Healing Relational Trauma Part 3 of 3 part series

Posted on September 1, 2011 by mchidley


We live in the shelter of each other    – a Celtic saying

Susan Johnson, arguably our era’s most prominent researcher and developer of today’s most coherent, research-based system of couples therapy, Emotion Focused Therapy, says emotional starvation is real. She echoes what John Bowlby said 40 years earlier. He and Mary Ainsworth in their now famous attachment studies documented that humans monitor the emotional and physical availability of our caregivers, that we reach out to this person when we are upset, that we miss this person when apart, and that we count on this person when we go out into the world to explore (Johnson, 2007). Harry Harlow, a colleague of Bowlby’s , found monkeys depend on what he termed “contact comfort” and preferred it even to food, when given the choice. On the flip side, isolation from a caregiver revealed the accumulating mental toxicity and crippling that results when there is emotional starvation.  “Effective dependency”, heretical in Bowlby’s day, when separation and individuation ruled developmental theory, still runs  counter to our culture’s norms. But it is now recognized as central to healthy social development and later satisfaction in adult love relationships. It turns out  that a sense of secure attachment not only makes close relationships work, but also is one of the keys to recovery from trauma.

 

The pain resulting from lack of secure attachment in adult love relationships is, I believe, one of the most underestimated forces affecting our health. When attachment bonds are strained or eroded, not just our mental life, but the delicate balance of our stress hormones, our immune systems, our cardiac function,  our overall resilience, aging process, and even longevity are often thrown into a downward spiral. It follows that when a person lacks a secure base and safe haven in relationships the effects of trauma are amplified and become even more pernicious.

 

Perhaps one of the most striking historical examples of this was the relationship between Abraham and Mary Todd Lincoln. After the death of their son Willy in 1862, the second son who had died,  Mary, who already suffered from mood problems, lapsed into a deeper and more complicated depression.  Kentucky born, she had also lost several brothers by that time who served on the Confederate side, as well as brother-in-laws, her sisters’ husbands, taking each successive loss worse than the last. She alternated between distracted and prolonged bouts of crying on the one hand, and frenzied outreach on the other,  at times writing Lincoln disorganized letters pleading for his support, even though they lived under the same roof.   But she could not access her husband and witnesses from that time testify she could not be consoled. He was already working up to eighteen hours a day as he took the troubled course of The American Civil War increasingly onto his own shoulders, but also used work to distance himself from her intensity.  Her descent into compulsive shopping was legendary, as she would buy up to 300 pairs of gloves at a time, or spent thousands on lavish furnishings for the White House to soothe herself. She could be rattled by the most benign of events. Once, when the President rode out to survey a nearby battlefield, a general’s wife happened to ride up beside him. Mary,  further back in in her carriage spotted this, and suspected an affair was underway. She fumed , accused, and tried to gather support for her point of view all through the day and into a reception dinner that night, embarrassing both Lincoln and his guests.  Without any internal or external anchor, she collapsed, and had to spend the next two days in bed. Her notorious tirades and flights into paranoia became more frequent,  and all but her own servants learned to stand clear. By the time of Lincoln’s assassination in April of 1865, she had little left with which to fight, and with that final blow, she never really recovered. She deteriorated over the next two years and was pronounced “insane” by her doctors, spending much of her remaining days in her darkened room in her family’s home in Illinois.

 

In Hold Me Tight, Susan Johnson cites numerous ingenious studies of couples under stress,  ranging from real life emergency room situations to experiments set up in laboratories.  These show that love bonds are literally our buffer, a mediating force in our perception of shock, stress, and pain. She has re-mapped the whole territory of couples counseling by seeing clearly that:  1) the intense emotions and life and death meanings that couples attribute to disconnection are not melodrama, but real. They make sense from a survival perspective and the ancient wiring of the limbic brain. 2) That deeper attachment needs and fears are the real plot beneath the surface drama of repeated conflicts. One partner feels an urgent need for closeness and to repair the gap and so goes on the attack. The other feels immobilized, like a failure, wary of emotional display,  and so withdraws in order to calm things down and preserve the status quo. Both miss the crux of the matter, and these strategies create further misunderstandings that just bring on more cycles of disconnection.  3) Moments of accurate emotional engagement that redress these underlying fears and needs are  key to restoring safety and jump-starting growth in both partners. The smallest moments or gestures of emotional engagement and responsiveness have inordinate power to redefine a couple’s map for the better, and therefore set them back on the right path.

 

The relationship between trauma and relational distress is a complex one, and much more has been written than can be summed here. But one point must be made relevant for those who work with survivors of trauma.  The partner who survives the kind of trauma caused willfully by another person  experiences what Judith Hermann called a “violation of connection”.  This kind of “attachment injury” involves a sense of betrayal or abandonment at one’s point of greatest need. It is especially potent to create distortion and poison the stability of a survivor’s current relationship.  There emerges a  reciprocal loop in which the after effects of trauma continue to erode the relationship, and, ongoing relationship distress can, in turn, exacerbate lingering symptoms of trauma. After awhile, the couples’ hair trigger reactivity, fiery clashes, cold withdrawals, and tense surveillance of one another can resemble a shared version of  PTSD.  This requires a skilled therapist who manifests genuineness, compassion, and patience, and who understands how to handle the inevitable impasses, working at a much slower pace.

 

Rapid Resolution Therapy has evolved as an individual method for healing trauma. It has different tools and approaches than those that work primarily in the context of the survivor’s relationship with their intimate partner. Our focus is on getting the individual’s mind to update and the recruitment of unconscious strength. Couple-based methods focus on accessing the strength nature has programmed into the “we”, as two stand together to face life’s troubles. Couples approaches claim that working models of the self and the relationship become stronger at the same time, and that may well be an advantage.  There is one important difference, however. Most models of couples therapy assume trauma’s effects will always be there in one form or another. RRT doesn’t  assume traumatic reactions have to be a permanent part of anyone’s life or that the dragon can only be “pushed further to the periphery” as the couple reconnects and muddles through together.  We know trauma can be cleared entirely and with lasting results.

But aside from these differences, RRT shares many commonalities, particularly with EFT. One is that when new information breaks through rigid constructs, it takes place in the deepest part of the mind.  RRT can look on with appreciation at a sister technology that understands how things can shift suddenly, how healing our need for  safe connection takes place below the level of negotiating, teaching communication skills,  ironing out cognitive errors, or learning new sexual positions. Second, we are pulling with the same pair of oars when we position clients to look at relationships scientifically. In the case of EFT, there is the the effort to make behavior understandable as mishandled attachment needs and primal fears that, when triggered, follow a predictable course for all humanity. We agree on the  therapist’s use of self to create a strong countervaling positive experience within the session. We concur with keeping participants emotionally connected to the present. And while we don’t “respect” feelings per se,  we respect the primordial wiring of the human mind,  and how its responses,  often confusing especially in relationships, are understandably oriented toward survival, and ultimately make sense.  Finally, we look forward together eagerly to the next few years and what new knowledge research will surely bring to us, about how to heal trauma’s ravages, whether individually or within a committed relationship.

I hope you, the reader, have enjoyed this three part series as much as I enjoyed writing it. I welcome your comments and wish you continued success and peace.

 

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Reconstructing Meaning Part 2 of 3

Posted on August 1, 2011 by mchidley

Last month we discussed the role affect regulation plays in recovery from trauma. Affect is driven by thoughts and thoughts, in turn, are informed by meanings. It is useful to note at the outset many of these meanings lie outside conscious mind’s power and scope. Deeper mind, with its vast storehouse of implicit memories and ability to condense meanings and code them in various ways, makes meaning much more than just a conscious construct or a unidimensional belief. Trauma in general, and relational trauma, in particular, ( that rises to the level of an attachment injury) has the power to smash into awareness and leave an indelible imprint, blowing to bits our basic assumptions about relationships, human nature, justice, self-efficacy, and the availability of support or safety in the world. Think of someone who has witnessed torture or been abused or abandoned with no hope of letup. He or she may reshuffle meanings in a way that refutes any belief in self-efficacy, justice, goodness, support, or safety and hold this refutation on a very deep level. This is the extreme. Others can simply develop a “sore spot” (Johnson, 2007) for the two primal wounds of deprivation or desertion that makes a relationship suddenly seem unsafe, when cued by current negative interactions.  It is this disordered meaning, then, that settles into place after the trauma and causes the survivor additional suffering. We see a range of  difficulties with trust, a dread of vulnerability, an existential wariness, or at the extreme, a conviction of living on borrowed time and inevitable doom.

Meanings are densely layered and complex. Think of a guy stuck in a traffic jam. No one is having much fun, but this guy is getting in and out of his car in an agitated way, shouts out expletives to no one in particular, and finally beats his fists on his steering wheel until his knuckles bleed. Whatever is going on with this guy, is about a lot more than just the traffic. Think of a tuning fork suspended over other tuning forks. An outer event or an inner one hits a note and they all start to vibrate. Events may “pull up” feelings, emotional tones, bodily sensations, sensory traces, interpersonal vignettes, memory fragments, etc., from across a lifetime that are all congealed in a flash into a composite meaning.

Rapid Resolution Therapy recognizes distorted meaning aggravates trauma in several subtle ways. And these may come from the culture or prior learning. First, there is the equation of troublesome feelings, thoughts, or behaviors with identity. This amounts to defining the self with passing states, or worse, labels. Second, there is the attempt to articulate desires or needs through negation. When someone rattles off how/what they don’t want to be or do, they haven’t yet accessed what they do want, making forward movement almost impossible. Third, the vanishing present. You may hear someone go on about the past, what they or others should’ve done, then jump to predicting the future, equally devoid of new possibility or different outcome. What happened to the present? It just disappeared, and with it, the awareness of corrective action that right now might turn things around. Fourth, introspection and self-analysis. Intelligent people use these to an obsessive degree, albeit with brilliant insightfulness, only to keep themselves stuck. With the headlights turned in, or the driver looking continually in the rear-view mirror at himself, the car cannot be effectively driven down the road. Lastly, one cannot grow up in this culture and escape the explanation of all mishaps by a moralistic outlook. The roots of this go back to Puritan times and even before. Success and doing well was equated with moral rectitude; its opposite was equated with falling from grace or being outside the predestined benefits reserved for the elect. If something bad happened, it’s because someone was somehow not right with God. This person was therefore to blame for opposing God’s will, and their suffering makes sense as a consequence. People should be doing well, prospering, feeling good, controlling things, overcoming, avoiding mistakes, etc. If they didn’t, it’s because they got themselves mixed up with the bad thing, didn’t apply themselves, or got on God’s bad side. In other words, it’s due to their sin. The conclusion that they brought this on themselves and are only getting what is coming to them is the final reductionistic step in a single cause view of the world, thus relieving us of the anxiety of living in a world with multiple causalities. It’s amazing how frequently this disturbed thinking still shows up even in intelligent people. It completely misses the scientific fact that things exist because they were caused; and causes, more often than not, are multi-dimensional and complex, a weaving together of genetics and the environment. Science knows that it is almost never one monolithic factor that explains something, but many factors, which are sorted out over time with painstaking construction of hypotheses and careful research.

When attachment goes poorly early in life, or secure initial attachment is later injured causing what is termed an “attachment wound”, the person is traumatized, and again we have an imprint to which attaches distorted meanings about self and others. When new injuries come about or one moves into a vulnerable state, these meanings emerge and are amplified. Again, think of the tuning fork. Especially in the context of abuse or neglect by those who should’ve protected or nurtured, meanings fall across the self: self is unloveable, defective, the cause of the bad behavior of others, deserving of abuse or abandonment. Or self is adrift in a dangerous world, unendingly and intolerably vulnerable to the betrayal and deceit of others, so self must be vigorously defended at all costs.

A movie that powerfully depicted all these was Good Will Hunting. Will, the hero, was brutalized as an orphan and learned to live on his own, fiercely anti-dependent with even his closest friends. But now as a young man he falls in love with a girl enrolled at the Ivy League college where he is a janitor. It has been a fairy tale of a romance and their love has blossomed into physical intimacy. But it is when she offers her whole-hearted commitment to him and invites him to share her life, he explodes. Putting her love on the line,  her needs in his hands,  and exposing herself to total rejection rings a big alarm in Will. His deep conviction of unlovability and certainty of inevitable betrayal by others, which have been pushed down into deeper mind for years, explode across the screen. We see his cycle: explode, push others away, numb out, retreat into familiar isolation, live to see another day. If you can call this living. Point is, the strong affect and behavior are driven by distorted meanings that lie far below conscious awareness.

Rapid Resolution Therapy seeks to neutralize destructive meanings: through exposing childlike moralisms and egocentricity, by inducing a more scientific view that because things were caused, they couldn’t, on final analysis, have happened any other way; by educating clients that our sophisticated brains, while capable of so much, are also prone to many errors and the attachment of deficient meanings at the point of injury is one of them. Our ability to attach catastrophic meanings and embellish them is a normal response to trauma, but if left unchecked, can lead us astray into a world of intense hurt. For survivors of trauma it is often the case, but interestingly enough, with a strong enough connection, they are eager to transition to a more neutral meaning or even to no particular meaning at all. People find real comfort as dysfunctional meanings are emptied out and events are seen as the result of a vast interplay of genetics and environment, including the brokenness in others, so it is finally ludicrous to place oneself at the center of it all. One assumes a more humble, grateful stance and even the ability to laugh at oneself, knowing the world is not going to unfold according to our preferences any time soon. In this profound transformation, the meanings attached to trauma disintegrate and are emptied of their existential sting.

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Treating Trauma: Affect Regulation (Part I of 3)

Posted on July 1, 2011 by mchidley

How does a person recover from trauma? The literature over the last decade or so has advocated that people improve if three key goals are met. These three goals emerge again and again across the writings of many of the recognized leaders in the field. In this three part series, I want discuss these and then reflect on them from a Rapid Resolution Therapy perspective. I’ll share some thoughts about the first today, leaving the other two for future blogs.

The first goal is affect regulation. This is the king of all goals because it is the most prominent symptom found in all populations, whether we’re talking war veterans or rape survivors, or people dealing with life threatening illness, or of course, survivors of early childhood abuse. The loss of the ability to regulate emotions, particularly anxiety and anger, is perhaps the most significant general effect of the trauma experience (van der Kolk, 1996). Why is this such a big deal? Well, aside from the misery it creates for the individual and his or her primary relationships, it constitutes the loss of a foundational skill, a skill so basic for living that it is developed in the first two years of life.

While the brain is going through its first major growth spurt, from the last trimester of pregnancy through the second birthday, a child is learning at a body-mind level from the primary caregiver how to tolerate intense affect and live with interpersonal stress. Through thousands of episodes of attunement (to the child’s needs), then mis-attunement (because no caregiver is perfect), then re-attunement and reconnection with the caregiver, a child is literally building the infrastructure of circuitry on the right side of the brain the necessary circuitry to allow for temporary lapses in important relationships and the emotional pain that attends them. How well he does this will tell the story of how he handles future trauma and forms relationships with those around him.

The child’s self learns to shift flexibly with the context as he goes from distress over an unmet need, to watching the caregiver sometimes miss the target, intensifying his distress, to then watching the caregiver pick up on the need correctly, and finally moving to meet the need. This is showing him that neither he nor the world are coming to an end and things will eventually become safe and stable once again; that distress doesn’t last and people, who are imperfect responders, can nevertheless be counted upon over the long haul. The next time you see a baby coming to the end of a crying jag as caregiver soothes, watch as the bottom lip shivers as the child quiets from the outside in. Maybe he lays his head against a shoulder one minute, rearing back to stare into the caring face the next, finally sticking his thumb in his mouth to suck on. You are witnessing in real time the building of new neural connections and the learning of affect regulation.

Unhealed trauma somehow disrupts this early circuitry and an adult who knows cognitively that life will go on will nevertheless react to stress, especially interpersonal stress, in a dysregulated way, swinging between extremes of rage or anxiety at one end and numbing and shut down of all affect at the other. They seem incapable of taking comfort , and affect will be prolonged and intense over seemingly minor issues. They describe themselves as thin-skinned, raw, like some buffer between them and life’s stress has been lost. So many clients have told me over the years about someone they were in some kind of close relationship with who was abused in their youth but never dealt with it. They describe when they’d fight,  the change that comes over the friend or relative, as if they were battling with a two year-old. They are more on the mark than they know.

Now the interesting thing about affect regulation is that it comes about in two ways. First comes the development of interactive regulation, as illustrated above, where we learn to reach for another. But then we develop auto-regulation, the ability to regulate stress autonomously. The thinking is, people who have had secure attachments will be able to use both modes. Those with organized insecure attachments will have difficulty shifting between one or the other, and those with disorganized insecure attachments will be able to access neither (Schore teleconference, 2011).

The trauma field has approached problematic affect regulation from multiple theoretical vistas, from cognitive restructuring to rapid eye movement desensitization, to exposure based therapies to body workers, to finding new meanings through post modern experiential, narrative and constructiontivist therapies to hypnosis and neuro-linguistic programming. Some say we are in the midst of a big paradigm shift, from primarily cognitively based approaches to recognizing the primacy of unconscious emotional processes and in the future we will train all therapists of whatever persuasion to work with affect in more (yes, I’ll say it) attuned ways.

From what I can tell, Rapid Resolution Therapy seems to be on the leading edge of this paradigm shift and has already tuned in to its possibilities. But we go about it differently than anyone else. From an RRT perspective, affect remains dysregulated because the deeper part of the brain hasn’t gotten the message that the dangerous event is over–isn’t even in existence. Therefore, it keeps sending obsolete messages to do something about the threat. One difference with RRT is that we actually tell the client this. It is amazing how many have gone for therapy for years and have never heard an explanation of how mind really works to relieve them of the misconception that the problem is due to some sort of personal defect or the result of not having “worked” on it hard enough.

From here it seems to me RRT combines the two natural forms of affect regulation. We essentially integrate and utilize both learning processes throughout the session. For instance, from the first moments, we pace the participant into a state of safety and hope, an altered state called connection, wherein they resonate to being deeply understood, held, and given the promise of forward movement. Then we hold up a model of a restored self and hold it up with absolute conviction. Through a variety of deepening techniques we use the energy of connection to move mind toward that model. We are actually retraining them, in a very rapid fashion, first how to use another to regulate the distress and then focusing attention on the deep resources they have within to do this for themselves. What makes us different is this: it is not a matter of discussion or processing in the classical sense, it is mainly a matter of updating and a recruitment of unconscious strength, a much quicker shift than many realize is possible. As mind absorbs this, what authors call the self-state shifts. Clients learn, like a child does, to shift the self with the context, to plug back into now, where one has survived the trauma and completed it, and to know this on all levels, throughout the body and mind. Clients focus their attention on what has changed–the present experience of stability, security, and reconnection, believing it will last and be there for them in the future, as well. In effect, we re-instate in them the ability to auto-regulate.

Attachment theorists remind us that attunement is not just between two minds but is communication between two bodies as well. As mind updates itself, this is confirmed on a bodily level. One of the keys to this, incredibly enough, is missed by many of the other therapies. And that is the importance of remaining emotionally connected in the present to the therapist. Approaching traumatic material this way enables them to reach a point of being able to tell these events as mere historical fact, as just one chapter in their lives. The therapist listens to all the horror of abuse with a calm body, staying emotionally present. Resonating to this and matching it, the client sees his or her body reacts less strongly, less strongly still, and eventually body does not react at all even though they are verbalizing what have been the most disturbing events of their lives. This is a new experience. Instead of the usual abreaction confirming entrapment in a past more real than the present, the felt equanimity confirms a present more real than the past. The trauma is really over, the past in fact does not exist except as a matter of record. Survival equals victory. On the way to this realization, I believe what we witness is the rapid transition from interactive regulation of affect to auto-regulation, as they take it over for themselves. The self has shifted with the context and confirmed on a deep body-mind level that one is here, now. They have the experience that mind can no longer recreate the pain, therefore safety and security exists, so one can move on to better things.

My hope is all readers will have found of something of value here. It is hard to capture in language the beauty and power of the total transformation we see daily. We take our inspiration from those who have struggled courageously for years against unpredictable affect and from the joy that comes in witnessing their sudden freedom. I particularly hope my colleagues will find some benchmarks and points of reference with the best thinking emerging from the field of trauma care and be inspired, as I have, to weave these new insights into their work.

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The Relational Animal

Posted on June 14, 2011 by mchidley

I recently heard a wonderful teleconference with Dan Siegel, author of The Developing Mind and Parenting from the Inside Out. Ideas from his latest, The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, were the substance of the teleconference.

Siegel distinguishes mind from brain and regularly questions mental health professionals, including psychiatrists, if they ever heard a lecture in which mind was defined. The answer is usually none have, which is incredible– it would be as incredible as osteo surgeons going through years of medical school and practice, doing replacements, amputations, reconstructions, etc., without ever having heard a definition of a “joint”. Siegel defines mind as an embodied, relational, emergent, self-organizing process which regulates the flow of energy and information.

In Siegel’s thinking mind is inherently relational. There’s no such thing as a mind developing on its own. In fact, research by Allan Schore and others indicates if an attuned relationship is unavailable for long periods early in life, the entire right side of the brain (the embodied part of mind) won’t develop–at least normally. Siegel emphasized how radical and threatening the idea of a relational mind continues to be–that our minds are not our sole possession, something ultimately of our own making, is deeply foreign to Western thinking. What is new is how profoundly dependent on relationships we are for not just psychological operations but physical development of the brain itself. That we differentiate not “from” but “with” others who love us (differentiation and dependence being different sides of the same coin, not opposite ends of a continuum). And that our mind is hardwired to go into alarm when we are cut off or in isolation, which throws a light on attachment and the injuries to it. Mind is not primary and ultimately dominant over relationships. What’s happening in relationships is the primary mover that shapes our minds and sets up capacities that will affect us for the rest of our lives.

Another concept which Siegel finds important is integration. Integration he says, throughout all of nature, is the heart of health. Integration is where different parts are allowed to be themselves, and when so allowed, linkage is naturally promoted between the parts, for the greater good of the system. Whether it is a brain, another organ system of the body, a family, or a whole society, this principle of health is central. Where it is blocked, any natural system, human or otherwise, will move toward chaos or rigidity or both. He says the whole of the DSM (Diagnostic and Statistical Manual of Mental Disorders) can be seen as various forms of impaired integration–mind tending toward either rigidity, chaos, or both.

Siegel teaches that compassion is the action of integration. Where integration shows up, compassion is always moving organisms with regard for separateness of entities, but also the possibilities of linking up, of influencing each other for the good. He says people can be taught how to monitor the flow of energy and information in their bodies and in their relationships (mindfulness), and as these modifications progress over time toward more and more integration you get a healthier person who is having a healthier influence on those around him.

Focused attention and mindful awareness is to therapy what a scalpel is to a surgeon and is what the therapist brings to the meeting. Focusing attention changes the mind, strengthening some neural circuits or creating new ones.

All this has helped deepen my understanding of what is going on in the connection phase of Rapid Resolution Therapy. The mind of therapist and client are relational and influence each other, and moment by moment, the opportunity this relatedness opens up is electric in all its potential. The two are both monitoring the flow of energy and information, with differing degrees of competence, and it is incumbent on the therapist to bring the scalpel of mindful awareness and focused attention to the possibilities for using that energy and, looking through a different lens, tapping into new information. When the client has a felt sense (a bodily experience) that the therapist “gets” them, that they matter and have value, a door starts to open. And if they begin to see that at least the therapist sees a model–a representation of and destination for the self that is healthy and new, and that it’s possible to get there– shared energy and information shifts and flows in a whole new way. There is a linkage that occurs and new forward momentum established that, I’m convinced, strengthens some, or creates new neural pathways in the brain (my internal image of this is jumping into crystal clear mountain stream with a good buddy). It is brought about by compassion, the effective action of the integration already held by the therapist, extended to the client, in which the client joins in. The door opens a little wider, then wider still, and then blows wide open. All sorts of powerful things start happening.

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A Better Way

Posted on June 7, 2011 by mchidley

Gavin had served his whole career with distinction as an explosives detection expert with the Bureau of Alcohol, Tobacco, and Firearms (ATF) before getting too near an IED (Improvised Explosive Device) in Afghanistan. Though physically unhurt, the deafening concussion of the blast had jangled his nerves. Coming home and going right into Hurricane Katrina sealed the deal, leaving him with full blown PTSD. He was especially sensitive to sudden, unusual sounds, like high winds, the beeping of a car alarm, or fireworks. Once during a Fourth of July celebration, as the family enjoyed the show, Gavin went missing. He was found next door, shivering on the floor in the neighbor’s shower.

The therapist who worked with Gavin was known for his unconventional ways. Instead of progressively exposing Gavin to more harsh stimuli, he reasoned Gavin had gone through so much specialized combat and explosives training in his life he had forgotten how to be his true self. Caesar, his therapist, concentrated first on relaxing and stabilizing Gavin’s nervous system. He did this by having him just float in the shallow end of a pool while in his arms. He introduced Gavin to the natural experiences he had missed out on growing up: being around newborns, being around a female, being part of a pack, just playing. You see, Gavin is a dog, specifically a Labrador Retriever.

Eventually Gavin learned to trust and to be at ease around most sounds. However, those associated with firearms and bombs, like the click of the hammer on a child’s toy gun or electronics that beeped, would still send him into “shut down” mode, where he would freeze or lie shivering as close to the floor as he could get. Caesar just kept working the connection he had with Gavin and associating more powerful cues, like smell, to safety and pleasure, across a score of different scenarios. Eventually, Gavin’s normal, safe dog routines grew powerful enough they could finally incorporate breaks in those routines and even the unexpected, like a loud sound. It is no accident that canines, whose nervous system has evolved alongside our own, would be so responsive to human cues of messages of safety. Science has established a dog can read our eye movements, body language, tone of voice, and even sniff out emergent cancers. It makes sense his partial capacity for mindsight, the ability to read and decipher the emotional state of a human, would be the hook used to lead him out of an early disability, as it was in the hands of such an able trainer and healer like Caesar.

A dysregulated nervous system is a challenge for any therapist. With humans, if you add layers of destructive meaning, such as a sense of being defective, you have an even more complicated picture. But the good news is the more complicated something is, the easier it is to disassemble. It starts with someone who believes in you and sees past the current distress to the restored essence…of you being yourself again. Then it takes showing and re-showing that the feared stimuli can be disabled, that the response is just a grouping of sensations that doesn’t mean anything and ultimately does not matter. One regains the experience that normal routines and pleasures can be counted on even while something unpleasant is going on. It’s like flipping the end of a telescope. Instead of the unpleasant thing being enlarged and overshadowing everything else, it is minimized, and can even be erased completely. Now just compare this approach with exposing any traumatized creature to more challenge and threat. The nervous system may eventually learn the same lessons, but only at the cost of tremendous additional pain. Which would you rather endure? I know what my choice would be. And I’m pretty sure about Gavin’s also.

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RRT

Posted on June 4, 2011 by mchidley

Forgive the Cat in the Hat sound of this, but I woke up and the words were just there, purpose being to give anyone reading a taste of what we do and how it might feel.

I try to say things one at a time,
To let you know how deeply that I’m
Committed to get you well and whole,
To get on your way toward your dearest goal.

I’ll say things slow or I’ll say them fast
I’m going for depth, an effect that will last.
Outrageous things you’ve never hoped,
Beyond your grasp, by the way you’ve coped.

But possible, just now, you’ll see,
That mind can shift quite easily
As it gets to a place relaxed and clear,
Watch, it just moved without doubt or fear.

I’ll say it just right, so you’ll follow along
And then you’ll take over, you can’t do it wrong.
In times of darkness or times of light,
From a deeper place that knows what is right

The part of you that is clear and strong,
That’ll get it right, that can sing it’s own song,
Locked onto what works, what fits, what’s best
With a mind that is free, with a heart that’s at rest.

It’s possible, it works, we know how you see,
The lock for itself creates the perfect key.
It’s hard to explain…we call it RRT
It is not up to you, but it IS up to me.

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A House Divided

Posted on June 1, 2011 by mchidley

Many of us who work with individual trauma also work with couples. As we work with pairs, we are aware the after-shocks of trauma, even when resolved for the individual, can continue to bedevil the relationship. This can be confusing ground, like an endless swamp, wherein the clinician can get easily lost up to the neck, in various inlets, whirlpools and eddies as couples come in with their(usually) skewed mythology of how things got to be this way, and propensity to externalize, blame, and justify a myriad of defensive adaptations.

The reason things are so murky is that mind of both has become captured by a cycle wherein the symptoms of trauma have transmitted inner distress and insecurity into the relationship. Instead of eliciting accessibility and responsiveness (those elements most needed for a secure attachment), the movements in their dance have only occasioned further wounding, pain and fear, victimizing both partners. The cycle takes on a life of its own, defeating partners’ attempts at contact and caring. A typical cycle might look like this: one’s criticism and protest is followed by defending and distancing in the other, leading to increased criticism that ends with either an explosion or mutual withdrawal by both for longer and longer periods of time (Johnson, 2005). The hurt and alienation and negative definition that ekes into the relationship may hang on long after a survivor has made substantial gains in individual therapy or even has been cleared entirely. Life inside the cycle, as it happens, is an altered state, holding both partners spellbound, helpless to do anything but follow it to its inevitable conclusion. New learning and exploration, let alone empathic responding, literally cannot happen in the more primitive parts of the brain thus engaged once the cycle has been activated.

For therapists, the way out of the swamp could be likened to needing a detailed road atlas of the present day United States. Only we seem to be metaphorically back in the year 1812, and as yet we only have a few provisional maps. The larger expanse of this territory is largely unmapped by mental health. The expert explorers and surveyors in our field are only just starting to write about it. What is clear is that individual methods do not apply for this work. For one, repeated relational cycles can’t be re-assigned to a past that is over and done with as mere data. The couple need only point to recent flare ups to assert that the danger is in fact still very real and present. And some of our most powerful interventions, like induction and working directly with the deeper part of mind don’t lend themselves to being carried out in the presence of one’s partner, particularly if that partner is seen as unsafe and antagonistic to the participant’s deepest needs and longings.

We do know that the kind of disturbance trauma leaves in couples’ relationships resembles PTSD (intrusive re-experiencing, numbness and avoidance, hyperarousal and escalation) and has to do with disordered attachment, the original trauma. A knowledge of attachment dynamics and the way attachment injuries show up is crucial to the therapist’s effectiveness. The fearful-avoidant style, in particular, as a residue of severe, complex PTSD, seems to be one of the most formidable of the swamp monsters that has to be wrestled to the ground and transformed. A fearful-avoidant participant manifests extreme neediness and extreme distrust at the same time, such that they are deeply ambivalent about close relationships. One minute they may pursue their partner and bid for attention, and the next, push away the very sustenance and caring they crave. They will talk about this as if two different selves are in charge who want different things, illustrating the confusion of identity and an incoherence of personal narrative that are the aftermath of sexual or emotional trauma. Another aspect is the secondary traumatization that has developed in the partner of a survivor. Accustomed ways of defending against more shame and failure, confusion and defeat, figure into the maintenance of “the cycle” and become part of the problem. Both survivor and partner can and must learn to identify the cycle and head it off.

One cannot overstate how much the therapist’s use of self to create a safe connection and context matters here. This becomes the bridge that both partners may eventually step out onto in their way back to each other. The bridge must be clear of hazards, point in the right direction, and above all, be sturdy. And yet the bridge must also be human, modeling the humility, accessibility, and responsiveness that each can learn from, having possibly never experienced it in their lives before. The therapist builds on connection and credibility as he or she seeks to destroy meanings that have warped the identities of the partners, even as he or she heightens new patterns and meanings that spell the beginnings of a secure base and a safe haven which the couple needs as they take new steps, the most tentative steps, toward each other again.

As my map fills in, I will from time to time, be sharing insights as to how this can work. For if healthy couples and families are the cornerstones of a healthy society, then we cannot stop with the relief of the individual. We would be leaving out an important part of the territory and , in my opinion, people who have depended on us to find a way out of living out their days in a house divided.

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Do it Anyway–by Mother Teresa

Posted on May 31, 2011 by mchidley

This is not a plug for any religion or religious position, but merely for the wisdom that is in this quote.

People are often unreasonable, illogical and self-centered. Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives. Be kind anyway.

If you are successful, you will win some false friends and some true enemies. Succeed anyway.

If you are honest and frank people may cheat you. Be honest and frank anyway.

What you spend years building, someone could destroy overnight. Build anyway.

If you find serenity and happiness, they may be jealous. Be happy anyway.

The good you do today, people will often forget tomorrow. Do good anyway.

Give the world the best you have, and it may never be enough. Give the world the best you’ve got anyway.

You see, in the final analysis, it is between you and God.
It was never between you and them anyway. (Based on Gal. 6.9)

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Expansion

Posted on May 19, 2011 by mchidley

Every conversation in therapy is an opportunity for profound connection. Connection here means not just passive listening or talking, but an altered state where people can influence each other. And where connection exists, there is the opportunity for expansion.

Every conversation in therapy can open things for the participant. For instance, there is important information embedded in emotion. As a participant experiences acceptance by the therapist, they progressively accept their own emotional experience and are willing to delve into it more. Borrowing the therapist’s eyes, they suddenly see how they’ve been seeing things, or discover their own needs hiding beneath a veneer of fear or anger. These expansions of self are infinite and sometimes very surprising, appearing in the most unexpected ways and places.

Therapists, too, can have things flip. We routinely guide people away from false and faulty meanings: 1) Thinking in terms of what is “not” wanted 2) aligning identity with pathology 3) disappearing the present through over-focus on future or past 4) the dead-ended pursuit of self-analysis.  But then a door opens up.

We help others make the shift into more productive thinking, but then learn ourselves that these lessons aren’t over and done with. Outside the session, the deeper contours of how we get mixed up in our own lives comes home. Or the client’s profound shift from misery to freedom may jolt into recognition something that has been out of awareness for some time. A light bulb goes on which, if not ignored, signals an expansion of self and an expanded capability to help the next person. We now know what life has been trying to show us.

Expansion in Rapid Resolution Therapy language means better and better attunement to what has immediate benefit and possibility. Less time is wasted on what leads to no good end. We feel excited as we connect to what is truly relevant in our own lives and thus lay hold of what has lasting appeal and significance. We lead with our essence instead of burying it under layers of pain or false meanings.

We have a saying in RRT, that even a tree can get it right. If we plant a seedling and come back in 20 years, the tree will have gotten it right–the branches will have grown up and the roots down. The same is true for us if we are willing to let natural expansions occur with each new conversation.

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The Advance of Science

Posted on May 6, 2011 by mchidley

In the Middle Ages physicians used to deal with fevers, infections, and all manner of illness by bleeding the patient. Cuts were made in various strategic places on the body and it was believed letting blood flow released pernicious elements such as too much heat, bile, phlem, etc. Later on researchers got the idea of replacing blood. At first the blood of sheep and other farm animals were used because it was thinner, cooler and didn’t clot so quickly. But given in any but small quantities,  the patient usually died. Primitive goose quills were used long before silver pipettes and eventually needles. If a person had an open wound in the 19th Century on the American frontier, it might get packed with bear grease or even dirt. Disease killed more soldiers in the Civil War than bullets because prior to germ theory, men routinely drew water for drinking and cooking from the same streams or lakesides they used as latrines. Only by degrees did medicine evolve new practices based on matching blood type, using sterilized instruments, creating a sterile field in wound care, and practicing basic sanitation.

Recently Melinda Paige, LMHC and Master Practitioner of Rapid Resolution Therapy wrote, “Traditional grief counseling is based on the belief that painful and sad feelings need to be experienced even more than they have been in order to finally be released.” This, we could say, is representative of the old medicine in our field. It is in contrast to newer findings from brain research that if the amygdala and the HPA axis (responsible for the fight, flight, or freeze response) can be kept quiet while the prefrontal lobe reprocesses experience, frozen grief and other painful reaction patterns actually seem to heal more efficiently.  Fear and traumatic hyperarousal constricts awareness and inhibits learning. It seems the brain can resume normal exploration of reality,  rewire itself and relearn almost anything, including trust, if provided a safe haven and dependable context.

John Bowlby, as early as 1969, started defining working models of the self as interpersonal and relational. Dan Siegel has expanded this into an interpersonal theory of mind that shows how moment by moment responses in therapy can be used to reconstruct experience in a more positive way.  Self-concept is always in relation to others and clients who have have suffered painful blows to their identity through trauma can be made accessible to a wider cache of potentially available images used to construct a sense of self, providing the therapist can create a special atmosphere of attuned responsiveness, comfort, respect, and structure.

RRT incorporates all these lessons as therapists pinpoint and eliminate each factor that leads to debilitating traumatic responses.  We dismantle destructive meanings and build, throughout the session, toward a new, emotionally neutral re-assignment of traumatic material as mere “data”,  shifting it away from a repetitive reliving of the experience itself. We offer a safe haven of attuned responsiveness in which clients can look through a different lens to see their own life and the actions of others in a way that sets them free from the disabling constructs of the past.

The business of science is to illuminate the existence of things through a dispassionate examination of causes.  It is a slow, methodical way of widening our perception of the world  and stands in contrast to the many ways we get bogged down while making sense of things. We recognize this and teach our clients that moralisms, dogmas of the past, and other faulty explanations can take us off track and even cause further harm. Yet there is no place for arrogance in this, merely gratitude. We stand on the shoulders of those who have gone before, as we open ourselves to what new insights science has to teach. We allow our own minds to be updated and look back on what we’ve done as the best we could do with what we knew at the time. We add new tools to a widening arsenal and apply them to the endlessly fascinating enterprise of helping others.

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