Note: This article was originally published in the Winter 2007 edition of MeadowLark, the magazine for The Meadows alumni.
Techniques for Managing Post-Traumatic Stress Disorder
By Lara Rosenberg
This article is based on a workshop that Lara gave February 13 - 14, 2006, in Sri Lanka hosted by the INGO RedR. The workshop is focused on staff working with individuals, families, and communities that have experienced or continue to experience traumatic events. It was an introductory workshop of particular value for staff having community experience, but limited or no psychological training. It was assumed that participants had prior knowledge of stress.
Stress affects us in many ways: cognitively, affectively, physiologically, and behaviorally. "Stress" is a broad term. It's part of all of our lives; each individual has his own ideas of how to define it. There are many definitions given to stress, but the important underlying factor is that stress results from a change in one's environment and requires an adjustment. The environmental changes that require us to adapt and adjust are known as "stressors" they can include anything out of the ordinary. Many think of stress as only negative, but it can be positive and necessary to our healthy development. The ways in which we adapt to our environments leave some stimulated and others with feelings of fear, nervousness, and confusion, which lead us to either solve or avoid a problem. Change always brings extra pressure, as individuals have to adapt to new circumstances.
Humans and animals are born with the capacity to react to threatening situations in adaptive ways; the "fight or flight response" allows individuals to experience resilience in response to danger. Bessel van der Kolk (1994) describes the fight response as hyper-arousal or protest and the flight response as freezing or numbing sensations, which allow individuals to avoid consciously experiencing the event.
Trauma is caused by a stressful occurrence "that is outside the range of usual human experience, and that would be markedly distressing to almost anyone" (Peter Levine, 1997). Post-traumatic stress disorder (PTSD) causes one to experience a prolonged or delayed reaction to an intensely stressful event. According to The DSM-IV Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, PTSD occurs when an individual experiences a threat (actual or perceived) of death or serious injury to self or others with a response of "intense fear, helplessness, or horror." PTSD can occur in adults and children from all socio-economic backgrounds. Most people who are exposed to a traumatic, stressful event experience some symptoms of PTSD in the days and weeks following exposure. According to the National Center for PTSD, data suggest that approximately 8 percent of men and 20 percent of women exposed to trauma develop PTSD; of that group, 30 percent develop a chronic form that persists throughout their lifetimes.
The World Health Organization (WHO) states that the prevalence of mild and moderate common mental disorders in the general population is 10% and can increase to 20% after a disaster. As stated by Dr. Daya Somasundaram from the Department of Psychiatry at the University of Jaffna, Sri Lanka (WHO, 2005), "WHO estimated that 50% may have problems and 5-10% have serious problems needing treatment. One [non-WHO] survey found 40% post-traumatic stress disorder (PTSD) in children," referring to people in Sri Lanka. Other data suggest that the mental health burden in Sri Lanka is even higher. Dr. Roy Lubit (2006), as well as Pia Mellody, a pioneer on the effects of childhood trauma, stresses that the full impact of trauma may not be experienced until a child reaches adulthood, engages in adult relationships and responsibilities, and develops more sophisticated cognitive capabilities.
The National Center for PTSD states that one of every three disaster survivors experiences some or all of the severe stress symptoms that may lead to lasting PTSD, anxiety disorders, or depression. Severe stress symptoms are extreme attempts to avoid memories and feelings. In order to numb their emotional pain, individuals will stay unusually busy, withdraw, and exhibit addictive behaviors. Violent behaviors often become prevalent.
Individuals can experience severe depression as part of PTSD, suffering a complete loss of hope, self-worth, motivation, and purpose. Some might experience disassociation, feeling outside of oneself as if living in a dream, or may become vacant for periods of time. Intrusive re-experiencing can occur through terrifying memories, nightmares, or flashbacks. For some, hyper-arousal manifests in panic attacks, rage, extreme irritability, or intense agitation. Other manifestations include severe anxiety, paralyzing worry, extreme helplessness, obsessive and compulsive behaviors, and feeling responsible for the event. Children often re-experience traumatic or stressful events through recurrent memories, nightmares, and play. Some children become very aroused, exhibiting nervousness, irritability, anger, disorganization, or agitation. Children also shun thoughts, feelings, or places that evoke memories of the event. Occasionally, they experience a loss of developmental patterns or skills, separation anxiety, bed-wetting, and learning difficulties. An 8-year old boy in Sri Lanka could not see for 10 weeks after enduring the terrifying experience of the tsunami, in which he lost his mother and home. This example of physical impairment demonstrates the freezing response described by Bessel van der Kolk (1996), as well as Peter Levine (1997) in his Somatic Experiencing® work.
Disaster stress may revive memories of prior trauma; pre-existing social, economic, spiritual, psychological, or medical problems can intensify. Individuals at higher risk for severe stress symptoms and lasting PTSD include those who have been exposed to other traumas, such as abuse, assault, or combat. Chronic poverty, homelessness, unemployment, or discrimination will often intensify the traumatic event, as can chronic illness and psychological disorders.
Most likely to develop PTSD are those who experience stress at a greater intensity, with unpredictability, uncontrollability, and real or perceived responsibility. Factors such as genetics, early-onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events also contribute to the disorder. Those who report a greater perceived threat, suffering, terror, and fear are at risk for developing PTSD, and a social environment that produces shame, guilt, stigmatization, or self-hatred can affect sufferers as well.
Individuals experiencing PTSD face an increased likelihood of co-occurring disorders such as alcohol/drug abuse and dependence, major depressive episodes, conduct disorders, and social phobias. According to the National Center for PTSD, "In a large-scale study, it was found that 88% of men and 79% of women with PTSD met the criteria for another psychiatric disorder." Some experience difficulty in their psychosocial functioning, with profound problems in their daily lives. Concurrent prevalent physical problems include headaches, dizziness, chest pain, and other aches and pains. Often medical doctors treat only the symptoms, without considering PSTD development.
At the same time, stressful or traumatic experiences can facilitate personal growth. In treating sufferers, it is most important to restore safety in their lives, build coping strategies, and reduce pain. It is necessary to find out how they are coping with the situation and stress. Healthy coping mechanisms should be slowly introduced if behavior patterns reflect unhealthy habits such as smoking, drinking, or staying unusually busy. When dealing with disclosure, it is important that a secure and confidential environment is maintained. Humanitarian aid workers should teach survivors of trauma that they are not alone in order to help reduce a sense of isolation and rebuild trust. The aid worker should acknowledge and validate the person's feelings and experiences by offering comfort and support.
Aid workers should assume people are doing their best to cope and should empower them to feel as in-control as possible. Victims should not be asked to reveal emotional information, but if they volunteer it, helpers should listen. Access to mental and physical health services should be provided. In addition to reducing anxiety and depression, valued and meaningful goals help individuals regain hope and purpose. Improved access to education and employment opportunities encourages achievement. It is important to restore individual dignity and value, create opportunities for pleasure, and foster connections by maintaining or re-establishing communication with family and the community. Expressing oneself through journaling, reading, or becoming aware of experiences helps to release stress. Eliminating self-blame for what is occurring allows people to grow. Relaxation methods such as walking, breathing, meditation, yoga, prayer, and listening to music also promote healing, as do self-care behaviors such as brushing teeth, showering, and taking care of one's living environment. Small goals should gradually lead to a focus on the big picture.
The majority of trauma survivors will prove resilient; their feelings of fear and anxiety, along with urges to avoid or relive the experience, will decrease over time. Everyone handles life experiences differently, and it is necessary to allow each individual to heal at his or her own pace. The experience will always be a part of this person's life; however, the possibility of growing from the experience becomes more attainable when anxiety is reduced.
Note: This article originally appeared in the Winter 2007 edition of MeadowLark, the magazine for alumni of The Meadows.
A Miracle is Just a Shift in Perception
By Colleen DeRango
In working with clients to help them heal their trauma, many of us in the Somatic Experiencing® community have come to recognize that one component preceding a shift in perception may not be a thought at all: It may be the body's "felt sense" of moving from a state of calm to anxiety and then to calm again, or what is called "pendulation."
Peter Levine's influence at Mellody House has generated a subtle shift in the way we work with clients; our focus is on supporting clients in establishing a sense of "internal resourcing," as opposed to concentrating on difficulties or problem areas. Somatic Experiencing reinforces this focus and gives us the necessary tools and language.
Consider an example: A cat attentively and expectantly watches a mole dig a tunnel under the lawn. The cat waits with positive expectancy for the mole to move. This visual image represents the idea of seizing or grabbing hold of the positive. As counselors, we do this by supporting the client in reconnecting with the felt sense of "I can."Sometimes this "I can" sensation is expressed in a bodily movement. Other times, the client experiences a bodily change, wherein he feels "less tight, less anxious, less painful, less stuck." Gently encouraging the client to experience his "felt sense" of this less painful state is often the beginning of the miracle of moving from "I can't" to "I can." Clients are adept at sensing their own states of non-calm; so we focus on beginning from a place of "safety, calm, centeredness - or when they last felt most like themselves." We reflect on how they experienced these states and, from this place of resource, we support them in "touching into" the edges of the more difficult sensations of "tightness, strain or constriction."
Therapists support clients in listening to what their bodies are sensing, and we challenge them to trust it. For example, in a guided meditation or group session, if a client begins to feel "closed-in" or "anxious," he's encouraged to do what he wants to do - and to experience it from a "felt sense." Oftentimes this includes leaving the room while sensing what it is like to be able to get up and leave. When we introduced this strategy, we thought perhaps clients wouldn't return. Yet they have always returned and quite often shared with the group their sensations of empowerment.
Additionally, we give clients choices; for example, in meditation sessions, they are welcome to follow the guided meditation or to make a choice about how they want to meditate and then do so. Choice, when given to trauma survivors, is powerful; clients often share that they experienced the act of choosing as a felt sense of power, as opposed to the powerlessness many experienced during past traumatic events.
Knowing that trauma is about disconnection and that healing is about reconnection, the client experiences the sensation of being able to move, versus the trauma of being forced to stay. We wondered if clients would use their ability to choose as an excuse to leave group. Interestingly, the clients who left once rarely left again; they shared that they experienced a "sensation of empowerment" as a "life force" versus "life depletion." In SE language, we would identify this as the "miracle" of self-regulation, i.e., activation and deactivation. In SE we also learn that the body has the ability to self-regulate and that "trauma disconnect" interrupts this capability.
Somatic Experiencing® meshes well with The Meadows' model, which is trauma-based. In the powerful Survivors' Workshop, an experiential exercise encourages the client to "identify with his functional adult caring for his inner child." He then shares his reality with the people in his life who have been "abusive, neglectful or abandoning." This involves resourcing prior to touching into the anxiety or pain. The workshop is completed within a community of five or six other clients. As in SE, healing work is meant to be processed with someone, versus by oneself.
At Mellody House, we reinforce the value of community in working toward trauma healing and recovering from addictions and self defeating, addictive behavior patterns. In essence, we encourage clients to support themselves and one another from a place of compassion. Following the SE approach of giving counselors permission to make mistakes while training, we encourage our clients to "experiment and make mistakes," encouraging the "try" without the limitation of the expectation of perfection. The successful part of the try is "pounced on positively," not only by counselors, but by other clients as well. As the client experiences the "felt sense" of "I can do this," energy becomes available to "touch into" more pain, anxiety, frustration or "stuckness." The "I can" part of self-regulation is restored, and the result is a client who senses new empowerment. "I cannot drink" becomes a "felt sense" experience of "I CAN not drink."
Clients who have achieved "self-empowerment" have an energy about them, a "coherence" that other clients seem to move toward. And somewhere along the way, the shift toward healing gains momentum, stronger than perhaps the "triggers to use." As a client discovers that "more of me is available to use my strategic thought" to manage the triggers, he develops resiliency.
I realized early on that I could talk at length with clients about their problems and still not know how to restore their resiliency. But if we can "pounce on the positive" and support clients in identifying their "felt senses" within, their human systems move into healing. The "I can" capacity of the human system is amazing.
In considering the recent Somatic Experiencing Conference, where many of us gathered to learn and to share our experiences, I think about the simple enjoyment of connecting with others in this community. My sensation of restored resiliency was reinforced by a wonderful "ventral vagal" connection with so many SE practitioners. What a strong reminder to balance work with fun, connection and growth.
In closing, instead of saying, "A miracle is just a shift in perception," one might say, "A miracle is the ability to shift and change perception." Either way, I believe in miracles.
The Meadows is pleased to announce several informative free lectures that will be presented throughout the coming summer weeks. These free lectures are open to the community and sponsored by The Meadows in various cities throughout the country. The lectures are targeted to graduates of The Meadows but are also open to the recovery community. Speakers include local therapists familiar with The Meadows' model.
In June there are three lectures to come. On June 23, Amanda Gray, MA, FGA will speak in London, U.K. about Trauma and Spirituality. On June 23, Dr. Janice Blair, PhD will deliver a lecture entitled Good Boundaries for Good Recovery Walking the Fine Line Between Caring and Caretaking in Scottsdale AZ. Finally, Dr. Judith Trenkamp, PhD, CSAT will present Co-Dependency: Roadblocks to Optimum Recovery in West Bloomfield, Michigan as the month ends on June 30.
Many more free lectures on other interesting and informative topics are scheduled throughout July and August also, to be presented in London and in various cities in Arizona, California, New York, Texas, and Washington. For more information about the above-noted or upcoming events, please see the Free Lectures Series schedule.
Note: This article was originally published in the Spring 2005 issue of MeadowLark, the magazine for alumni of The Meadows.
The Co-Addicted Tango: Pia Mellody's Theory of Love Addiction and Love Avoidance
By Lawrence S. Freundlich
When Ms. "Crazy for Love" meets Mr. "Give Me Some Room to Breathe," the stage is set for what Pia Mellody calls "The Co-Addicted Tango." Ms. "Crazy for Love" is in Mellody's clinical terms, "The Love Addict," and Mr. "Give Me Some Room to Breathe," is "The Love Avoidant." They will each find something attractive about one another and inevitably something that will detract from one another, making their dysfunctional relationship as painful as it is frenetic and a back-and-forth "Co-Addictive Tango."
The Love Addict, to whom I have just referred to as "Crazy for Love," I identify as a woman, and the Love Avoidant, to whom I have just referred to as "Give me Some Room to Breathe," I identify as a man. Is this gender typing accurate? After all, men can be Love Addicts and women can be Love Avoidants? In fact there are powerful forces at work in American culture that distribute Love Addiction to women with significantly greater frequency than to men, and Love Avoidance to men with significantly greater frequency than to women. The most powerful generator of this disproportion is revealed when we understand the psychological concepts of "disempowerment" and "false empowerment."
Trauma results from either disempowering abuse or "falsely empowering" abuse, which, because of its falseness, disempowers as well. Abusive parents either shame the children into silence as a way of diminishing their own external stress, thereby disempowering the children, or assigning the children roles for which the parents should be responsible, thereby falsely empowering the children.
In our culture, young girls are trained to believe that men are the source of value, power and abundance; it is the female whose prevailing dysfunction is the outcome of "disempowering abuse." Her need to be taken care of by a man greater than herself is consistent with Love Addiction. The main conscious fear in relationships from which Love Addicts suffer is fear of neglect and abandonment. In childhood their parents have shamed them into thinking of themselves as unworthy. Without the help of an outside agency, like a husband, for example, they do not feel they have what it takes to be whole.
On the other hand, young males in our culture are raised to believe that it is their job to control and dominate- to be the source of value, power and abundance. They are trained to care "for the little woman," because she can't care for herself. It is the male whose prevailing dysfunction is the outcome of falsely empowering abuse. His need to caretake the needy female is consistent with Love Avoidance. The primary conscious fear of the Love Avoidant is fear of being drained, suffocated and overwhelmed. In their childhoods, the parents of Love Avoidants have forced on the child the role of caring for the needs of the parents. In this role reversal, the parent is being taken care of by the child. Giving the child the adult role is a form of enmeshment, which causes the love avoidant to think of intimacy as a job. They learn to resent this job as the neediness of the Love Addict becomes overwhelming.
The Love Addict enters into the relationship feeling an unbearable sense of inadequacy. Her relationship with the Love Avoidant is as doomed as it is inevitable. Having been neglected and abandoned by her own parents, she has learned that all attempts at intimacy will be painfully unsuccessful. When she seeks a love mate she will, therefore, find someone familiarly not intimate, but someone who will be good at mimicking intimacy. She deludes herself into believing that the mimicry is the real thing by creating her lover in accordance to a fantasy of her own making. The Love Avoidant becomes her knight in shining armor- "armor" being the operative psychological irony- shiny, but impervious to intimate contact.
The Love Avoidant, on the other hand, enters the relationship not because he is seeking confirmation of his own worth but out of a sense of duty. In his childhood, his parents taught him that it is his job to care for people who cannot care for themselves. As an adult, the Love Avoidant, while feeling superior or pity for the neediness of his Love Addicted partner, thrives on the power it gives him over her. Eventually, he grows resentful of all the work it takes to be a caretaker. He begins to feel suffocated and lifeless.
The suffocating Love Avoidant begins to distance himself from the Love Addict, who after several bouts of hysterically trying to get him back, eventually becomes exhausted with the pursuit of the Love Avoidant and turns to someone else with whom to be helplessly Love Addicted or to some other addiction to cover her pain of inadequacy. The substitute addiction could be food, alcohol, sex, work, spending or exercise- any addictive activity.
At this point in the Co-Addicted Tango, the Love Avoidant, who is no longer the object of the Love Addict's desire, feels the pain of no longer being needed. Without someone whose weakness cries out for his strength, his sense of superiority wavers. What value does he have if he cannot care for the needy? This triggers deep, underlying abandonment fears- sardonically the same kind of abandonment fears that lie at the heart of the Love Addict's emotional dysfunction. Love Addicts, never having been unconditionally loved by their neglectful and/or abandoning parents, look for a knight in shining armor to provide them with the self-esteem with which they never had mirrored for them by their own parents. Love Avoidants, on the other hand, almost never got a chance to feel their inherent worth, because in childhood they were empowered to care for their own parents. While not having received love from the parents, their caretaking gives them a sense of grandiosity, while masking the haunting truth that they have never been intimately loved. This false empowerment very effectively hides the crucial truth that they, like the Love Addict, were starved of intimacy. The contempt they feel for the neediness of the Love Addict, is the masked contempt they feel for themselves at not having been worthy of their parents' love. Contempt is shame turned outward on anyone whose weaknesses reminds us of the intolerable shame of our inadequacy.
Deprived of the caretaking role by the withdrawal of the Love Addict, the Love Avoidant finally feels the jolt of the carried shame of abandonment; and the Love Avoidant, who once feared being smothered by the Love Addict, now turns around to get close to the Love Addict again, using all of his powers of seduction to get back into control of the relationship.
One is running and the other is chasing all the time. When the one who is chasing finally gets close to the one running away, they both erupt into intensity, either a romantic interlude or a terrific fight. As the lyrics to the classic song say, "You Always Hurt the One You Love." This behavior is what most people call "normal"; and if it isn't "normal," it certainly is "familiar."
This attraction to what is familiar, says Pia Mellody, starts in our family of origin. "Familiarity" is the central engine of child hood character formation. In the case of Love Addicts and Love Avoidants, each person is first attracted to the other specifically because of the "familiar" traits that the other exhibits. These traits, although painful, are familiar from childhood and appear a safe way to keep the family system stable.
Both the Love Addict and Love Avoidant are traumatized children who originally adapted in order to survive within the abusive family system. They believed that only by adapting to their parents' expectations of them would they remain protected. Maintaining the status quo, even if it was a dysfunctional status quo, was for these children better than being abandoned or losing their identity (role) within the family.
The abandonment pain felt by Love Addicts in their families of origin teaches them as children to be quiet, alone, needless and wantless so as not to bother the parents. Later, they are unconsciously attracted to people who do not aggressively seek attachment to them. They unconsciously seek to replicate their childhood relationships. A part of self-esteem was wounded in the childhoods of Love Addicts. Abandonment and neglect send the message that they were not worth being with. A large part of their attraction toward Love Avoidants is that Love Addicts find in people who walk away from them an opportunity to heal the wound to their childhood self-esteem. If they can make an adult who withholds intimacy connect and fall in love with them, they can prove that they have inherent worth. Only a child can be abandoned; adults cannot. Healthy, mature adults have it within their capacities to deal satisfactorily with the vagaries of relationships without calling their inherent worth into question.
Love Avoidants are accustomed to needy, dependent, helpless people whom they can rescue, which gives them control and a 7 feeling of safety and power. When they pick up the right signal, Love Avoidants move in seductively and powerfully. People who think for themselves, say directly what they mean, solve their own problems and care adequately for themselves are not interesting to Love Avoidants.
The conscious fear of Love Avoidants is the fear of being drained and used. The unconscious fear of Love Avoidants is the conscious fear of Love Addicts, and that is the fear of abandonment. Abandonment is the core issue for both, but getting at the abandonment issue through shame reduction therapy is much more difficult with Love Avoidants than it is with Love Addicts. Disempowering abuse keeps Love Addicts close to their shame core all the time. Love Avoidants are walled off from their shame core by the grandiosity of their childhood false empowerment.
Pia Mellody's elegant charting of the dance of avoidance and pursuit between the Love Addict and the Love Avoidant is a fascinating anthropology of failed relationality, which deserves the name "Co-Addicted Tango." But understanding the various stages through which Love Avoidant/Love Addicted relationships travel is not enough to effect healing from the traumatic wounds that set these relationships in motion. For that healing to hap pen, as with all childhood relational trauma, shame reduction must take place.
The therapeutic contribution of presenting Pia Mellody's modus operandi of the Co-Addicted Tango to the patients is that the compelling accuracy of her models reduces the patients' shame by exposing their delusions to reason. As they come to see the delusions of Addiction and Avoidance in their own emotional lives, they see that they are not alone in the world of relational dysfunction. More importantly, they come to see that the emotions that seize them during relational trauma are not their fault, that they are not worthless. Undoing the automatic descent into shame and worthless ness during relational stress takes more than intellectual understanding.
Love Addicts and Love Avoidants must revisit the scenes of their childhood wounding by going back in time with the help of a therapist to confront their childhood abusers with their honest testimony of how their parents' abuse caused shame, pain and bewilderment. There comes a moment in this process of shame reduction when patients are able to rid themselves of carried shame. This emotional "detoxification" is at the center of recovery. The traumatic inheritance of abandonment has poisoned both Love Addict and Love Avoidant with shame of being who they are- better than or less when, disempowered or falsely empowered- it hardly makes a difference. Shame will run and ruin their relation ships unless they heal.
Note: This article was originally published in the Summer 2008 issue of MeadowLark, the alumni magazine of The Meadows.
Science and Ancient Wisdom: Treatment Here-and-Now
Before reading further, take 20 to 30 seconds to do this exercise: Let your gaze leave this article and let your eyes look around wherever, and at whatever, they want - just 20 seconds or so. (Really, try it, and then come back to reading.) People in my Somatic Experiencing® (SE) Trauma Treatment courses who try this are surprised that, in a very short time, they feel noticeably more relaxed, peaceful, and in the "here-and-now." Some say they should do this all the time!
Thanks to the forward-thinking people at The Meadows, the connection between trauma and addiction is better understood and more effectively treated. Part of this treatment at The Meadows' extended-care facilities consists of working with the trauma-resolution skills of Peter Levine’s Somatic Experiencing®. The relationship between trauma and the exercise you just tried is that, according to Bessel van der Kolk, post-traumatic stress is fundamentally a disorder in the ability to be in the here-and-now. This means that the state of- the-art in trauma therapy is no longer intense regressive or cathartic therapy. Instead, state-of-the-art therapy is the process of becoming alive to the moment.
For those I train in SE, like those at The Meadows, working in the here-and-now is a cornerstone of clinical theory and practice. When doing his dissertation decades ago, Peter Levine met Stephen Porges and explored his research. Porges' "Polyvagal Theory" (Porges, 2001) shows how one pathway of the nervous system engages freeze and another relates to social engagement. Levine discovered how to work with the transition of the nervous system through these phases (freeze and engagement), as well as the phases of fight and flight. This is SE. This article’s focus is on the engagement phase, which must be integrated into all other nervous system phases.
While Porges' emphasis is based on single linear phase transitions, in SE we work with non-linear and rapid cycling states, for instance, freeze and fight, or flight and orientation. Traumatic symptomology such as intrusion of fight, flight and freeze means that the past has become the present. Flashbacks are the classic example of such disorientation - innocuous cues can trigger an all-out response. In other words, the person temporarily experiences a state that is disconnected from the actual here-and-now environment. One of the antidotes to this traumatic recollection is orientation. I provisionally define orientation as "connecting to the environment through the senses" - in other words, coming back to our senses. This is a broader understanding of engagement than social engagement, per se. For clients whose early life experiences were marked by trauma and abuse, social engagement is actually a trigger for fight, flight and freeze. In this process of orientation, rather than being inundated with a cycle of feelings, thoughts, and sensations associated with unresolved trauma, the client's attention can be directed to the reality of the environment that is available through the senses. Typically we see decreased blood pressure and decreased heart rate, as well as the subjective experience of greater relaxation and interest. In other words, it is the difference between stopping to smell the roses and reliving getting stuck by a thorn!
With many severely disoriented clients, much of the initial therapeutic work (in addition to establishing rapport) consists of the stabilization that comes from establishing better cognitive pathways or habits of here-and-now sensory attention. In attending to the sensory experiences of the external world, physiological mechanisms for assessing safety are allowed to occur without undue influence from traumatic memory. The mechanisms of this assessment are far too important, in a survival sense, for the slow processing of linear thought or conscious effort. Porges aptly names this subconscious process of safety assessment "neuroception" (Porges, 2004). Thus, a natural orientation to the external environment via the senses facilitates the neuroception of safety.
This approach is receiving increasing scientific and popular attention (Time Magazine: Mind & Body Special Issue, January 27, 2007, pp. 55ff). Whether incorporated into CBT, DBT or meditation, the role of the observer is crucial. The process of orientation is fundamental to this cognitive activity. However, many traditions that recommend observation may not adequately reinforce with clients the importance of orientation to the outer versus the inner environment. For those with significant disorientation, it is nearly impossible to track the interior landscape without being involuntarily drawn into what SE terms the "Trauma Vortex." The involuntary and repetitive attraction to this "vortex" is the disruption of the approach-avoidance system, and it is one of the dynamics that underlies addiction and compulsive behaviors in general. Although somatically informed therapists draw from Levine's work, they often make the mistake of inviting clients' attention to the inward sensate experience, without consideration to the vital criteria that indicate whether a client can negotiate such attention without reactivating and reinforcing trauma states. For instance, one of the most common beginner's mistakes is when a therapist asks an anxious client to focus on that sensation in the body. For some clients, this can work well and provide a sense of relief and transition to a more relaxed state; for others, this can lead to further discomfort and other states of disintegration. It is vital for the therapist to immediately and accurately assess the client's capacity in order to determine the appropriate intervention. Without such assessment skill, the safer route is to begin with external orientation, which can stimulate the innate orienting response and build stability.
Once relative stability is attained, a balance of interior and exterior attention can be facilitated. Then a more neutral and practiced observation of the range of experiences can be enjoyed, as the attention can shift naturally between affective experiences, both positive and negative. (This fundamental process at the heart of SE is known as "pendulation," which I discussed briefly in the Summer 2006 edition of The Cutting Edge) This natural swing between polarities is the normal condition of the balanced nervous system. And interestingly, the resulting integration that comes from this innate oscillation is a broader and more nuanced life in the here-and-now. The experience brings awareness, presence, and a greater ability to experience life on its own terms, without undue constriction or elation. Obtained after significant work of attending, this resulting state can yield an expanse of awareness with an increasing ease of relation and a connectedness to everything that is. This state, known among meditative adepts, is simply our human mind freed of its overlay of conditioning hewn by survival networks related to approach-avoidance. Freed from the dominance of an ill-conditioned approachavoidance paradigm, one enjoys engagement with what is now, new and alive. And so, as clinicians, we can orient to the fact that we live in a time of opportunity, when mind and body are becoming reacquainted, and when science can shake hands with ancient wisdom.
Hoskinson, S. (2006) "SE's Systemic View of Functional Reward Systems." The Cutting Edge, Summer 2006. See TheMeadows.org.
Porges S. W. (2001) "The polyvagal theory: phylogenetic substrates of a social nervous system." International Journal of Psychophysiology, 42, 123-146.
Porges, S. (2004) "Neuroception: A subconscious system for detecting threats and safety." Zero to Three [Online] National Center for Infants, Toddlers and Families. No. 5, May. See zerotothree.org.
Stengel, R. (Ed.). (2007). The brain: A user's guide [Mind and body special issue]. TIME, 169 (5).
ABOUT THE AUTHOR
STEVEN HOSKINSON, MA, MAT
Under the auspices of Hoskinson Consulting in Encinitas, California, Steven Hoskinson, MA, MAT, is an international consultant and trainer for clinicians and trauma treatment providers. Steven is a Senior International Instructor for the Foundation for Human Enrichment and has done research in creativity, myth and spirituality. His perspectives include evolutionary, developmental, cognitive-behavioral and systems approaches within a mindfulness framework. Other major influences include personal mentoring with Peter Levine, PhD, more than 20 years of experience in the contemplative arts, and a decade as a practicing aikidoist. www.HoskinsonConsulting.org