds of environments, we do not have the chance to learn from others and emulate their healthy boundaries, nor are we able to exercise healthy boundaries ourselves without negative consequences. So, instinctively, we make the best choice for ourselves by unconsciously developing relational boundary styles that are most suited to our particular circumstances. The boundary styles we develop often served as survival resources by helping us make the best of difficult or less than optimal relationships. Building on Chapter 19, “A Somatic Sense of Boundaries,” this chapter describes four relational boundary styles developed in the context of early attachment, and helps you learn which of these styles are familiar to you. With 798

mindful awareness of the behaviors and body cues of each style, you will begin to identify when you use these styles in present-day interactions with others. UNDERBOUNDED STYLE

This boundary style is particularly well adapted to a family environment in which members tend to merge with each other, where what is “me” and what is “you” is blurred. In such situations, it is usually not acceptable or safe to set one’s own individual boundaries. Perhaps the family defines individuality as “disloyal,” or maybe setting boundaries is considered “disrespectful” and even punished. Sometimes it is safer to be merged so that we can better sense what is needed or wanted by our parents, moment by moment. Individuals who have developed an underbounded style understandably have difficulty setting limits or saying “no” and have trouble differentiating their feelings, opinions, needs, and preferences from those of others. If you grew up in a family in which an underbounded boundary style was adaptive, you may experience some of the following: • You may have difficulty saying “no” and find yourself frequently acquiescing or saying “yes” even when you don’t want to. • You may fear that others will reject, abandon, mistreat you, be angry with or disappointed in you if you say “no.” • You may feel you must please others by giving in to their needs, preferences, and desires; you may often end up feeling used and taken advantage of. • You may have difficulty identifying your own feelings, preferences, and needs and distinguishing yours from those of others. • You may tend to turn to others for advice, help, and direction instead of having confidence in your own sense of what you want, need, or prefer. You may allow others to tell you what to do, think and feel. • You may have a desire to merge in relationships, have difficulty differentiating yourself from others, or feel hurt or rejected if they have different feelings or opinions than you do. • In relationships, you are apt to “give too much” and share too much too soon. You also may have difficulty keeping the confidences of others. • If you have trouble saying “no,” you may be susceptible to emotional, physical, or sexual abuse and might find yourself in a constant state of trying to recover from your boundaries being violated. • You may lack awareness of social space; that is, unconsciously get too close, physically or emotionally, to others. You might get hurtful feedback that others experience you as intrusive, needy, or as violating their boundaries. You may not understand why they react that way. • You may find it so easy to empathize with others’ emotions that their side of 799

the story feels more compelling than your own emotions or point of view. Your body might reflect having learned diffuse or lax boundaries by being either collapsed, unguarded, or both. The tendency to merge with others may literally show up in a loss of muscular definition and tone in your body. Your body language might give the message that you cannot protect or defend yourself or that your sense of self is weak and easily manipulated to do the bidding of others. A few examples of this are going to the movie others want to see instead of stating your preference, agreeing to help them when you do not want to, and perhaps even violating your own sexual or physical preferences to meet the desires of someone else. It is important to note that certain strengths or survival resources characterize this boundary style as well. A person with an underbounded style, because of the permeable nature of his or her boundaries, often has a sensitivity or awareness of others and the ability for empathy and attunement to the feelings of others. OVERBOUNDED STYLE

This boundary style tends to be rigid, impenetrable, inflexible, and dense instead of permeable. It is easier and more familiar for someone with this style to say “no” than to say “yes.” The overbounded style is adaptive in family environments in which parents avoid physical or emotional contact with the child, such that the child must meet his or her own needs, or those contexts in which it isn’t safe to be vulnerable or to let down your guard. The caregivers may be abusive emotionally or physically, inducing fear and avoidance of close relationships in the child. In such a family, it is safer to be alone, self-reliant, guarded. Mistrust might be more adaptive than trust. If you have grown up in a family in which an overbounded boundary style was most adaptive, you may experience some of the following: • Your automatic response to others may be to say “no” rather than to say “yes.” Or you may find it difficult to say “yes” to others’ requests; it may feel like “giving in” or being too vulnerable. • You may believe that the “wall” you put up is a healthy boundary, but in fact it keeps everything out. When you have a wall, you cannot let much of anything in, not even good things. • You may be hypervigilantly protective of your “space” and prefer more distance in relationships. Contact with others can feel invasive, rather than nourishing. • You may be uncomfortable revealing personal information and do not solicit personal information from others. • You rarely ask for the opinions, feelings, or thoughts of others, and avoid asking for help. You probably tend to be self-reliant and independent. 800

• You may perceive others as a potential threat and have difficulty with trust, intimacy, and vulnerability. It may be hard for you to let down your guard. • You may find yourself isolated from others; find it difficult to let others get close, and you may spend much of your time alone. Or perhaps when you spend time with other people, you notice that there is an emotional distance between you and others, but you do not understand how you “keep people out.” • Empathy and attuning to others are hindered by an overbounded style. You may avoid being vulnerable or getting involved emotionally with other people. This may result in others’ view of you as emotionally unavailable, closed, insensitive, inconsiderate, or abrasive. And you may or may not understand why they say such things. The tendency for rigid boundaries with others may literally show up in an increased muscular tonicity in your body. Your body might reflect these rigid and strong boundaries by being tense and guarded. Your body language might give the message that you do not want anyone near you and that you want to be left alone. Individuals with an overbounded style also have certain strengths or survival resources. This boundary style protects a sense of self and reduces the influence and impact of other people’s feelings and opinions. People with this style can be helpful in times of stress, since they are self-sufficient, able to take charge, and give off an aura of confidence and self-assurance. PENDULUM BOUNDARY STYLE

With this boundary style, we might swing back and forth from underbounded to overbounded. We may risk vulnerability and open up to others, perhaps too much. Then, when opening up leads to the experience of pain or being overwhelmed, we react by closing down. We find ourselves swinging from one polarity to the other, sometimes in response to triggers, sometimes in response to the negative consequences of the other side of the pendulum. When we are overbounded, we tend to feel too alone; when we are underbounded, we tend to feel too vulnerable. These two different states can be confusing, both to the person with this boundary style and to the people interacting with him or her. Sometimes, when these states are extreme, they can be dysregulating. But if the pendulum style does not occur to an extreme degree, the ability to open up and close down can sometimes make this style more integrated and flexible in relationships than the previous two styles. INCOMPLETE BOUNDARY STYLE

This boundary has “holes” in it. With this style, it is possible to have healthy boundaries much of the time but become over- or underbounded in certain situations, such as at work or at social gatherings, with certain people, such as with 801

romantic partners, authority figures, parents, or children. We may have trouble saying “no” to a lover or spouse but can easily say “no” to strangers, friends, or coworkers. A loss of healthy boundary may also occur when we are in certain emotional, mental, or physical states: for example, being tired, sick, needy, angry, or distressed. In these cases, our healthy boundaries may become weak or rigid. However, a person with this style has a generally healthy and adaptive boundary, and is able to say “yes” or “no” effectively in most situations.

Working with Your Boundary Style If you have an underbounded style, it might be helpful to practice the grounding and alignment resources taught in previous chapters. These resources can help you feel less collapsed or vulnerable and more connected with yourself so that you do not get thrown off track by the needs or demands of other people. The “pushing” motions illustrated in many previous chapters can help you experience a “no” in your body. Carol said that she had never been able to say “no” to others, much to her frustration. Each time she intended to give her rehearsed speech about why she could not do something that was asked of her, she became reluctant to speak, her shoulders collapsed, and she would sigh and then give in. Carol learned to increase the tone and tension in her muscles and condense her own energy by imagining pulling her energy close to her body in order to feel more differentiated from others and reduce the permeability of her boundary. Her therapist’s instruction to practice the opposite physical movement from the collapse (dig her feet into the floor, lengthen her spine, and set her shoulders back) helped her to feel the strong “no” she’d always wanted to say. Practicing the movements in session, then the words, until her “no” became louder and authoritative felt liberating. An overbounded style is often the result of a fear of becoming underbounded and vulnerable, and it is important that you do not try to override such a boundary, physically or emotionally. If this is your boundary style, you may be hypersensitive to feelings of intrusion and physical proximity and need to learn that proximity does not necessarily mean that you are in danger or about to be asked to do something you do not wish to do. However, it is important for you to maintain control over the amount of opening and relaxing of your rigid boundary so that it can occur naturally and spontaneously at a tolerable pace for you. Learning to strengthen the physically felt sense of self in your body that was not present when the overbounded habit was first learned can be helpful. Dan felt so tired of his wife’s sadness that he didn’t let her in, couldn’t attune to her emotionally, and couldn’t let down his guard. He wanted to be the kind of husband who made her feel good about herself, rather than insecure, so he was open to 802

explore the tightening in his chest, which to him meant that his heart was protected. Voluntarily tightening the muscles of his chest was followed by the impulse to relax them. Then he could feel more open toward his wife and that felt good to him. Continuing to practice these exercises was also much easier for him than “trying to let my guard down.” Once Dan learned that his rigid boundary style is something he can control, rather than something that only happens automatically, his boundary became increasingly voluntary rather than automatic. He learned the difference between “Don’t come in” versus “I choose not to let you in.” With choice, he felt he then had the option to learn to say “yes” to his wife and to other people and things that had meaning for him.

Negotiating Boundaries and Predicting Boundary Violations Learning to increase your sensitivity to the somatic warning signs of upcoming or actual boundary violations is essential in negotiating relational boundaries, as we explored in Chapter 19, “A Somatic Sense of Boundaries.” Reading the nonverbal signals from others goes hand in hand with tuning into your own internal cues in relation to boundaries. Awareness of those nonverbal signals from others that tell you that you might be too close, or that they do not want to hear the personal information you are divulging, or that they need to end the conversation will help you learn to respect the boundaries of others. Tuning into sensations and movement impulses in your body that convey discomfort, alarm, or uneasiness will help you anticipate potential boundary violations. By increasing awareness of your own body cues and those of others and practicing new physical and verbal boundary habits, you can transform your relational boundary style into a choice rather than an automatic habit. Through the worksheets that follow, you can explore how to identify the physical signals of your relational boundary style(s) and how to embody a physically felt sense of healthy relational boundaries so that you can better enjoy your relationships.

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Boundary Styles in Relationships YOUR B OUNDARY STYLES Purpose: To identify situations in which you tend to be underbounded or overbounded or tend to use a pendulum or healthy boundary, and to identify situations in which you want to set a boundary differently. Directions: Review the characteristics of healthy boundaries found in Chapter 19, “A Somatic Sense of Boundaries,” and the characteristics of the other boundary styles found in this chapter. Then follow the prompts below. Take your time to sense how you experience each boundary style physically and describe in the boxes. 1. Situation(s) in which you tend to be underbounded (e.g., those in which you fail to say “no,” do things you don’t want to do, don’t stand up for yourself, reveal too much about yourself or others.) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 2. Describe what you experience in your body when you are underbounded. 3. Situation(s) in which you tend to be overbounded (e.g., those in which you feel unnecessarily guarded, mistrustful, secretive, emotionally distant, automatically say “no”): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 4. Describe what you experience in your body when you are overbounded. 5. Situation(s) in which you tend to have a pendulum style (e.g., those in which you are too quick to say “yes” and open up, then feel overwhelmed or too open so you withdraw or close down):

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__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 6. Describe what you experience in your body when you use a pendulum style boundary. 7. Situation(s) in which you tend to have a healthy boundary (e.g., those in which you can state your preferences, stand up for yourself, say “no” or refuse requests you do not want to meet): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 8. Describe what you experience in your body when you use a healthy boundary. 9. Identify a physical element from #8 that you can use as a somatic resource in situations in which you use an overbounded, underbounded or a pendulum boundary (e.g., My posture is aligned, but not tense, and my breathing is full). Practice embodying this resource in those situations.

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Boundary Styles in Relationships SAYING “NO” IN A RELATIONSHIP Purpose: To identify the postures, gestures, expressions and movements that convey “no” without words in order to gain awareness of the nonverbal ways you establish your relational boundaries. Directions: Study the list below of the ways that you might set a boundary by saying “no” with your body. Then follow the prompts. 1. First, circle any ways you nonverbally say “no” that you remember using in the past. In the empty boxes, write down any other ways of setting a boundary that you have used that are not on the list. Shake your Furrow your brow, head frown or scowl

Move away or lean back

Change your voice tone

Purse your Clench your jaw or lips thrust it forward

Look down or away

Display aggressive posture

Crinkle your nose

Make a “stop sign” or gesture with your hand

Narrow, roll, or close your eyes

Square your shoulders or hunch them forward

Laugh or snicker

Make physical contact (e.g., hit, push)

Cross your arms or legs

Tighten your body

Make a stern or firm facial expression

Turn your body away

Move your Sigh with exasperation head back or disgust

Raise one or both eyebrows

2. Describe any memories of saying “no” with your body that stand out to you. 3. Throughout the week, pay attention to your interactions with others. At the end of each day, make a tally mark next any ways you noticed that you say “no” with your body. Add any other ways of saying no that you used that are not on the list. At the end of the week, answer the remaining prompts. 4. Describe a situation in which the way you set or conveyed a boundary was 808

ineffective, dysregulated, or otherwise unsatisfactory to you. 5. How do you want to convey your boundary with your body in similar situations in the future? How do you want to convey your boundary verbally in similar situations in the future? Take your time to mindfully say the words out loud while you convey your boundary with your body simultaneously. Describe your experience.

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Boundary Styles in Relationships SAYING “YES” IN A RELATIONSHIP Purpose: To identify postures, gestures, expressions, and movements that correspond with saying “yes” in relationships, and identify situations in which you said “yes” when you wanted to say “no.” Directions: Study the list below of a few of the ways you might say “yes” with your body. Then complete the prompts. 1. First, circle any of the ways of saying “yes” that you remember using in the past. In the empty boxes, write down any other ways of saying “yes” nonverbally that you have used that are not on the list. Nod your head

Raise your brow

Smile or grin

Say “yes” with your eyes

Tilt your head to one side

Make eye contact

Say “yes” with an open & relaxed posture

Make physical contact on arm, shoulder, hand; hug

Open your hands or arms

Reach out

Move forward or closer

Turn your body toward

Soften your muscles

Blink or bat your eyes

Take a breath, emphasizing the exhale 2. Describe any memories of saying “yes” with your body that stand out to you. 2. Throughout the week, pay attention to your interactions with others, noting when you say “yes” with any of these actions. At the end of each day, make a tally mark next to any ways you noticed you say yes with your body. In the empty boxes in the chart, write down any other ways of saying “yes” with your body that are not on the list. Take special notice of any situations in which you wanted to say “yes” but did not, or wanted to say “no” but said “yes” anyway.

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3. Do you recall any moments in which you wanted to say “yes”, but did not? If so, how did your body refrain from saying “yes (e.g., tighten up, pull back, look away, collapse, or something else)? 6. Do you recall any moments in the past week in which you wanted to say “no” but said “yes” instead? If so, describe the moment and how it felt in your body. 7. Describe any changes you would like to make in the nonverbal ways you say “yes” and “no” to others. (e.g., I would like to move forward and touch my kids more; I would like to keep my body relaxed and maintain eye contact when I say no”.)

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Boundary Styles in Relationships SETTING B OUNDARIES WITH ANOTHER P ERSON Purpose: To explore setting a tangible boundary with your therapist, and to identify your initial impulses when your boundary is breached, what it feels like to reestablish your boundary, and what you experience physically when your boundary is respected. Directions: Review the TANGIBLE BOUNDARY EXERCISE worksheet in Chapter 19, “A Somatic Sense of Boundaries,” and establish a tangible boundary. Then practice each step below with your therapist, and write down what you notice —your thoughts, emotions, body response, and memories.

1. Set a Tangible Boundary Sitting across from your therapist, set a tangible boundary using a piece of string, rope, scarves, pillows or other objects. Take your time until you have a sense of your boundary and can experience it physically and describe your experience to your therapist.

2. A Breach of Boundary Notice what happens if your therapist slowly crosses your tangible boundary physically without invitation (e.g, for the purpose of the exercise, you do not want your therapist to cross your boundary). Mindfully notice your automatic response. Thoughts: (e.g., I have to endure this; I can’t keep people out.) 814

Emotions: (e.g., Unhappy, mad, helpless, anxious.) Body response: (e.g., Tighten, lean backward, move forward, be still.) Memories: (e.g., My mom kept hugging me when I didn’t want her to; of being abused.)

3. Respect of a Boundary Now, have your therapist move out of your tangible boundary. Mindfully notice your response, especially in your body, when your therapist is no longer in your boundary. Thoughts: Emotions: Body response: Memories:

4. Reestablish Your Boundary This time, as your therapist crosses your tangible boundary, slowly push him or her out with your hands. Your therapist can hold a pillow for you to push against. Mindfully notice your responses, especially in your body, when your therapist moves out of your boundary as you push. Thoughts: Emotions: Body response: Memories:

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CHAPTER 33

Connecting with Others Proximity-Seeking Actions THERAPISTS’ GUIDE TO CHAPTER 33

Purpose of this chapter When we talk about feeling “close” to someone or feeling “too far away,” we are describing the inborn drive of proximity seeking, the cornerstone of attachment behavior. Bowlby (1969/1982) observed that the attachment drive organizes proximity-seeking behaviors to secure the nearness of attachment figures in two primary ways: signaling behavior, which is designed to bring the attachment figure closer, and approach behavior, which is designed to bring the individual closer to the attachment figure. Proximity-seeking behavior changes “based on that person’s forecasts of how accessible and responsive his attachment figures are likely to be should he turn to them for support” (Bowlby, 1973 p. 203). Thus, this innate system adjusts to the behavior of the attachment figures. If the attachment figure is unreliable, the proximity-seeking behaviors may become overactive. If the attachment figure is neglectful, unavailable, or punishing in the face of need and vulnerability, the proximity-seeking behaviors may become underactive. This chapter’s purpose is to help clients understand their difficulties in relationships in terms of their physical habits of seeking proximity, learn how these habits have developed, and practice more effective proximity-seeking actions.

Clients Who Might Benefit Many of our traumatized clients and many whose early attachment relationships were inadequate come to therapy with difficulties in both signaling behavior and approach behaviors. Nearly all clients are likely to benefit from exploring proximity-seeking actions as described in this chapter because nearly all will report problems in relationships, especially close ones. Those who speak 816

indirectly about these actions, may say things along these lines: “I want a relationship, but I can’t approach people. I can’t even look them in the eye, much less carry on a conversation.” Or “I don’t reach out to others. I just holed up in my apartment all weekend and didn’t even answer the phone.” Or “Why doesn’t he reach out to me? I call him all the time, but he never calls me.” These clients will find this material especially useful. Those with current relational difficulties can benefit enormously from understanding both the origins of proximity-seeking actions in early attachment and by discovering ways to change those that they want to change through the practice of new actions. Both those who have not been able to reach out and have ended up alone and isolated and those who frantically seek proximity and often drive others away can make use of this material. Clients with unresolved trauma who experience the sequential or simultaneous stimulation of defensive and proximity-seeking impulses can also benefit from this chapter. Parents who are triggered by their children’s proximity seeking or who have difficulty separating from their children might discover that this material can affect not only their well-being but that of their children as well.

Suggestions for Clinical Use This chapter builds on the understanding of beliefs, emotions, and relational boundaries that clients have gained through working with previous chapters in this section. You can help them understand their current relational patterns in terms of their habits of proximity-seeking actions learned in early attachment experiences. You can emphasize that an important way to begin changing any long-held dissatisfying relational behaviors is to explore physical proximity-seeking actions, such as reaching out, making eye contact, or decreasing distance. After completing the previous chapters, it will make sense to clients that, since our early attachment experiences begin before the acquisition of the language to describe them, we naturally remember how to seek proximity with our bodies and emotions rather than as concepts or descriptions. One of the most accessible proximity-seeking actions to explore is the simple act of reaching out, which, as the chapter illustrates, is executed in a variety of styles that reflects and sustains unsymbolized meaning: palm up, palm down, full arm extension or with bent elbow held close to the body, and so forth. If attachment figures are neglectful, a child may cease reaching out to them and depend more upon autoregulation than interactive. Adaptive in that context, a prediction that no one will respond to proximity-seeking behavior can result in the literal abandonment of integrated, purposeful action of reaching out in all relationships. Exploring this action in therapy can be a fruitful avenue of insight and growth. Proximity is fine-tuned by eye contact, bringing people closer or more distant. 817

Eyes can be intent, as the absorbed gaze of a baby with his mother, or blank and unseeing, like the vacant stare of a person in shock. Eye contact can be frightening for some clients who may be “beset by shame and anxiety and terrified by being judged and ‘seen’ by the therapist” (Courtois, 1999, p. 190). You might experiment with this proximity-seeking action by making eye contact with your client, having one or the other of you look away or close the eyes, and then help the client be mindful of what happens internally and what changes relationally. Healthy relationships require both connection and distance. “Too much” or “too little” distance between people can be equally negative (Hall, Harrigan, & Rosenthal, 1995, p. 21). Clients need to understand that proximity-seeking actions and relational boundaries go hand in hand, and using both as needed, contributes to increased connection and intimacy. Weaving the material in this chapter together with material in the previous chapter, “Boundary Styles in Relationships,” will help clients understand this concept. Because exploring both distance and closeness are usually evocative for clients, strong transference responses can be stimulated when we experiment with proximity seeking, boundary setting, or increasing distance. We may also notice our own countertransference to clients’ needs for either proximity or distance: It might be difficult to tolerate the client who sits as far as possible from us and cannot sustain eye contact. Or we may become uncomfortable with the client who wants greater proximity or sustained eye contact. We may find ourselves interpreting clients’ proximity-seeking behavior, or lack of it, toward us in habitual ways. It can be revealing to notice what happens in our own bodies when clients seek or withdraw from proximity with us? When a client complains, “I can’t get out of my shell,” you have an opportunity to help him observe how the shell protects him from proximity-seeking actions and to notice with him how necessary that shell once was in his family of origin. Or if a client is inconsolable because her boyfriend hasn’t called in the last 24 hours, you might say something like, “It makes sense that staying close and connected is important for you—that’s how you kept your mother’s attention during her depressions. That might be why you get upset when your boyfriend doesn’t call.” It’s important to acknowledge currently ineffective proximity seeking actions as having been adaptive in the past. After you do so, you can start helping clients notice these patterns and then ask them to mindfully experiment with the proximityseeking actions that are most familiar and natural and assess their efficacy in their current lives. From there, clients can explore more adaptive proximity-seeking actions that challenge their implicit relational knowing.

Introduction to the Worksheets 818

Since these worksheets directly pertain to seeking proximity in relationship, they lend themselves to exploration together in session. Clients who are less avoidant than others might appreciate the opportunity to explore many of these exercises together with you. However, it may be especially helpful for more avoidant, dismissing clients for whom these issues may be uncomfortable to discuss and write about to initially complete the worksheets in the privacy of their own home before exploring them together with you. The first worksheet, YOUR PROXIMITY-SEEKING ACTIONS, asks clients to reflect on and observe how they, and others in their lives, seek proximity. They will assess how they respond to the proximity-seeking actions of others, as well as which actions they use the most and can perform easily, which are more difficult, and which ones they do not use. It often comes as a surprise to clients that there are so many everyday proximity-seeking actions, and that they are comfortable with some, and uncomfortable with others. You can explore this worksheet in terms of what proximity seeking actions clients use with you, discuss if they are effective, and whether other ones could be more effective. The two worksheets on REACHING OUT instruct clients to practice different ways of reaching out to discover their internal reactions, which styles are more comfortable or familiar, and which are uncomfortable or unfamiliar. With clients for whom reaching out feels threatening, you can explore these worksheets together in therapy sessions and break down each step into smaller pieces, slowly experimenting together with each one. For some clients, identifying habitual patterns will spontaneously encourage experimenting with new proximity-seeking actions; for others, these worksheets may require overcoming fears of proximity or proximity-seeking actions. EXECUTING PROXIMITY-SEEKING ACTIONS is designed for use with another person, and can be most beneficial to explore together in session. Clients experiment with being on both the giving and receiving end of three proximityseeking actions—reaching out, eye contact, and leaning toward—bringing mindful attention to the building blocks that emerge. Lastly, the worksheet PROXIMITY & DISTANCE combines an action of proximity seeking with one of setting boundaries. It can be effective as an in-session exploration and will help clients decipher the somatic indicators that inform them that they need more physical distance or more proximity to another person. The worksheet instructs clients to make beckoning and boundary motion, but you might also make these motions yourself and explore your client’s response to them. This can be particularly helpful for clients who have trouble accurately interpreting the intentions of others who seek proximity to or distance from them.

Adapting this Material for Dissociative Clients 819

Dissociative clients typically have developed patterns of simultaneous or sequential proximity-seeking and defensive actions that are the hallmark of disorganized–disoriented attachment. Even simple proximity-seeking actions can be associated with past experiences of fear and threat, such as feeling trapped or smothered; painful memories of seeking attachment and being exploited, hurt, rejected, or humiliated; or memories in which reaching out by adults was connected to “grooming” (making children feel special through special activities, games, or presents to entice them into an abusive relationship). Such clients are not accustomed to being respected, comforted, and reassured by proximity to others. Proximity-seeking movements may be triggering, difficult, or even impossible to execute, and it will be your job as therapist to maximize their dual awareness and self-compassion, validating the function of avoiding or distorting proximity-seeking actions in past environments. At the same time, these clients do execute some proximity-seeking actions, even by meeting with you, and the ways they do so in their lives today can be brought to light and explored. Clients with dissociative disorders will undoubtedly discover that some parts of them have learned proximity-seeking behaviors that are not adaptive in their current lives. For example, child parts may continually reach out for help by calling in crisis, beseeching with their eyes, or becoming panicked or inconsolable at the end of a session or when someone leaves for a short period of time. Other parts avoid proximity by shutting down, refusing eye contact, and distancing as relationships become more intimate, or pushing others away by starting arguments and fights. The mindful study of these patterns can be rewarding and integrative as clients examine alternating or simultaneous impulses to move toward and away from others. You can ask clients to notice how different parts react if they imagine reaching out or creating more distance with a partner, spouse, potential partner, or yourself. Client can facilitate compassionate and respectful inner dialogue among parts with different proximity-seeking and avoiding styles and tendencies. Experimenting with distance and closeness, proximity-seeking versus proximityavoiding physical actions can be a way for all parts of the client to express their different roles in perpetuating disorganized–disoriented attachment patterns. As dysregulated arousal or animal defense responses are noted, you can help your clients understand them as somatic communications, validating how dangerous it was to negotiate proximity in the context of abuse and frightening caregiving in childhood. Eventually, though, this group of clients must be supported to find a way in which all parts can work together to execute proximity-seeking actions capable of forming and maintaining healthier relationships in their current lives, remembering that proximity seeking goes hand in hand with setting appropriate boundaries.

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CHAPTER 33 Connecting with Others: Proximity-Seeking Actions As infants and children, we need supportive people close by to provide food, clothing, guidance, stimulation, comfort, and protection in order to assure our survival and well-being. The social engagement system of the full-term infant (explained in Chapter 11, “Neuroception and the Window of Tolerance) enables certain “proximity seeking” actions—facial expressions, eye contact, vocalizations, fussing, and crying—that signal the caregiver to come close to minister to the infant’s needs. Additional actions soon develop—reaching out, holding on, pulling, postures and other gestures. We continue to use variations of these basic proximity-seeking actions throughout our lives to make friends, develop relationships, and secure the nearness of other people, especially our close friends and family. However, if these actions are difficult or frightening for us, interactions with others can become challenging and we may simply avoid them. This chapter discusses how proximity-seeking actions develop, what happens when they elicit the emotional pain of rejection or criticism rather than comfort, or, worse, what ensues when proximity-seeking results in abuse. This chapter is designed to help you in understand some of your patterns of seeking or avoiding contact with others and to explore actions that can facilitate the fulfillment you seek in your relationships.

How Proximity-Seeking Actions Develop As human beings, we are emotionally bonded, or “attached,” to certain people to whom we need and want to be close. Fortunately for infants, establishing these bonds depends on crying, facial expressions, and other forms of signaling that they need care, rather than on coordinated movements of the body. As motor skills develop, the periphery of the body—arms and legs—are used to achieve nearness to others. Crawling toward the parents, following them around, climbing up on their laps, holding on, clinging, and resisting being put down are normal behaviors that maintain closeness to significant people in the child’s life.. “Good-enough” parents show their care and protection by responding sensitively and affectionately to the baby with their own proximity-seeking behaviors. They pick her up, hold her close, stroke her, coo and use the voice, along with rocking and comforting movements, to soothe her. Parents also seek 823

proximity when the child is not distressed, too, by cuddling, holding, snuggling, and playing with the child. Even when the child does not seek contact, a parent may watch him with a loving expression, smile or gaze fondly at him, or reach out to pat his cheek or tousle his hair. These actions all convey an implicit message to children that close relationships are rewarding, that others want to be near to them, and that their own proximity-seeking actions are welcomed and will be responded to favorably most of the time. If we have experienced an abundance of these kinds of interactions, then initiating and sustaining friendships and intimate adult relationships are smoother and easier for us. We know how to ask others to come nearer and how to express our needs and desires for contact. We can engage appropriately in physical behaviors that maximize closeness, such as making eye contact, hugging those with whom we feel safe and comfortable, holding hands, offering physical comfort, and engaging sexually with an intimate partner. Trusting that we will be responded to with sensitivity, we have little or no avoidance, anger, or fear of seeking proximity when we wish or need to do so. We also are better able to tolerate frustrations and disappointments in relationships when proximity is not possible or not satisfying. Due to early experiences of being regulated and cared for by those we trust, we are able to seek and receive, with no ambivalence, the soothing and calming we need from people close to us. We are also able to regulate ourselves when we are alone or when others are unavailable.

When Proximity-Seeking Actions Are Challenging Sometimes parents actively thwart or block proximity-seeking behaviors, responding to them with negative emotions, withdrawal, pushing the child away, or even abusing or punishing the child. Sometimes these responses are intentionally malicious, but they can also be the result of a parent’s own blind spots or past experience of proximity seeking with their own caregivers. Some parents may dislike physical contact, except on their own terms, and may respond to their child’s overtures with an avoidance of eye contact, a disapproving facial expression, or a rejecting tone of voice. If this is the case, the child may learn to avoid making eye contact, reaching out, and stop seeking closeness. This child may look for someone else (a sibling, grandmother, other adult or friend) who will respond favorably, or she may isolate herself if there is no one to respond to her. When this happens, the child’s “implicit relational knowing”—what she has learned implicitly and nonverbally about how to be in relationships—tells her that she is on her own. If eye contact was not satisfying in infancy and childhood, we may have difficulty with eye contact as adults. Children are very sensitive to the quality of 824

eye contact with their attachment figures. A sudden tightening or narrowing of the eyes can convey pain, aversion, disagreement, suspicion, or threat, while a widening of the eyes might signal excitement, surprise, or shock. Other ways of communicating with the eyes (i.e., glancing, pupil dilation or constriction, blinking eyes, wide or shrouded, eyes angled downward or upward, frequency, length and intensity of eye contact) all convey implicit messages. Some parents have an excessive need for eye contact with their children, while others do not seek it or may even avoid eye contact. If as children we are looked at in a negative way, we might become afraid of what we will see in another person’s eyes. Even as adults, we may expect to see similar criticism, disappointment, withdrawal, or rejection if that was what we perceived in the eyes of the people close to us growing up. We may also be anxious about making eye contact if we fear being seen ourselves, if we have beliefs like “I’m bad,” or “If people see who I am, they will not like me,” or if being seen has provoked negative responses in the past. Proximity-seeking actions can be abandoned or distorted, if we received repeated negative responses to them in childhood. As we get older, we may be unable to reach out to others in a relaxed, confident manner—with palms up, our arms fully extended in a way that conveys openness and an expectation that our reaching will be met. We may instead withdraw from relationships, shun physical contact, and have a hard time making eye contact, reaching out, or even being near others. If we do reach out, we may do so in a way that reflects and sustains implicit meanings about the pain of seeking proximity with our attachment figures. We may reach out with a stiff arm, palm down, tense shoulders, or a rigid spine, bracing ourselves for a negative response. Or we may reach out weakly, shoulders rounded, holding the elbow close to the waist rather than fully extending the arm because we don’t expect anyone to respond. Or we may reach out in a demanding, eager way, driven by intense need, leaning forward, both arms fully extended. All of these styles of reaching out, learned in the context of early attachment relationships, impact the quality of our current relationships.

Exploring Proximity-Seeking Actions Exploring reaching out, eye contact, and physical nearness can all reveal the implicit relational knowing about proximity-seeking that we learned in our childhood relationships. Marilyn longed for friends she could depend upon. But in her daily life, she failed to initiate conversations with others and avoided eye contact, and she often pulled back, looked away, and tightened her shoulders and jaw when someone approached her. In therapy, she found it unfamiliar and uncomfortable to reach out with her arms and did so awkwardly and stiffly, averting her gaze. She said it was easier to push away than to reach out because no 825

one had ever responded in a way that felt good to her. Max said that relationships were “for other people,” not for him. When he explored reaching out in therapy, his body drooped and his reaching was partial and weak, with his bent elbow remaining close to his side. His gaze turned downward and he failed to extend his arm fully. The gesture lacked energy and conviction. He said, “What is the point? No one will reach back.” The lack of muscle tone, energy, and vitality in his arms as he reached echoed his words. Both reflected a paucity of empathic parental attention and care. Like Max and Marilyn, Boris had experienced a lack of attention and care as a child, and he grew up distrusting that he could count on anyone but himself. He reported to his therapist that his girlfriend had complained that he always seemed suspicious of her. His therapist noticed that Boris frequently narrowed his eyes. When she asked him to explore doing it mindfully, he realized that he felt wary of everyone, even his therapist, although he had never verbalized that even to himself. Boris eventually traced this pattern back to emotionally charged memories of a childhood with an unpredictable and withdrawn mother, which left him feeling on guard, insecure, and suspicious in relationships. Becoming aware of this pattern, working through the difficulties of his childhood, and inhibiting the narrowing of his eyes enabled him to be more trusting and convey his desire to connection instead of suspicion to his girlfriend. Instead of being distant and unresponsive, like Max’s, Marilyn’s and Boris’s parents, Carmen’s parents were inconsistent in their availability, sometimes allowing and encouraging proximity and sometimes not. Unsure if her parents would respond to her need for contact, Carmen engaged in increased and sometimes frantic proximity-seeking behavior. Yet, being unsure about whether she could count on them, she was unable to relax into feeling connected and comforted even when they responded positively to her. In therapy, Carmen experimented with reaching out to her therapist. She leaned forward eagerly, reaching out with a full extension of her arms, taking a step forward as she did so, and her wide eyes held unflinching contact with her therapist. She asked if she could come even closer and became agitated and irritated when her therapist instead suggested she might explore reaching out from an increased distance. Carmen was preoccupied with the emotional and physical availability of others and interpreted her therapist’s suggestions to mean that he wasn’t available to her. This interpretation was an artifact left over from having had to fight for the attention she needed as a child and to struggle to maintain it when she got it. Given her attachment history, it made perfect sense that her proximity-seeking actions were exaggerated rather than curtailed as in Max’s case. If our caregivers were frightening to us as children, our proximity-seeking actions become more complicated. When parents are loud, intrusive, loom over us, or are unpredictably reactive, invasive, threatening, abusive, or frightened and 826

unable to respond when we seek proximity, nearness to them become associated with danger and threat. Two conflicting systems have been stimulated in us when we experience relational trauma like this—animal defense (with the goal of protection) and attachment (with the goal of proximity). As adults, we might seek proximity but, once we achieve closeness, we may freeze, find it hard to speak, withdraw, or collapse and shut down. We may want to get away, and find ourselves tightening up and pulling away, or ending a relationship. Or we may find ourselves being aggressive and even picking fights with those with whom we had been longing to connect. Nora had experienced relational trauma as a child and came to therapy because she was confused by her current relationships. She complained that she had very little support in her life. She wanted to sit closer to her therapist and to hold her hand when she felt lonely or sad. When her therapist asked Nora to try reaching out, however, her body pulled back at the same time, and she turned her gaze away. Nora felt suddenly distrustful, and her body tightened as if expecting an attack. Instead of helping her to feel close and safer, reaching triggered animal defenses. She held back from reaching out, became hypervigilant, and avoided eye contact. Her therapist helped Nora feel safe reaching out by exploring both proximityseeking and defensive actions at the same time. She directed Nora to reach out with one hand while putting her other hand up, as if making a “stop” sign. With this gesture, Nora took a deep breath, saying, “I was always going back and forth from one to the other—either reaching or pushing. But I need both—I need contact, but I need to know I can have a boundary and protect myself too.” Over time, she learned to integrate proximity seeking with boundaries and found she began to feel safer and more regulated in her relationships with others. She had discovered that boundaries and proximity seeking go hand in hand, and that confidence in her ability to set a boundary, when needed, increases her openness to proximity. Cooper also needed to be able to set boundaries in order to comfortably seek proximity. He was apprehensive about physical nearness, even with his family. He and his therapist decided to stand across the room from each other and explore decreasing the distance between them. As Cooper made a beckoning motion to signal his therapist to walk toward him, he felt an immediate desire to back up. As he explored that impulse, memories of his seductive, unbounded mother came up. She had insisted on cuddling, hugging, and being physically close to Cooper even when he was a teenager. Cooper had made an unconscious decision to just stay away from proximity lest it turn into something he did not want. As he explored asking his therapist to move back, with words and gesture, and then asking her to move closer, he began to experience a felt sense of control he had not experienced with his mother. Developing trust that his boundary would be respected gave him what he needed to feel comfortable seeking proximity Exploring our unconscious proximity-seeking actions in therapy can be 827

revealing. The habits we have formed that impact how we make eye contact, reach out, and seek or avoid nearness to others by moving toward or leaning toward them all reflect past experiences. Exploring proximity seeking actions in the worksheets that follow can help us learn about our unconscious habits of proximity seeking in attachment relationships and how to develop new, more satisfying patterns.

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Connecting with Others YOUR P ROXIMITY-SEEKING ACTIONS Purpose: To explore different proximity-seeking actions (direct and indirect, physical and verbal), assess which ones you use frequently, which ones you use infrequently or not at all, and how you respond to those of others. Directions: Review the list of proximity seeking actions below. Circle which ones are familiar to you, and underline which ones are not. Add any other proximityseeking actions you might use in the bottom line. Then follow the numbered prompts. Smile invitingly

Show distress, incompetence or helplessness, cry

Stand close to someone

Lean forward

Show a need, such as for help or comfort

Move closer, sit next to, or take a step closer

Turn your body fully toward another person

Make an indirect request for proximity (e.g., “Could you sit beside me to look at this article?” or “The sofa is more comfortable than the chair you are sitting on.”)

Change voice tone or volume (louder, softer, higher, or lower)

Widen your Change in voice quality (tender, aggressive, eyes sweet, pitiful, cajoling)

Hug, touch, shake hands, take someone’s hand, lean on someone

Make full Intimidate, coerce, or blame others to get them to Reach out, make eye contact; come closer to you a beckoning hold eye motion contact Act flirtatious

Show inviting or welcoming facial expressions

Ask someone to come closer

Tilt head to Offer something someone needs or wants so they Show relaxed, one side will come closer open body posture

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1. Put a tally mark next to the proximity seeking actions you make in relationships with others over the next few days. Also notice which ones others make. 2. Describe three significant experiences when you used any of the proximityseeking actions above. 3. Put a tally mark next to the proximity seeking actions you make in relationships with others over the next few days. Also notice the ones others make towards you. 4. Describe what you learned about the proximity seeking actions you made over the past few days (e.g., I learned that I try to coerce my partner, make full eye contact and move closer even when she doesn’t want me to.) 5. Choose a proximity-seeking action another made toward you that stands out and describe your reaction to it. 6. What one proximity-seeking action might you explore in order to attract more of the kind of contact you want?

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Connecting with Others REACHING OUT, P ART 1 Purpose: To explore various ways of physically reaching out to others, describe how you experience each way of reaching out, and speculate about what each might communicate to another person. Directions: One at a time, look at the pictures and read the descriptions below of each way of reaching out. Physically imitate each of the styles of reaching out, imagining you are reaching out to another person. Take your time to experience each way of reaching out. Then follow the prompts for each one. Reaching out with stiff arms, hunched shoulders, & tight chest

Describe your thoughts, emotions, and body responses when you reach in this way.

Is this way of reaching familiar or unfamiliar? Do you, or does someone you know, reach out like this?

What might this way of reaching convey to another person?

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Reaching out by leaning forward, with head and neck in front of shoulders, & arms overextended

Describe your thoughts, emotions, and body responses when you reach in this way.

Is this way of reaching familiar or unfamiliar? Do you, or does someone you know, reach out like this?

What might this way of reaching convey to another person?

Reaching out halfway with hunched shoulders, arms pinned to side, head/neck pulled in & eyes downcast

Describe your thoughts, emotions, and body responses when you reach in this way. 834

Is this way of reaching familiar or unfamiliar? Do you, or does someone you know, reach out like this?

What might this way of reaching convey to another person?

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Connecting with Others REACHING OUT, P ART 2 Purpose: To explore various ways of physically reaching out to others, describe how you experience each way of reaching out, and speculate about what each might communicate to another person. Directions: One at a time, look at the pictures and read the descriptions below of each way of reaching out. Physically imitate each of the styles of reaching out, imagining you are reaching out to another person. Take your time to experience each way of reaching out. Then follow the prompts for each one. Reaching out with palm sideways, eyes averted, & head down & to the side

Describe your thoughts, emotions, and body responses when you reach in this way.

Is this way of reaching familiar or unfamiliar? Do you, or does someone you know, reach out like this?

What might this way of reaching convey to another person?

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Reaching out with palm down, stiff arm, & upper body pulling back

Describe your thoughts, emotions, and body responses when you reach in this way.

Is this way of reaching familiar or unfamiliar? Do you, or does someone you know, reach out like this?

What might this way of reaching convey to another person?

Reaching out with palm up, eye contact, chin level, & spine aligned

Describe your thoughts, emotions, and body responses when you reach in this way.

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Is this way of reaching familiar or unfamiliar? Do you, or does someone you know, reach out like this?

What might this way of reaching convey to another person?

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Connecting with Others EXECUTING P ROXIMITY-SEEKING ACTIONS Purpose: To explore three proximity-seeking actions and describe your experience of executing them. Directions: First, reflect on what you expect when you seek proximity to others. Do you expect people to respond negatively or positively in general? Do you expect some to respond positively and others, negatively? I expect____________________________________________________________ Then follow the prompts below, exploring these actions with your therapist. 1. Take the time to be mindful of your body, emotions, and thoughts in the present moment. Then notice how they change when you try each of the proximity-seeking actions below with your therapist. After you try each one a few times, record your experience in the four boxes around each action.

Reach Out Body Movements & Sensations: Thoughts: Emotions: Images/Memories:

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Lean Toward Body Movements & Sensations: Thoughts: Emotions: Images/Memories:

Eye Contact Body Movements & Sensations: Thoughts: Emotions: Images/Memories: 2. Is it easy and familiar to make these actions toward another person, or is it difficult? What early attachment experience contributed to the actions being easy or 842

difficult?

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Connecting with Others P ROXIMITY & DISTANCE Purpose: To develop awareness of your body’s signals that inform you when the distance between you and another person is “too close,” “too far,” or “just right.” Directions: Read through the prompts below and then complete this exercise with your therapist. 1. Stand at least 10 feet apart from your therapist (stand even further apart if you can) and face one another. With your arm and hand, make a motion beckoning your therapist to walk toward you very slowly. Be mindful of what happens in your body as proximity is increased. As soon as you feel an internal change—a slight tightening or collapse, a leaning back, change in your breath, or anything else— change your beckoning motion to a “stop” motion, palm facing outward, at which point your therapist will stop. Discuss your experience. 2. Ask your therapist to slowly back away from you until he or she feels too far away from you. Pay attention to what body signals inform you that he or she is too far away. Discuss your experience. 3. Then experiment with beckoning and stop motions again. Repeat this until you can identify precisely what body signals tell you that your therapist is too close and what signals tell you that he or she is too far away. Record those signals in the chart below. “Too Close” Body Signals

“Too Far” Body Signals

4. Experiment with beckoning and stop motions again until you can physically sense the degree of proximity that feels just “right” to you. It may be indicated by a change in breath, a relaxation, the ability to easily make eye contact, an opening in your body. Describe the body signals of the “right” proximity in the box to the right. Body Signals of the “Right” Proximity 5. Track the body signals you identified as too close, too far, and “just right” throughout the week and identify the situation in which you experience the body signals for each degree of proximity below. “Too Close” Situation

“Too Far” Situation

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Right Proximity

Discuss what you discovered with your therapist at the end of the week.

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CHAPTER 34

Play, Pleasure, and Positive Emotions THERAPISTS’ GUIDE TO CHAPTER 34

Purpose of this Chapter Regulation of affect and emotion “is not just the reduction of affective intensity, the dampening of negative emotion. It also involves an amplification, an intensification of positive emotion, a condition necessary for more complex self-organization” (Schore, 2003a, p. 78). Panksepp (2000) elaborates, “It would seem that joy lowers the neural threshold for perceiving life events as being positive and hopeful while raising those for perceiving events as negative and hopeless” (p. 186). As we draw toward the conclusion of this book, providing opportunities for clients to increase positive emotions is a major goal. But lacking past experience with attachment figures who welcomed positive emotions by their own nonverbal communications—prosody, laughter, welcoming movements and gestures, facial expressions, and other body language—our clients are often challenged when it comes to a full-bodied capacity to enjoy life and to play. As Panksepp and Biven (2012) state, the urge to play is “fragile because a great number of environmental manipulations can reduce play—including all events that induce negative emotions states, such as anger, fear, pain, and separation distress” (p. 255). Experts in trauma and attachment have long noted the effects of fear, neglect, inconsistent parental availability, excessive criticism and rejection on children’s ability to play. In some environments, laughter may even have been used maliciously, inducing negative affect in children. Panksepp and Biven (2012) assert that “the dark side of human laughter has long been known to occur in response to seeing others hurt, humiliated, or embarrassed” (p. 370). Attachment researchers have observed the curtailed exploratory and play behavior of children with insecure–ambivalent attachment, the stereotyped movements and behavior seen in children with disorganized attachment, and the loss of interpersonal play in those with insecure–avoidant attachment (Cassidy & Shaver, 1999). Similarly, van der Kolk (1996a) has described the restriction of creative and playful behavior in abused children. 847

Because play and positive emotions depend upon secure attachment for their full elaboration, and defensive responses require inhibition of spontaneous or playful behavior, it is not surprising that positive emotions can be challenging for our clients. Play and pleasure are not compatible with hypervigilance, bodily tension, constricted movements, or hyper- and hypoarousal, or with fear of criticism, judgment, humiliation, or rejection. Integral to the third phase of treatment, this chapter’s goals are to help clients expand their capacity for positive emotions, pleasure, and play by working with the patterns that inhibit the ability to experience increased joie de vivre and exploring new possibilities to foster these capacities. Cannon (2013) even goes so far as to say that it may be that learning to live more in the “spirit of play” than in the “spirit of seriousness” is the end goal of all therapy. A playful life stance allows us to embrace life and each other with lightness, humor, and openness.

Clients Who Might Benefit First and foremost, clients whose relationships and enjoyment of life are compromised by difficulties with tolerating or expressing positive emotions will benefit greatly from the work of this chapter. Whether clients encounter problems playing with their children, having fun with a significant other, engaging playfully with friends, or taking time off work to relax and enjoy themselves, their quality of life is diminished and opportunities are lost to deepen bonds with their loved ones. Those who are intimidated by or awkward with verbal playful repartee may benefit from this material. This chapter is particularly important for the positive-affectintolerant clients who are triggered by pleasurable feelings or their expression. Some of these clients have avoided social situations, such as the annual company picnic, “games night,” or other potentially enjoyable activities, because they trigger anxiety, hyperarousal, hypoarousal, or even self-destructive behavior. Good feelings may evoke shame, the urge to hide, deflection of positive feedback, withdrawal into invisibility, and isolation. This chapter will also be useful for clients whose attachment patterns keep them out of relationships or “on the outside looking in,” reinforcing feelings of not truly belonging or being able to engage with others in an enjoyable way. Limiting beliefs such as “I can’t make mistakes,” “Life is work, not play,” “Having fun gets you in trouble,” or “I have to do things the right way” will all constrain extemporaneous play and pleasure. The inability to be spontaneous, to laugh and smile, to “play” in verbal conversation, or to engage in activities requiring freedom of movement (i.e., tag or hide-and-seek with children, bowling or dance with adults) supports limiting beliefs that continue to curtail the spontaneous behavior of positive emotions.

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Suggestions for Clinical Use By this stage of this book, much work has already been done with regard to clients’ fears, dysregulation, painful emotions, limiting beliefs, and corresponding physical tendencies. As they are increasingly able to neurocept safety, clients may spontaneously smile and laugh more often, increasingly enjoy eye contact with you, and more easily execute proximity-seeking actions. Their voices may be lighter and less tense and their bodies may move more freely. In the context of your attunement and collaboration, clients can learn to become more curious and mindful of internal experience in response to these pleasurable expressions, of thoughts or memories of play and positive affect and the movements that express them, or of spontaneous moments of playful interaction and positive affect with you in session. Capitalizing on every in-the-moment experience of humor, lightness, spontaneity, relaxation, playfulness, or mutuality as it occurs in the therapy session will promote clients’ capacity for positive states. When you see clients smile and relax the shoulders a bit, for example, you can enhance the moment by naming and mirroring their actions or sharing your own experience. You might say something like “A smile comes when you talk about your kids, and your shoulders seem to relax” or “It feels good to smile, doesn’t it? Let’s stay with that good feeling for a few minutes. What else happens in your body or with your thoughts, images, or emotions?” Another way to explore body movements that go along with positive emotions is to discover with your clients what kind of posture and movements they would want to make in a context of enjoyment, fun and play, such as, opening, expressive movements; jumping, dancing movements with legs and arms; bouncy steps; tilting the head; a more upright, open posture or a different kind of walk or facial expression. You might playfully model these movements yourself and invite them to join you. This may test your own ability to engage in or demonstrate carefree, silly, playful actions and possibly refine them at your client’s instruction. Some clients may be unable to experience positive emotions with you, with others, or generally in life, and might report that they do not know what activities or interactions would bring them pleasure, satisfaction, joy, or other feelings of wellbeing. They will need your help to discover which people and activities induce, even slightly, positive emotions or awaken their impulse to play. You also might capitalize on the connection, pleasure, and playfulness some clients have found with their pets, but may not experience in human interactions. For example, one client brought her dog to therapy and explored positive emotion with her therapist as they played together with her dog. You might also use the material to encourage clients’ curiosity about how they “hold themselves back,” keep a poker face, stay serious, or guard against play or positive emotions. Some clients may recall a family expectation to appear happy even in the midst of fear or emotional pain, whereas others recall the importance of 849

never appearing joyful or excited no matter how much fun they were having. These slivers of memory may help clients address survival resources or coping behaviors that inculcated limiting beliefs related to positive emotions. Keep in mind that challenging clients capacities for pleasure may catalyze apprehension or increase procedurally learned physical patterns that still constrict their enjoyment of life. For many clients at this stage, remaining focused on increasing the capacity for play and pleasure will be more useful than exploring negative patterns associated with positive emotions that have already been addressed. You can help clients sense the safety of the here and now, remind them of their ability to set boundaries and say “no,” but still continue to encourage their exploration of the spontaneous, relaxed, more expressive movements characteristic of positive emotion. Some clients may find positive feelings even harder to tolerate than distressing emotions. When positive emotions feel more out of control or more foreign, or clients associate pleasurable feelings with trauma, punishment, abandonment, criticism, or rejection, the material in previous chapters can help you process and shift limiting beliefs and emotions that prohibit play and positive emotions. Afterwards, to the extent possible, given each individual client’s capacity, you can notice, and help clients notice, how their procedural tendencies interfere with enjoyable interactions. For example, having a tense face and body, pulling back, or furrowing the brow might put off playful overtures from a significant other or potential partner. They can then practice inhibiting such tendencies. Keep in mind that exploring any type of positive emotion will support the goals of this chapter. As Panksepp (2000) states, “In addition to laughter, we may need to focus on issues such as hope, love and confidence as natural, health-promoting features of the brain–mind in humans” (p. 186). Although some of your clients may welcome only high-arousal pleasurable states, and others only low-arousal ones, positive emotions at both extremes of the window of tolerance are valuable to explore and deepen in therapy. Additionally, you can encourage your clients to experiment with embedding play and fun into their ordinary lives by “do[ing] many purposeful, productive things playfully, mixing seriousness and frivolity together into the same activity” (Caldwell, 2003, p. 304).

Introduction to the Worksheets The worksheet REMEMBERING FUN TIMES asks clients to think about two times in their past when they had fun and felt playful. If the idea of fun or playfulness is confusing for your clients, referencing slivers of childhood memory may help them relate to the worksheet. You can encourage your client to remember by asking, “Can you remember fun times as a child? In your family, were there ever laughs and 850

smiles? Did people ever interact playfully or seem to enjoy each others’ company? What things did you do for fun with anyone in your family? Did anyone ever enjoy your enjoyment of something?” This worksheet can be helpful for clients whose constricted movements, hypo- and hyperarousal, avoidance behavior, or tension in the face and body is observed in session. On the LOOKOUT FOR FUN & PLAY encourages clients to heighten their awareness of the playfulness already available or spontaneously occurring in themselves and in others. Even if they insist that they never feel pleasure, the concrete categories and examples here may help them become aware of the little acts of play that often go unrecognized. Clients will benefit from your validation of even the smallest moments of playfulness. For some clients, positive feelings were met with humiliation and scorn or punished emotionally or physically, leading to somatic patterns that inhibit playfulness. POSTURES & MOVEMENTS TO SUPPORT PLAYFULNESS & FUN brings to light the body responses that dampen or constrict the capacity to feel pleasure or to “flow” spontaneously moment to moment, and contrast these with body responses that communicate a readiness to play. The two of you might playfully experiment together with movements that prevent or invite play. You can become aware of the sometimes subtle changes in the body that participate in each of these states. HIGH AND LOW AROUSAL POSITIVE EMOTIONS helps clients identify pleasurable emotions at both extremes of the window of tolerance, assess the ones that are familiar to them and the ones that are not, and explore some ways to develop one emotion that is unfamiliar. BELIEFS THAT LIMIT POSITIVE EMOTIONS is designed to elicit the cognitive schemas that underlie difficulties feeling the full range of pleasurable emotions and to begin experimenting with alternative beliefs that allow a more relaxed, deeply pleasurable experience of life. The activities in PRACTICING PLAYFULNESS can be used to encourage clients to step outside their comfort zone and to identify and intentionally engage in playful activities of their choosing and then mindfully notice their responses. With observation and practice of what feels good, clients can discover how their experience changes when they can enjoy playfulness. Your ongoing encouragement to follow through with the activities of the final steps of these worksheets will be essential for lasting change.

Adapting this Material for Dissociative Clients Clients with dissociative disorders can be helped to notice that some parts find positive emotions and playfulness antithetical or even threatening. Other parts may dismiss playfulness as silly or stupid as an avoidance strategy. Ones too frozen or hypoaroused may not be able to experience these qualities. Some parts may associate play with trauma, such as when “games” were used to groom or seduce a 851

child. Yet other parts may be persistently playful or silly in order to avoid painful emotions and memories. Certain parts may feel betrayed by experiencing pleasure during sexual abuse. It is especially important to validate each part’s reactions to positive emotion as consistent with that part’s role in helping the client survive so that you do not inadvertently increase the internal conflicts between parts holding different survival strategies. If you use one or more of the worksheets with your dissociative clients, they might experiment with different parts filling them out and then sharing the results internally at home or in session with you, if they find that helpful. It will be important to discover what each part needs in order to foster positive emotions in a way that is tolerable and feels good, emphasizing that no part has to try something that feels dangerous or overwhelming. Even if your clients are too dysregulated to increase play and positive emotions at this time, there is still a therapeutic benefit in helping them notice the internal struggles between parts in regard to this topic. By observing how some parts long to feel good and how others fight all positive feelings, holding both in awareness simultaneously, you can foster a small but significant piece of integration. Helping parts communicated with one another can sometimes promote discovery of common ground or common longings for pleasurable emotions. Perhaps parts can agree on one playful action to explore, or one positive emotion to cultivate. Or, if some parts cannot agree at this time, perhaps they can observe from a safe distance. If the material in this chapter exceeds the integrative capacity of dissociative clients with a narrow window of tolerance or abuse histories that cause them to associate pleasure with danger or pain, you can also use the chapter for psychoeducation about positive affect intolerance, break down the material into small steps, or save it for a later time in therapy when the client can make better use of it.

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CHAPTER 34 Positive Emotions, Pleasure, and Play Despite the growth you have accomplished as you have gone through this book, you might still feel that life could be more enjoyable. Maybe you don’t remember the last time you laughed out loud or thoroughly enjoyed yourself. Maybe you long to put your stress and worries aside and just have some fun. In the hectic pace of modern life, it’s easy to be so consumed with work and commitments that we don’t find the time to just kick back, relax, and play. Or, when we do manage to carve out some time for ourselves, we don’t want to do anything except surf the internet or zone out in front of the TV. Some of us may find that we don’t have the energy or motivation to engage in playful activities or just don’t know how to have fun. Perhaps you have a tendency to be “all work and no play,”or to have difficulty “letting go,” to be good in a crisis but tongue-tied in social situations calling for laughter and small talk. Maybe you feel envious of parents who easily giggle and play with their children, or of the fun-loving friend whose laughter is contagious and whose big, openhearted smile lights up a room. Maybe you find yourself focusing on the negative aspects of life. Positive emotions of all kinds—joy, hope, excitement, contentment, or tenderness—might be few and far between. Some of us grew up in environments that were not conducive to positive emotions such as the joy, delight, exuberance, laughter, and fun that go along with being playful and lighthearted. The capacity for play and other positive emotions cannot develop under the scrutiny of a strict, disapproving, overly serious, or performance-oriented parents, nor in the shadow of threat and danger. If safety and well-being are at risk, or if children are concerned about being criticized or rejected, their pleasurable feelings and playful activities are instantly terminated, and the body tenses, constricts, and pulls back. Spontaneous movements cease, voices quiet, and actions tend to become small, wary, frozen or constrained. If these conditions are prolonged, the ability to play and experience positive emotions can be greatly diminished, creating far-ranging consequences for our capacity to revel in the enjoyment of positive emotions and playful spontaneity. We may miss out on the advantages of the deeply serene, exuberant, or uplifting emotional states that foster resilience, safeguard us in difficult times and contribute to our enjoyment of life. This chapter explains how childhood environments nurture or limit positive emotions, explores the physical characteristics of playfulness, and provides some ideas for how to reclaim and further develop our capacity for play, pleasure, and positive emotions. 854

How Play and Positive Emotions Develop Joan complained that her life was tedious and she never had any fun. Spontaneity, laughter, and the confidence and flexibility to engage in open-ended, unstructured playful activities were unfamiliar to her. The contraction and hunching of her shoulders, a lack of free movement in her upper body, and a plodding, heavy quality to her gait all went along with being “too serious.” Her tense body and constricted way of moving were the opposite of the relaxed, open body posture that invites playfulness, pleasure, and positive emotions. Though Joan wished she could “lighten up” and enjoy herself, she felt uncomfortable when she attempted to be more spontaneous and playful. She found that movements typical of a playful attitude—tilting of the head, an unexpected gesture, sudden laughter, a whimsical expression or grin, a bounce to one’s gait— were foreign to her and often made her nervous when she saw them in others. And, when she observed others relaxing and enjoying themselves, she thought they were “wasting time.” Joan had come to associate play, pleasure, and positive emotions with laziness, being unproductive, and being vulnerable to ridicule or threat. She had little experience with the joyful spontaneity and elation characteristic of play, and rarely felt happy, delighted, or even contented. She failed to see the humor in things, and habitually viewed herself and others from a negative perspective. Simply put, she did not know how to “feel good.” We are all born with an innate impulse to play and enjoy ourselves, a need that is met when our caregivers play with us. We’ve all heard the shrieks of laughter and joy when a mother or father takes a child’s excitement to the upper edges of the window of tolerance by chasing her in the park, tossing him into the air, or playing a stimulating game of peek-a-boo. During these high-energy interactions, each person responds to the other with laughter and rapid changes in movements, heart rate, and breathing as arousal states fluctuate. Through these activities, the child learns to enjoy sympathetic high-arousal states coupled with joyful exuberance and a measure of unpredictability through these activities. If these high-arousal states alternate with calming, soothing interactions, the child also learns to enjoy quiet parasympathetic low-arousal states of serenity, tenderness, deep relaxation and contentment. In these interactions, extreme states of high- and low-arousal have been paired with pleasurable emotions instead of with the fear that accompanies hyper- and hypoarousal. The association of high- and low-arousal states with positive experiences supports a flexible nervous system that can adapt quickly to all kinds of stimulation and a wide range of life events. The window of tolerance can expand to include both calm (peaceful, serene, contented, tender, relaxed, or restful) and intense (exhilarated, excited, delighted, ecstatic, hilarious, elated) emotions. Play activities change over a lifetime. In childhood, they range from the social 855

play of peek-a-boo, to hide-and-seek, to uncontrollable silliness and rough-andtumble play with peers or adults. As we mature, play activities become more elaborated include imaginative play, creative activities and spontaneous group play activities. Later in childhood, less physical and more cognitive varieties of play often emerge in the form of jokes, puns, word games, and other kinds of verbal repartee, mental humor, comedy, and entertainment. Although “contest” activities— organized sports, music, or art competitions, video games, and other competitive pursuits—can be a lot of fun and are often described as play, they do not qualify as playful if they are anxiety-driven or excessively focused on “winning.” True play is anxiety free, without pressure, and engaged for its own sake rather than to achieve a goal, such as to win or out-do someone else. The spontaneous nature of playful activities strengthens attachment and social bonds in a different way from being comforted when distressed or generally cared for. Play helps us develop a capacity for mutuality and an appreciation of shared enjoyment unadulterated by pressures to win approval or avoid losing or fear of performing poorly. Elevated excitement, joy, and elation are paired with highenergy play activities such as tag or sports or energetic, fun verbal banter with others, and often followed by relaxing, enjoyable, more restful, quiet pleasure, such as hanging out or enjoying a beer together.

Recovering from Negative Emotions The overall ability to experience positive emotions is enhanced when children receive support to transition from negative emotions, such as disappointment, to positive ones. Running euphorically can sometimes be followed by a fall; trying to catch a ball and missing it might lead to disappointment; parents’ lack of attunement can lead to hurt feelings. Being able to recover from painful or unpleasant moments so as to shift back into pleasurable states is critical in learning to transition easily among different states and not stay stuck in any one emotion. When good-enough parents comfort children when they are hurt or disappointed, recovery is quickly fostered. When they provide “interactive repair” by soothing the distress caused by parents’ own misattunements, children learn that breaches in connection are temporary. When caregivers get angry at the child for no good reason, and then apologize and seek to reestablish connection, they are helping a child recover from that painful moment. The child learns that even parents make mistakes and that closeness can be restored after discord. The felt experience of positive emotions followed by negative emotions followed by positive emotions imparts an attitude of hope and trust that negative feelings have a beginning and end. When parents must interrupt the child’s play for bedtime, they provide support to manage the frustration. They might even create a 856

playful routine of storytelling or fantasy that interweaves fun with the disappointment of ending something pleasurable. When the child falls and bruises a knee, good interactive repair from a caregiver provides both comfort and reorienting of attention to something enjoyable. When parents return after separation from their child, they communicate pleasure and excitement, upon reunion even when the child has been upset at their absence. This transitioning from positive to negative and back to positive emotions helps children develop resiliency and flexible, adaptive capabilities in all their social relationships.

When Play Cannot Develop Play and positive emotions cannot thrive in environments such as the one in which Joan was raised, where she learned to associate happy or excited feelings with vulnerability, ridicule, disapproval, disdain, and occasionally even danger. Positive emotions and play require the subjective experience of safety and receptivity. When those have been missing, we instead experience uneasiness or fear or other negative emotions that compete with pleasure and play. When highand low-intensity forms of positive emotions are absent or paired with fear or apprehension, the window of tolerance becomes restricted, and we will have less tolerance for all kinds of emotions. Navigating rapid alterations from the high arousal of joy and excitement to quiet states or the ending of playtime can become difficult. We may have trouble shifting states to accommodate the changing environment, task, or relational context and may stay “stuck” in states of hyper- or hypoarousal aggression, isolation, fear, shyness, worry, withdrawal, and so forth. Joan’s parents, preoccupied with their own troubles, did not provide adequate soothing of her states of distress, nor did they play with her. As a child, Joan’s energy was focused on avoiding stress and placating her anxious, depressed mother. And at school, some of the bullies in her class found enjoyment in her clumsiness at group sports, teasing her mercilessly and laughing when she became embarrassed. These humiliating experiences caused Joan to shut down and withdraw from her peers. As an adult, she found herself feeling stiff and awkward in social situations, unable to laugh, engage in conversation, or enjoy herself. Joan had become more accustomed to avoiding pain, fear, and humiliation than to seeking out situations that would make her feel good.

Learning to Play Reclaiming or enhancing the capacity for play, pleasure and positive emotions can foster resilience and buoyancy. There are many ways to do this. Joan’s first step 857

was to be on the lookout for fleeting moments of playfulness and enjoyment in her daily life. With her therapist’s encouragement she began to orient toward even the briefest of giggles, laughter, smiles, and other expressions of fun in others. As she noticed moments with others that felt good, she also noticed her response—a brief smile, a slight lift of her posture, a warm or tingly sensation. With practice, she began to identify situations, people, and activities that elicited pleasurable feelings. Gradually, she changed her orienting habits from only paying attention to serious cues to also paying attention to positive and playful cues. With her therapist, Joan explored different postures and movements to counter her stiffness and constriction. She practiced exchanging her plodding gait for a bouncy, head-up walk, her hunched shoulders and rounded spine for an upright posture that encouraged eye contact and engagement with others and supported positive feelings. She practiced looking around to see what colors, people, or scenery she found pleasing, and then tuning in to savor her internal experience of enjoyment. During one therapy session, Joan and her therapist decided to explore playing together through a game of catch, playfully throwing a soft ball back and forth. At first, Joan felt uneasy and awkward, saying, “This is dumb.” Catching it, though, she began to feel a sense of lightness, and a giggle rising up into her with the satisfying feeling of catching the ball. She remembered how humiliated she had felt as a child when the others kids had teased her mercilessly for being clumsy and shy. Eventually, she had refused to join in neighborhood games, but she had felt lonely and jealous when she saw the other kids playing catch outside her window. Joan tearfully told her therapist that she had felt so miserable as a child that she had wished she had never been born. For Joan, an important step was to grieve for the friendless sad child she had been who had grown up without the laughter, playfulness, and fun that every child deserves. Over many sessions, Joan and her therapist continued to experiment with playful games of catch until gradually, Joan’s discomfort gave way to laughter and enjoyment of the fun and mutuality of this simple activity. After one particularly fast-paced, fun game of catch filled with spontaneous laughter, Joan found the words to describe the pleasure and enjoyment she felt in that moment: “I feel the joy connected to an energized feeling in my chest that has warm, tingly feeling around my heart. There’s a feeling of radiating energy that seems to go from the core of my body out my arms and legs. My eyes widen, and I feel the slight tightening of muscles in my cheeks and mouth that go with a smile. And I feel the good feeling of happy tears behind my eyes.” As Joan practiced finding other activities that stimulated these pleasurable sensations and joyful feelings in her daily life, her capacity for positive emotions slowly grew. Bill complained of feeling socially awkward, perpetually scattered and unable to focus, reflected in his quick, uncontained, impetuous movements, and in his eyes 858

that darted around the room. He always had several projects going at once, many of which remained incomplete, and he told his therapist he could never rest. He always felt that there was too much to do. With his hands in constant motion, Bill spoke rapidly and hardly seemed to pause for breath. He was distracted and uncomfortable in social interactions and his strained smile communicated that he did not enjoy himself. In therapy, Bill learned to pause and notice his rapid heart rate, anxiety, all-over tension, and apprehension when he thought about not moving so fast or doing so much. He began to realize that “slowing down” made him uneasy. In his work with his therapist, Bill realized that his apprehension was left over from a family who prized “doing” over “being.” Always staying so busy interfered with his enjoyment of life, and especially quiet, tender, or relaxing moments that had “no purpose.” Every night at dinner, his parents would ask, “What do you have to show for yourself today?” The more projects he reported to his parents, the more they praised him. Bill had learned at a young age to turn his attention to goal-oriented, “productive” activities and tried to meet their expectations by doing more. Bill’s therapist encouraged him to experiment with doing nothing. He stretched out on the sofa and tried to let his body sink into the comfy cushions, but he couldn’t relax. Mindfully, Bill noticed his impulses to move, uneasy emotions (nervousness, anxiety) and thoughts of “Stop being so lazy! You should be doing something. You’re just wasting time.” Bill’s first step was to reexperience the emotional pain he had felt at dinnertime when his parents demanded proof of his achievements for the day. He also remembered vividly a time when he was 7 years old lying on his back in the summer sun watching the clouds float by and daydreaming. His reverie was suddenly interrupted by his father sarcastic voice saying that Bill was a “lazy slug” and that he would never amount to anything. Ashamed and hurt, Bill had pushed away a tender, quiet, dreamy part of himself. Eventually, after processing this sliver of memory filled with anger at his father and grief for the part of himself he had lost, Bill inhibited his impulses to move and challenged his self-critical thoughts with, “I have a right to relax. I don’t have to produce all the time. It’s OK to be lazy sometime. I can just enjoy myself.” Bill gradually began to relax and enjoy the sensations of his muscles letting go and his breathing deepening and he slowly felt more connection and peace within himself. Later, Bill reported that as he practiced low-arousal pleasurable states, he discovered a newfound tenderness in activities with his 4-year-old son—quietly cuddling at bedtime, lying together on the grass watching clouds and making up stories, and sometimes just tenderly snuggling with no talking at all. Whether in therapy or with friends and family, all of us have experienced moments of pleasure, fun, playfulness, and other positive emotions that included spontaneous movements, relaxation, pleasurable eye contact, deep calm, contentment, smiling or laughter. The worksheets that follow will help you watch 859

for incipient spontaneous actions and emotions—the beginning of a smile, meaningful eye contact, a gentle and kind moment with another person, the trust of a child or pet, a more expansive or playful movement, a bounce in your walk—you can learn to capitalize on those moments by participating more consciously in them, enabling the moment to linger. The worksheets will encourage you to explore all kinds of positive emotions from excitement, joy, humor, and lightheartedness to tranquility, deep satisfaction, or quiet tenderness. The ability to enjoy a wide range of positive emotions can counter the often arduous work of therapy and help us expand the boundaries of our windows of tolerance.

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Pleasure, Play, and Positive Emotions REMEMBERING F UN TIMES Purpose: To explore the physical actions you used during two times in the past when you had the most fun, and to identify the emotions and beliefs associated with those physical actions. Directions: Take a look at the examples of fun and playful actions and activities below, and circle the ones you remember experiencing. Add any additional fun actions you have experienced in the empty boxes. Imitating people in a funny way, acting out a silly skit, laughing at slapstick antics

Skipping, hopping, twirling around, doing cartwheels, or walking with a bounce in your step

Doing cannonball jumps into a pool or having a water balloon fight, running through a sprinkler

Telling jokes or funny stories or laughing at jokes or funny stories

Talking in a funny voice, singing a silly song, making funny noises

Making faces or dressing up in a funny outfit

Playing a high energy Smiling, snickering, Jumping on a bed or game (e.g., tag or giggling or just being silly trampoline, or swinging as Pictionary) and with friends high as you can on a swing shrieking with laughter Select two times in your life when you had the most fun. They could be childhood memories or more recent memories. They could be activities from the chart above. Describe your memories in the first boxes and then, follow the arrows. Describe the first memory. Remember and describe your physical expressions or actions of this fun moment. Remember how each of those actions felt in your body, and describe what you felt. Describe the emotions you felt during this fun moment.

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What thoughts did you have about yourself, others, or the world? Describe the second memory. Remember and describe your physical expression or actions of this fun moment Remember how each of those actions in your body, and describe what you felt. Describe the emotions you felt during this fun moment. What thoughts did you have about yourself, others, or the world? How could you incorporate these or similar playful actions and activities more fully into your life today?

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Pleasure, Play, and Positive Emotions ON THE LOOKOUT FOR F UN & P LAY Purpose: To become more aware of the fleeting moments of fun and playfulness in your daily life that you experience yourself or that you notice in others. Directions: Over the next week, be aware of playful or fun moments that you initiate or experience, and notice when others are having fun. Describe these moments in the categories provided below. At the end of the week, answer the questions at the bottom of the page. Moments of fun and playfulness I noticed in myself Spontaneous actions e.g., I decided on a whim to take the kids to get ice cream. Jokes, puns, seeing humor in things e.g., I imitated my boss with my coworkers and we all laughed out loud. Laughter, smiling e.g., I cracked up at a sit-com I watched. Other: Moments of fun and playfulness I noticed in others Spontaneous actions e.g., When I took my kids to the park, they met some new kids and they laughed and shrieked at the treasure hunt game they made up. Jokes, puns, seeing humor in things e.g., My boss told a really funny story during a meeting. Laughter, smiling 865

e.g., My husband laughed when our two-year-old son offered to share the cookie he had slobbered on. Other: Did you notice any fun or playfulness in your life that you had not acknowledged until now? If so, make a commitment to remember to recognize those overlooked moments in your life and enjoy them.

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Pleasure, Play, and Positive Emotions P OSTURES & MOVEMENTS TO SUPPORT P LAYFULNESS & F UN Purpose: To discover postures and movements that prevent you from playing and to try on postures and movements that invite play. Directions: Experiment with postures, movements and expressions that invite play and inhibit play by following the prompts below. 1. Find a posture, movement, or expression that conveys, “I’m not in the mood to have fun. I don’t want to play.” Do you keep your head down, are you still or tense at parties? Do you avoid eye contact, or slump when others are joking around, smile when you don’t want to, keep silent, or something else? Take a few moments to embody the expression you found and then fill in the chart below. Describe your posture, movement, or expression.

How does it feel in your body?

What emotions and thoughts go along with it?

What memories go along with it?

2. Now find a posture, movement, or expression that says “Let’s play!” or “Let’s have fun.” Try thinking of a mischievous child ready for fun, teenagers joking around with their friends, or a dog dropping a ball in front of you and giving your that playful look. Take a few moments to embody the expression you found and then describe your experience in the chart below. Describe your posture, movement, or expression.

How does it feel in your body?

What emotions and thoughts go along with it?

What memories go along with it?

4. Identify three situations in which you want to embody a playful attitude with others (e.g., When my family comes to visit; weekend mornings when the kids climb into bed with us; with my too-serious friend).

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Pleasure, Play, and Positive Emotions HIGH AROUSAL AND LOW AROUSAL P OSITIVE EMOTIONS Purpose: To identify high and low arousal pleasurable emotions that you experience frequently, as well as those that you experience infrequently but would like to experience more. Directions: Follow the prompts below. 1. Circle pleasurable high arousal emotions you experience frequently. Add any that are not on the list in the empty space at the bottom. High Arousal Positive Emotions Astonished

Exhilarated

Jubilant

Delighted

Exuberant

Overjoyed

Ecstatic

Giddy

Silly

Enthusiastic

Gleeful

Thrilled

Excited

Happy

Triumphant

2. List three of the high arousal emotions that you circled. Describe a situation or person that evokes each one and how you experience each of them physically. a. b. c. Window of Tolerance 3. Circle pleasurable low arousal emotions that you experience frequently. Add any that are not on the list in the empty space at the bottom. Low Arousal Positive Emotions Affectionate

Contemplative

Peaceful

Calm

Contented

Pleased

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Caring

Grateful

Satisfied

Compassionate

Kindhearted

Tender

Composed

Loving

Tranquil

4. List three of the low arousal emotions that you circled. Then describe a situation or person that evokes each one and how you experience each of them physically. a. b. c. 5. Choose one high arousal emotion and one low arousal emotion that you do not experience very often and describe how you might cultivate each one.

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Pleasure, Play, and Positive Emotions B ELIEFS THAT LIMIT P OSITIVE EMOTIONS Purpose: To explore early experiences that curtailed your positive emotions in some way, and identify the beliefs you formed that constrict your ability to experience good feelings in your life today. Directions: Reflect on early relational experiences that curtailed your positive emotions (e.g., being hushed, laughed at, shamed, or criticized for being, excited, silly, or loving, or growing up with caregivers who were stressed, depressed, too serious, overemphasized accomplishments, or frowned on play or good feelings). Then follow the prompts below. 1. Describe the experience that curtailed your positive emotions. 2. Describe the belief you formed and how it affects your body. 3. Describe how the belief affects your ability for positive emotions today. 4. How could you challenge the veracity of the limiting belief? (e.g., My parents taught me that I should be serious and never be silly, but being with my friend Joe challenges the belief because he is silly all the time and I can be silly with him.) 5. How could you change your body to support the new belief? (e.g., I could remember to relax, smile, and giggle more.) 6. What activities could you try out? (e.g., I could hang out with Joe and my friend’s children who are good at being silly and be silly with them.)

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Pleasure, Play, and Positive Emotions P RACTICING P LAYFULNESS Purpose: To intentionally engage in playful activities with others. Directions: Review the playful activities below and write new ones you think of in the space provided. Choose three of these activities to try out. Write down the activity in the bubbles and your emotional and physical responses when you try it out in the corresponding ovals. Consider how you know when you are having fun and how your body changes when you are being playful. • Do things with a friend that make you laugh (e.g., sing in a silly voice, skip down the street). • Play with a child, puppy, or pet. • Think of funny things that have happened to you and tell your friends or family. • Watch a funny TV show. • Do something fun you used to do, but stopped doing. • Throw a lively dance party. • Go out to a comedy show or funny movie. • Roughhouse with your kids, a friend, or partner. • Buy a joke book, or search for jokes online, find one you love, and tell it. • Google “funny short stories” and read them with your therapist, a friend, or kids. • Go to a park or playground and play on the swings with a child or friend. • Take silly photos of yourself with a friend or family member. • Other:

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Challenging Your Window of Tolerance THERAPISTS’ GUIDE TO CHAPTER 35

Purpose of this Chapter At the start of this book, your clients are likely to have struggled with dysregulation or problematic emotions as well as with disturbing sensations or a lack of body awareness. As they learned the mindfulness skills of deconstructing triggered or painful experiences into component building blocks and then orienting to the environment or directing their mindful attention to their internal experience in regulating ways, they were slowly able to expand their windows of tolerance. Connecting with the body in new ways, trying out unfamiliar actions, and exploring undeveloped resources has also increased their windows. Through utilizing their resource repertoire, exploring implicit memories, and changing procedural patterns, their capacity for optimal arousal and social engagement has surely grown. With these expanded capacities, and with more relational resources, they might feel ready to seek out greater risks, knowing that they have the resources to regulate themselves if they become dysregulated. Human beings have a need for safety, rest, and deep relaxation, which requires co-opting the dorsal vagal system for immobilizing states, without the fear that accompanies dorsal vagal shutdown (Porges, 2011). But we also have a need for novelty, which is risky and unpredictable and requires that we are able to mobilize sympathetic arousal without the extreme fear associated with hyperarousal states (Porges, 2011). Therapy itself “is always a dance of safety, uncertainty, and risky challenge” (Ogden, in press). Safety is necessary to establish a context in which psychotherapy can begin, but without helping clients to brave novelty, therapeutic progress is limited. We have given attention to creating safety, regulating arousal and developing resources in Phase 1, embarked on the arduous task of addressing painful memories in Phase 2, and attended to expressing emotions, challenging beliefs, and exploring relationships in Phase 3. Now, at the culmination of this book, this final chapter encourages clients to brave uncertainty not to resolve the past but to change the future by undertaking new challenges that directly expands 877

their windows of tolerance and increases their capacity for full living and relating. This final chapter of the book can be the beginning of increased vitality for your clients, as you and they use this material to develop their confidence to seek out and enjoy new adventures and endeavors.

Clients Who Might Benefit Most clients can benefit from directly and purposefully challenging their windows of tolerance unless they are unable to regulate arousal. In that case, more time should probably be spent developing the regulatory resources and skills of Phase 1 (which indirectly expands their windows). This chapter may be of particular benefit to those who characteristically avoid challenge and change and those who cling to such beliefs as “I’ll never be safe” or “I’m not capable” or “It’s not OK to make mistakes” even after they have found resources to regulate and have addressed the memories that shaped the beliefs. They can be encouraged to put these limited beliefs aside in order to undertake the challenges of this chapter. Clients who take impulsive risks without preparation or thoughtfulness will also benefit from more careful and thorough consideration of appropriate risks and their possible outcomes. Another group of clients for whom this chapter might be helpful are those who have rich, full, meaningful lives but cannot connect fully to their lives emotionally. As they challenge themselves to take risks, especially relational risks such as expressing their love for their children in physical ways, taking more initiative with their friends, or exploring the renewal of a sexual relationship with a spouse, their tolerance for novelty will grow.

Suggestions for Clinical Use As clients enter the uncharted territory of healthy risk and change, they will need your support to tolerate arousal that might be precariously on the edges of the window. As Bromberg states, each therapist has the intention “to provide sufficient safety so that the patient can make it back from the edge of the abyss and be aware of having done so. . . The optimal treatment context requires that the patient feel ‘safe but not too safe’” (2006, p. 189). You will need to support clients to inhibit old patterns of avoidance or constriction and challenge them to take the healthy risks that will allow them to live life more fully and richly. To have a window of tolerance spacious enough to encompass joy and sorrow, tragedy and triumph, requires going outside of one’s comfort zone, teetering on the edge of the window, and then discovering that the worst has not happened. Instead, clients will find that they have faced a fear or a challenge that leaves them feeling exhilarated, solid, and 878

confident. As clients consciously inhibit old patterns by working and “playing” at the edges of the window, neuroplasticity is harnessed that allows both the alteration of already-existing connections in the brain and the formation of brand-new connections (Siegel, 2010a). Some clients who take impulsive risks but fail to assess the consequences of their actions will need your assistance to predict and evaluate potential outcomes of risk-taking activities and select appropriate risks that will help them lead more grounded yet vibrant lives. Many clients will recognize that their already expanded windows of tolerance can support their braving more emotional, physical, or intellectual risks. Old procedural learning may still bias others to react negatively to healthy challenge, risk, and change. It is valuable information to many clients to know that their avoidance of risk-taking is procedurally learned and related to the past, and also that their overavoidance of novelty works against them in achieving their goals. To expand their tolerance for arousal and live a fuller life, they will have to allow and accept uneasy feelings outside of their comfort zone. They will need your support to dare to take on challenges that, until now, they have neurocepted as dangerous or uncomfortable (most likely because the outcome was either unknown or predicted to be negative). If you can encourage clients to take little risks, particularly in the direction of what they have always wanted, and help them develop their confidence that they now have the resources to handle whatever the outcome might be, their windows of tolerance and their enjoyment in life will gradually expand. Some clients will need your explicit encouragement and psychoeducation to take on needed challenges and push beyond the limits of their comfort zones for the longer-term reward of a more vital life. To challenge such beliefs as “There’s no use trying,” “I’ll just fail,” or “I don’t deserve it,” it may be more important to jump into the tasks of this chapter rather than to continue to explore the pain of these beliefs. Clients might then realize discrepancies between what they expect to happen and what does happen. For clients who are triggered by optimal arousal states, engaging in some activities that promote optimal arousal, rather than challenging their windows excessively, is also a form of healthy risk-taking for them. At this stage, every time clients are triggered by another step forward or are disappointed in the outcome of the risk they took, an opportunity is provided for further integration of the work of this chapter. As you and your clients reframe any dysregulation or disappointment as natural parts of risk taking that provide occasions for tolerating frustration and using resources, their confidence will continue to grow and their best selves will emerge.

Introduction to the Worksheets 879

A good starting place might be the worksheet entitled YOUR “BEST SELF” because it encourages clients to identify their dreams and hopes for themselves, and invites them to envision how they can take their new accumulated knowledge and resources, expanded window of tolerance, and access to social engagement to become the kind of person they may have long wished to be—not limited by autonomic hyper- and hypoarousa, biased neuroception, or procedurally learned patterns. It can also be helpful for impulsive clients because it will encourage them to thoughtfully consider their longer-term goals for themselves. Although this worksheet might bring up old cognitive schemas or even grief if it evokes awareness of lost time, its purpose is to inspire clients to take the risks needed to expand their capacity for full participation in life and in relationships. EXPANDING YOUR WINDOW: HIGH AROUSAL CHALLENGES seeks to help clients remember times when they have embarked upon activities that challenged their windows at the upper end. The companion worksheet, EXPANDING YOUR WINDOW: LOW AROUSAL CHALLENGES, seeks to help them remember times when they have engaged in activities that challenged their window at the lower end. This pair of worksheets emphasizes expansion of the windows at both edges, building confidence for taking two different kinds of risks in their lives today. These two worksheets also help them examine any unresolved negative effects from previous high arousal and low arousal challenges. Clients may need your guidance to resolve any negative repercussions from these challenges, and to identify and try out appropriate high and low arousal challenges in their current lives. With CREATIVE RESOURCES TO EXPAND YOUR WINDOW OF TOLERANCE, you can help your clients integrate the material they studied on categories of resources in Chapter 14, “Taking Inventory: Categories of Resources,” by identifying a risk they might undertake in each category, trying it out and then describing the result. PRACTICE TAKING RISKS continues to explore high and low arousal challenges by asking clients to choose a particular action or activity that they have been afraid to try and then to deliberately engage in that activity between sessions. By determining one concrete thing clients could do to expand their arousal at each edge of the window, and with your support, the task becomes manageable and possible.

Adapting this Material for Dissociative Clients By definition, dissociation implies a tendency to neurocept danger and threat rather than safety. Feeling safe is not accessible when clients or parts of the client are hyper- or hypoaroused. For these clients, taking risks or enjoying challenges may be frightening and unfamiliar, possibly connected to experiences of punishment or 880

humiliation. With orienting biased toward threat cues, they may have difficulty challenging the regulatory boundaries of their windows. Both high and low arousal might be coupled with excessive fear or shame rather than with excitement or relaxation. Thus, experiencing the bodily feelings related to low arousal and pleasurable states of calm, quiet, and contentment, or to high arousal excitement, joy, and elation may be triggering. Clients with dissociative disorders may have several different reactions to this chapter. They might long to feel happy, but happy feelings might evoke shame in a humiliated part, and fear in a child part connected to being punished for smiling, who heard words like, “I’ll wipe that smile off your face.” Yet another part might equate the bodily sensations of excitement (increased heart rate, butterflies in the stomach) with fear or rage and thus neurocept danger. Similarly low arousal challenges may evoke pleasurable states such as tranquility or contentment that may be coupled with anxiety. Dissociative clients and each of their parts generally want to stay within their comfort zone of what is familiar and so will need your consistent encouragement to brave appropriate small challenges that will expand the window. Facilitating collaboration among parts to agree on healthy risks that are appropriate for clients as a whole is optimal. You can help clients elicit the support of stronger, more confident qualities or parts of themselves to support the frightened, shutdown, or withdrawn parts so that they can successfully undertake challenges. Because optimal arousal itself is so challenging for this group of clients, it is important to proceed extremely slowly with an experimental attitude if you choose to explore risk-taking. You and your clients need to be prepared that doing so might take their arousal to the edges of the window of tolerance. The excitement of risk can easily catalyze hyper- or hypoarousal in these clients. You might experiment by simply asking clients to notice what happens when they (or parts of them) imagine taking the smallest risk, and be curious together about the reactions of different parts. You can help clients identify an appropriate risk for each part, and then explore how to modify that risk so that it is tolerable or acceptable for the other parts. If that is too dysregulating, you and your clients can titrate even more, perhaps just by discussing the psychoeducational content of the chapter, and discover the reaction of different parts to the discussion. For clients with dissociative disorders, risks and challenges might include work on decreasing switching and tolerating the resulting sensations and affects; increasing the ability to mindfully track and accept the voices, thoughts, emotions, and body responses of different parts; staying aware of the emergence of internal parts; or working with the fears of parts that are phobic of change and risk-taking. For those clients who can gradually build up a capacity for taking healthy risks, this chapter will ultimately prove useful when adapted to their specific needs. For others, it can be postponed, and the work can return to resourcing and regulating if 881

exposure to “too much” risk increases dysregulation or threatens stability.

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CHAPTER 35 Challenging Your Window of Tolerance Human beings have innate drives for both novelty and safety. We need a certain degree of safety to venture out of our comfort zones and explore new endeavors that challenge our capacities. Through the previous chapters and worksheets, you have developed resources, addressed painful memories, and explored the effects of trauma and attachment wounds. All this hard work has helped the grip of the past on your current life to relax a little, or a lot, so that you can experience more security and ease within yourself and with others. You are now ready to turn more attention to moving forward instead of focusing on regulating arousal or resolving the influence of a painful past. You are better prepared to challenge yourself to undertake appropriate risks, seek novel activities and pursue new adventures. Risk and novelty bring a sense of vitality, vibrancy and the joy of learning to our lives. Think of the wonder, excitement, and curiosity of a small child who discovers something new every day. We can recapture that feeling by pursuing new activities that are a little out of our comfort zones and take our arousal to the limits of our windows of tolerance. You have already begun to directly expand your window of tolerance through the previous chapters, especially the last chapter’s task of exploring play and positive emotions. This chapter is meant to continue to challenge you to widen your window through deliberate healthy risk-taking that expands your personal and professional horizons. By seeking appropriate novelty and new challenges and pursuing a greater variety of activities and stimulation, you can develop areas of your life that you may have neglected, such as intimate relationships, occupational and professional desires, recreational activities, special talents, or spiritual interests.

The Width of the Window of Tolerance Each of us has a habitual “width” of the window of tolerance. When our arousal is within this width, we feel safe enough to interact comfortably with others and participate in the world around us. If our windows are wide enough, we can usually tolerate and be present with both distressing feelings and pleasurable emotions without arousal reaching extremes of hyper- or hypoarousal. If we had responsive caregivers who provided comfort and stimulation as needed so that arousal did not 884

remain too long in an uncomfortably high or low zone, then we likely developed wide windows as children. The immature brain structures that regulate emotions are supported to mature when caregivers offer soothing when our arousal is too high and provide stimulating activities (e.g., a game of peek-a-boo, an interesting toy) when arousal is too low this supports a wider window of tolerance. When caregivers can relax with us in pleasurable low-arousal states, or join with us in the excitement or joy of high arousal states, a wider window is also encouraged. It is never too late to widen your window. With each resource you have developed, and with every step you have taken to resolve the past, you have been increasing the width of your window. As you regulate unpleasant high arousal states (e.g., fear, distress, frustration, or disappointment) and low arousal ones (e.g., hopelessness, shame, helplessness, or boredom), your window expands. As you allow and enjoy the high arousal positive emotions at the upper edge (e.g., excitement, passion, joy, playfulness) or lower end (e.g., relaxation, tenderness, peace, contentment), your window also expands. An internal confidence in your ability to regulate arousal provides you with a safe base inside yourself that you can rely on as you begin to focus directly on seeking out the challenges and risks that will not only expand your window even more but also expand your world. Remember that research in neuroplasticity suggests that no matter how old we are, our brains are always capable of changing. Typically, though, we fall into habits that reinforce well-established neural pathways that bias our patterns of thoughts, emotions, and behaviors to familiar ones connected to the past. To change the brain and expand our windows of tolerance, we must interrupt and inhibit old habits and try new things that challenge our comfort zones. The exciting part of this is that we can become conscious and intentional participants in changing our brains and widening our windows by purposefully seeking out novel endeavors. When we take healthy, appropriate risks that are challenging or new, we stimulate neuronal firing in areas of the brain not stimulated by familiar, routine activities. To capitalize on neuroplasticity and expand our windows, we can consciously choose to brave a variety of novel challenges, we might develop our creative abilities through art, dance, music, writing, or theater; learn something new, such as a foreign language; take up a physical discipline; explore uncharted territory in relationships with others; challenge our avoidance of previously feared situations; or engage in any activity that pushes our boundaries. As Aniah considered what she could pursue that would expand her window, she thought of a passion she had given up in her youth that she wanted to reclaim. As a small child, Aniah had loved to sing, but was ridiculed and mocked for her poor pitch at home and at school. Aniah had loved the music at her church, but her fear of performing in front of others and being criticized and teased prevented her from joining the choir, and eventually she stopped singing altogether. She wanted to take up singing again to expand her window but her fear held her back. Reminded by her 885

therapist that if she were not a bit scared, she could not test her courage, Aniah challenged her window by enrolling in a singing class. She found that with coaching from her teacher, her pitch improved, and she was able to reclaim a lost passion of childhood with gusto by joining her church choir.

Appropriate Risk-taking Determining appropriate risks to take can be challenging in and of itself. Paying attention to our bodies can help. We can learn to assess when old patterns of procedural learning interfere with our ability to navigate challenges and explore new possibilities. For example, Jerome wanted to leave a job he did not enjoy even though it paid well. He decided to pick up the phone to schedule an interview for a job he really wanted—it was his dream job—but his arm tightened by his side. He asked himself what was the meaning of his arm tightening? Is it: “I will open myself to danger? Failure? Loss? Shame? Criticism?” Staying mindful for a few moments, Jerome realized that his tension stemmed from growing up in a family where his parents both had dead-end jobs that they described as monotonous and boring, the “daily grind.” “Another day, another dollar,” was their favorite expression, always uttered in a hopeless tone. He was taught that he should not expect happiness or success in the workplace. He learned to work to pay the bills, not for enjoyment or satisfaction. Scheduling that job interview was anxiety-producing for Jerome because it challenged his family’s beliefs. Jerome remembered his father’s advice: “Life is hard and you should not expect much out of it. Don’t set yourself up for disappointment. Just get through the day and be glad you’ve got food on the table.” Once he recognized the message he had received, he understood his own reluctance and the meaning of the tension in his arm. With these new insights, Jerome overcame his hesitation and made the call, which turned out to be well worth the effort because his new job allowed him to use the skills he possessed and also challenged him to develop new ones. Often, the risks that are most challenging involve relationships—to open up, start dating, assert ourselves, explore sexual intimacy, change entrenched patterns, or participate in a challenging group activity, like Aniah did by joining the choir. Expanding the window of tolerance by deliberately challenging relational habits can support intimacy. Sometimes the first step is to recognize and inhibit our usual behaviors. Jennifer and Steven’s constant fighting resulted from faulty neuroception that repeatedly activated hyperarousal for both of them, even when both wished to be close. Their therapist encouraged them to inhibit their usual impulsive reactions of blaming the other person when they started to get in a fight. This was a risk for both that challenged their regulatory capacities; they were accustomed to “blowing off steam” by fighting, and both shied away from admitting their underlying feelings 886

of inadequacy and vulnerability. Inhibiting their usual behavior in order to “hang out” in the intense vulnerable feelings, noticing them as body and emotional experiences, was challenging. They both felt “safer” fighting and blaming the other person than feeling their vulnerable emotions. Jennifer recalled tearfully how she’d had to fight to be seen in a family that showed little interest in her, which she interpreted as meaning that she did not matter to them. She realized that when Steven was preoccupied with work, her old pattern emerged. Steven had avoided vulnerability for as long as he could remember, having grown up with an overwhelmed single mother who needed him to be calm and strong. He had put aside his own needs to take care of her. Steven began to realize that he implicitly interpreted Jennifer’s demands for attention as the same message of his childhood—that his needs were not important—and his interpretation resulted in his angrily “fleeing” from the relationship into his work. Each needed to challenge their childhood patterns in order to risk vulnerability in the presence of the other. Instead of reactively fighting or withdrawing, Jennifer learned to recognize the tension in her chest that precipitated a fight, to take a breath, and to say, “I feel like blaming you, but I don’t want to do that. It’s hard for me to be vulnerable and be able to say I need to feel that I matter to you right now.” Stephen learned to recognize the tension in his jaw and legs when he just wanted to get away, and, instead of leaving, to say, “I think my old patterns are coming up. Let’s sit and hold hands and really listen to each other, and I will try not to pull away.” Learning to notice their tendencies to fight, choosing to inhibit habitual behaviors, and being open with their needs and vulnerable feelings instead of fighting was immensely challenging for each of them, and they practiced in fits and starts. But their commitment to seek proximity instead of fight and to risk being vulnerable by asking for what they needed from one another widened each of their windows and brought them closer. To identify suitable risks that would help you stretch beyond your current capacities and challenge your comfort zone, you might ask yourself if you could become your best self, the person you would want to be, what capacities or skills would you have that you do not have now? How would you be different in your close relationships? Would you behave differently in your life than you do now? Is there a risk you might take with someone you are close to that could deepen your connection? Is there some activity you have always wanted to do that you have been afraid to undertake, such as dance, climb a mountain, play the clarinet, or paint? Do you wish to spend more time with friends or to create a beautiful garden? What would it be like to just be, to do nothing instead of being busy all the time? Imagining alternative ways of being or visualizing yourself as becoming more of the person you would like to be can generate meaningful and expand your window. When Lauren thought about what would happen if she could wave a magic 887

wand and be whoever she wanted, she realized she had missed the dancing she had so loved as a child, but had given up because she had gained weight. She imagined herself as a dancer who was graceful and confident. John realized that, if he were his best self, he would feel strong enough to take an aikido class to develop his internal strength and the assertion he needed to achieve his goal. For Sam, becoming his best self was a more internal process. At first, he was confused by the language: “Best self?” he asked. “What in the world does that mean?” But with his therapist’s help, he recognized his wish to become a more relaxed, less judgmental person, less apt to react angrily or impatiently. As he practiced slowing himself down, deliberately relaxing, consciously inhibiting critical thoughts and orienting to positive ones instead of negative ones, he learned to feel more content and less frustrated. As you work toward widening your own window of tolerance, keep in mind that neuroplastic change requires novelty. Although there is security and predictability in doing what is familiar, it usually doesn’t lead to progress. By turning your mindful attention to inhibiting the procedural learning that holds you back and then intentionally trying something new that challenges those patterns without overwhelming your capacities, you create new experiences for yourself. Remember, any novel endeavor should and will feel at least slightly scary and nerve-wracking. It is natural to be a bit apprehensive about what might happen if you take a risk because the outcome is not entirely certain. Something could go wrong, it won’t be perfect, you might give up, fail, or make mistakes. But when you make mistakes and recover from them, you are able to grow. If we’re not a tiny bit scared when we embark on something new, it’s not much of a risk. The worksheets that follow will guide you to determine appropriate risks that will expand your window of tolerance. The risks you decide to take should not cause your arousal to be too dysregulated but they should be unnerving enough to take your arousal to the limits of your window so your capacities, and your window, can expand.

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Challenging Your Window of Tolerance YOUR “B EST SELF” Purpose: To think about moving beyond the limitations and constraints of the past, reflect on the person you wish to be, and identify some steps to becoming your “best self.” Directions: Take your time to visualize and imagine becoming your “best self.” You might use a memory of being at your best or imagine being the person you want to be. Then follow the prompts below. 1. How does your body look and feel if you imagine embodying your best self? What is different—your posture, arousal, breathing, tension, facial expression? What physical actions might be easier: reaching out, letting go, pushing away, taking in, setting boundaries? 2. In what activities do you see yourself participating that you are not engaged in currently? 3. What beliefs would you have about yourself, others, or the world if you were your best self? 4. How would you be different in your interactions with the people in your life? How might others respond to you differently? 5. What holds you back from becoming your best self? 6. Describe three steps you could take on the road to becoming your best self. 7. What somatic resources could you practice to support the three steps you identified in #6?

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Challenging Your Window of Tolerance EXPANDING YOUR WINDOW: LOW AROUSAL CHALLENGES Purpose: To identify and explore times in your life when you have embarked on activities and relationships that were out of your comfort zone at the lower edge of your window of tolerance. Directions: Describe three times when you have challenged the lower edge of your window in the chart below (e.g., explored quiet states, took a peaceful vacation, took a meditation course, did yoga, wrote in a journal, showed tender feelings, cuddled with a child or pet, took a health day off work). Then complete the prompts. Challenge 1

Challenge 2

Challenge 3

Take your time to remember each one and then describe your body responses and emotions for each of those situations below. Body Sensations Movements Emotions Describe the positive elements of these experiences. Explain any negative elements. How might you use the memory of these low arousal challenges to build confidence to undertake a low arousal challenge in your current life?

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Challenging Your Window of Tolerance EXPANDING YOUR WINDOW: HIGH AROUSAL CHALLENGES Purpose: To identify and explore times in your life when you have embarked on activities and relationships that were out of your comfort zone at the upper edge of your window of tolerance. Directions: Describe three times when you have challenged the upper edge of your window in the chart below (e.g., gave a toast at a wedding despite fear of public speaking, took a new class, learned something difficult, explored an intimate relationship, risked being honest with a close friend or family member). Then complete the prompts. Challenge 1

Challenge 2

Challenge 3

Take your time to remember each one and then describe your body responses and emotions for each of those situations below. Body Sensations Movements Emotions Describe the positive elements of these experiences. Explain any negative elements. How might you use the memory of these high arousal challenges to build confidence to undertake a high arousal challenge in your current life?

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Challenging Your Window of Tolerance CREATIVE RESOURCES TO EXPAND YOUR WINDOW, P ART 1 Purpose: To challenge your window of tolerance by identifying and pursuing new risks in different categories of resources. Directions: One category at a time, read through the examples. Then describe a risk in that category that you could take that challenges your window of tolerance to expand. Practice the challenging activity and then describe your body’s responses. Relational Risk to Take E.g., reach out to a new acquaintance; tell someone who intimidates you how you feel; ask someone out on a date; take a risk to be vulnerable; set a boundary with someone that you have previously haven’t; strike up a conversation with someone you don’t know; apologize to someone; form a new friendship; get a pet. Your Body’s Response: Somatic Risk to Take E.g., try a new sport, dance, or yoga class; challenge yourself in your exercise routine; train for a marathon; stand tall with someone you usually slump around; relax your body or reach out during an argument; take time to relax in a hammock; do nothing; get a massage; try a new kind of bodywork like shiatsu or rolfing. Your Body’s Response: Emotional Risk to Take E.g., express emotions that you feel less comfortable expressing; be more emotionally open with your family; show more tenderness or passion; be assertive in a situation where you’re usually passive; allow yourself to be with painful emotions; express more playful or positive emotions. Your Body’s Response: Intellectual Risk to Take E.g., go to a lecture on a topic you don’t know a lot about; learn something new; read a challenging book; go back to school; write a paper and submit it for publication; play demanding brain games, learn and use new words; start a study group or book club; watch a documentary; research a topic and teach someone about it; volunteer as a tutor to students or senior citizens; learn a new computer 896

program. Your Body’s Response: Artistic Risk to Take E.g., take an art or creative writing class; learn how to make pottery; take up a musical instrument; go to a concert, poetry reading, play, or art show you typically would not attend; learn a new artistic medium to work in; write a poem or story; perform a musical piece or enter an art show; join a theater group; redecorate your house. Your Body’s Response:

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Challenging Your Window of Tolerance CREATIVE RESOURCES TO EXPAND YOUR WINDOW, P ART 2 Purpose: To challenge your window of tolerance by identifying and pursuing new risks in different categories of resources. Directions: One category at a time, read through the examples. Then describe a risk in that category that you could take that challenges your window of tolerance to expand. Practice the challenging activity and then describe your body’s responses. Material Risk to Take E.g., make a budget or financial plan for yourself or family; apply for a new job or position; purchase something that you wouldn’t normally let yourself buy; make an effort to enjoy something material that you already have, like a comfy chair; remodel or rearrange a room in your home to make it more enjoyable or buy something that will make a room more enjoyable or pleasant; get rid of things you no longer need. Your Body’s Response: Spiritual Risk to Take E.g., take up meditation or go to a prayer group; participate in a spiritual or religious community in a new way; explore spiritual reading material; go on a retreat; visit temples, synagogues, churches, or mosques; challenge your spiritual beliefs; explore an unfamiliar religion or spiritual path, discuss spirituality with a friend or family member. Your Body’s Response: Psychological Risk to Take E.g., go to a challenging workshop; join a therapy group; try couples therapy; volunteer for something that will challenge you psychologically, such as hospice, Big Brother/Sister, or a food bank, or outreach for offenders or senior citizens; journal about your psychological successes and challenges; write a memoire. Your Body’s Response: Natures Risk to Take 899

E.g., plan a nature adventure, such as visiting a natural wonder or hiking the Grand Canyon; go white water rafting; camping in the wilderness; fishing on the ocean; climb a mountain; start a blog about your experiences in nature; volunteer to clean up a natural area; grow your own vegetables or houseplants, join a birdwatching group. Your Body’s Response:

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Challenging Your Window of Tolerance P RACTICE TAKING RISKS Purpose: To challenge yourself to expand your window of tolerance by pursuing novel activities that are out of your comfort zone and take your arousal to the edges of your window. Directions: Reflect on people, situations, or activities that are intimidating or challenging for you that you can use to challenge yourself to expand your window of tolerance. It could be confronting a person or situation, rekindling a talent or ability, or pursuing an interest or passion that you have avoided or that feels difficult to learn. 1. In the circle below, describe one way you can challenge yourself this week at the upper edge of your window (e.g., speak up in a meeting at work, flirt with someone; pursue a passion for hip hop dance; go to a French language meetup.) High Arousal Challenge Low Arousal Challenge 2. Describe the situation and people’s responses to you during this high arousal challenge. 3. Describe below how you experienced the high arousal challenge in your body, emotions, and thoughts. Body

Emotions

Thoughts

Window of Tolerance 4. In the circle to the left, describe one way you can challenge yourself this week at the lower edge of your window (e.g., take time off work to take a nap in the afternoon, go to a meditation group, get a massage, do nothing at a time when you would normally be busy, snuggle with your kid, turn off your phone and computer for a day to relax, let someone else take care of you). 5. Describe the situation and people’s responses to you during this low arousal 902

challenge. 6. Describe to the right how you experienced the low arousal challenge in your body, emotions, and thoughts. Body

Emotions

Thoughts

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Afterword By the time you have reached the end of this book, it should be self-evident that who we are, what we feel, and what we believe are intrinsically connected to our bodies. The overarching ambition throughout this work has been to experientially expose the inherent wisdom of this connection, unveiling an innate knowledge that goes beyond cognitive understanding. We have learned that the way we move, stand, sit, and so forth, is the result of personal history interacting with immediate circumstance. If we understand this, we also understand that the intelligence of our bodies is not static. Our posture, movement and sensation fluctuate moment-to-moment depending on the present situation and the people we are with as well as our internal state, predictions, and expectations. These bodily fluctuations are not only obvious and on a large scale, like a conspicuous change in posture, but also subtle and slight, but no less profound, like an inward tensing that is not outwardly apparent. Because the body itself is a living, complex system constantly in flux, we can think of the intelligence of the body as an emergent property that arises out of our ever-changing experience with others, the world, and our self. The body’s actions and their meanings are shaped by our surroundings, developing anew in moment-to-moment interactions with others and the environment. It is the response of others that gives our actions meaning and significance and thus it is also this response that shapes the form of each of our actions in the here and now. Without someone or something to reach for, we would not reach at all; without another person to reach back, we would not reach out for contact. As we have learned, over time repeated responses from others lead to repeated actions in ourselves, eventually shaping our posture and the way we move. However, new relationships, and new developments in long-term relationships, bring forth new actions and new ways of being. Therefore, our actions cannot be entirely predetermined, but emerge anew as they adapt and adjust to context and relationships. Thus, the study of our actions demands an interest in these adaptations and a certain comfort with unpredictability that in turn generate new insight and understanding. The inception of knowledge lies in wonderment and questioning. Young children naturally possess these qualities, and spontaneously seek adventure and novelty. They have an innate curiosity and desire to learn and grow. Picture a little 904

girl’s expression of awe as she discovers a flower or butterfly with her father close by sharing the wonder of her experience, or the beaming face of a toddler taking his first steps towards the welcoming arms of his proud mom. These moments epitomize our innate thirst for challenge, exploration, and knowledge and the shared relational experiences that encourage it. We catch a glimpse of the delight in the process and its reward. We can capitalize on this innate capacity to learn and grow in many ways, including remaining curious about the body’s emerging intelligence. In doing so, we are likely to find ourselves inquiring into our internal world, how it changes in relationship with others, and being open to the discoveries, whatever they might be. We may pay more attention to what happens internally when we meet a stranger or an old friend, how our bodies change when we are angry or joyful, how we seek to know and become known through actions such as eye contact and proximity seeking movements as well as how we seek to conceal who we are or set boundaries through tension, gaze aversion or distance-seeking actions. Unpredictability is an inherent quality of emergence, and thus mindful study of our own bodies carries with it a certain degree of psychological risk. Unforeseen discoveries abound, some of which may be welcome and pleasant, some unwelcome and unpleasant. We may like and appreciate what we discover about ourselves and who we are in relationship with others. We may also dislike or be disturbed by what we find, or notice that our view of ourselves is challenged by our discoveries. All adventures, including the adventure of mindful awareness, hold a measure of risk and require courage and flexibility, along with the willingness to accept unpredictability. We might be intimidated by the prospect, but realize intuitively that there is sometimes more at stake by not taking a risk to try something new or to cultivate awareness. You may have originally picked up this volume with the hope that exploring your sensation, posture, and movement would catalyze the change you desired. Hopefully, as you’ve delved into the somewhat unpredictable landscape of your internal somatic experience in relationship to others, you have been rewarded by the joy of new discoveries and a deeper respect for your body’s wisdom. Since this wisdom is emergent—always in transition—learning from it can continue throughout the lifespan. Your body has different things to teach you at different times of your life, through different relationships, and as you go through various life processes and challenges. The structure of the book is intended to provide tools for continuing to draw upon the emerging intelligence of your body in a practical and progressive way—not only as a guide to help heal from the wounds of the past but also as a roadmap for discovery and growth in the future. You can revisit the chapters and worksheets of this volume as often as you like throughout your life to continue to discover and draw upon the ever-changing intelligence of your body. Keep in mind that what makes the body intelligent is not its fixity but its 905

emergence. We run the risk of boxing in new discoveries before they have fully revealed themselves if we are intently driven to find answers. Thus, we must resist hastily defining the body’s wisdom, lest a deeper knowing be curtailed. Seeking to understand its ever-changing intelligence with a gentle curiosity, while refraining from focusing on it too precisely or too intently, can allow its wisdom to unfold organically. The dance of discovery then stays alive and meanings gradually become more transparent. It is not always comfortable or easy to refrain from grasping for an external goal in favor of resting in the faith that the process itself is of maximum value. Reaching beyond what we know into what we don’t know, for what we want instead of what we might have had to settle for, means we find the courage to relinquish our fixation on the outcome and trust the process even in the face of discomfort and unpredictability. The sensation and movement of the body is a laboratory that is always available to teach us more about the hidden recesses of the self, expanding our understanding so that we can try out new ways of living and relating. Resisting the impulse to “know” too soon, remaining in a creative place of unfamiliarity, and opening to the mystery of the body’s intelligence will yield treasures throughout the lifespan that we never knew were there.

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Glossary Animal defenses the instinctive survival responses common to most animals in the face of danger or threat, including cry-for-help, fight, flight, freeze, feigned death/shut down. Align, alignment to bring the segments of the body into a vertical line in which the shoulders are relaxed and drawn downward, the head reaches toward the sky and sits centered over the shoulders, the chest rests over the lower half of the body, the torso is stacked above the pelvis, and the legs and feet are directly under the body. Arousal the degree of activation of the autonomic nervous system (note, arousal does not refer to sexual arousal in the context of this book). Arousal cycle the cycle created when arousal diverts from a starting point, or baseline, either by increasing or decreasing, and then returns to baseline. Attachment a biologically driven need for affiliation with other humans that begins in infancy and continues throughout the lifespan. Attachment cry an instinctive response used to secure the nearness of the attachment figure; usually used in reference to when infants cry upon separation with their attachment figures, or when they are frightened or uncomfortable. See also cry for help. Attachment figure the people who take care of us as children, to whom we form enduring emotional bonds; as adults, our attachment figures also include the people to whom we form emotional bonds that endure over time (i.e., partners, spouses, close friends, our children and other relatives). Attachment history the history of our experience with attachment figures, usually referring to childhood attachment figures, but also include attachment formed in adulthood. Autonomic arousal the activation of the autonomic nervous system; see also arousal. Autonomic nervous system the regulatory system of the body that is responsible for body functions, such as heartbeat, digestion, and breathing, that are not consiously directed; it consista of the sympathetic nervous system and the parasympathetic nervous system. Bottom-up processing a term used in this volume to indicate how autonomic arousal, postures, movements, expressions, gestures and sensations of the body affects emotional and cognitive processing. Boundary the emotional and physical sense of the need for protection or physical distance from others and the sense of our right to our personal preferences, emotions, thoughts and opinions. Building blocks the five elements (cognitions or thoughts, emotions, five-sense perceptions, movements, and body sensations) that comprise our present moment internal experience; the building blocks are the focus of mindful attention in Sensorimotor Psychotherapy. Caregiver a term used in this volume to refer to a childhood “attachment figure.” See also attachment figure. Centering resource a somatic resource of being aware of the core of the body in order to regulate arousal and regain a sense of being connected with ourselves when we are distressed or “off center.” Containment resource a somatic resource that helps us sense the actual physical container of our bodies— the skin and superficial muscles. Core (of the body) refers to the spine and surrounding muscles. Creative resource a personal strength or competency that nurtures our spiritual, physical, emotional, and mental development. Cry-for-help a mobilizing animal defense used by humans and other animals when they feel threatened and want to summon help; also called the “separation cry” or attachment cry. See also animal defenses. Directed mindfulness deliberately choosing particular elements of present-moment internal experience on

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which to focus. Dissociate/Dissociated/Dissociation to involuntarily compartmentalize, interrupt, detach from usually associated processes such that we experience a disruption of continuity of awareness, identity, history, memory, and so forth. Dual awareness to experience a state specific memory, to a degree, while remaining rooted in the here and now by being mindful of one’s internal reactions (building blocks) and aware of the surroundings. Dysregulated arousal autonomic arousal that greatly exceeds the window of tolerance so that it is either intolerably high (hyperarousal) or intolerably low (hypoarousal). Dysregulated emotions emotions that are accompanied by hyper or hyporaousal, often related to animal defenses. Embody to understand or “know” something through experience—emotions and the physically felt sense— rather than through reflection, analysis, thoughts or objectivity. External resources sources of support that reside outside oneself, such as organizations, people, and things. Faulty neuroception the inability to distinguish whether the environment and other people are safe, such as detecting danger when there is no real threat. Also see neuroception. Feigned death an immobilizing animal defense in which the body becomes limp, collapsed, hypoaroused, and may appear dead. Also called “shutdown.” Fight mobilizing animal defense involving movement toward the source of threat with aggression. Flight mobilizing animal defense involving movement away from the source of threat. Freeze an immobilizing animal defense that includes an inability to move coupled with hyperarousal; the body is tense and the senses are hyper-alert. Gait a person’s manner of walking. Grounding a foundational somatic resource; the felt sense of a somatic base of support and connection to the ground. See also undergrounded and overgrounded. High arousal arousal that approaches, or is slightly over, the upper edge of the window of tolerance. Hyperarousal arousal that is excessively over the upper edge of the window of tolerance associated with intense sensations as agitation, trembling, rapid heart rate, or overwhelming emotions such as rage, terror or panic. Hypoarousal arousal that is excessively under the lower edge of the window of tolerance associated with inability to move, heaviness, numbness or remotions like despair or hoplessness or an an absence of feelings. Immobilizing defenses instinctive animal defenses that keep us from moving in order to protect us; see freeze and feign death/shutdown. Implicit memory non-verbal memories; somatic and emotional memory states similar to those experienced in past events, but not accompanied by an internal sense that something from the past is being remembered. Integrate/integration the adaptive process of assimilating our experiences through linking cognitive, emotional and physical processes that helps foster a consistent sense of self over time and contexts; also used to describe when present moment connections – cognitive, emotional, and somatic – are made and experienced among dissociative parts. Interactive repair the effort made in a relationship to mend a breach in connection, misattunement, or boundary violation; often used in reference to attachment figures providing interactive repair to soothe an upset infant or child. Internal experience the sum effect of the moment-to-moment fluctuation of the building blocks of present experience (sensations, movements, five-sense-perceptions, emotions and thoughts. See also internal state and building blocks. Internal resources capacities that reside within us that help us regulate arousal and enhance feelings of competency or mastery. Interrupted resource a resource whose development was truncated due to trauma, stress, relational strife or other events. Low arousal autonomic arousal that approaches or is slightly under to lower edge of the window of tolerance. Mammalian brain the area of the brain that is concerned with our emotional and relational experience, so called because it developed with the first mammals. Also called limbic brain. Mobilizing defenses animal defenses that propel us to take protective action, such as the cry for help, flight, and fight defenses.

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Neocortex the last part of the brain to develop in evolution, sometimes called the “thinking” brain because it is responsible for our reasoning, self- awareness, and abstraction abilities. Neural networks bundles of neurons that connect one region of the brain or nervous system with another for a common purpose. Neuroception a neural process that occurs outside of awareness that automatically detects and assesses features in the environment and cues from others that indicate degrees of safety, danger, and threat. Neuroplasticity the brain’s plastic or maleable quality that enables it to grow new neural networks and make old ones obsolete, through experience, including the way we orient. Orienting the process of paying attention to, or orienting toward, select environmental cues to the exclusion of others. Orienting reflex the instinctive, involuntary movement of focusing our attention toward a novel stimuli, automatically turning our eyes or even the entire head and body toward it. See also orienting. Overgrounded a state in which our energy sinks downward in our bodies, as if the feet are pushing strongly downward without the counterbalance of lengthening the spine and lifting toward the sky; the opposite of ungrounded. Parts (of self) a term used to describe repeatedly activated states of mind or aspects of the personality. Different “parts” may hold different core beliefs, emotional biases, procedural tendencies that are not integrated. In dissociatve disorders, parts of the self are more highly compartmentalized, such that each might function outside of one’s control or awareness some of the time. Procedural learning habits of movement, behavior, actions or skills that are automatic; learned as adaptations to specific environments (like slumping to avoid being seen) or to perform certain actions efficiently (like tying our shoes); implicit memory for physical behaviors. Regulate, regulated, regulation the ability to monitor and modify internal processes; to soothe or intensify our emotions, arousal, and sensations until they do not feel uncomfortably low or high, to bring arousal within a window of tolerance. Relational knowing the knowledge about how to interact with others—what kinds of sounds, facial expressions, or actions will be welcomed or rejected and what to expect in relationships—acquired through our negative and positive experiences with those who care for us in childhood. Relational trauma interactions with with other people, including those with attachment figures, that are experienced as threatening and stimulate dysregulated arousal and animal defense. Reptilian brain a lower brain structure that is the oldest of the three areas of the triune brain that operates on instinct and is responsible for the survival-related functions of the body. Also called the brainstem. Resources anything that enhances the quality of our lives or provides what we need to meet life’s challenges. See also internal resource, external resource, creative resources, somatic resources, survival resources, & interrupted resource. Sense of self an emergent, associative process, rather than a fixed “thing,” that develops from an inborn need and disposition to relate to others; an internal sense of identity in a particular moment. Sensorimotor includes both motor and sensory functions, movments and pathways; 5-sense perception, sensation, and movement of all kinds; the “body” level of information processing. Sensorimotor Psychotherapy A body-oriented talking psychotherapy that specifically addresses trauma and attachment wounds, emphasizing the body as an avenue for exploration and vehicle for change. Sliver (of memory) a small but important moment in a memory that can be focused on to process its effects in therapy, rather than attending to the entire memory at once. Social engagement system a set of circuits including the ventral vagal nerve that stimulates engagement with the environment and other human beings through our facial expressions, eye movements, voicebox, and turning and tilting of the head; the social engagement system is accessible when when we feel safe. Somatic having to do with the body. Somatic resources resources that reside within the body; the physical functions, actions, and capacities that provide a sense of well-being and competency on a physical level and in turn positively affect how we feel. Stabilize (arousal) to modify or regulate autonomic arousal, impulses and behavior, and emotional distress so that arousal remains within or returns to the window of tolerance. State (Internal state) the subjective experience of our building blocks (sensation, movement, five-sense perception, emotions and cognition) in the present moment; a temporary activation of neural firing patterns.

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State-specific memory the reexperience (in therapy, to a manageable degree) of an internal state similar to the one we were in when the past event actually occurred. Survival resources resources that help us endure and cope with adverse experiences. Top down processing a term used in this volume to indicate how thought processes (insight, beliefs, reasoning, reflection, and so forth) affect the body and emotional processing. Trauma overwhelming experiences that cannot be integrated that elicit instinctive survival mechanisms of hyper- or hypoarousal and subcortical animal defenses. Trigger those things, situations, people, or internal experiences that we reflexively neurocept as threatening when they are not, causing arousal to exceed the window of tolerance. Triune brain an evolutionary model of the brain (MacLean 1988) that divides it into three defined but integrated regions, the reptialian brain, the mammalian brain, and the neocortex. Ungrounded a state in which our energy rises upward in our bodies, causing us to lose a solid feeling of connection to the support of the ground. Window of tolerance a zone of optimal arousal, not too high and not too low, within which we can adaptively and flexibly process stimuli, including thoughts, emotions and physical reactions, without becoming overwhelmed or numb (Siegel, 1999).

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Acknowledgments This book has been decades in the making, endured countless revisions, and benefitted from contributions from a variety of sources. First and foremost, I’d like to thank my students and clients from the 1970s to the present day who taught me how to be a psychotherapist, motivated me to come up with new ways to treat their troubles, and inspired the initial worksheets that evolved into the ones created for this book. They have been my best teachers. For over a decade it has been an enormous privilege to work closely with Janina Fisher. I am deeply grateful to her for consistently supporting this book’s concept, graciously enduring all the revisions I put it through, and diligently laboring over its contents. Janina’s clinical expertise shines throughout this volume, especially in the practical suggestions in the therapist’s guides and in many of the clinical examples woven through the chapters. Since the early 2000s, she has been essential to Sensorimotor Psychotherapy Institute’s growth and development, serving as the institute’s Assistant Educational Director, Director of Trainer Development, Director of Research, and Senior Trainer. With her original voice, boundless energy, astute business sense, exceptional talent as a trainer, and comprehensive understanding of the field of trauma and its treatment. Janina is an irreplaceable asset to the work of Sensorimotor Psychotherapy. I want to extend a special thank you to everyone else who offered their moral support and contributed their time and expertise to improve this book: Kekuni Minton, who for two and a half decades has been my primary collaborator in developing Sensorimotor Psychotherapy, for troubleshooting some of the more complex worksheets; Kathy Steele, for all the enlivening and enlightening discussions on dissociation and attachment, and for reworking the sections in the therapist’s guides on how to adapt each chapter’s contents for use with dissociative clients; Steve Porges, whose Polyvagal Theory changed the way I think of psychotherapy, for promptly answering all my questions about neuroception; Bonnie Goldstein, for staying up with me for half the night on more than one occasion to review the worksheets in their entirety and for suggesting the concept for the very first worksheet; Betty Cannon for revising some of the more problematic chapters during the final weeks of writing and even providing a few case examples; Susan Aposhyan and Christine Caldwell for reviewing the chapter on breath; Ame Cutler, Brigitta Karelis, Susan Miller, Marion Solomon, Judy 919

Schore, and Anne Suokas-Cunliffe for their encouragement and feedback on the worksheets. I am so grateful to many other esteemed colleagues who have generously offered their friendship and knowledge over the years: Bessel van der Kolk, who has provided so many opportunities, helped me understand neuroscience, always believed in this work, and supported me during one the most difficult life challenges; Onno van der Hart, who, along with Kathy Steele, has strongly influenced how I think about dissociation, for his willingness to brainstorm with me and offer a helping hand when I needed it; Allan Schore, whose work has changed how I think about my own work, for taking me under his wing to nurture my professional growth and challenge me to explore unchartered territory; Philip Bromberg, who has inspired me with his own beautiful writing, encouraged me to find my voice, and patiently taught me that therapeutic enactments are anything but “mistakes;” Beatrice Beebe, who provided just the right advice when I needed it most and taught me the significance of video micro-analysis; Jaak Panksepp, whose emphasis on play and novelty, and so much more, has influenced my thinking; Marion Solomon, for her zest for learning and commitment to strengthening relationships; Dan Siegel for his big picture view and for helping me clarify how we use mindfulness in Sensorimotor Psychotherapy; and Ed Tronick for exposing the complexity of meaning-making and embracing the messiness of relationships. I am grateful to Marilyn Devalier, Ruth Lanius, Clare Pain, Judy Schore, and Martha Stark whose support and ideas over the years have contributed directly or indirectly to this book. SPI’s outstanding group of trainers deserve a special, heartfelt thank you for their commitment to teach Sensorimotor Psychotherapy throughout the world and for their unique contributions to and skillful applications of this body of work, both of which further its impact and efficacy so much more than I could take it alone: Kekuni Minton, Christina Dickinson, Janina Fisher, Brigitta Karelis, Lana Epstein, Ame Cutler, Andrew Harkin, Anne Westcott, Esther Perez, Rebeca Farca, Tony Buckley, Bonnie Goldstien, Linda Cooke, Rochelle Sharpe Lohrasbe, Amy Gladstone, and Mason Sommers. It is an honor to work with such a gifted group of trainers. Deb Del Hierro, my assistant, has my sincere appreciation and admiration for her diligent work on the manuscript. She worked with me nearly full time for over a year to bring this book to fruition, editing it countless times, formatting all the worksheets and designing many of them, and troubleshooting difficult sections to make them more understandable. Deb, along with Anthony Del Heirro, illustrated this volume with precise, hand drawn figures and technical drawings that clearly communicate the concepts. Deb’s superb artistic talent and editing skills, impeccable grammar, fresh eyes, eagerness to learn about Sensorimotor Psychotherapy, and willingness to go the extra mile right down to the last hour have 920

been indispensable. My deepest, heartfelt gratitude goes to my son and CEO of the Sensorimotor Psychotherapy Institute, Brennan Arnold, whose generous support, both personal and professional, means the world to me. As my son, he is the source of immeasurable joy, pride, and comfort. As the institute’s CEO, his business acumen, skilled leadership, and systemic approach ensure that the school runs well, grows responsibly, and is sustainable. Without Brennan, I would not have had the support, time or peace of mind I needed to write this book. I am grateful to him, Nate Mariotti (SPI’s exceptional Director of Training Operations), Sheldon Romer (our consultant), Deb Del Hierro, Elizabeth Haupt, Kristi Horward, Lauren Sands, Laurie Bukovinsky, and the rest of the staff of the Sensorimotor Psychotherapy Institute for taking on extra work during the past several years so that I could focus on the manuscript. But beyond making it possible to devote myself to writing, this capable and talented group is essential to the work of Sensorimotor Psychotherapy. Without their skillful attention to the enormous complexities of this Institute, it would be impossible to carry out our training programs throughout the world. I am immensely proud and appreciative of the collaboration between trainers and office staff, and what we are able to accomplish together. It is always a pleasure to work with the staff at Norton. Deborah Malmud goes out of her way to patiently and promptly respond to my many concerns, no matter how trivial. Her faith in my writing and in this volume has carried this book through from beginning to end. I also want to thank Margaret Ryan, whose expert editing and suggestions made this work much clearer, more user-friendly, and grammatically correct. Katie Moyer has been extremely patient and helpful in the last months of production. A huge thank you goes to my dear friends and family for their unwavering personal support and tolerance of my unavailability during the writing of this book; my mother, who always insisted that I reach beyond what I thought I could do; Paul Joel, whose incomparable talent for improvisation made life an adventure for nearly three decades; and the children of all ages in my life: my son, Brennan Arnold; stepchildren, Ally and Quinsen Joel; goddaughters, Jovanna Stepan, and Shira Goldstein; nephews, Redmond and Matthew Ogden; niece, Shante Ogden; and grandniece, Mia Ogden. You kids keep me young at heart and never fail to inspire me to play, laugh, and learn. And, finally, thanks to you, the reader, for considering these ideas and interventions and for your efforts to integrate them into your therapeutic work. I hope you will forgive any inadequacies or inaccuracies that may still remain, which are entirely my own responsibility. This book was written especially for you, and I am eager to hear what you discover! Pat Ogden 921

Founder and Educational Director, Sensorimotor Psychotherapy Institute First and foremost, I want to thank Pat Ogden from the bottom of my heart for the opportunity to assist her in writing this book directly to clients and their therapists. Not only am I grateful to her for having been an incredibly generous teacher and mentor, but I also feel privileged to practice and teach her work every day of my professional life. What drew me to it ten years ago was its theoretical strength, exquisite relationality, and ability to reach and resolve traumatic memories and emotional pain without re-living them over and over again. Having the chance to assist Pat on this very important book was a welcome opportunity to support her and reach the therapists and trauma survivors all over the world who struggle to successfully address the legacy of trauma and attachment failure in therapy. Had it not been for my longtime friend and mentor, Bessel van der Kolk, I would never have met Pat and changed the course of my clinical work after twenty years of traditional psychodynamic practice. I am eternally grateful for my years at the Trauma Center, the opportunity to learn from him, his encouragement of my teaching and writing, and the privilege of being part of the revolution in the trauma world over the last twenty years reflected in this book. Last but surely not least, I want to thank my family and my family of friends for their support and patience. No one can appreciate the sacrifice of loved ones without having written a book: the weekends, evenings, vacations, even phone calls they give up so that we can write, edit or perfect what we’ve already written. Special thanks to Stephanie Ross and Deborah Spragg for their persistent encouragement of my writing; Lisa Ferentz and Linda Graham, important members of my writing support system; dear friends Frank and Michael Anderson; my wonderful Sensorimotor Psychotherapy community of students and colleagues in the Bay Area, New York, Seattle, Phoenix, Oslo and London; and my oldest friend and colleague Lana Epstein. To my family (Camille, Jason and Kelli, Jadu, Julia, Ruby, and Nika), I owe you! I owe you not only my heartfelt love and thanks but also the many makeup dinners, weekends, and family events in your future! Janina Fisher Assistant Educational Director, Sensorimotor Psychotherapy Institute; Instructor, The Trauma Center

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Index Page numbers listed correspond to the print edition of this book. You can use your device’s search function to locate particular terms in the text. Page numbers followed by italic f or t refer to figures or tables, respectively. abdominal muscles, 356, 367, 371 abreaction, 558, 634–35 absolute beliefs, 614–15 abstract thinking, 177, 179 abuse development of resources interrupted by, 421 directed mindfulness therapy with, 163–64 emotional dysregulation related to, 564, 567–68 immobilizing defenses in response to, 100, 229–30, 462, 520–21 overbounded relational style related to, 687 as relational trauma, 66 restoring empowering actions in client with history of, 523 see also sexual abuse acceptance and approval from attachment figures benefits of grounding for clients with adverse experiences in, 325–26 boundary development and, 399–400, 401 breathing adaptations to obtain, 375, 378–79 compliance to obtain, 100 maladaptive behaviors in attempt to win, 78, 100, 164, 226, 262, 594, 641 need for, 226 postural adaptations to obtain, 81–82, 100 procedural learning to win, 96 in unsatisfactory but secure attachment, 30–31 accident-prone clients, 325, 332 accidents, traumatic, 66, 461–62, 520 action sequences, 25, 180 healthy flexibility of, 26 in maintenance of attachment patterns, 30 in making of predictions, 26, 27 as representative of early interaction patterns, 26, 30–31 action systems in dissociation, 36–37 failure to integrate, as result of trauma, 37–38 goal conflicts among, 39 addiction. see substance abuse and addiction addressing memories in therapy client’s eagerness for, 441 client’s reluctance to take on, 441, 473–74, 493–94 clients who might benefit from implicit memory work, 435–36

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conditions for effective integration in, 441 with dissociative client, 438–39, 458 goals for, 248, 435, 441, 479 maintaining awareness of present moment in, 473 as phase of therapy process, 17, 19–20, 243, 244, 245, 247 by promoting awareness and processing of implicit memories, 435, 436–38, 443–44 resource repertoire for, 435–36, 437, 438, 444–46, 447–53, 480–81 resources for reconstructing memory in, 455 social engagement with therapist in, 503 strategies and techniques for, 248 strategies and technques for, 19–20 worksheets for implicit memory interventions, 438, 447–53 see also dual awareness of past and present in memory work; reconstructing memory; sliver of memory ADHD, 72 Adjusting Sensory Stimulation worksheet, 304, 323 adrenaline, 32, 82, 543–44 affect communication cure, 47 affective competence, 31, 632 agency, mindfulness to promote sense of, 131 age of client, 54, 55 aggression in boundary-setting, 392, 400 brain’s regulation of, 180 regulating overactive defenses leading to, 517–18, 523–24 agoraphobia, 111, 229, 516 alcoholic father, overactive flight defense in client with, 524 alert immobility, 32 alignment defined, 769 see also core alignment amnesia, 38, 80 amygdala activated by distressing reminder, 174 fear response in, 539 function of, 179–80 sensitized to danger cues, 181 anger arousal of, in support of threat response, 557 hyperarousal and, 228 orienting habits in clients with problems of, 111–12 reflected and sustained by body, 633 reframing, as resource, 258 in response to distressing events, 161 anger management issues breath work and, 370, 378 restoring empowering action to address, 516 animal defenses activated by implicit neuroception in therapy, 43 defined, 769 in dissociation, 36–37, 222 effects of repetitive activation of, 519, 521 elicited in trauma, 29, 515 emotional response and, 557 enduring emotions related to, 563–64 executing, in empowering manner, 517

924

extremes of emotional dysregulation related to, 564–66 functions of, 37, 515, 519 goals of daily life system versus, 37 goals of restoring empowering actions, 519–20 identifying dysregulated emotions associated with, 558–59, 563, 569–73 identifying emergence of attachment legacy in, 592–93 inflexible, 521–22 instinctive mobilization of, 519 integrating, 522–25 need for adaptive flexibility in, 521–22 neurophysiology of, 516 proximity-seeking actions and, 708–9 recognizing, 517, 527 relational issues related to dysregulation of, 516 survival role of emotions in, 557 therapeutic goals for work with, 19–20, 515, 525 therapeutic intervention with emotional dysregulation related to, 566–68 therapists’ guide to emotions and, 557–61 in threat response, 32–33, 515 types of, 519 worksheets, 517, 527–31 worksheets on emotional dysregulation associated with, 560, 569–81 see also cry for help defense; fright-freeze-flight response; shutdown defense Animal Defensive Responses & the Body worksheets, 517, 518, 529, 531 anterior cingulate, 41 anxiety adapting therapy process for client with, 73 benefits of mindful attention to, 161–62 breathing patterns associated with, 369, 378 hyperarousal and, 228 restoring empowering action to clients with, 516 somatic resources for soothing, 308 approach–avoidance tendencies, 680 approach behaviors, 699 arousal biphasic, 538 breathing techniques to regulate, 18, 389 challenges in widening window of tolerance, 747, 748 of daily life systems, 37 defined, 769 developing resources to regulate, 247–48 in emotional processing of trauma-related core beliefs, 617 exploration of neuroception for dysregulated, 219, 220–21 exploring body sensations to relieve, 206 faulty neuroception in dysregulation of, 228–29 goals of sliver of memory work, 494–95, 499–500, 501–2 grounding resources for regulating, 325, 327–28, 345 identifying triggers to regulate, 228–30 manifestations of attachment history in, 31–32 manifestations of trauma experience in, 32 neuroception correlated with level of, 227 normal daily fluctuations of, 225, 239 orientation for clients about regulating, in therapy process, 68–70 recognizing optimal, 222, 241 recognizing signs of dysregulated, 220–21, 231

925

regulating, in exploration of traumatic memory, 248 in sensorimotor sequencing, 539 social engagement system in regulation of, 30 therapeutic relationship in regulation of, 46–47 transgenerational transmission of patterns of, 228 working at edge of client’s regulatory boundaries of, 48–49 worksheets for recognizing signs and patterns of, 221–22 see also hyperarousal; hypoarousal; window of tolerance arousal cycle, 541, 545–47, 555, 769 artistics resources, 277, 278t, 279 asthma, 370, 378 attachment adaptation to caregiving deficits, 594 animal defenses and, 592–93 brain activity in, 180 brain development and, 181 child’s response to parental expectations in, 31, 262–63, 332 clients who might benefit from exploration of relational capacities related to, 585–86 complexity and contradiction in, 34 defined, 769 developmental significance of, 20 in development of beliefs, 20, 614, 617–18 in development of boundary styles, 21, 399–400 in development of emotional biases, 20 in development of proximity-seeking behaviors, 31–32, 699, 705–7 disconfirmation of self-states in, 35–36 formation of working models from, 33–34 healthy formation of, 591–92, 593 influence on emotions, 631, 640 intervention with painful emotions related to, 245, 632–35, 642–44 intervention with relational capacities influenced by, 586–88, 594–95 learning to recover from negative emotions in, 729 neurocepted safety and, 226 nonverbal expression of, 25 organization of proximity-seeking behaviors and, 699 orientation for clients about, 66 orienting response and, 16, 116 posture as expression of, 31, 81–82, 95, 254–55, 262–63 problems in. see attachment inadequacies or failure procedural learning and, 99–102 relational capacities influenced by, 585, 591–92, 593, 685 resources from positive relational experience in, 588–89, 597, 599 secure, 28 selection of worksheets based on client’s, 56 social engagement system and, 29–30 therapists’ guide to emotions and, 585–89 therapists’ guide to legacy of, 585–89 unsatisfactory, 30–31 walking style as expression of, 661–62 working with dissociative clients on emotions related to, 636–37 working with dissociative clients on relational patterns as legacy of, 589 worksheets on emotions related to, 635–36, 645–53 worksheets on relational patterns as legacy of, 588–89, 597–605 see also attachment figures attachment cry, 32

926

defined, 769 attachment figures animal defenses aroused by, 521 boundary setting and, 399–400 breathing patterns developed as adaptation to, 378 child’s response to expectations of, 31, 78, 81–82, 262–63, 332 child’s working models of, 35 defined, 66, 769 development of relational habits with, 66 disapproval from, neurocepted as danger, 31, 226 eye contact with, 706–7 in formation of core beliefs, 613 in formation of emotional habits, 640 loss of grounding in relationship with, 332 mindful attention toward, 134 orienting habits learned from, 113 procedural learning in relationship with, 96 proximity-seeking behavior with, 699 resource development and, 419 see also acceptance and approval from attachment figures attachment-focused therapy, 14, 51 attachment inadequacies or failure behavioral manifestations of, 31–32 benefits of directed mindfulness for clients with, 157–58 benefits of grounding for clients with, 325–26 boundary development and, 399–400 breathing patterns and, 375 client’s troubled by memory work with, 494 development of inflexible animal defenses in response to, 521 development of survival resources in response to, 262–63, 419–20 difficulties with proximity-seeking behaviors related to, 699–700 directed mindfulness in examination of, 42–43 disconnect from body in response to, 83–84 dissociation related to, 37 fear of memory of, 435–36 feelings toward body influenced by, 82–83 feeling ungrounded as result of, 332 hypoarousal patterns related to, 228 impaired capacity for play and pleasure related to, 721–22, 727, 730 implicit memories of, 442–43 influence on building blocks of present experience, 140 influence on gait, 655–56 intergenerational transmission of arousal patterns through, 228 neuroception of danger in, 226 nonverbal indicators reflecting, 40 orientation for clients about, 65–67 persistence of adaptive responses to, 82 postural adaptations to, 347, 354–55 reconstructing memory of, 456 relational patterns as legacy of, 592, 685 as result of trauma experience, 33 sliver of memory, 502–3, 513 strengths recognition impeded by, 255, 261–62 trauma versus, 29 treatment model for intervention with, 243

927

types of, 30 Attitudes and Actions worksheet, 79, 91 autonomic arousal, 15, 17, 30, 31–32, 69, 225, 537, 769 autonomic functions brain control of, 180 exploring body sensations to relieve arousal of, 206 normal fluctuations of arousal, 225 trauma-related arousal of, 537, 543 autonomic nervous system, 17, 69, 769 autoregulation developmental influences on capacity for, 30, 700 manifestations of attachment history in, 31–32 auxiliary cortex, 46 avoidance behavior breathing patterns associated with, 369 client’s understanding of, 158 inhibiting, to challenge window of tolerance, 746, 747 Awareness of Physical Boundaries worksheet, 393–94, 405 back of the body, 304, 309–10, 319, 356, 371 Bainbridge Cohen, B., 302 Beebe, B., 26, 47 behavioral disorders, 72 beliefs attachment-related, 20, 614, 617–18 body sensations and, 201, 609–10 clients who might benefit from exploration of, 608 clinical significance of, 607–8 compassion for self in early formation of, 610, 627 continuum of positive and negative, 614–15 current desires inhibited by, 610, 629 exploring connections of emotions and body sensations and, 198–200, 204–7, 217 expressed as absolutes, 614–15 focus on physical elements associated with negative, 159, 165 formation of, 613, 614 goals of therapy for, 249, 613 healthy development of, 616 implicit processes in formation of, 616 influence of posture on, 355 limiting, 615, 629 patterns of locomotion and, 21 physical habits and, 20, 609, 615, 616, 617, 618 positive emotions limited by, 725, 741 processing emotions in exploration of, 610 slivers of memory and, 609 therapeutic intervention with, 20, 608–9, 617, 618 therapists’ guide to, 607–11 therapist’s modeling of physical manifestations of, 60 transference-countertransference reactions in exploration of, 608 trauma-related, 617 types of, 614–15 upgrading, 615–16 vocabulary for describing, 215 walking as expression of, 661–62 working with dissociative client on, 611

928

worksheets, 609–10, 619–29 Beliefs, Emotions, and the Body worksheet, 200, 217 Beliefs That Limit Positive Emotions worksheet, 725, 741 best self, 754–55, 757 bike riding, 311 biphasic arousal, 538 bipolar disorder, client with, 73 Biven, L., 721 body alienation from, in clients with dissociative disorder, 80 awareness, therepeutic experiments with, 44 client’s dislike or phobia of, 57–58, 78 client’s resistance to working with, 77 clinical significance of, 14–15, 22, 25, 28, 53, 102 directed mindfulness to identify effects of thoughts on, 159, 169 disconnecting from, 83–84 effects of trauma on attitudes towards, 82–83 emotional states reflected and sustained by, 631, 633–34, 635, 639–40, 642–44, 645 homeostatic regulation of, 81 influence of early experience on structure of, 27 intelligence of, 13, 775, 776, 777 introducing client to attending to, 60–61 language of, 16, 25, 27, 95, 99 manifestations of attachment experience in, 81–82 manifestations of early implicit memory in, 436 manifestations of trauma exposure in, 82 in meaning-making, 27–28, 607 reconnecting with, 84 substitute language for, 58 therapist’s guides to wisdom of, 77–80 therapist’s use of own, to demonstrate or model actions, 59–60 translating language of, 97 wisdom of, 16, 77–78, 81, 776–77 worksheets for exploring client’s attitudes toward and connection to, 79–80, 85–93 see also body sensation(s); movement(s); nonverbal expression; posture body-oriented talking therapy, 14 Body Reading for Core Beliefs worksheet, 609–10, 619 Body Reading worksheet, 97, 103 body sensation(s) beliefs reflected and sustained by, 201, 609–10, 619, 621 brain activity in, 180 as building block of present experience, 140 clinical use of, 198–99 defined, 201 exploration of, in sensorimotor sequencing, 539, 549, 551 exploration of, with dissociative client, 200 exploring connections of emotions and beliefs and, 198–200, 204–7, 217 feedback loop of beliefs and emotions and, 651 indications for therapeutic focus on, 197–98 internal states influenced by, 201 introduction to exploration of, 201–2 mindful awareness of, 197 sources of, 201 therapeutic significance of, 197 therapists’ guide to, 197–200

929

therapuetic goals in work with, 17 in triune brain model, 174 using movement and touch to increase, 211 vocabulary for describing, 198, 199, 202–4, 206, 207, 213 worksheets, 199–200, 209–17 Body’s Signals worksheet, 79–80, 93 bottom-up approach, 64 to address dysregulated animal defenses, 516, 566–67 to address dysregulated emotions, 558 defined, 769 to regulate hyperarousal, 537 triune brain model to explain, 175 bottom-up hijacking of neocortex, 181 bottom-up information processing, 182–83 boundaries aggressive setting of, 392 communication of, 19, 391, 397, 400–402, 403, 409 defined, 769 development of, 399–400 function of, 397 maladaptive, 391 physical and internal, 18–19, 391, 397–98, 405, 407 in relationships, 21 respect for client’s, 393 signs of failure to set, 392–93 somatic sense of, 18–19 therapeutic goals in work with, 21, 391 therapeutic relationship and, 392 therapeutic work at edge of regulatory, 48–49 touch, 398 unhealthy, signs of, 391 validating client’s, 58 verbal and nonverbal setting, 392, 394 see also relational boundaries; somatic sense of boundaries Boundaries: Respected and Breached worksheet, 394, 413 Bowlby, J., 34, 39, 46, 632, 699 brain development of, 178–79, 180–82 hemispheres, 178–79 homeostatic regulation of body by, 81 regulation of social engagement system in, 29–30 structure and functions of, 177 triune model of, 17 brain-injured client, 54 brain stem, 29, 180 breathing arousal triggered by experiments in, 372, 378, 379 biological functions of, 375, 377–78 cautions in therapeutic intervention with, 370, 372, 378 clients who might benefit from work with, 369–70 conscious control of, 377 implementing interventions with, 370–71, 378–80 increasing awareness of, 370, 371, 379, 381, 385 intervention goals, 369 interventions with dissociative clients, 372–73

930

maladaptive patterns of, 375, 378 mechanics of, 375–77 as personal resource, 18 posture and, 371, 378, 383 to regulate arousal, 389 as resource for processing implicit memories, 444 suboptimal patterns of, 369 therapists’ guide to, 369–73 therapist’s modeling of interventions with, 371 worksheets, 371–72, 381–89 Bromberg, P., 27, 35, 36, 45, 48, 49, 437, 587–88, 746 bronchi, 376, 543 Building Blocks of a Good Experience worksheet, 134, 145 building blocks of present experience awareness of boundaries and, 394, 413 awareness of resources and, 285, 305, 307, 437 benefits of mindful curiosity about, 162 body sensation as, 138f, 140 cognitions as, 138, 138f defined, 138f, 770 directed mindfulness to change focus on, 161–62 directed mindfulness to focus on, with dissociative client, 159–60 dual awareness and, 475, 477, 480, 481, 482, 485, 487 effects of distressing events on, 161 emotions as, 138–39, 138f five, 137, 138f. see also specific building block five-sense perception as, 138f, 139 focus on, in directed mindfulness, 132–33, 134, 137, 157, 158, 165, 167 mindful awareness of, to explore information processing, 182, 183 movement as, 138f, 139 to notice faulty neuroception, 222 proximity-seeking and, 702 sliver of memory and, 495, 499, 502 therapeutic goals in work with, 131 therapeutic significance of, 162 use of triune brain model to explain, 174, 178, 178t Bull, N., 348, 634 bullying, 66, 350, 524 butterflies in stomach, 140, 162, 178, 201, 397, 639, 749 Cannon, B., 722 carbon dioxide, 372, 375, 376–77 cardiovascular system effects of attachment trauma in, 33 homeostatic regulation of, 81 hypoarousal effects in, 227 neural regulation of, 180 threat response in, 32, 82, 227, 543 use of breathing techniques with clients with problems of, 370 Categories of Resources worksheet, 279, 293, 295 catharsis, 370, 558, 566, 636–37 centering, 18 benefits of, 308 clients who might benefit from, 302 defined, 770

931

dissociative client’s perception of, 305 to process implicit memory, 445 as somatic resource, 309 worksheet, 304, 317 Centering: Hand on Heart/Hand on Belly worksheet, 304, 317 center of gravity, 309 cerebellum, 180 change bottom up approach to, 64 client orientation about, 73 in exploration of orienting habits, 112 imagining or visualizing, 754–55 implicit and explicit processes in therapeutic process of, 51–52 importance of therapeutic relationship in, 21–22, 45–46 lifelong process of, 776–77 limitations of talking cure for, 25 of orienting habits, 118–19 reconnecting with body in, 84 safety in therapeutic relationship and, 587–88 in Sensorimotor Psychotherapy, 14–15 therapeutic journey to, 247 Changing Negative Beliefs worksheet, 159, 165 Changing Orienting Habits worksheet, 113, 129 Choosing Slivers of a Difficult Memory worksheet, 496, 505 Choosing What to Orient To worksheet, 113, 125 clinical examples of therapeutic situations or problems, 55, 68 closed postures, 354 cognitive functioning benefits of directed mindfulness, 162–63 benefits of grounding, 325 building blocks of present awareness, 137, 138, 138f difficulty in concentrating, 325, 332 effects of being ungrounded, 325, 332 erroneous or negative beliefs in, 138 manifestation of personal history in, 20 neurophysiology of, 17 procedural learning versus, 97–98, 109 reliance on, in disconnect from somatic intelligence, 83–84 top-down processing, 179 in triune brain model, 174–75, 177, 178, 179 cognitive schemas, 607, 608, 609, 611, 725 cognitive therapy, mindfulness-based, 41 cold compress, 372 collapsed posture, 349, 351, 355, 371, 392 compartmentalization, dissociative, 37, 62, 63, 64, 80 Compassion for Yourself worksheet, 610, 627 competencies and abilities, 247, 249, 256, 261, 264. see also resources; strengths recognition competitive behavior, 180 compliance with abusive treatment, 100, 262–63 postural adaptations to, 347 confidence exploration of, as missing resource, 416 loss of, as resource, 419 reinforcing client’s, 60–61, 78–79 for sensorimotor sequencing, 538

932

to start therapy, 247 Connecting with the Back of the Body worksheet, 304, 319 contacting present experience, 61, 62 containment, 18 dissociative client’s perception of, 305 as resource, 309, 770 worksheet, 304, 321 Containment Resources worksheet, 304, 321 contest activities, 729 Contradictions Between Mind and Body worksheet, 97–98, 109 control, client’s sense of affirming, 59 core alignment and, 356–57 orienting to new stimuli to improve, 112 in processing implicit memories, 438 core alignment assessment, 349 characteristics of good posture, 355–57 clients who might benefit from work with, 347 clinical use of, 348–49 exercises, 365 grounding and, 355–56 mindfulness in therapeutic work with, 350 psychological benefits of, 355 risk of triggering clients in work with, 350, 351 therapeutic significance of, 18, 347 therapist’s comfort in working with, 349 therapists’ guide to, 347–51 use of muscles in, 356 working with dissociative clients on, 350–51 worksheets, 349–50, 359–67 Core Alignment and Posture worksheets, 349, 359, 361 core emotions, 632, 633, 634, 640, 641, 642, 643 corpus callosum, 179 cortisol, 33 Cozolino, L., 417 Creating New Patterns worksheet, 159, 167 creative resources, 18 benefits of, 262 defined, 770 developing, with dissociative client, 258–59 embodying, 258, 273, 297 to expand window of tolerance, 763, 765 goals of therapy, 255, 256 healthy function of, 264 helping clients recognize and acknowledge, 256–57, 264–65 replacing survival resources with, 258, 264–65, 275 therapists’ guide to, 255–59 worksheets, 258, 271–75, 287–91 Creative Resources to Expand Your Window of Tolerance worksheet, 748 Creative Resource to Expand Your Window worksheets, 763, 765 cry for help defense in adulthood, 520 brain control of, 180 defined, 770

933

emotional dysregulation in, 563, 565 overactivation of, physical and behavioral manifestations of, 521 overactive, 394–95 purpose of, 32, 37, 519, 520 regulating, 524–25 see also animal defenses cuddling, 311 culturally-sensitive practice, 680, 685 curiosity, 42–43, 162 daily life systems, 37, 63–64 Damasio, A., 631, 633–34 dancing, 302, 307, 311, 335, 421, 723, 754–55 danger animal defenses stimulated by, 36–37, 521 attachment figures neurocepted as source of, 31, 66, 226, 708 beliefs associated with, 617 chronic neuroception of, in attachment trauma, 33 dissociative client’s neuroception of, 222–23, 611, 748 emotional responses in neuroception of, 557, 558, 561, 563 faulty neuroception of, as result of adverse experience, 17, 37, 43, 82, 140, 219–20, 228–29 loss neurocepted as, 226 mindful awareness of faulty neuroception of, 182–83, 206, 221–22 neuroception of, 226–27, 543–45 orienting toward, 112, 114, 116 role of neuroception in assessing, 17 see also safety; threat response death of attachment figure, 226 decoding, 46, 47 Deepening the State-Specific Memory worksheet, 476, 491 defenses activation by reptilian brain, 181 daily life systems in conflict with, 37–38, 63 in dissociation, 71 function of, 33, 63, 515 inhibition of, for social engagement, 30 need for attachment in conflict with need for, 33 see also animal defenses; survival behaviors; threat response depression adapting material for client with, 73 breathing patterns in, 369, 378, 379 exploration of orienting response in clients with, 112 hypoarousal and, 228 identifying resources in, 281–85 influence of posture on, 348 Developing a Resource in Breathing worksheet, 371, 385 Developing Missing External Resources, 417–18, 431 Developing Missing Internal Resources worksheet, 417–18, 429 developing resources in therapy client’s resistance to, 278 by deepening available resources, 278, 282–85 with dissociative client, 279–80 goals for, 262 internal and external, 279, 281–85, 287–91 missing or undeveloped. see missing resources

934

as phase of therapy process, 17, 18–19, 243, 247–48 promoting client’s understanding of, 278 by reclaiming lost resources, 278 taking inventory, 277–85 taking inventory worksheets, 279, 287–99 therapist’s stance for, 256 see also creative resources; somatic resources; survival resources development, childhood of body structure, 27 boundary setting in, 399–400 of brain, 178–79, 180–82 effects of repeated activation of threat response in, 181–82 failure to develop resources in, 419–20 formation of core beliefs in, 614 formation of predictions and expectancies in, 26–27 healthy attachment experience in, 591–92 influence of infant–caregiver interactions on, 26–27 innate curiosity in, 776 integration of self-states in, 34–35 internal working models in, 33–34 interruption of resource development in, 421, 423 learning of procedural patterns and habits in, 99 learning to recover from negative emotions, 729 meaning-making in, 607, 614 organization of proximity-seeking behaviors in, 699 play behaviors in, 728–29 proximity-seeking actions in, 21, 705–7 resource acquisition in, 419 social engagement system in, 29–30, 225–26 somatic sense of boundaries in, 19 of spine, 353 use of somatic resources in, 308 of walking style, 661 developmental delay, 54 diabetes, 370, 378 dialectical behavior therapy, 41 diaphragm, 376, 378 diet, 83 Different Ways of Breathing worksheet, 371, 385 Different Ways of Walking worksheet, 657, 669 digestion, 180 Dijkstra, K., 96 directed mindfulness client’s potential misunderstanding of, 158 clinical examples of, 163–64 clinical use of, 42, 62, 158–59, 161–62 defined, 157, 161, 770 with dissociative clients, 159–60 focus of attention in, 62, 157 focus on physical elements associated with negative beliefs, 159, 165 in grounding exercises, 326, 327 to identify animal defense-associated emotional dysregulation, 559 to identify effects of thoughts on body, 159, 165 neuroplasticity and, 17, 157, 161, 162–64 to notice faulty neuroception, 222

935

in promoting dual awareness in memory work, 474–75, 476 in sensorimotor sequencing, 539–40, 544 tasks of, 162–64 therapeutic value of, 157–58 worksheets, 159, 165–71 Directed Mindfulness worksheet, 159, 171 disconfirmation, 35–36, 38, 50, 634 disconnect from body in anticipation of emotional pain, 83 as healthy response to distressing circumstances, 83 potential harm from, 83–84 in response to emotional pain, 83, 201–2 therapeutic intervention with, 198, 201–2 disconnect from internal experience, 133 Discovering a Core Belief from Your Body worksheet, 610, 621 Discovering Your Current Posture worksheet, 363 Discovering Your Current Posturing worksheet, 349–50 disorganized-disoriented attachment action sequences and, 30, 37 dissociation and, 682, 702–3 formation of, 33 play behavior and, 721–22 trauma-related dissociation and, 38 dissociative client(s), 15 adapting therapy material for, 71–73, 80 breathing interventions with, 372–73 conflict between systems of defense and daily life in, 36–37, 63–64, 71–72 continuum of integrative failure in, 34–35, 38 core alignment work with, 350–51 developing missing resources with, 418 developing resources with, 258–59, 279–80 developing somatic resources with, 305 diagnostic signs and symptoms of, 38–39, 98 directed mindfulness work with, 159–60 dual awareness work with, 476–77 examining triune brain model with, 176 exploration of procedural learning with, 98 exploring body sensations with, 200 exploring boundaries with, 394–95 exploring mindfulness with, 135 exploring neuroception with, 222–23 exploring orienting habits with, 113–14 failure to integrate self-states in, 35–37, 38, 39 with fear of integration, 246 focus on walking with, 658–59 grounding exercises for, 328–29 implicit memory work with, 438–39 interaction of action systems in, 38 legacy of attachment in relational patterns of, 589 psychoeducation for, 63 reactions to optimal arousal by, 749 reconstructing memory with, 458 resistance to therapy by, 63 restoring empowering actions with, 518 risks and challenges in widening window of tolerance with, 748-749

936

sensorimotor sequencing with, 541–42 slowing sympathetic arousal in, 372 therapeutic goals for, 63–64 therapist orientation for work with, 62–64 therapy planning and implementation with, 245–46 treatment model for intervention with, 243 use of therapeutic experiments with, 44–45 working on attachment-related emotion with, 636–37 working on core beliefs with, 611 working on play and positive emotions with, 725–26 working on proximity-seeking actions with, 702–3 working with animal defense-associated dysregulated emotion, 560–61 working with sliver of memory with, 496–97 see also parts of self in dissociation dissociative identity disorder, 62, 64 distrust, 348 dogs, fear of, 118–19 dorsal vagal system, 33, 227, 370, 372, 521, 745 dual awareness defined, 770 in processing attachment-related emotions, 643–44 to restore empowering action, 516–17 therapeutic significance of, 19 see also dual awareness of past and present in memory work Dual Awareness of an Upsetting Childhood Memory worksheet, 476, 489 dual awareness of past and present in memory work clients who might benefit from focus on, 473–74 with dissociative client, 476–77 experience of, 479–80 managing client’s dysregulation in, 474–76, 480–81 practicing, 480–82 selection of sliver of memory and, 495 therapeutic rationale for, 479 therapeutic significance of, 473, 479 therapists’ guide to, 473–77 working with client on, 474–75 worksheets, 475–76, 483–91 Dual Awareness of Recent Interpersonal Conflict worksheet, 476, 487 dyslexia, 57, 72 dysregulated arousal defined, 770 identifying triggers and signs of, 221, 228–30 instinctive activation of, 17 mindful attention to, 206 somatic resources for, 302–3 therapeutic goals for, 219, 220–21, 224 see also hyperarousal; hypoarousal Dysregulated Emotions & the Body worksheet, 560, 579 Early Attachment and Orienting worksheet, 113, 127 eating disorders, 255, 256 embedded relational mindfulness, 41–43, 61–62 Embodying a Creative Resource worksheet, 258, 271 Embodying an Unfamiliar Emotion worksheet, 635–36, 653 Embodying a Resource worksheet, 279, 297

937

Embodying a State-Specific Memory & Being Mindful worksheet, 476, 485 emotional attunement, 47 emotional biases attachment experience in development of, 20, 641–42 manifestation of personal history in, 20 reflected and sustained in body, 635, 642–44 as relational defenses, 633 therapeutic goals in work with, 20 emotional pain, 83 emotional resources, 277, 283t Emotions, Beliefs & The Body worksheet, 635, 651 Emotions, Defenses, and Behavior worksheet, 560 Emotions, Defenses, and Behavior worksheets, 561, 569–73 Emotions, Expressions, & the Body worksheet, 635, 645 Emotions, High Arousal, and Hyperarousal worksheet, 560, 575 Emotions, Low Arousal, and Hyperarousal worksheet, 560, 577 Emotions and Early Attachment worksheet, 649 emotions and emotional processes addressing attachment-related, in therapy, 245, 631–32 affective competence in, 31, 632 attachment-related development of, 631, 640 attachment-related problems in, 639 attachment trauma manifestations in, 33 benefits of directed mindfulness for, 162–63 bottom-up approach for addressing problems of, 558 as building block of present experience, 138–39, 138f, 161 clients who might benefit from work with, 632 client–therapist attunement in work with, 47 clinical significance of, 631, 634–35 containment exercises for, 304 core versus patterned, 633 directed mindfulness to deepen experience of, 158 disconnect from, 558, 565–66, 567–68 effects of implicit memory on, 442 enduring animal defense-related dysregulation of, 563–64 exploration of neuroception in, 219–20 exploring connections of beliefs and body sensations and, 198–200, 201–2, 204–7, 217 extremes of arousal in, related to animal defenses, 564–66 feedback loop of beliefs and physical sensations and, 635, 651 healthy, 639 identifying animal defense-associated dysregulation of, 558–59, 563, 569–73 influence of past experiences on present, 138–39 influence of posture on, 347, 348, 355, 359, 361 internal working models of, 34 intervention with breathing and, 379 lack of control over, 558 manifestations of insecure attachment patterns in, 30–31 mindful attention to internal experience, 132–34 negative effects of intense arousal of, 557 neurophysiology of, 17 outcomes of imperfect but secure attachment, 30–31 positive affect intolerance in, 722, 724 preparatory movements indicating dysregulation of, 559 problems in traumatized clients, 558 procedural learning and, 97, 633

938

recovering from negative emotions, 729 reflected and sustained by body, 631, 633–34, 635, 639–40, 645 relational defenses in, 640–42 resources for dysregulated, 581 role of boundaries in, 398 sensorimotor processing versus emotional processing, 566–67 sudden surges in, 558 survival function of, in threat response, 557 therapeutic intervention for dysregulated and vehement, 558–60, 563 therapeutic intervention for trauma-related dysregulation of, 566–68 therapeutic intervention with painful attachment-related, 632–35, 639, 642–44 therapeutic processing of attachment-related, 639 therapeutic use of triune brain model to examine, 174 therapists’ guide to attachment, 631–37 threat-related, animal defenses and, 557 trauma-related beliefs and, 617 triune brain model of, 173, 174, 175, 177, 178, 179–80, 191 vocabulary for describing, 213 walking as expression of, 661 withdrawal as survival resource, 263 working with dissociative client on animal defense-associated dysregulation of, 560–61 working with dissociative client on attachment-related, 636–37 worksheets on animal defense-associated dysregulation of, 560, 569–81 worksheets on attachment-related, 635–36, 645–53 worksheet to become aware of and name, 134, 147 see also positive emotions Emotions & Early Attachment worksheet, 649 empathy, 688 empowering action(s) for addressing dysregulated emotions, 558 client’s fear of, 517 client who might benefit from work with, 515–16 to identify animal defense-associated emotional dysregulation, 560 integrating animal defenses to restore, 522–25 for intervention with trauma-related core beliefs, 617 therapeutic goals in restoration of, 19–20, 515, 525 therapeutic interventions to restore, 516–17, 517 therapists’ guide to, 515–18 triggering dysregulation in work with, 517 working with dissociative clients on, 518 worksheets, 517–18, 527–35 enactments, therapeutic, 16 emotional processing and, 634–35 in exploration of core beliefs, 608 legacy of attachment history in, 587–88 navigating, 51, 437–38 source of, 49, 50, 51 encoding, 46, 47 Engaging Your TVA Muscle worksheet, 350, 367 enmeshment, 32, 392, 685 Executing Proximity-Seeking Actions worksheet, 702, 717 executive functioning, 179 exercise and physical activity, 83, 302 mechanics of breathing in, 376–77 as somatic resources, 311

939

Exercises for Posture & Alignment worksheet, 350, 365 Existing & Missing Resources worksheet, 417, 425 Expanding Your Window: High Arousal Challenges worksheet, 748, 761 Expanding Your Window: Low Arousal Challenges worksheet, 748, 759 Exploring Beliefs That Hold You Back worksheet, 610, 629 Exploring Your Relationship To The Body worksheet, 79, 85 external resources clinical use of, 281 defined, 770 identifying, 279, 285, 287–91, 456 missing, identifying and developing, 417–18, 431 purpose of, 281 in reconstructing memory, 456, 463 somatic, 301, 310–11 types of, 281, 283–84t working with dissociative client on, 279–80 worksheets, 279, 285, 287–91, 417–18, 431 External Somatic Resources worksheet, 303–4, 315 eye contact, 706–7 in attachment formation, 30, 31, 32, 180 avoidance of, 95–96, 100, 101, 400–401, 586, 615, 703 awareness of, 59, 60, 609, 700, 709 in boundary setting, 402 cultural differences in, 685 influence of attachment experience on style of, 43–44, 82, 662, 706 negative response to, 28 as proximity-seeking behavior, 700–701, 702, 705, 706–7, 709 therapeutic relationship and, 503, 701 eye gaze, 13, 29 facial expression, 13, 25, 61 clinical significance of, 99 communication of boundaries through, 397 emotional communication through, 633–34, 635, 639–40 infant’s regulation and use of, 29–30, 32, 705 legacy of attachment in, 40, 593, 615, 706, 721 memory and, 96 as procedurally learned habit, 593 therapist’s, 474 facial muscles, 29–30 fading away, feeling of, 328 fainting, 521 Familiar and Unfamiliar Emotions worksheet, 635, 647 family animal defenses developed in context of, 519, 521 boundary dynamics, 399–400, 686, 687 breathing patterns developed in context of, 370, 378 circumstances leading to underdevelopment of resources, 415, 418, 420 high-achieving, 332, 369–70 survival resources developed in context of, 262, 263 fatigue, 83, 93 fear, 139, 161 of addressing painful memories, 493–94 as animal defense-related emotional dysregulation, 565 of being alone, 524–25

940

of body sensations, 200 breathing patterns in, 378 of disappointing attachment figures, 332 faulty neuroception as source of, 220 hyperarousal and, 228 of memory of adverse experience, 435 neurophysiology of, 539 of reconnecting with body, 84 wisdom of body and, 79, 87 Fears and Hopes worksheet, 79, 87 feet, nerve endings of, 334 feigned death. see shutdown defense felt sense of boundaries, 18–19, 391, 397 of competency and well-being, 301 in grounding, 18 of resolving past trauma, 537 of self, 689–90 in therapeutic relationship, 21–22 five-sense perception, 138f, 139, 174, 178, 499 flashbacks, 66, 327, 455–56, 458, 497, 538, 540–41 flight defense. see fright-freeze-flight response flooding, emotional, 174 Focusing on Your Resources worksheet, 457–58, 471 Focusing Your Sense of Hearing worksheet, 134, 149 Focusing Your Sense of Sight worksheet, 134, 151 Focusing Your Sense of Taste and Smell worksheet, 134, 155 Focusing Your Sense of Touch worksheet, 134, 153 form and function, 27 framing, mindful attention and, 62 Franklin, E., 657 Frederick, A., 538 free association, 158 freeze defense. see fright-freeze-flight response fright-freeze-flight response attachment trauma manifestations in, 33 brain activity in, 180 defined, 770 developmental significance of early activation of, 181–82 discovering, in therapy, 522–23 emotional dysregulation in, 563, 565 empowering actions to replace, 517–18, 519–20 exploration of orienting response in clients with problems of, 112 exploring physical feel of, 529, 531 initiation of, 519, 520–21 mobilizing and immobilizing actions in, 519, 520–21 neurophysiology of, 516, 543 overactive, physical and behavioral manifestations of, 521 overactive flight response, 516, 521, 524 regulating fight defense in, 523–24 stimulation of, 225 survival function of, 37 to trauma, 32–33, 82, 520 see also animal defenses future

941

adverse experiences promoting focus on, 101 language indicating focus on, 133 rehearsing response to challenges in, to develop new resources, 422, 425 unconscious presumptions about, in procedural learning, 101 gait. see walking Gallese, V., 303 garden work, 311 gesture, 13 Getting to Know the Body’s Language worksheet, 97, 105 Goldman, A., 303 good-enough parenting, 20, 28, 705 Good Times, Bad Times, & Your Body worksheet, 97, 107 Grigsby, J., 40 grounding, 18 causes and effects of becoming ungrounded, 331–33 clients who might benefit from, 325–26 clinical use of, 326–27 core alignment and, 355–56 defined, 325, 770 directed mindfulness to facilitate, 158 for dissociative clients, 328–29 exercises for increasing, 334–35 metaphors for, 331 mindfulness to promote, 42 overgrounded state, 326, 327, 333 physical manifestations of problems in, 331–32, 333 as resource for processing implicit memories, 444 therapeutic value of, 325, 331, 333–34, 335, 420 therapists’ guide to, 325–29 therapist’s physical modeling of, 59–60 worksheets, 327–28, 337–45 Grounding Resources worksheets, 327, 337–41 habits, 15 of attention, 158, 162 beliefs and, 20 of orienting, 111 physical manifestations of trauma and attachment problems in, 25, 95 procedural learning of, 99 survival behavior, brain control of, 173 therapeutic focus on, 53 therepeutic experiments with, 43–44 see also procedural patterns and habits Harnessing a Resources from a Positive Relational Experience worksheet, 588 Harnessing a Somatic Resource from a Positive Relational Experience worksheet, 599 Harnessing Neuroplasticity for Positive Change worksheet, 159, 169 hate crimes, 66 Having a Bad Day? worksheet, 279, 299 health resources, 281 hearing, 139, 304 focusing sense of, 134, 149 here and now, 15 adverse experiences interfering with being present in, 137 building blocks of present experience, 130, 131, 134, 137–40, 138f

942

dual awareness of past and, 19 mindfulness to become aware of internal experience in, 131, 133 processing adverse memories in, 436 processing client–therapist enactments in, 51 shared awareness of client’s experience in, 61 teaching mindfulness in, 61–62 therapy process as taking place in, 45 in work with sliver of memory, 499 see also dual awareness of past and present in memory work hide-and-seek, 728 High and Low Arousal Positive Emotions worksheet, 725 High Arousal Emotions and Attachment worksheet, 635 hijacking of neocortex, 175–76, 181, 195 Hijacking of Your Neocortex worksheet, 175–76, 195 hippocampus, 180 hoarding, 180 Hobson, J., 557 holding environment, 304 homeostasis, 81 hopelessness, 161, 228, 326, 370, 379 How Our Different Brains Remember worksheet, 175, 187 Hughes, D., 255 hunger, 83, 93 hyperarousal as animal defense-related dysregulation, 564 as attachment trauma outcome, 33 biphasic reactions, 538 boundary work with clients in, 394 breathing interventions for, 369, 379 breathing patterns in, 370 client’s understanding of, as faulty neuroception, 219–20, 223, 229 defined, 770 disengagement from body sensations in, 201–2 elicited in trauma, 29 empowering actions to regulate, 517–18 grounding to regulate, 42, 158, 325, 327–28, 345 identifying animal defense-associated dysregulation of, 575 long-term effects of, 228 neurocepted danger as source of, 225, 226, 227 neurophysiology of, 537 play and pleasure incompatible with, 722 of pleasurable emotions, 728, 739 recognizing triggers worksheet, 221–22, 233 related to unresolved trauma, 32, 40, 82 sensorimotor sequencing to treat trauma-related, 20, 538, 543. see also sensorimotor sequencing signs and symptoms of, 40, 221, 228, 538 therapeutic processing of, 20 as threat response, 225 tracking to regulate, with dissociative client, 223 triggered by memory work, 480–81, 494–95 walking patterns related to, 662 in zones of arousal in window of tolerance, 69–70 hypervigilance, 33, 114, 348, 722 hypoarousal as animal defense-related dysregulation, 564

943

as attachment trauma outcome, 33, 228 biphasic reactions, 538 boundary work with clients in, 394 breathing interventions for, 369, 379 breathing patterns in, 370 client’s understanding of, as faulty neuroception, 219, 225 defined, 771 disengagement from body sensations in, 201–2 elicited in trauma, 29 exploring body sensations to relieve, 206 grounding skills to regulate, 325, 327–28, 345 identifying animal defense-associated dysregulation of, 577 long-term effects of, 228 neurocepted danger as source of, 225, 227 play and pleasure incompatible with, 722 recognizing triggers worksheet, 221–22, 235 reframed as survival resource, 262–63 replacing, with empowering defense, 517 signs and symptoms of, 40, 221 tracking to regulate, with dissociative client, 223 triggered by memory work, 494–95 walking patterns related to, 662 in zones of arousal in window of tolerance, 69–70 Identifying Implicit Memories worksheet, 438, 447 Identifying Resources for Addressing a Sliver of Memory worksheet, 496, 507 Identify Resources for Addressing a Sliver of Memory worksheet, 497 immobilizing defenses, 37, 82, 517, 518, 519, 520–21, 565 defined, 771 implicit memory client’s sense of control in work with, 438 clients who might benefit from therapeutic focus on, 435–36 defined, 441–42, 771 in dissociative client, 246, 438–39 effects on present experience, 436, 442 focus of Sensorimotor Psychotherapy on, 435 formation of, 442 identifying, 443–44, 447 intrusive, 435–36 physical manifestations of, 436 recognizing emergence of, 438 resource repertoire for work with, 437, 438, 441, 444–46 role of mindfulness in controlling reactions to, 131–32 sliver of memory replaced by, 495 therapeutic examination of, in absence of explicit content, 40 therapeutic goals for, 435, 437 therapeutic interventions to promote awareness and processing of, 19, 436–38 therapists’ guide to, 435–39 workings of, 442 worksheets, 438, 447–53 implicit processing, clinical significance of, 25 implicit relational knowing, 585, 586–87 impulsive behavior, 112, 174 exploration of neuroception for, 219–20 grounding exercises for dissociative clients with, 328

944

hyperarousal and, 228 inadequacy, feelings of, 65, 164, 202, 255, 261 incomplete boundary style, 689 Increasing Sensation worksheet, 199, 211 indicators, nonverbal, 39–41 unconscious encoding and decoding of, in therapy, 47 infant–caregiver interactions brain activity in, 180 brain development and, 180–81 in development of social engagement system, 225–26 formation of beliefs through, 614 in formation of predictions and expectations, 26–27, 28–29 implicit memory formation in, 442 role of infant social engagement system in, 29 see also attachment information processing, 17 bottom-up and top-down forms of, 182–83 feeling of safety necessary for, 416 in triune brain model, 174, 175, 177–80, 182–83 worksheet on three levels of, 175, 183, 185 insecure-ambivalent attachment, 30, 32 capacity for play and, 721–22 insecure-avoidant attachment, 30, 31–32 instinctual behaviors, 173 brain control of, 180 insula, 41 integration defined, 771 of implicit memories, 443 therapeutic goals and strategies for, 17, 19–20 intellectual resources, 277, 283t intelligence of body, 13, 775, 776, 777 interactive repair, 729, 771 Internal Boundaries worksheet, 394, 407 internal experience building blocks of present experience comprising reaction to, 131, 132–33, 134 client’s detachment from, 133 contradictory communications about, 39–40 defined, 771 mindfulness skills for exploring, 131–34 physical manifestations of, 61 teaching mindful awareness of, 17, 42–43, 46, 61–62 of traumatized individuals, 37 Internal & External Creative Resources worksheet, 287–91 Internal & External Resources worksheet, 279 Internal Somatic Resources worksheet, 303, 313 internal working models, 33–34 interoception. see body sensations interpersonal interactions and relationships boundary-related problems in, 392 boundary styles in, 21 clients who might benefit from exploration of attachment legacy in, 585–86 clients who might benefit from exploration of boundary styles in, 679–80 cultural differences in, 680, 685 daily life systems for, 37

945

differentiation of self and other, 686–87 dual awareness of recent conflict in, 476, 487 dysregulated arousal as obstacle to, 228 effects of early implicit relational memory on, 436, 442, 443 expanding window of tolerance by challenging habits of, 753–54 exploration of orienting habits in clients with problems of, 111, 112 fear of being alone interfering with, 524–25 goals of therapeutic process for, 248–49 influence of attachment-related emotional patterns on, 634 internal working models of, 34 interventions with attachment-related problems in, 586–88, 594–95 legacy of attachment experience in, 20, 31, 32, 95–96, 585, 591–92, 593 neural activity in, 180 proximity-seeking actions in, 21 role of boundaries in, 397, 398–99, 401, 407 signs of overbounded relational style in, 687–88 signs of underbounded relational style in, 686–87 somatic resources for regulating, 302 survival resources interfering with, 263 trauma effects on, 32 working with dissociative clients on legacy of attachment in, 589 worksheets on legacy of attachment in, 588–89, 597–605 see also proximity-seeking actions; relational boundaries interpersonal neurobiology, 14 interrupted resource, 417, 421–22, 771 Interrupted Resource worksheet, 417, 423 Janet, P., 17, 243 joy, 139, 249, 633, 640, 721, 727, 729, 732, 746 Kaschak, M. P., 96 Kurtz, R., 39, 46, 47, 61 Laird, J. D., 96 language of body, 16, 25, 27, 95, 99 body sensation vocabulary, 198, 202–4, 206, 207 clients with learning disabilities of, 57 indicating past or future focus, 133 play with, 728–29 translating body’s, 97, 105 translating nonverbal, into words, 99 use of simple, in therapy, 47 vocabulary for beliefs and meaning, 215 Lapides, F., 47 laughter, 721 learned helplessness, 255 learning disabilities, 54, 57, 72 LeDoux, J. E., 539 Legacy of a Positive Relational Experience worksheet, 588 Legacy of Attachment in Difficult Relationships worksheet, 603 Legacy of Attachment in Positive Relationships worksheet, 588–89, 605 Legacy of Early Attachment in Difficult Relationships worksheet, 588 lethargy, 228 Letter To Your Body, 79, 89

946

Levine, P., 372, 538 limbic brain, 179, 516 Llinas, R., 608 locus of control, 356–57 Lookout for Fun & Play worksheet, 725, 735 Low Arousal Emotions and Attachment worksheet, 635 MacLean, P. D., 173 mammalian brain, 17, 173, 174, 176, 177, 178, 179–80 defined, 771 see also triune brain Maroda, K. J., 634 massage, 310, 311, 335 material resources, 277, 281, 284t meaning-making body in, 27–28, 607 elements of, 613 enactments in therapeutic relationship and, 437–38 expectations for future and, 607 formation of core beliefs and, 613 healthy attachment and, 28 implicit, in infant development, 607 implicit and explicit processes in therapeutic process of, 51–52 influence of infant–caregiver interactions on, 26–27, 614 relational nature of, 775 in sensorimotor sequencing, 545–46 survival function of, 27 trauma effects on, 28, 29 memory discovering somatic resources by recalling, 310 dissociative client’s, therapy process and, 246 of early experiences as unconscious expectations, 27 exploring body reactions to good versus bad, 97, 107 formation of working models in, 33–34 intrusive recurrent, 139, 443, 473–74 neurophysiology of, 459, 460–61 procedural, 99 processing in mammalian brain, 179–80 processing in present, 436 in processing of sensory stimuli, 26 reconstructing. see reconstructing memory Sensorimotor Psychotherapy treatment of, 435 sliver of. see sliver of memory subjective nature of, 459 therapeutic examination of nonverbal, 40 in triune brain model, worksheet on, 175, 187 workings of, 456, 459 see also addressing memories in therapy migraines, 370, 378 mindfulness awareness of information processing style, 182 to become aware of internal experience, 131 building blocks of present awareness and, 137–42, 138f, 182, 183 challenges for dissociative clients, 135 clinical use of, 132–34

947

curiosity and, 42–43 defined, 41, 137 in exploration of emotions, 631–32 in framing of therapeutic exploration, 62 to promote grounding, 334 to regulate fight defense, 523–24 as resource for processing implicit memories, 444–45 to restore empowering action, 516–17, 525 in Sensorimotor Psychotherapy, 41–43 Sensorimotor Psychotherapy approach to, 17 as somatic resource, 307 teaching, 61–62 in therapeutic experiments, 43–45 in therapeutic relationship, 132 therapeutic value of, 41, 131–32, 137, 141–43 therapists’ guide to, 157–60 walking with, 657, 677 worksheets to learn, 134, 145–55 see also directed mindfulness mirror neuron system, 60, 303, 371 missing resources, 278 causes of, 415, 416, 419–22, 421 clients who might benefit from work on, 415–16 identifying, 417–18, 425 manifestations of, 416 neuroplastic change and development of, 416–17 obstacles to development of, 416 as obstacle to therapeutic progress, 415 therapeutic interventions to develop, 278, 416–17, 419 therapists’ guide to developing, 415–18 working with dissociative client on, 418 worksheets on development of, 417–18, 423–31 mistrust, 392 mobilizing defenses, 37, 517–18, 519, 520, 521–22, 771 Modifying Your Walk worksheet, 657, 675 Montgomery, A., 47 motor cortex, 174 movement(s), 13 associated with positive emotions, 723, 725, 728 as building block of present experience, 139, 161 changes caused by distressing events, 161 development of procedural habits of, 99 emotional expression and, 639–40, 651 identifying somatic resources in, 308 increasing awareness of, in moving forward phase of therapy, 21 internal experience manifested by, 61 manifestations of past experience in, 95 as somatic resource, 18, 310 to support playfulness and fun, 737 therapeutic goals in exploration of habits of, 95–96 therepeutic experiments with habits of, 44 triune brain activity in habits of, 193 triune brain model of, 174 unconscious adaptation in, 28 moving forward phase of therapy

948

techniques and goals in, 20–21 therapeutic goals of, 613, 722 in therapy process, 17, 20–21, 243, 248–49 walking as focus of, 655. see also walking mugging, defenses mobilized in response to, 522–23 musculature abdominal, 350, 376, 664 body sensation of, 201 for breathing, 375, 376 in core alignment, 18, 353, 356, 367 in grounded state, 334 in immobilizing defenses, 520–21 relational styles associated with, 687, 688 sense of containment in, 309 social engagement system regulation of, 29–30 threat response, 543 in ungrounded state, 333 My Body Brain worksheet, 175, 193 My Emotional Brain worksheet, 175, 191 My Thinking Brain worksheet, 175, 189 Naming Thoughts & Emotions worksheet, 134, 147 nature, as resource, 277, 281–82, 284t Negative Relational Experience worksheet, 588, 601 Negative Thoughts & Core Beliefs worksheet, 610, 625 neglect legacy of, 592 nervous system responses to, 33 as source of trauma, 66 neocortex anatomy of, 178 building blocks of, 178t decreased activity of, in response to threat, 174–75 defined, 771 in dissociation, 176 hijacking of, 175–76, 181, 195 information processing in, 178–79, 178t mindfulness and, 162–63 therapeutic use of triune brain model of, 173–74 threat response in, 181–82 in triune brain model, 17, 173, 177 see also triune brain neural networks, 181, 771 memory and, 459, 460–61 neuroception activation of arousal through, 225 benefits of therapeutic focus on, 220–21 causes of dysregulated animal defenses, 19–20 defined, 17, 30, 219, 771 development of social engagement system and, 225–26 in dissociative client, 222–23 effects of trauma on, 37, 43 faulty, defined, 770 faulty, dysregulated arousal as result of, 225, 228 goals of therapeutic focus on, 219

949

indications for therapeutic focus on, 219–20 physiology of, in threat response, 543–44 recognizing triggers of, to regulate arousal, 228–30 restoring empowering action to counter faulty, 515–16 as source of dysregulated arousal, 225 stimulation of threat response by, 225, 226–27 therapists’ guide to, 219–23 window of tolerance and, 225 worksheet for understanding, 237 worksheets on window of tolerance and, 221–22, 231–41 see also neuroception of safety neuroception of safety activation of arousal in, 225 for daily life systems, 37 in development of social engagement system, 30, 37 in dissociative client, 222–23 in early development, 30, 31 effects of dysregulation of, 516 as goal of therapy, 230 recognizing optimal arousal in, 222, 241 trauma effects on, 32 use of mindfulness to increase client’s, 43 see also neuroception neurophysiology of animal defenses, 516, 543 of attention, 157 of breathing, 376–77 of fear, 539 of hyperarousal, 537 of mirror neuron system, 60 of neuroception of danger, 226–27 of social engagement system, 29–30 of threat response, 32–33, 543–44 of trauma-related dissociation, 36–37 see also brain; neuroplasticity neuroplasticity in brain development, 180–81 in challenging window of tolerance, 746–47, 752, 755 defined, 771 for developing missing resources, 416–17 directed mindfulness and, 17, 161, 162–64 mindful attention and, 157, 158–59 process of change in, 163–64 in reconstructing memory, 455 therapeutic significance of, 161 therapists’ guide to, 157–60 worksheets on, 57, 159, 165–71 nightmares, 66, 538 night terrors, 516 Nonverbal Boundary Setting worksheet, 393 nonverbal expression of boundaries and boundary setting problems, 392–93, 394, 397–98, 400–402, 403, 409 clinical significance of, 39, 51–52 to communicate safety in therapy, 46 contradicted by verbal expression, 39–40, 400–401

950

development of social engagement system and, 30 indications for opportunity to explore somatic resources, 302–3 manifestations of trauma and attachment problems through, 25, 133 messages conveyed by posture, 44, 353, 359, 361, 363 of somatic narrative, 13 between therapist and client, 46–47 translated into words, 99 nonverbal indicators, 39–41 Noticing Body Sensations for Sensorimotor Sequencing worksheet, 540 Noticing Body Sensations of High Arousal worksheet, 549 Noticing Your Breath worksheet, 371, 381 novelty-seeking, 745, 755 numbness in animal defense-related emotional dysregulation, 565–66 in dissociative client, 200, 222 hyperarousal and, 228 mindful exploration of, 133, 198, 436, 567–68 related to past adverse experience, 66, 161, 563 as trauma response, 82 organizational resources, 281 orientation for clients, 16 on adapting material, 72–73 on attachment and trauma, 65–67 goals of, 65 in implementing Sensorimotor Psychotherapy, 54, 55–57 introducing attending to the body, 60–61 psychoeducation, 58–59 repairing therapeutic relationship, 70 safety and risk, 68–70 structure and use of book, 67–68 on trauma-related dissociation, 71–72 orientation for therapists, 16 addressing trauma-related dissociation, 62–64 attitude and positive reinforcement, 60–61 demonstrating body actions for clients, 59–60 embedded relational mindfulness skills, 61–62 exploring client’s dislike or phobia of body, 57–58 implementing material, 55–57 psychoeducation, 58–59 orienting response in capacity for play and positive emotions, 730 clients benefiting from work with, 111–12 cue recognition in, 112 defined, 111, 771 effects of adverse experience on, 16, 116, 117–18 in emotional functioning, 633 failure to assess safety and acceptance in, 118 failure to recognize danger in, 112, 118 habits of, 111 as involuntary reflexive instinct, 115–16 purpose of, 115, 116–17 as somatic resource, 307 as survival behavior, 112 therapeutic goals in work with, 112, 118–19

951

therapists’ guide to, 111–14 working with dissociative clients on, 113–14 worksheets for exploring, 113, 121–29 Oscillating Between Sliver of Memory and Resources worksheet, 496, 511 out-of-body experiences, 328 overbounded relational style, 681, 687–88, 689–90 overgrounded, 326, 327, 333, 348, 356, 771 oxygen, 376–77 panic, 66, 563, 566 body sensations in, 206 breathing patterns associated with, 378, 379 restoring empowering action to clients with, 516 sensorimotor sequencing for, 538 therapist’s modeling of physical effects of, 59–60 Panksepp, J., 721, 724 parasympathetic nervous system in shutdown defense, 521 threat response of, 32–33 parts of self in dissociation attachment legacies of, 589 boundary tendencies of, 395, 682–83 breathing exercises with, 372 challenging window of tolerance with, 749 clinical conceptualization of, 38, 64, 71–72, 80, 98 conflicting beliefs among, 611 core alignment work and, 351 defined, 771 developing missing resources of, 418 dual awareness work with, 476–77 emotional functioning of, 636 experience of, 71 exploring animal defenses with, 560–61 exploring body sensations with, 200 exploring play and positive emotions with, 725–26 exploring walking with, 658–59 grounding exercises and, 328–29 identifying resources with, 279–80 memory work with, 246, 438–39, 458, 496–97 mindfulness to regulate switching between, 160 orienting patterns of, 113–14 procedural tendencies of, 98 proximity-seeking behaviors of, 702–3 recognizing emergence of, 135 restoring empowering action with, 518 somatic resources of, 305 therapeutic goals for, 64, 80 in triune model of brain, 176 patterned emotions, 633 peek-a-boo, 728 pendulation, 496 pendulum boundary style, 688 petting your dog, 311 phase-oriented treatment model, 17, 243, 244, 245, 247–50 Phases of Treatment: Goals & Tasks worksheet, 245

952

phobias and phobic reactions, 37 about body, 54, 57–58, 78, 80, 305 about emotion, 636 about memory, 246, 435, 473, 494–95 about parts of self, 63 about positive emotions, 256, 258 about risks and challenges, 749 physical activity. see exercise and physical activity physical disabilities or handicaps, 72 play attachment experience as source of impaired capacity for, 721–22, 727, 730 clients who might benefit from therapeutic focus on, 722 contest activities versus, 729 development of capacity for, 728–29 impaired capacity for, 721 movements and postures associated with, 725 rationale for increasing or amplifying, 727 socialization benefits of, 729 therapeutic goals in work with, 722 therapeutic interventions to increase capacity for, 723–24, 730–32 therapists’ guide to, 721–26 working with dissociative clients on, 725–26 worksheets, 724–25, 733–43 playing dead, 227 Porges, S. W., 29, 516 Positive Elements of a Distressing Event worksheets, 457, 465–69 positive emotion(s) attachment experience as source of impaired capacity for, 721–22, 727, 730 body sensations associated with, 199 client’s aversion or resistance to, 303, 727–28 clients who might benefit from therapeutic focus on, 722 development of capacity for, 728–29 grief work and, 637 high and low arousal of, 728, 739 impaired capacity for experiencing, 721, 727–28 limiting beliefs, 725, 741 movements and postures associated with, 725, 728 rationale for increasing or amplifying, 21, 721, 727 recovering from negative emotions to experience, 729 slivers of memory of, 723–24 therapeutic goals in work with, 722 therapeutic interventions to promote, 723–24, 730–32 therapists’ guide to, 721–26 vocabulary for describing, 202 working with dissociative clients on, 725–26 worksheets, 725, 733–43 Positive Relational Experience worksheet, 597 posttraumatic stress disorder, 55, 243 difficulties in accepting positive feedback in, 257 posture, 13 associated with positive emotions, 723, 725, 728 beliefs reflected and sustained by, 609–10, 617, 618, 619 breathing and, 371, 378, 383 client’s discomfort with therapeutic interventions with, 348 communication of meaning through, 44, 353, 359, 361, 363

953

core as determinant of, 353 development of procedural habits of, 99 effects of trauma experience on, 347, 354 framing of therapeutic exploration of, 62 good qualities of, 355–57 identifying somatic resources in, 308 infant development, 353 influence of, on emotions, 347, 348 internal experience manifested by, 61 manifestation of attachment experience in, 31, 81–82, 95, 262–63, 354–55 manifestation of emotional biases in, 635 psychological effects of poor, 355 resources for processing implicit memory, 445 rigid, 347, 348, 353, 354, 355, 356, 371 signs and symptoms of dissociative disorder in, 98 slumped, 347, 348, 353, 354, 356, 378, 420 to support playfulness and fun, 737 therapeutic goals in exploration of habits of, 95–96 therepeutic experiments with habits of, 44 triune brain activity in habits of, 193 unconscious adaptation in, 28 walking and, 663 see also core alignment Posture, Tension, and Breath worksheet, 371, 383 Postures & Movements to Support Playfulness & Fun worksheet, 725, 737 Practice Taking Risks worksheet, 748 Practice Walking Mindfully worksheet, 657, 677 Practicing Playfulness worksheet, 725, 742 Practicing Taking Risks worksheet, 767 predictions and expectations clinical significance of, 27 healthy attachment experience and, 28 influence of infant experiences in formation of, 26–27 meaning-making and, 607 in procedural learning, 101 in processing of sensory stimuli, 26 trauma effects on, 28, 29 prefrontal cortex, 41, 133, 176 fear response in, 539 premotor cortex, 174 preparatory movements, 559 problem solving, 179 procedural memory, 99 legacy of attachment encoded in, 585 working models encoded in, 34 procedural patterns and habits ability to navigate challenges impeded by, 753 attachment experience and, 20 beliefs and, 607–8, 613, 616 development of, 99 effects of dissociative disorder on therapeutic work with, 98 effects of trauma and attachment on, 99–102 in emotional functioning, 633 introducing clients to concept of, 96–97 manifestation of personal history in, 20, 95, 99

954

mental knowing versus, 97–98, 109 in mobilization of animal defenses, 519–20 as obstacles to setting boundaries, 391 as reflection of early implicit relational memory, 436 relational boundary setting as, 685 relational defenses as, 640–42 therapeutic exploration of, 95–96, 101–2 therapists’ guide to, 95–98 unconscious presumptions about future in, 101 worksheets for exploring, 97–98, 103–9 prosody, 13, 25, 40, 47, 474 Proximity & Distance worksheet, 702, 719 proximity-seeking action(s), 245 attachment experience in development of, 31–32, 699, 705–7 clients who might benefit from exploration of, 699–700 defensive actions and, 708–9 eye contact as, 28, 31, 700–701, 706–7, 708 healthy, 706 identification of, 702, 711 infant response in Still Face experiments, 26–27 making meaning and predictions influenced by early experience of, 28–29 malformation of, 706–7 physical nearness as, 708–9, 719 purpose of, 699, 705 reaching out as, 28, 31, 700, 702, 707, 713, 715 relational boundaries and, 700, 701, 709 therapeutic goals in work with, 21, 709 therapeutic interventions with, 700–701, 707–9 therapists’ guide to, 699–703 transference -countertransference reactions in work with, 701 working with dissociative client on, 702–3 worksheets, 701–2, 711–19 psychoeducation, 58–59, 63, 223 about relational boundaries, 680 about therapy process, 244–45 psychological resources, 277, 284t psychotherapy as affect communicating cure, 47 limitations of talking cure in, 25 pushing away, 30, 31, 32, 397, 398, 517, 547, 567, 617 rape, 66 reaching out, 28, 30, 31, 59, 700, 707–8, 713, 715 Reaching Out worksheets, 702, 713, 715 reading the body, 97, 103 reality testing, 113–14 Recognizing Animal Defenses worksheet, 517, 518, 527 Recognizing Optimal Arousal worksheet, 222, 241 Recognizing Triggers & Regulating Hyperarousal worksheet, 221–22, 233 Recognizing Triggers & Regulating Hypoarousal worksheet, 221–22 Recognizing Your Survival Resources worksheet, 257, 267 reconnecting with body, 84 reconstructing memory, 19 clients who might benefit from, 455–56 with dissociative client, 458

955

goals for, 455 identifying resources for, 455, 456–58, 460–63, 467, 469, 471 process of, 460 therapeutic rationale for, 459–61, 463 therapists’ guide to, 455–58 working with clients on, 456–57 worksheets, 457–58, 465–71 reflexive behavior, 117, 180 reframing, 18 emotional dysregulation as survival response, 559 inadequacies as missing resources, 416 of maladaptive behaviors as survival resources, 255–58, 262–63, 269 Reframing a Survival Resource worksheet, 257–58, 269 Regulating Arousal with Grounding Resources worksheet, 327–28, 345 Regulating Dysregulated Mobilizing Defenses worksheet, 517–18, 535 Regulating Your Arousal or Mood with Your Breath worksheet, 371–72, 389 regulation of emotions, sensations, and impulses, 18 containment resources for, 309 defined, 772 developing resources for, 247–48 grounding for, 325, 327–28, 345 missing resources for, 416 orientation for clients about, 68–70 rationale for therapeutic focus on body sensation for, 197 somatic resources for, 301, 304, 310 therapist’s role in, 46 working at edges of client’s boundaries of, 48–49 in work with sliver of memory, 495 reinforcement of client’s body awareness, 60–61 relational boundaries anticipating and recognizing violations of, 690, 697 as attachment legacy, 679, 685, 686, 687 attachment trauma as violation of, 679 clients who might benefit from focus on, 679–80 cultural differences in, 680, 685 of dissociative clients, 682–83 formation of, 685 incomplete style, 689 overbounded style, 687–88, 689–90 pendulum style, 688 proximity-seeking actions and, 700, 701, 709 purpose of, 680 saying “yes” and “no” and, 680–81, 686, 687, 689, 693, 695 style assessment, 680–81, 686–89, 691 therapeutic intervention with, 689–90 therapeutic significance of, 679 therapists’ guide to, 679–83 underbounded style, 686–87, 689 working with dissociative client on, 682–83 worksheets, 681–82, 691–97 relational defenses, 633, 640–42 relational knowing, 593, 597, 772 relational resources, 277, 283t relational trauma, 29 defined, 772

956

orientation for clients about, 66 relaxation techniques, 370 religious institutions, 281 Remembering a Painful Attachment Experience worksheet, 513 Remembering Fun Times worksheet, 724–25, 733 Replacing Immobilizing Defense with a Mobilizing Defense worksheet, 533 Replacing Immobilizing Defensive Responses with Empowering Actions worksheet, 517 Replacing Survival Resources with Creative Resources worksheet, 258, 275 reptilian brain, 17, 173, 174, 176, 177, 178, 180, 516 defined, 772 see also triune brain resilience, learning, 729 Resource and Reaction Balance worksheet, 438, 453 resources categories of, 18–19, 277, 279, 283–84t, 293, 295 for challenging window of tolerance, 746, 748 defined, 772 development of, 419 for dysregulated emotions, 581 embodying, 279 external, 303–4, 310–11, 315, 417–18, 431, 770 as facts and capacities versus opinions, 256 function of, 261 identifying weak or missing, 19 internal capacities, 261, 277, 279, 281–85, 303, 313, 417–18, 429, 771 interrupted development of, 421–22, 423, 771 for memory work, 19, 245, 435–36, 437, 438, 441, 444–46, 447–53, 455, 456–58, 460–63, 467, 469, 471 from positive relational attachment experience, 588–89, 597, 599 recognizing, 18 scope of, 261 for sensorimotor sequencing, 540, 546–47 therapists’ guide to categories of, 277–80 use of future templates to develop new, 422, 425 for work with sliver of memory, 496, 507–11 see also developing resources in therapy; somatic resources Resources for Dysregulated Emotions worksheet, 560, 581 respiratory system, 378 problems of, breathing techniques and, 370 threat response, 543 right-brain to right-brain communication, 22 in therapeutic relationship, 47 right hemisphere of brain, implicit processing in, 25 rigid posture, 347, 348, 353, 354, 355, 356, 371 risk-taking, healthy and appropriate, 745, 747, 752, 753–55, 767, 776 running, 311 safety body-to-body affective communication to create, 46 child’s meeting of parental expectations to feel, 31, 221, 332 compliance with abusive treatment to attain, 100 need for feeling of, to orient to new information, 416 need for novelty and, 745 orientation for clients about, in therapy process, 68–70 in therapeutic environment, 43, 45–46, 48, 587–88, 746 therapist’s window of tolerance to establish, 48

957

see danger; neuroception of safety Saying “No” in a Relationship worksheet, 681, 693 saying “yes” and “no,” 680–81, 686, 687, 689, 693, 695 Saying “Yes” in a Relationship worksheet, 681, 695 Schnall, S., 96 Schore, A. N., 25, 45, 51 secure attachment, 30–31 self-esteem, 18, 243, 247 goals of developing resources phase of therapy, 255, 256, 262 identifying resources in clients with low, 277–78 self-harm behavior disconnect from body leading to, 83 exploration of orienting response in clients with, 112 reframed as survival resource, 255, 256, 258, 263–64 self-judgment, 161 self-loathing, exploration of orienting habits in clients with, 111 self-perception, 18 imagining or visualizing best self, 754–55 in underbounded relational style, 686–87 self-regulation developmental influences on capacity for, 30 mindfulness to improve, 131 selection of worksheets based on client’s capacity for, 56 self-representation(s), 14–15 self-soothing, 179, 301, 305, 308 self-states disconfirmation of, in development, 35–36 integration of, in development, 34–35 nonverbal indicators revealing conflict between, 39–40 therapeutic experiments in processing of, 44–45 trauma-related dissociation and, 35, 36–37, 38, 39 Sensations Sequencing through the Body worksheet, 540–41, 551 sensorimotor processing defined, 772 directed mindfulness in, 539–40 emotional processing versus, 566–67 neurophysiology of, 17 in triune brain model, 174, 178 Sensorimotor Psychotherapy approach to memory treatment, 435 client psychoeducation about, 58–59 clinical significance of nonverbal behaviors in, 39 collaborative implementation of, 53–54 conceptual basis of, 14–15 contraindications to, 54 defined, 772 examples of clinical situations and problems, 55 mindfulness applications in, 41–43 orientation for clients in implementation of, 54 preparation and training of therapists for, 13–14, 53, 54–55 Sensorimotor Psychotherapy Institute, 14 sensorimotor sequencing, 20 for addressing dysregulated emotions, 558, 568 benefits of, 547 clients who might benefit from, 538

958

clinical use of, 538–40, 544–45 defined, 537, 544 with dissociative client, 541–42 level of arousal in, 539, 541, 544–45 meaning-making and, 545–46 one arousal cycle at a time, 541, 545–47, 555 requirements for successful intervention with, 538, 542 selecting resource for, 540, 546–47 stalled, 540 therapeutic rationale for, 537, 543 therapists’ guide to, 537–42 therapist’s stance in, 539–40 worksheets, 540–41, 549–55 Sensorimotor Sequencing & The Window of Tolerance worksheet, 541, 553 sensory stimuli developing somatic resources for moderating responses to, 302, 304, 323 heightening awareness of, 134 orienting response to, 16, 115–16 processing of, 26 reexperiencing reminders of adverse events, 139 separation cry, 32 Sequencing One Arousal Cycle at a Time worksheet, 541, 555 Setting Boundaries with Another Person worksheet, 681–82, 697 sexual abuse, 227 core beliefs related to, 617 feelings about body from, 82 hypoarousal as response to, 227 as relational trauma, 66 resource development interrupted by, 421 shame, 161, 415–16 about body, 57–58 about body sensations, 200 benefits of memory reconstruction in clients with, 456 dysregulated animal defenses as cause of, 516 exploration of orienting habits in clients with, 111 reframed as survival resource, 255, 258 therapeutic use of triune brain model to examine, 174 toward body, attachment or trauma experience leading to, 83 shoulders beliefs and, 617 boundary style and, 689 breathing and, 378–79 emotions and, 59, 61, 353, 633, 640 in good posture, 355 grounding and, 331, 332, 333 manifestations of early experiences in, 27, 31, 95, 98, 100–101, 262 mindful awareness of, 41, 61, 162, 203, 206, 221, 264–65, 540, 723 procedural learning expressed in, 101 relational style and, 707 in walking, 661, 662, 664–65 shutdown defense, 33, 520–21 emotional dysregulation in, 563, 565–66 overactive, physical and behavioral manifestations of, 521 signs of, 559–60 triggered in memory work, 496

959

unresolved trauma and, 43 see also animal defenses Siegel, D., 157, 348, 455 sight, focusing sense of, 134, 139, 151 signaling behavior, 699 Signals of Autonomic Arousal worksheet, 231 skateboarding, 311 sleep, 58, 83, 311, 516 Sliver of Attachment Memory for Work with Emotions worksheet, 496 sliver of memory of belief formation, 609, 610 clients who might benefit from focus on, 493–94 clinical use of, 493, 494–95, 499, 503 defined, 499, 772 for emotional processing, 634 to identify animal defense-associated emotional dysregulation, 560 of positive experience, 723–24 resources for work with, 496, 507, 509, 511 restoring empowering action and, 517, 520, 522–23 selecting, 493, 494–95, 496, 499–500, 505 in sensorimotor sequencing, 539, 540, 541, 544, 553 therapists’ guide to, 493–97 of trauma, 500–502 worksheets, 496, 505–13 work with attachment wounds, 502–3, 513 work with dissociative client, 496–97 smell, focusing sense of, 134, 155 social engagement system attachment formation and, 30–31 defined, 772 development of, 225–26 disruption of, in therapeutic relationship, 503 neural regulation of, 29–30, 180 neurocepted safety in stimulation of, 225 in play activities, 729 in promoting dual awareness in memory work, 474 purpose of, 30 switching from defensive strategies to, 516 in therapeutic setting, 46 threat response in, 33 trauma effects on, 32 social resources, 281 somatic narrative significance of, 13 therapeutic examination of verbal narrative and, 40–41 somatic psychology approaches, 14. see also Sensorimotor Psychotherapy Somatic Psychotherapy essential principles of, 15–16 practice settings for, 15 Somatic Resource for a Sliver of Memory worksheet, 496, 509 somatic resources, 18, 247–48 centering as, 308–9 clients who might benefit from development of, 301–2 clinical use of, 302–3, 307 containment as, 309–10

960

defined, 772 developmental causes of absence or distortion of, 301 development and use of, across lifespan, 308 discovering existing, 307308 dynamic nature of, 302 functions of, 307 individual differences in, 307 internal and external, 283t, 303–4, 310–11, 313–15 for intervention with trauma-related core beliefs, 617 for memory work, 438, 444–45, 451 movements as, 310 positive memories leading to, 310 from positive relational experiences, 599 practicing, 311, 327 range of, 283t, 307 in restoring empowering actions, 518 for sensorimotor sequencing, 546–47 therapeutic goals for developing, 301 therapists’ guide to, 301–5 therapist’s modeling of, 303 working with dissociative client to develop, 305 worksheets, 303–4, 313–23 for work with sliver of memory, 496, 509 see also grounding somatic sense of boundaries clients who might benefit from work with, 392 clinical use of, 392–93 as essential resource, 391 healthy functioning of, 397–99 missing resources for, 420 promoting awareness of, 394, 405, 411 reactions to violations of, 393–94 resources for processing implicit memory, 445 therapeutic goals in work with, 391, 397, 401–2 therapists’ guide to, 391–95 worksheets, 393–94, 403–13 work with dissociative client on, 394–95 see also boundaries; relational boundaries speechless terror of trauma, 25 spine alignment of, as resource, 18, 347 curves of, 353, 354f infant development, 353 postural adaptation of, to adverse experience, 347 see also core alignment spiritual resources, 277, 279, 284t sports, 729 startle reflex, 180 state-specific memory, 19, 435, 442, 473, 476, 479, 485, 491 defined, 772 see also dual awareness of past and present in memory work Steele, K., 37, 304 Stepper, ., 347 Stevens, D., 40 Still Face experiments, 26

961

Strack, F., 347 strengths recognition, 18, 247 creative resources, 264–65 therapeutic goals for, 249, 262 therapists’ guide to, 255–59 trauma experience and attachment difficulty as obstacles to, 255, 261–62 worksheets, 167–275 see also developing resources in therapy subcortical processing of animal defensive response, 519 development of, 179 dysregulated arousal governed by, 220–21 hijacking of neocortex, 175–76, 195 threat response in, 174–75 substance abuse and addiction, 73 restoring empowering action to clients with, 516 as survival resource, 264 suicidal behavior or ideation, 73 as survival resource, 263–64 survival behaviors, 27 brain control of, 173, 177, 180 dysregulated arousal as, 220–21 effects of repeated activation of, on brain development, 181 orienting habits as, 112 physical responses to trauma, 82 response to neurocepted danger, 225 threat response, 37 survival resources, 18 adaptive role of, 262, 263–64 to avoid disapproval of attachment figures, 262–63 boundary habits as, 400 defined, 773 developing, with dissociative client, 258–59 goals of therapy, 255, 256 helping clients recognize and acknowledge, 256–57, 262–63, 267 in overbounded relational style, 688 reframing maladaptive behaviors as, 255, 256, 262–63, 269 replaced with creative resources, 258, 264–65, 275 therapists’ guide to, 255–59 worksheets, 257–58, 267, 269 swimming, 311 sympathetic nervous system in breathing, 376 effects of attachment trauma in, 33 effects of childhood neglect experience in, 33 threat response in, 32–33, 82, 226–27, 543 synaptic pruning, 181 Tackling Future Challenges worksheet, 417, 425 talking cure, 25, 47 Tangible Boundary Exercise worksheet, 394, 411 taste, focusing sense of, 134, 155 temperature regulation, 81, 180 tension, 95, 97, 193 as animal defense-associated dysregulation, 559

962

breathing and, 371, 383 core beliefs and, 621 development of procedural habits of, 99 directed mindfulness to relax, 162 as expression of emotional bias, 642 in interpersonal relating, as attachment legacy, 586 as manifestation of early experience, 25, 99–100 play and pleasure incompatible with, 722 as precursor to action, 100 terror as animal defense-associated dysregulation, 559 flight defense and, 563, 566 trauma beliefs and, 617 thalamus, 179 therapeutic experiments elicitation of adversarial self-states or parts in, 44–45 purpose of, 43 spontaneous use of, 45 types of, 43–44 with walking, 664–65 therapeutic relationship client’s efforts to meet therapist’s expectations in, 221 client’s neuroception of danger in, 221 clinical significance of, 13, 21–22, 45–46 disruption of social engagement in, 503 embedded relational mindfulness in, 41–43 emergence of boundary issues in, 392 emotional attunement in, 47 evocation of implicit memories in, 437–38 exploration of boundary styles in, 681–82 implicit and explicit journeys of client and therapist in, 49–52 legacy of attachment history in, 587–88 mindful awareness in, 132 navigating enactments in, 50–51 nonverbal communication in, 46–47 orienting client about misunderstanding and repair in, 70 in promoting dual awareness in memory work, 474 safety in, 43, 45–49, 48, 587–88 showing respect for client’s boundaries in, 393 therapist’s window of tolerance in establishing, 47–48 use of Sensorimotor Psychotherapy workbook in context of, 13–14 for work with painful attachment-related emotions, 632 see also enactments, therapeutic; transference–countertransference reactions therapist education and training for Sensorimotor Psychotherapy, 13–14, 53, 54–55 therapists’ guides to beliefs, 607–11 to boundaries, 391–95 to boundary styles in relationships, 679–83 to categories of resources, 277–80 to challenging window of tolerance, 745–49 to core alignment, 347–51 to developing missing resources, 415–18 to directed mindfulness and neuroplasticity, 157–60 to dual awareness, 473–77

963

to emotions and animal defenses, 557–61 to empowering actions, 515–18 to exploring body sensations, 197–200 to exploring breath, 369–73 to exploring walking, 655–59 to grounding, 325–29 to implicit memory, 435–39 to legacy of attachment, 585–89 to making sense of emotions, 631–37 to mindfulness, 131–35 to neuroception and window of tolerance, 219–23 to orienting response, 111–14 to phases of therapy, 243–46 to play and positive emotions, 721–26 to procedural learning, 95–98 to proximity-seeking, 699–703 to reconstructing memory, 455–58 to sensorimotor sequencing, 537–42 to slivery of memory, 493–97 to somatice resources, 301–5 to survival and creative resources, 255–59 to triune brain and information processing, 173–76 use of, 54–55, 67 to wisdom of body, 77–80 therapy process challenges for therapists in, 49 client characteristics determining design and implementation of, 244, 250 client preparation for, 247 client’s understanding of goals and tasks of, 244–45 collaborative planning and implementation of, 243, 245 exploration of body sensations in, 201–7 exploration of orienting habits in, 112 flexibility of implementation of, 250 goals for exploration of procedural learning in, 95–96 implicit and explicit journeys of client and therapist in, 49–52 introducing procedural learning in, 96–97 as journey, 247 mindful awareness of building blocks of present experience in, 140–42 orientation for clients about safety and risk in, 68–70 phase 1 of treatment. see developing resources in therapy phase 2 of treatment. see addressing memories in therapy phase 3 of treatment. see moving forward phase of therapy planning and implementation with dissociative client, 245–46 prioritizing client-appropriate challenges in, 55 spontaneous and open-ended nature of, 45 structure and sequencing, 244, 245, 249–50 therapists’ guide to, 243–46 three phases of, 17, 243, 244, 245, 247–50, 613 use of mindfulness in, 132–34 worksheets, 245, 250, 251 thirst, 83, 93 threat response activation in unresolved trauma, 33, 36–37, 43, 82 animal defenses in, 32–33, 515 becoming ungrounded as, 331–32

964

in dissociation, 71 effects of repetitive activation of, 33, 519, 521 faulty neuroception leading to, 219–20, 228–29 neurobiology of, 179–80, 226–27, 543–44 neurocepted danger as source of, 17, 225, 226 in relational trauma, 66 repeated activation of, brain development and, 181–82 see also danger Three Levels of Information Processing worksheet, 175, 185 Todd, M. E., 27 top-down processing, 179, 182–83, 516 defined, 773 touch boundaries, 398 focusing sense of, 134, 153 tracking, 61, 62, 64 in sensorimotor sequencing, 540 Tracking Your Arousal worksheet, 222, 239 Tracking Your Orienting Habits worksheet, 113, 123 transference–countertransference reactions, 49 in exploration of core beliefs, 608 as legacy of attachment, 587 windows of tolerance and, 48 in work with proximity-seeking, 701 transverse abdominal muscle, 356, 367 Trauma and the Body: A Sensorimotor Approach to Psychotherapy (Ogden, Minton & Pain), 13 trauma experience attachment failure versus, 29 attachment outcomes from, 33 attention problems in sufferers of, 157 benefits of directed mindfulness for clients with, 157 breathing patterns and, 375 compliance of victim in, 100 conflict between systems of defense and daily life as result of, 37, 63–64 core beliefs related to, 617 in development of beliefs, 20 difficulties with proximity-seeking behaviors related to, 699–700 directed mindfulness in examination of, 42–43 disconnect from body in response to, 83–84 dislike or phobia of body after, 57–58 dissociative response to, 34–39 dual awareness in reexperience of, 19 effects on brain development, 181–82 effects on procedural learning, 99–102 emergence of implicit memories of, 443–44 emotional problems arising from, 558 failure to develop resources as result of, 416 failure to integrate action systems as result of, 37–38 fear of memory of, 435–36 feelings toward body influenced by, 82–83 goals for memory processing of, 248, 537 goals for therapeutic intervention with, 41 impaired capacity for play related to, 721–22 influence of, on making meaning and predictions, 28, 29 influence on building blocks of present experience, 140

965

influence on gait, 655–56 innate physical responses to, 82 neuroception impairment in, 32, 43 nonverbal indicators reflecting, 40 nonverbal manifestations of, 25 orientation for clients about, 65–67 orienting response and, 16, 116 persistence of adaptive responses to, 82 physiological effects of reactivated, 537, 543 postural adaptations to, 347, 354 recalibrating nervous system as goal of treatment for, 537 reconstructing memory of, 455–56 sliver of memory of, 500–501 strengths recognition impeded by, 255, 261–62 types of, 66 ungrounding as effect of, 331–32 walking style as expression of, 662 triggers, arousal, 228–30, 233, 235 for animal defense-associated dysregulated emotion, 560 in breathing exercises, 372, 378, 379 defined, 773 grounding exercises as, for dissociative client, 328–29 in memory work, 480–81 triune brain, 17 conflict among parts of, 178 defined, 773 dominance of parts in, 174–75 effects of adverse experiences on functions of, 174–75 exploring, with dissociative clients, 176 information processing in, 175, 177–80, 182–83 memory processes in, 175, 179–80, 187 structure and function, 173, 177f therapeutic use of concept of, 173–75 therapists’ guide to, 173–76 worksheets on, 175–76 Tronick, E. Z., 26, 51–52, 607 trust, 279, 392, 687, 688 underbounded relational style, 680, 681, 682, 686–87, 688, 689 Understanding Your Neuroception worksheet, 222, 237 ungrounded state defined, 773 experience of, 18, 331–32, 378 signs of, 333 therapeutic exploration of, 326, 327, 331 Upsetting Situations & Core Beliefs worksheet, 610, 623 vagus nerve and vagal system breathing exercises and stimulation of, 370 dissociation and, 372 in hypoarousal, 227 immobilizing state and, 745 in shutdown defense, 521 in social engagement system, 29 validating client’s preferences and boundaries, 58

966

van der Hart, O., 304, 636–37 van der Kolk, B. A., 416, 721–22 vehement emotions, 557, 558 Verbal and Nonverbal Boundaries worksheet, 394, 409 visualization exercises, 444 Vocabulary for Beliefs and Meanings worksheet, 199–200, 215 Vocabulary for Emotions worksheet, 199, 213 Vocabulary for Sensations worksheet, 199, 209 vulnerability, feelings of, 304 walking, 311 clients who might benefit from therapeutic focus on, 655–56 clinical significance of, 655 determinants of, 655, 661–62, 665 experimenting with, 664–65, 669, 675 as expression of beliefs, 661–62 as expression of emotional state, 661 goals of therapeutic focus on, 655 habits, 661–62 increasing awareness of, in moving forward phase of therapy, 21 metaphors for feeling based on, 656 mindful, 657, 677 physical elements of, 663–64, 665 posture and, 663 therapeutic intervention with, 656–57, 662–63, 664–65 therapists’ guide to exploration of, 655–59 working with dissociative client on, 658–59 worksheets, 657, 667–77 Walking with Someone Significant worksheet, 657, 673 What a Walk Conveys worksheet, 657, 667 What Stands Out worksheet, 113, 121 When You Felt Ungrounded worksheet, 327, 343 Wilkinson, M., 35 window of tolerance, 17, 20 appropriate risk taking to widen, 753–55 arousal challenges in widening, 747, 748 benefits of challenging, 745–46 creative resources to expand, 763, 765 defined, 773 experience of positive emotions in, 728, 739 helping clients to challenge, 746–47 high arousal challenges for expanding, 761 identifying animal defense-associated emotional dysregulation in, 558, 564, 565f in interpersonal relationships, 753–54 low arousal challenges for expanding, 759 neuroception and, 225 neuroplastic change in widening of, 752, 755 as optimal arousal zone, 227 orientation for clients about, 69 preparing clients to challenge, 746 rationale for challenging, 751 recognizing neuroceptions to return arousal to, 219, 220, 221, 222 resources for widening, 752 in sensorimotor sequencing, 539, 541, 553 strategies for increasing, 745

967

to sustain dual awareness, 516–17 therapeutic goals for widening, 21, 249 therapist’s, 47–48 therapists’ guide to, 219–23 therapists’ guide to challenging, 745–49 wide enough, 751–52 working at edge of client’s regulatory boundaries of, 48–49 working with dissociative client to challenge, 748–49 worksheets on challenging, 747–48, 757–67 worksheets on neuroception and, 221–22, 231–41 Winnicott, D., 304 wisdom of body, 16, 77, 81, 776–77 disconnect from, 83–84 therapeutic significance of, 84 therapists’ guide to, 77–80 word games, 728–29 workaholism, 115, 263, 302 worksheets on animal defense-associated emotional dysregulation, 560, 569–81 for assessing client’s attitudes toward and connection to body, 79–80, 85–93 for assessing client’s fears and hopes about somatic therapy, 79, 87 on attachment-related emotions, 635–36, 645–53 beginning set of, 79–80 on beliefs and cognitive schemas, 609–10, 619–29 body sensation, 199–200, 209–17 on breathing interventions, 371–72, 381–89 on challenging window of tolerance, 747–48, 757–67 client’s resistance to completing, 57 client–therapist collaboration in use of, 56–57, 68 for completion between sessions, 56, 57, 68 core alignment, 349–50, 359–67 on creative and survival resources, 257–58, 267–75 on developing missing resources, 417–18, 423–31 on directed mindfulness, 159, 165–71 on dual awareness of past and present, 475–76, 483–91 to explore procedural learning, 97–98, 103–9 for exploring orienting habits, 113, 121–29 grounding, 327–28, 337–45 to identify building blocks of present experience with mindfulness, 134, 142–43, 145 for implicit memory work, 438, 447–53 on information processing, 183, 185–95 on legacy of attachment in relational patterns, 588–89, 597–605 matching client capacities and characteristics to, 56 neuroception and window of tolerance, 221–22, 231–41 orientation for clients about, 67–68 on play and positive emotions, 724–25, 733–43 proximity-seeking, 701–2, 711–19 purpose of, 15, 56 reconstructing memory, 457–58, 465–71 relational boundary, 681–82, 691–97 repeated use of, 57 restoring empowering action, 517–18, 527–35 sensorimotor sequencing, 540–41, 549–55 sliver of memory, 496, 505–13 somatic resource, 303–4, 313–23

968

on somatic sense of boundaries, 393–94, 403–13 taking inventory of resources, 279, 287–99 therapist’s preparation for use of, 54–55 on treatment goals and tasks, 245, 250, 251 on triune brain, 175–76, 183, 185–95 on walking, 657, 667–77 yoga, 78–79, 311 Your Autonomic Arousal Patterns worksheet, 221 Your “Best Self” worksheet, 747–48, 757 Your Boundary Styles worksheet, 681, 691 Your Creative Resources worksheet, 258, 271 Your Personal Resource Repertoire worksheet, 438, 449 Your Proximity-Seeking Actions worksheet, 702, 711 Your Somatic Resource Repertoire worksheet, 438, 451 Your Unique Style of Remembering worksheet, 475–76, 483 Your Walking Style worksheet, 657, 671 Zwann, R. A., 96

969

Also available from THE NORTON SERIES ON INTERPERSONAL NEUROBIOLOGY The Birth of Intersubjectivity Psychodynamics, Neurobiology, and the Self Massimo Ammaniti, Vittorio Gallese Neurobiology for Clinical Social Work: Theory and Practice Jeffrey S. Applegate, Janet R. Shapiro Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology Bonnie Badenoch The Brain-Savvy Therapist’s Workbook Bonnie Badenoch Neurobiologically Informed Trauma Therapy with Children and Adolescents: Understanding Mechanisms of Change Linda Chapman Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real Richard A. Chefetz The Healthy Aging Brain: Sustaining Attachment, Attaining Wisdom Louis Cozolino The Neuroscience of Human Relationships: Attachment And the Developing Social Brain Louis Cozolino The Neuroscience of Psychotherapy: Healing the Social Brain Louis Cozolino From Axons to Identity: Neurological Explorations of the Nature of the Self Todd E. Feinberg Loving with the Brain in Mind: Neurobiology and Couple Therapy Mona DeKoven Fishbane Body Sense: The Science and Practice of Embodied Self-Awareness Alan Fogel The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice Diana Fosha, Daniel J. Siegel, Marion Solomon Healing the Traumatized Self: Consciousness, Neuroscience, Treatment Paul Frewen, Ruth Lanius The Neuropsychology of the Unconscious: Integrating Brain and Mind in Psychotherapy Efrat Ginot The Impact of Attachment Susan Hart

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Affect Regulation Theory: A Clinical Model Daniel Hill Brain-Based Parenting: The Neuroscience of Caregiving for Healthy Attachment Daniel A. Hughes, Jonathan Baylin Self-Agency in Psychotherapy: Attachment, Autonomy, and Intimacy Jean Knox Infant/Child Mental Health, Early Intervention, and Relationship-Based Therapies: A Neurorelational Framework for Interdisciplinary Practice Connie Lillas, Janiece Turnbull Clinical Intuition in Psychotherapy: The Neurobiology of Embodied Response Terry Marks-Tarlow Awakening Clinical Intuition: An Experiential Workbook for Psychotherapists Terry Marks-Tarlow A Dissociation Model of Borderline Personality Disorder Russell Meares Borderline Personality Disorder and the Conversational Model: A Clinician’s Manual Russell Meares Neurobiology Essentials for Clinicians: What Every Therapist Needs to Know Arlene Montgomery Trauma and the Body: A Sensorimotor Approach to Psychotherapy Pat Ogden, Kekuni Minton, Clare Pain, Et Al. The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions Jaak Panksepp, Lucy Biven The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation Stephen W. Porges Affect Dysregulation and Disorders of the Self Allan N. Schore Affect Regulation and the Repair of the Self Allan N. Schore The Science of the Art of Psychotherapy Allan N. Schore The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being Daniel J. Siegel Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind Daniel J. Siegel Healing Moments in Psychotherapy Daniel J. Siegel, Marion Solomon Healing Trauma: Attachment, Mind, Body and Brain Daniel J. Siegel, Marion Solomon

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Love and War in Intimate Relationships: Connection, Disconnection, and Mutual Regulation in Couple Therapy Marion Solomon, Stan Tatkin The Present Moment in Psychotherapy and Everyday Life Daniel N. Stern The Neurobehavioral and Social-Emotional Development of Infants and Children Ed Tronick The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization Onno Van Der Hart, Ellert R. S. Nijenhuis, Kathy Steele Changing Minds in Therapy: Emotion, Attachment, Trauma, and Neurobiology Margaret Wilkinson For complete book details, and to order online, please visit the Series webpage at www.tiny.cc/1zrsfw

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Copyright © 2015 by Pat Ogden All rights reserved First Edition For information about permission to reproduce selections from this book, write to Permissions, W. W. Norton & Company, Inc., 500 Fifth Avenue, New York, NY 10110 For information about special discounts for bulk purchases, please contact W. W. Norton Special Sales at [email protected] or 800-233-4830 Book design by Carole Desnoes Production manager: Leeann Graham ISBN: 978-0-393-70613-0 ISBN: 978-0-393-70850-9 (e-book) W. W. Norton & Company, Inc. 500 Fifth Avenue, New York, N.Y. 10110 www.wwnorton.com W. W. Norton & Company Ltd. Castle House, 75/76 Wells Street, London W1T 3QT

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