Incident trauma enters our lives unanticipated and uninvited. It ruptures the fabric of life and can be devastating—whether it be motor vehicle collisions, medical diagnosis, assaults of any kind, natural disasters, accidents, illnesses, loss, and the list goes on. As therapists, we need to be cognizant not only of the intense disruption and dysregulation to the autonomic nervous system (ANS), but we need to be aware of the disruption to identity that often comes with the experience. The loss of self, the loss of who I was, who I am, and who I can become, can be called into question, depending on the type and severity of the trauma, the disruption, and the injuries—psychological, neurophysiological, and physical.
One of the things I talk about as a trauma therapist and educator, is that the theory and process of metabolizing incident based traumatic material is relatively straight forward, particularly when there is a secure base, as there is with secure attachment—where there is a foundational integrity of the integrative functioning within the self. Often healing or resolution gets stymied when working with a person who has an underlying insecure attachment, where there is a deficiency in the integration capacity in the bodyself. This is when we as therapists, are called not only to travel to the abyss of trauma itself, but to negotiate that journey with a psyche and ANS that have foundational injuries that unconsciously thwart the integration of material. Kalsched (1998) aptly captures this dynamic: “for the traumatized psyche, integration is the worst imaginable thing, apparently equivalent in the ‘mind’ of the defending Self to some early horror—never to be repeated. It is as though integration threatens a re-experience of the ‘unthinkable’ affect. Therefore, connections among the components of experience are attacked in true ‘auto-immune’ fashion” (p. 89). These defenses are employed to maintain some stability in the system and to protect the psyche from re-experiencing the unbearable anguish of the affective experience of the trauma—the terror, pain, and unknown. For the insecurely attached system or psyche, the processing of traumatic material is threatening—too threatening for the systems to allow it to emerge, to surface, and involuntarily, unconscious defense structures emerge to shut down the process.
As clinicians, we also need to be cognizant of ramifications of what happens after a traumatic event, and the myriad of ways in which people’s early relational dynamics may be replicated as they navigate their post trauma reality. For some folks who have to interact with insurance companies (disability or otherwise), the medical and legal systems, employers, and other institutions, they may experience the recapitulation of their relational dynamics of early life. This can be particularly potent when interfacing with overburdened or profit driven systems, where they are left to languish unattended and in the unknown, a familiar abyss for some.
The Canadian healthcare system is a prime example, where people often wait for months to over a year for diagnostic imaging, access to specialists, and for adequate pain intervention and management, all of which can feel like there isn’t anyone to help them, evoking experiences that: no one cares, they don’t matter, no one sees them, etc., which may be reminiscent of early experiences wired into their internal working model. We can also see replication of early life experiences activating feelings that: there’s not enough for me, I have to manage this on my own, there is no relief, I don’t know what to do to make it better, to feel okay, to be safe—all of which can incite fear, anger, and/or helplessness for people, and complicate healing.
When people land in our clinical practice, we as therapists must be aware of the post trauma context in which people are living. For some clients, they may feel unmoored and unsafe, due to the recapitulation of early relational injurious experience, which destabilize them and needs to be attended to in the treatment process. In attending to our clients with this larger lens, and being tuned to the underlying relational security, or lack thereof (as with insecure attachment), therapists are better able to understand the complexity of processing traumatic incidents when there is underlying relational trauma.
References:
Kalsched, D. E. (1998). Archetypal affect, anxiety, and defence in patents who have suffered early trauma. Post-Jungians Today, 84 – 104.
The Body is Foundational for Somatic Psychotherapy
Psychotherapists are often curious about, how do I bring the body into my clinical practice? To be clear, we are always working with the body—whether we are adept at listening, deciphering, and utilizing the information is another story. As a therapist educator, the question then becomes, how do I assist clinicians to bring the body–theirs and clients—into practice. Conceptually, I speak about this in three key components: right brain to right brain, body to body therapeutic practice; embodied practice: and working with the modes of the right hemisphere.
Right Brain to Right Brain, Body to Body Therapeutic Practice
Bodies are always communicating under the, or embedded within, verbal dialogue. As clinicians, our capacity to regulate our autonomic nervous system (ANS) and offer dyadic regulation allows opportunities for dyadic regulation that over time increase the client’s capacity to regulate their own system—such regulation is at the core of both relational and incident trauma repair.
Therapists also need to be cognisant of the non-verbal communication that happens between bodies—the tone of voice, facial expression, and the way the body moves, or doesn’t, all transmit information beneath the dialogue to the other, as does each person’s current internal state. This transmission of information, either increases or decreases a client’s sense of safety (often unconscious), and its accurate interpretation or neuroception (Porges, 2011) is shaped by number of factors, including: their history; what is happening in the moment in the therapeutic dyad; the therapist’s ability to regulate; and the congruency of the therapist’s words and internal experience. This also can be true in reverse, where the attuned therapist registers discrepancies in congruence of the narration and physiology of the client—this can open a doorway for process. The therapist is also susceptible to their own history colouring their perception or neuroception of the therapeutic work, particularly when they are dysregulated. Given this, the capacity for the therapist to regulate their own ANS is integral to all somatic or body-centred practice, and I would propose, to good therapy in general.
Embodied Psychotherapy
Embodied psychotherapy for me, speaks to the valuing and use of the therapist’s body, and the client’s body, in clinical process and practice. By this, I mean a few different things that can be summed up as the therapist using their body to feel into and resonate with the client’s body as they bring content, both psychological and physiological, into the work. In using one’s body to feel into, regulate, and resonate, therapists are better able to: catch nuanced, or discrepant material that needs attending; track shifts in their ANS state and the client’s state in the moment; feel into the dissociated material that is out of the client’s awareness, and; track dyadic connection and disconnection. In using the body as a tuning fork, therapists are able attune, sophisticate, and nuance their clinical awareness, enhancing relational contact and collaboration in the clinical process, both moment to moment, and over time.
With embodied practice, therapists also lean into the conceptual framework of the window of tolerance (Siegal, 1999), utilizing their embodied awareness to track and then up or down regulate affect and content to help guide the processing of material. Further, use of Porges’ polyvagal theory (2011), in combination with the use of sensations and felt sense, is used to decipher what is happening in the ANS. In combination with this and other bodily based information, the therapist discerns in the moment whether to stay the course, or up or down regulate the system—this can happen in several different ways, ranging from increasing relational contact to making interventions to disrupt the ANS state. What I am meaning here, is that with embodied practice therapists tracks whether there is enough regulation and vitality in the client’s ANS state, or if more ventral vagal is needed to regulate and support the metabolizing of material—so, down regulating in the case of too much sympathetic arousal in the ANS, or upregulating when the ANS has too much dorsal vagal state dominance to metabolize material.
Right Hemisphere Processing in Psychotherapy
We understand that trauma is held in the body and right brain, and that left hemispheric work is refractory for trauma resolution. With this understanding, in addition to right brain to right brain, body to body process, and embodied practice, somatic psychotherapy utilizes processing through the different modes of the right hemisphere—sensations, sensory motor or gestures, emotion, images and the imaginal, including metaphors and analogies, and the symbolic or archetypal realms. In doing so, the psyche or bodyself brings into awareness unmetabolized and unintegrated material. In working in the right (rather than left brain processing) and processing through right hemispheric modes, traumatic material can begin the process of metabolizing through linking and differentiating elements of the experience, which supports regulation, organization and ultimately integration, all in service of change.
Wrapping Up
Admittedly, this blog just scratched the surface of how to bring the body into clinical practice. My hope is to alight more curiosity by opening your attention to these different but related elements of how the body can be utilized in somatic psychotherapy—right brain to right brain, body to body therapeutic practice; embodied practice: and working with the modes of the right hemisphere. As a therapist educator, I witness profound changes in therapist’s clinical practice, and their capacity and acumen, as they embrace and embody a somatic orientation in their work.
References
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. New York, NY: Norton.
Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. Guilford Press.
Chronic shame is deeply woven into the stories and neurophysiology of many of clients seeking therapy. Because chronic shame is a relational injury, with its roots in early life, it is woven into the fabric of the self and largely nonverbal in origin, impairing healthy relational capacity, disrupting regulation, and most significantly, distorting one’s sense of self. This early wiring of the psyche and body becomes the shaky ground that further shaming experiences across the lifespan are built upon.
In clinical practice, chronic shame shapes the therapeutic work and relationship, this can be both confusing for client and therapist, and can be a forceful inhibitor of the therapeutic process. In my teaching and clinical practice, an area of focus when working with clients who struggle with chronic shame, is meeting the underlying emotion that is present, but often inaccessible below the content—to listen below the words.
In therapy, clients often offer appraisals of themselves and their inherent lack of self worth or value which are truly heartbreaking and categorically untrue. In these moments, therapists get to glimpse the tormented, distorted inner world of the client. In response to this anguish, therapists can feel compelled to offer kind and (often) accurate assurances to the contrary, attempting to talk them out of their bleak view of themselves, to provide them (and the therapist) some respite from the suffering which has now enveloped the therapeutic space. This will have little effect.
Despite the best clinical intentions, meeting chronic shame head on through cognitive means is counter productive, and Schore tells us, refractory (2015). It often initiates an attack or collapse within the client—a reflexive defense of their distorted position, which to the client feels irrefutable on all levels, cognitively, emotionally, and neurophysiologically, due to the well worn and catastrophic shame cascade. Additionally, there is often a myriad of examples from their history that verify to themselves their distorted assessment. Engaging too cognitively with chronic shame activation puts the clinician into conflict with the client’s understanding of themselves, the world, and their place in it; with our words, often not heard as accurate, or exploratory, or true, but misheard and misinterpreted as threatening, pitying, mocking, or just plain wrong. The other side of this mishearing and misinterpretation, is for the client to hear us as confirming their worst beliefs, adding yet another layer of ‘proof’ to their bleak belief of self. This creates a delicate and difficult therapeutic dance, that can easily activate the therapist’s own feelings of inadequacy, inefficacy, and shame. So, given this dynamic, what to do?
In working with clients with chronic shame, we want to keep our ears, and even more importantly, our hearts, tuned to listen for the painful emotional truths that exist below the thinking, stories, beliefs, and appraisals that they offer up in therapy. Our attention is tuned to listen for the emotion that is below the client’s words, what may be largely out of their awareness, what is too painful to share or tolerate. Therapists want to listen for the loss, the pain, the fear, the sadness, and the relational cruelty that the client endured. It is these events and experiences which created the necessity for chronic shame to exist for them as both a source of protection, and (unwittingly), the creator of immense pain. Therapists want to listen for the excruciating double bind that exists for these clients—wanting to connect with people, and the fear and threat of connecting—as people have been the source of their pain. This fear extends to, and is often exacerbated within the therapeutic relationship.
When we notice these underlying truths of loss, longing, sadness, grief, etc., we can gently, and with absolute congruence, reflect back what we are seeing and tracking emotionally, how we imagine it was for them at the time of the experience or in the relationship, or how their words are impacting us in the moment, to name a few. Our therapeutic intent is to respond as a caring, engaged, interested person, something which has often been so lacking in the lives, particularly the early lives, of our clients with chronic shame. We want to offer a glimpse of a new relational reality where their words and experiences have meaning and touch others.
I have found that over time, through attuned attention to the underlying emotions existing below the chronic shame, clients become better able to take in (if only for a moment), the reality and truth of what is being reflected back to them, and get a clearer view into their emotional world which has been disavowed, dissociated, and distorted. As this expanding view of themselves becomes internalized, the world, their place in it, and the possibilities for living (hope, creativity, dreaming, excitement, etc.) emerge, inviting growth and greater freedom in all areas of life.
References
Schore, A. (December 2015). Allan Schore Seattle Study Group.
Attachment theory and research seems to be everywhere these days and I routinely hear from clinicians, how do I apply attachment theory to my clinical practice? Having had the immense privilege to train with Dr. Mary Main and Dr. Erik Hesse in the Adult Attachment Interview, and with Dr. Allan Schore, who writes on modern attachment theory and regulation theory, I have spent many years integrating and educating therapists on the application of these teachings to clinical practice. So, in a nutshell (or a blog post), here are some salient ways that I apply attachment theory to clinical practice, specifically working with insecure organized attachment (dismissive and preoccupied) from a Somatic Attachment Psychotherapy orientation.
The Therapeutic Relationship
We know that our relational wiring, established through the early caregiving experiences, fires at pre or unconscious levels of awareness, so, using and making explicit the relational dynamics emerging in the therapeutic relationship can be a potent way to bring relational patterns into the here and now. For clients to feel and identify ways in which their underlying beliefs operate out of awareness, such as: I have to disavow my feelings to protect our relationship; I have to take care of you so you can take care of me; I have to accommodate you to preserve our relationship, I’m too much, I’m not enough, etc., can illuminate potent understanding. In bringing awareness of these relational patterns from the implicit to the explicit, we can process how these patterns of relating emerged in early life, and how they continue to limit what is possible today. With this emergent awareness, folks can make better sense of their life and relational patterns, work toward deeper understanding and compassion for self, and begin disrupting their habituated relational ways as they evolve into more flexible patterns of relating.
Internal Working Models
The internal working models that emerge through early caregiving experiences wires how one understands who they are, how relationships work, and how the world works. We can listen for attachment material that pertains to the IWM such as:
the distorted self – ex) I am bad, I am unloveable, I am needy – as well as, tracking and attending the protective self-care defences that undermine or persecute the self
distorted relational understandings – ex) I have to disavow my needs/feelings/wants to maintain our relationship
distorted understandings of the world – ex) bad things happen when I’m happy, people aren’t safe
As these distortions come to light, we can work to disrupt the fixity or certainty of these beliefs that run at various levels of consciousness, bringing fuller awareness, which in turn, allows for a renegotiation of experience and relating over time.
Affect Regulation
We know that dyadic regulation is necessary to establish self regulation capacity where people can have flexibility in regulating their autonomic nervous system – ANS. One of the hallmarks of insecure attachment is the lack of flexibility in their regulation capacity, meaning that they can have difficulty leaning into co-regulation (think dismissive attachment) or alternatively, lack capacity to regulate their system on their own (think preoccupied attachment). Through the therapeutic relationship, we can offer dyadic regulation to, over time, shift the wiring of the ANS so people are able to increase not only their capacity to regulate, but increase the flexibility in the ways they respond under relational distress. In working to increase one’s regulation capacity, we work with finding safe pathways into the body or felt sense, shifting ANS states, attending and processing relationally, and leaning into organised or coherent self states.
Thinking and Feeling
We can listen for biases toward thinking or not thinking, feeling or not feeling, that will give us some information towards what modes of processing or, said another way, what defences have been utilised to manage early, less than optimal, relational care. In broad generalizations, we can think of preoccupied states of mind as defending against thinking and often having difficulty containing and regulating their intense affect. Alternatively, we can think of dismissive states of mind defending against affect and finding haven the left hemisphere, the intellect.
Given these broad strokes, when I sit with folks with these presentations, I work towards helping them build pathways into the less developed modes of process. In thinking about folks with a more preoccupied state, we work to develop and enhance their witness self so they are able to experience more continuity of self, and story, rather than being hijacked by their intense affect. With more capacity to regulate, and be in contact with the self, they are better able to stay in the here and now, and work to metabolize experience, coming to more truth or clarity about who they are and what they need or want.
In sitting with folks with a more dismissive bias, our work, in part, is about creating enough safety so they are able to access the emotion that is present and defended against. In bringing regulation and relational connection, their stories become less rigid and more emotionally nuanced, opening them to increased understanding of self and context, and more nuanced experience of relating.
Wrapping Up
In writing about the translation of attachment theory to clinical practice, I think one can portray a simplicity to a very complex and nuanced way of seeing and understanding lived experience, and working toward reparation of early relational injuries. The ongoing tracking and attending to attachment material, to what is happening in the relationship, how we as therapist are engaging, and how our own attachment biases are alive, is demanding and beautiful work that continues to challenge our growth and capacity, and offer rich clinical practice.
In my clinical practice I see a thread of chronic shame woven throughout the fabric of life of many of my male, or male identifying clients; a thread just waiting to be plucked that sets in motion a degree of dysregulation and personal pain that will be avoided at nearly all costs. The difficulty is that this thread is most often initiated in their most intimate relationships— those of deep love, that are most precious, including their relationship with those tender, routinely disavowed wants and needs within themselves.
Many definitions of shame/chronic shame exist, and those which ring most true for me attempt to describe with heart the wholesale dysregulation, destruction, and attack on the very core of the person that shame elicits. Patricia DeYoung (2015) defines chronic shame as “one’s felt sense of self disintegrating in relation to a dysregulating other” (p. 18) and Dorahy (2015) includes the desire to hide, disappear or even die. For those who experience chronic shame, these descriptions begin to describe what it feels like psychologically and neurophysiologically when activated.
It’s important to differentiate between shame and chronic shame. Chronic shame appears much earlier than shame; first seen in the 2nd year of life, prior to conscious memory, remaining in a wordless state (Hill, 2015). The dysregulation experienced by the child is “”affectively burnt in” the infant’s developing right brain” (Schore, 2014, p.390), becoming a thread that is waiting to be picked, touching “a wound made from the inside by an unseen hand” (Kaufman, 1989, p.5), that reverberates throughout one’s interpersonal life. Additional research by Schore (2017) shows that male children are at increased risk for a number of psychopathologies because of slower brain maturation, particularly on the right brain, which leaves them vulnerable longer to negative experiences, particularly relational trauma that form the fabric of shame.
For those with chronic shame, integrated strategies for avoiding and surviving shame (Hill, 2015) are woven into the client’s Internal Working Model (Bowlby, 1973) – the way that people see themselves, the world, and their place in it. If we add to this Daniel Siegel’s (2010) assertion that ‘the brain is an anticipation machine’, we can see why chronic shame states are so incredibly enduring, and that no matter how safe or stable things are in the present, the thread of chronic shame remains active, and when activated, the same neural affective states that were experienced as a child are re-experienced by the adult client. We must remember that because chronic shame is formed prior to declarative memory, it exists outside of the conscious memory system, leaving it largely impervious to cognitive therapies, rendering clients baffled by the repetition of these intensely dysregulating interactions.
The benefit of bringing shame more into our clinical awareness, is that it can shift our focus from simply attending to behavioural issues and patterns—addictions, disengagement, anger, perfection, procrastination, pleasing—and begin to see the role that chronic shame, which is often dissociated from the client’s awareness, is having on initiating or perpetuating these patterns, and focus not just on the fire, but the fuel that is feeding it.
Clinically, I see two common expressions of chronic shame that are often used unconsciously and interchangeably by the client. The first is to internalize the shame and implode or collapse in on themselves, feeling the full weight of the humiliation or mortification embedded in the affective states of their nervous system and psyche. The second is to externalize and attack the interpersonal other, feeling the grandiosity and righteousness of their actions in defense of the disintegrating self (shame reaction). Chefetz (2016) includes contempt, dissmell, and disgust within the shame spectrum of emotion, and I see this play out both internally and externally within each pattern. Needless to say, the severity and intractability of chronic shame creates massive turmoil and strain within their most intimate interpersonal relationships.
Research and my clinical experience suggest that what is needed for clients to work through chronic shame is for them to experience solid, stable, caring relationships, including the therapeutic relationship, where they can feel the pluck of the dysregulating shame and share it with another person, have it witnessed, and, against all expectations in their emotional being, have them not be judged or criticized, but witnessed and cared for. This deeply relational process, both within, and outside of therapy, creates opportunities for corrective emotional experiences that begin to unwind the chronic shame, both cognitively for the client, as they begin to develop a fuller relationship with this process that resides in them, and within their neurophysiology. Donald Kalsched (2013) sums this process best: “what has been broken relationally must be repaired relationally. This calls for affectively focused treatment” (p. 13, Italics in original). Processing chronic shame is long term work, and requires nuance and care to weave between the disintegrating, near automatic responses of the shame state, and the need to provide an attuned, caring presence: Over time “the therapist provides an emotional re-education and remediates a developmental void” (Maroda, 2009, p.20). Additionally, it is critical that the intense affect be modulated so that dissociation can be limited and the client can maintain connection to their adult witness within the present moment, as the healing of trauma can only happen in the here and now.
It is my hope that as clinicians, we can attune to this debilitating dynamic in our clients that is often overlooked or misinterpreted, but is actually hiding in plain sight.
References
Bowlby, J. (1973). Attachment and Loss, Vol. 2: Separation, Anxiety, and Anger. London: Penguin Books.
Chefetz, R. Catastrophic Shame and the Reorganization of Self, retrieved online Nov 4, 2018- http://csar.nyc/catastrophic-shame-and-the-reorganization-of-self/
DeYoung, P. (2015). Understanding and treating chronic shame: A relational/neurobiological approach. New York: Routledge.
Dorahy, M. (2015). Shame and Dissociation in Complex Trauma Disorders Webinar.
Hill, D. (2015). Affect regulation theory: A clinical model. New York: Norton.
Kalsched, D. (2013). Trauma and the Soul: A psycho-spiritual approach to human development and its interruption. New York: Routledge.
Kaufman, G. (1989). The psychology of shame: theory and treatment of shame-based syndromes- 2nd edition. New York: Springer.
Maroda, K. (2009). Less is more: An argument for the judicious use of self-disclosure. In Bloomgarden, A. and Mennuti, R. B., (Eds.) Psychotherapist Revealed: Therapists Speak About Self-Disclosure inPsychotherapy. New York: Routledge, p. 17 – 30.
Schore, A. (2014). The right brain dominant in psychotherapy. Psychotherapy. 51 (3): p. 388-397.
Schore, A. (2017). All our sons: The developmental neurobiology and neuroendocrinology of boys at risk. Infant Mental Health Journal. 38(1): p.15-52
Siegel, D. (2010). Mindsight: The New Science of Personal Transformation. New York. Bantam.
In reflecting on what it means to be an attachment oriented, relationally focused, somatic psychotherapist and educator, I come to three questions that speak to the heart of the matter: What does it take to regulate a nervous system dysregulated by trauma, whether that be relational, incident or a complex blend? What does it take to offer reparative therapeutic experiences for development and maturation of the right brain and to shift attachment patterning? And, what does it take to venture into the abyss of the underworld and accompany the client as they reclaim their vital life force?
Early primary relationships build the growing self and wire the brain to anticipate and expect (Siegal, 2010) for better or for worse. Insecure attachment, created through inconsistent and unpredictable affect regulation and repair whereby the infant is left for long periods in high/hyper arousal states (abuse) and/or low/hypo arousal states (neglect), affectively imprints neurophysiological patterns in the body (Schore, 2014). Caregiver failure to recognise or respond to a genuine aspect of the child forces dissociation/disavowal of that part(s) (Bromberg, 2011), infusing chronic shame into the insecure internal working model (IWM) of the self. Thus, we find with insecure attachment the IWM has a distorted sense of self and impaired knowing of healthy relationships, scaffolded upon a dysregulated autonomic nervous system (ANS), impaired processing of the right brain, and patterns of relating and affect management strategies that lack flexibility.
Trauma wounds the neurophysiological body, fragments the psyche, and forces the soul into the abyss. Wounds of this nature call for therapists to jointly descend into the abyss of the underworld to accompany, witness and support the return to life (Wirtz, 2014), to facilitate regulation of the ANS and offer reparative relational experiences. In addressing both the psyche’s response and the bodily based impact of trauma, I believe the trinity of attachment-oriented relational psychotherapy, somatic work and an embodied regulated clinician are essential for the restoration of the integrity of the self.
What does it take to regulate a nervous system dysregulated by trauma, whether that be relational, incident or a complex blend of both?
The ability of clinicians to make interventions to help the ANS process the bound or chaotic material of the right brain/body calls for a strong understanding of neuroscience including The Polyvagal Theory (Porges), the window of tolerance (Siegal), and Regulation Theory (Schore) to work safely and effectively with hyper/hypo arousal states. Additionally, a deep understanding of the complexity of the ANS and adroit use of specific somatic interventions and right brain processes to: foster embodiment; create movement and integration of energy bound and dispersed; restore thwarted or impaired impulses for connection and protection; embody, sense and process dissociated emotional and physiological content; and create a regulated ANS that can integrate the horror and terror inherent in trauma. While somatic processing is critical for the regulation of the ANS and integration of traumatic material, it is insufficient to repair the depth of psychic fragmentation and soul descent of individuals with histories of early trauma.
What does it take to offer reparative therapeutic experiences for development and maturation of the right brain and shifts in attachment patterning?
It is well documented that the therapeutic relationship can offer reparative experiences (Pearlman, & Courtois, 2005; Siegal, 2012; Wirtz, 2014) and such opportunities require clinicians to engage in relational practice that goes beyond alliance building, attunement, and empathy to include establishment of the regulated, witness self to help integrate non-recognised dissociated parts and to reorganize the distorted IWM in the reparation of early trauma. Additionally, authenticity and emotional processing of the relationship completes “the cycle of affective communication that was insufficiently developed in childhood” and provides “an emotional re-education” that “remediates a developmental void” (Maroda, 2010, p. 20). To build a safe enough haven for exploration and connection, therapist awareness of their own attachment patterning is paramount. The safety of the therapeutic relationship offers clients’ opportunities to: experience a secure base from which to relate, explore and assess their own system of relating and IWM; attempt and process new ways of relating to pave new relational and neural pathways; and explore rupture and repair dynamics that reveal dissociative relational material, that when addressed, heal past wounds.
And, what does it take to venture into the abyss of the underworld and accompany the client as they reclaim their vital life force?
The embodied regulation of the clinician is essential to bear “witness” (Prince, 2009), “to behold” (van Loben Sels, 2005), to stay present, embodied and regulated in the face of unspeakable, undigested, extreme suffering of the other. Holding steady as the client’s dissociative material emerges asks us to reach within and beyond into our depths of connection to the sentient archetypal world, to hold our ground and avail ourselves as the regulated anchor in the dysregulated realm of trauma.
References
Bromberg, P. M. (2011). The shadow of the tsunami and the growth of the relational mind. New York: Routledge.
Maroda, K. J. (2010). Less is More: An argument for the judicious use of self-disclosure. In, Bloomgarden and Mennuti, R. (Eds.) Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy. New York: Routledge, p. 17 – 30.
Pearlman, L.A., & Courtois, C. A. (2005). Clinical application of the attachment framework: Relational treatment of complex trauma. International Society for Traumatic Stress Studies. p. 449 – 459.
Prince, R. (2009). The Self in Pain: The Paradox of Memory, The Paradox of Testimony. The American Journal of Psychoanalysis. 69, p. 279 – 290.
Schore, A.N. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51, 3, p. 388 – 397.
Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are. 2nd ed. The Guilford Press: New York.
Siegal, D. J. (2010). UCLA Adult Attachment in a Clinical Context Conference DVD with Main and Hesse.
van Lobel Sels, R. (2005). When a body meets a body. Spring 72, p. 219 – 250.
Wirtz, U. (2014). Trauma and beyond: The mystery of transformation. New Orleans: Spring Journal Books.
