I escaped the conference yesterday, and am typing in the dark this morning beside my snoring husband. I can’t see my notes, so let me tell you my impression of the conference:
Trauma impacts the right hemisphere of the brain. Helpful trauma therapy targets the right brain. Left brain cognitions and interpretations don’t have much impact on the right brain. (So said Alan Schore in 500 quotes, yesterday.)
How do we, as therapists, help traumatized people heal? We use our attuned relationship with them to keep them present and socially engaged. If they are socially engaged, now, they’re in a meyelenated ventral vagal state and can’t go dorsal/shut down /immobilized or too ventral/ mobilized/ hypervigilant. Connect. Attune. Not just with your words: "I hear you say that you’re scared." Attune with your body. "I feel your fear in the room." Then help your clients locate that sensation. "Where is it in your body?" Then stay connected with them as they mindfully explore what it’s like to be scared, while connected to you, and tracing the affect through their body. If you’re Pat Ogden, you will have your clients try out the movement that they didn’t get to do when the bad thing happened. (I have a movement tx background and incorporate this in what I do.) If you’re Diana Fosha, you’ll use the power of your connection and your brilliant countertransferential language to do hold the clients in your therapeutic embrace while they move through the trauma. (I use her language all the time – in the moment self-disclosure as containment and dual attention, cool stuff.) If you’re Francine Shapiro, you will make sure that client have a deep, attuned connection with you, while bringing cognitions, affect, and sensations into consciousness, applying periodic eye movements, and deeply connecting during the breaks between, while the clients watch their minds clear the trauma. If you’re Dan Siegel, you’ll teach your clients mindfulness, so that they can get fully present, so that they can socially engage, be present with the trauma, and let it move through with whatever techniques you use. If you’re Bessel van der Kolk, you might do any of the above, and you’ll send them to Yoga class, to become re-embodied.
What are the threads that run through this varied work?
1. Presence. Getting into the here and now experience of body, affect, and thought. That includes clients being inside the Window of Tolerance: not overstimulated, not immobilized (dorsal vagal), not over-mobilized (unmeyelenated ventral vagal). Present and capable of connection so that the work can move through them.
2. Dual Attention: In EMDR, it’s the bilateral stimulation. In Yoga and in Ogden’s work it’s the attention to bodily experience. In Fosha and good relational analytic work it’s the relationship that keeps one mind on the present and the other on the traumatic past.
3. Affect while in relationship: In all of this work, clients have affective experiences while "held" inside the window of tolerance and a therapeutic relationship. It’s not that the affect is "discharged", though it might be. It’s that it is felt; not avoided; witnessed; survived; and transformed into a memory, no longer a developmental catastrophe.
4. Relationship with self and the other: Tolerance for one’s own affect and history. Capacity for relating to others.
You have just read the thesis of my next book, Trauma Therapies. I already had it, and was validated and heartened by what I heard, every moment. The next wave of therapy is Right Brain, Mindful, Affective, Embodied, and Relational.
The husband is up and it's time to go. I'm on vacation for the rest of the week. Imagine me bird and scenery-watching on the California coast, self-regulating with no set schedule. I want to see a Condor, this time.
Yes, I was at the conference too. Thank you for a great summary and synthesis of complex material.
Another point repeated or implied by most of the speakers involved the importance of the psychotherapist’s own stamina and ability to go the distance in his or her own psyche.
To be on the edge or past a patient’s “window of tolerance” the therapist has to be willing and able to go to such places in her or his own psyche.
It’s a new articulation of the psychoanalytic point of view – which I agree with. We therapists must do our own deep work in order to work with others.
In working with traumatized people we have to have done and/or keep doing our own very deep work indeed.
Thanks for a great post! Enjoy your bird watching!
Joanna Poppink, MFT
Los Angeles eating disorder recovery psychotherapist
Good point, Joanna,
When I was teaching EMDR, I used to send students to therapy when they didn’t appear to have the affect tolerance for their clients’ grief, shame, or anger. I’ve sent a few consultees in my day, too.
I really appreciate you giving these brief summaries of what you got at the conference. I attended this conference all the way back in 2003. It can all get so overwhelming with the amount of trainings, and personalities, and books…its like, why did i even go to graduate school? Because much of what i learned is not what these people are saying is going to help our clients…looking at your conference summary, it almost seems pretty straight forward…like there are only a few new things ‘under the sun’ and not as many as all the different models, centers, workshops etc would suggest. I think van der Kolk’s center puts all the main ideas into a single unit…what do you/others think? Thanks, RM
I think that Bessel does put the main ideas together. I’ve loved watching his growth since I first saw him, 11 years ago.
Robin, I just found your comments through Googling info on Daniel Siegel. I must say that you put his ideas in written form better than he does.( He’s a great speaker.) You also have a great way of addressing the meta-message, what it is we all do to help healing, how it can be seen as different and yet all have the same common ingredients.
Having seen Dan Siegel at the Psychotherapy Networker conference and being tremendously impressed by his message of integration, connection and meaning, I’ve been trying to find good written descriptions of what he conveys so that I can use them in my teaching Psychopathology, Theories of Psychotherapy, Clinical Skills, Pssychology of Illness and Wellness and Human Development at Lesley University and Cambridge College here in Boston. Yours is the best description that I have found of both what he says and how it fits into the rest of the world of psychological theory.
I’ve been pondering more and more about how Dan Siegel’s view on interpersonal neurobiology are part of a larger equation that includes Besel’s more holistic approach to trauma, Jerry Kagan’s approach to human development, Francine Shapiro’s underpinnings of EMDR, Freud’s contributions to secular relational healing, most religious/spiritual/humanistic approaches, etc. etc. etc.
Ultimately, it seems to get simpler and simpler. It’s all about what helps you ( and helps us clicians to help our clients) to be a mensch, a respectful, caring human being. There are many paths to getting there, but the mountain is the same one.
I absolutely agree.
I recently came across your blog and have been reading about trauma therapy. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.