Hello and welcome to the Trauma Therapy Transformation Podcast where we explore health,
Recovery and consciousness.
Well,
I think it might be interesting to talk about my early experience which I think gave me the interest in trauma.
I grew up in Northern Ireland,
The trouble spot of the troubles and I think exposure to all that violence was a key determinant for me wanting to both leave there and also to understand what had happened.
And there was one particular incident when I was no more in a moment and I was instantly thrown onto the ground.
I was only about nine at the time and I was thrown onto the ground before I realised what had happened and then a split second later there was the explosion.
And then I started to realise that my reptilian brain had sort of thrust me onto the ground as a protective mechanism.
Before the impact.
Before the impact.
Wow,
How interesting.
Yeah,
And it made me realise that there's this instinctive hardwired part of our brain that has survived from millennia really to protect us from those life threatening situations.
And my sort of journey through medicine and learning about the neurology gave me that key to work out if that information is sort of burned into that part of the brain,
The emotional part or the reptilian part.
We need to titrate that up and titrate how the body responds if you like at that moment of impact and take it out of that,
You know,
Wherever that block is so you have the person understand the driver.
Good,
Nice introduction.
Actually the topic I sent you earlier by Skype and also by email is throughout time,
How early life patterns affect our physical and mental health.
This is our suggested topic for today.
So it kind of feeds into what you just started to recount about your personal experience and the reptile brain etc.
If you would allow me,
I just had some thoughts as I was preparing the topic,
If you'd allow me just to kind of expose it from my site.
Sure.
And then I'm very keen to hear what your further responses are.
So as I was thinking of just to open it up,
I mean,
Trauma,
The word itself is quite stigmatised and marginalised and I think in the main,
In the public domain,
We're not really aware of how much it impacts us and especially when that happens in early life situations like what you just mentioned,
But also other situations like birth in itself can be quite complicated.
Early life diseases like meningitis or any kind of other disease that really severely impacts you,
Loss of a parent or loss of a sister or a brother.
So these are kind of the more normal or what we consider normal early life traumas that can happen to us.
But even there,
We don't see the ramifications on a long term scale,
What they do to our physical health and mental health.
And then of course we have the more,
What we consider more traumas in the,
Again,
In the society,
What we consider in society as trauma.
That when we talk about severe neglect or abuse,
Sexual abuse,
Beatings,
Living or growing up with a depressed or alcoholic or drug dependent parent.
So yeah,
All of that is what I consider trauma and that affects us very deeply in what you mentioned earlier in our nervous system.
And as you probably know and probably better than me is that in an early life stage,
Our limbic structure and the brainstem and the amygdala,
Thalamus and the pons,
The medulla,
They get this strong wiring of going into fight,
Flight,
Freeze mode.
And then we kind of keep running on that for the rest of our lives if we don't find any help to kind of break out of that.
So and that starts to loop on itself.
Now this is just from a nervous system perspective and it's very condensed the way I explain it.
But from there on also the emotions are involved in it.
So the hyper and hypo reflexes,
The endocrine system and from there on.
And I think the Chinese medicine is a bit more advanced to see how emotions impact our organ system.
So how anger,
Frustration,
Irritation is related to the liver,
How sense of loss,
Connection,
Compassion is related to the chest and the heart,
Etc.
So my point is just to make a link between the nervous system reflexes,
The endocrine system and our emotions and then how it affects our organs and the way we.
.
.
You're speaking exactly my language.
And when I became interested in this area I felt that early life experiences were key and it links very much to the erics and developmental stages.
So from zero to one we have trust versus mistrust.
From one to sort of two and a half we have autonomy versus shame and doubt.
And if those developmental stages are disrupted they play on right into your other life.
And for three and a half years I was part of a perinatal and infant mental health services team with adults who've been through traumatic births or very insecure attachments with their children.
And what we found,
And I'll just give you an example of a mother who was 20,
She was expecting her second child but she'd had very little relationship with her two year old and this was because she'd spent approximately six to nine months with alcohol dependence,
Drug dependence in and out of hospital.
So she had a very poor relationship with her two year old and she wanted a better relationship with her baby that was due to be born.
As part of the work we would get her to interact with the child but when she.
.
.
This is called the watch,
Wait and wonder approach.
Watch,
Wait and wonder.
So you sit with your baby on a mat,
You watch the baby,
You wait to see what the baby does and you wonder what's in the baby's mind and it helps to build up the attachment.
So when she was there there was a toy telephone and she just froze and the reason for that was when she was a baby it reminded her of the abuse she experienced by her father and her uncle because that same type of plastic telephone toy was enduring.
So until we were able to deal with her own traumas we couldn't help her to effectively parent her child.
So it just highlights how you carry that transgenerational abuse and neglect into the next generation.
What was called reenactment.
More reenactment and I was able to do a session with her where she was maybe eight months pregnant and she wanted to have a positive birth where she could feel that attachment and feel that instant bond and connection.
So I did an imaginary birth which was going to happen in about a month's time and get her to imagine how it would really be,
How she would want it to be.
A couple of months later she came back and it had worked out exactly as we'd imagined it today and she was able to see the baby,
Sort of hold the baby and get that bonding and attachment.
So it was a very powerful demonstration of the influence of that early experience and early attachment and what's really interesting is that the babies that are born have,
To be born through the birth canal,
Their heads are about 50% of adult size and up to the age of five they grow to 90% of adult size.
So that shaping of the brain,
Shaping of the emotions,
Shaping of the cortex is very much dependent on the mother-father interaction and scaffolding of the baby's brain as it were.
It can be for good or for ill so you can either make the,
Make those brain stem responses constantly in fight or flight or you can actually shrink the cortex because it's not getting nurtured.
Right,
This is very interesting that you mentioned that,
That you can shrink the cortex or not activate the cortex enough that it develops.
So you get an inverted sort of development and I bring my little brain here to explain when I'm talking to people about this.
I sort of will tell them how very much the information is driven by what sensory information comes in through these cranial nerves into the brain stem and that's if you like through our sensory motor knowledge,
Our key determinants of behaviour and then it can be either interpreted as dangerous and it triggers that instinct reflex that you're talking about or we can modulate it with our cortex to enable it to be processed.
Right,
Right.
We thought about it but if you're working from the point of abuse and neglect very early on in life you're starting at a disadvantage in terms of your capacity to regulate things.
Right,
Let's see if we can recap that a little bit because for me it makes perfect sense because I'm quite versed in this material but for some other people who might be listening into that it might go a bit over the top too quick.
So just to put it in my own words we have the reptilian brain which is part of the brain stem at the pons of the medulla and then those have the functions of fight,
Flight and freeze and you were mentioning that when those are to activate it together with the limbic system which is the amygdala and the thalamus and then the basal ganglia,
Those they can kind of keep or start looping on themselves and prevent the cortex to grow any further or to get activated properly and that kind of ties in with how we grow up,
The environment we grow up in and the nurture we get from our parents or our parent.
So I mean my question from there is that how can you with a session using imaginary,
Using a,
Like creating a,
How would I say that,
Creating a setting,
A story where you can activate healthy patterns rather than reinforce unhealthy patterns and this is an interesting question for other people to also listen to as to how is that being achieved because you can't change the past what happened.
So about ten years ago I was introduced to a paediatrician called Dr Joan Lovett,
L-O-V-E-T-T and her background was working as a doctor in a hospital and she was very tired one evening and she ended up in a very serious car crash and she was in hospital for a year.
She decided she would change the focus of her work to work with very early children who were traumatised and she concentrated on what she talked about as pre-verbal trauma or before the age of five when your body stores the information but your cortex doesn't register as a narrative story and she worked her way out of the way to build a narrative story from the parental history that would actually fill in the missing pieces of the jigsaw that the body was experiencing and then there are a number of ways where you read out this story to the person while they're experiencing and absorbing the information through generally some form of bilateral stimulation which takes it from where it's stored in the body up through the nervous system to the right side of the brain and then the left speech centre part of the brain where those neural networks can be activated.
I would be interested to know what kind of languaging is used.
It's very straightforward.
There are two books that have been written.
One is called Small Wonders which was out from about ten years ago and this is the second one.
It's called Trauma Attachment Time Ball.
And this is her latest book and it's modifying EMDR to help children resolve trauma and develop loving relationships.
So for whatever the situation is you build up a story,
Build up a narrative,
What's called a healing narrative and this would be through meeting with the parents,
Finding out what had happened to the child about your child that was neglected or adopted or had meningitis as you say and you talk about the difficulties that the child had,
What they went through,
What they would have felt,
What they would have sensed and then you build it almost like in a fairytale way of how they are now and how their bullpain was.
How would you build the parents' supportive structure in that new narrative?
Well they would be,
If the parents have been supportive of the child and they're not the cause of the problem,
They can be part of the healing group.
Let's say the child was removed from the parents and is now with adoptive or foster carers,
Then those new carers would be part of the healing group.
So I have been working with a number of children who from the age of say not to three were in very abusive,
Neglected parental relationships where they were physically abused,
Sexually abused,
Emotionally abused and now four,
Five,
Six,
Seven years down the line they've been a foster care placement or an adoptive placement but they're still reacting with the anger,
With the behaviour as if towards their original parental structure.
So the parents,
The new adoptive parents find it very difficult to relate to that because they haven't done anything but they're receiving the results.
So that requires working with the parents' own traumas initially and then helping them to recognise that this behaviour is related to the previous exposure.
Kind of making a cognitive understanding.
That they get an understanding so they're able to sort of deflect the direct aggression or behaviour and not see it as directed towards them.
And what I get from you is that it's a long term process where you're working with these families?
Well I've taken the approach that trauma is very much encapsulated I think in the body and if we can lance the trauma and bring the wound,
Open the wound in a way,
We can allow the natural healing mechanisms to take place and that part of the process can be quick and I take the approach that because I've a lot of experience now working with very severe traumatic histories that there is almost,
It's almost like if you laser in or you focus in on what the root cause is,
You can bring it to the surface and in a lot of therapeutic encounters I think because people are working on a talking level,
On a symptom level,
They skirt over the issues and they don't actually get deep enough and if we keep the person safe to be able to explore that and we wire their brains in such a way to give them the resilience to contain that emotion.
You say some important things there,
Resilience,
Containing,
Providing safety.
I would also put in there the body of course is really treating the cause rather than the symptom.
And I think what I find,
I would even go back further in my experience to when I talk to a mother and I ask the history,
I would ask her when she became pregnant,
How did she feel because that can set the tone of the pregnancy if it was wanted or unwanted and particularly how the pregnancy developed,
If there was physical trauma during the pregnancy or an abusive partner for example,
All of those things will have impacted on the baby in utero but it will have been impacted as a sensory experience and not as a cognitive experience.
Right,
Good that you mentioned that.
Now just to build on further on that,
Say as an example I'm stuck within that flight freeze mechanism,
I don't have access to more capacity of my higher functionings,
My rational part,
My cortex etc.
What we just talked about earlier.
Then one of the dilemmas I see is that okay you can open the wound as you said with carefulness,
With trust,
With providing safety,
Boundaries,
Building up slowly resilience but there will be still kind of a habit pattern that we formed of relating to our old structure rather than opening up into new possibilities which is one of the elements I use in my model that okay you can address the post-traumatic stress,
Developmental or incidental but there's a part that it's like we almost form a love affair with our suffering that we find safety in it and I know this sounds a bit perverse but because it's within the known those structures of fight flight freeze however horrible they might be that to move out of that means to move away from maybe an abusive family structure and move away from a pattern that we're used to and then to start growing into a larger part of ourselves so there's a lot of hesitancy there as well to kind of go in there.
Have you heard of the expression the devil you know is better than the devil you don't know?
In other forms yeah.
So we cling on to what we know even if it's bad because we're afraid of the unknown and there is a sort of football analogy here.
Last night England were playing Iceland and they went one nil off and then they drew and then they froze because their expectations were that.
Right sounds like the Dutch team yeah.
So their fear paralysed them and those are patterns that I think can be addressed and what I think is very helpful and I've done a model of this of what I call the hyper arousal dissociative state which I call the rapids which are the racing thoughts the affective disturbance the personality in fragments the impulsivity the dissociation and the suicidality and the corollary of that is the frozen state a freeze reaction sort of oblivious to the world zonked out or like a zombie and emotionally numb and if you activate they're almost like two sides of the same coin so you can flip from one to the other and Erskill as therapist and scaffolding and using contact statements and bringing those neurological patterns out of those repeated ways that they've used will help to widen that window of tolerance into both the hyper aroused state and extending down into the hyper aroused state and those are where those those patterns become automatic and reflexive and instinctive in a way.
Would you say that through this work because you're trying to contain hyper arousal and hypo arousal effects that you're actually when you successfully move through trauma you might be more resilient than before?
I certainly think that's true and I think what we as therapists need to be strong enough within ourselves to do is to not shy away from putting someone at the edge of their window where we bring them to the upper limits that they can cope with and then gently bring them back down again because this is what will help the new neural networks and new neural pathways to feed into almost like a root if you think of the tree as the neuron and the roots as the brain making connections you can think of those roots as making other connections and building a network of capacity to communicate in those high or low levels of arousal and people I find have new built patterns so for example this girl that I'm dealing with at the moment she goes into escalating patterns of higher arousal to the point where she just self harms because she doesn't have the capacity to go down again.
She uses me and has sort of formed me as a sort of way of actually bringing her down and containing her but that person needs the stability and security of bigger structures to help do that.
Right,
I mean it's good to emphasise here that it's very delicate work.
What I refer to often is that you're working with a minefield and you have to navigate through it quite carefully.
It's a very good analogy because you can step on a mine easily and explode it off and you don't necessarily know where those mines are so it's almost like if you can neutralise them or get the bomb disposal squad out and work out where those minefields might be and clear a pathway.
And also to know that sometimes a trigger happens but then you have like slowly on you're building up the tools to regulate that high energy charge to bring that back again and as careful as we are as therapists to titrate which is to slowly on build up capacity while we work with hyperarousal still sometimes it happens that something gets set off and then it takes another session to contain that and to work with that so just to build on that it doesn't necessarily have to be a bad thing when something gets a bit activated.
I would see it as essential and in my approach I have a model that I think is,
If you can see it,
It really just shows a sort of map of a session so we have a period of initiation where you gather the information and deepen the arousal and then we have a peak where we keep going back to the focused target that we're working on until we can reduce that level of subjective unit of distress and when we've done that then there's a period of relaxation and then finally the most important bit is a period of unwinding and reflection and sort of allowing the information to be reflected and learnt from so I would see the process of if someone comes in in a highly aroused state that we necessarily push them as far as they can go,
Bring them down to equilibrium state again and then give them an opportunity to reflect on the session so there is some learning that has gone on and I think what mistakes are made in a lot of sessions that are relatively shorter is that you never actually get to go into the traumatic material in depth and you possibly partially activate but then there isn't the capacity to learn from that experience.
I mean there's two interesting things that I pick up here,
One is that there's the cognitive part to integrate what happened and then there's the somatic part or the kind of activation part where people actually experience both the traumatic side of it and then also ideally of course the healing cycle of it of bringing it back down,
Integrating it both emotionally and cognitively.
Then I mean one other thought if I can still catch you what I got later is that okay we're bringing people to a hyperactive state or we're allowing them to together with the therapist or with the helper to go into that danger zone and I mean like I said it's a minefield so there's a healing opportunity but there's also a danger opportunity where you might trigger to such an extent that the person is in a re-traumatized state so there's just to emphasize that I'm bringing that back there there's yeah that carefulness,
Necessity of carefulness to kind of know and have the tools and also to have that center within oneself that okay you know as a professional or a helper to how to deal with that or how to bring that back to a.
.
.
I think that's a very very important point and I think people that go into this work it's the idea of the wounded healer so that if you've been through difficulties yourself you have a experiential understanding that is almost as you say a somatic understanding as well as the cognitive understanding so you can bring that to bear in your achievement with the client and with the patient to listen to their suffering rather than necessarily have a preset agenda as to what you're going to do and follow it through irrespective of what you're doing.
Right,
This is very important that I guess as a psychiatrist this is quite the way that traditionally the approach is from the medical system.
And I think that this is where the medical system has failed and I have a view of psychiatry which is particularly I think different it goes back to the ancient Greek idea of psyche being the mind of the spirit or the soul and the atrocious being the doctor who is responsible for the healing so it's like healing of the spirit,
Healing of the mind,
Healing of the soul.
Right.
And I think it's very much around the integration of the energy along with the endocrine system and with the immune system and getting the body,
Getting us to understand that the mind isn't residing in any one place but it's everywhere at a cellular level right through the organs,
Right through our nervous system and right through our belief system and interacting with the environment as well.
Interesting,
Yeah.
I mean one other thing came up is you said that there's the responsibility of the helper,
Professional or doctor to assist that process.
What would you see in your eyes is the responsibility of the patient or the one who is looking for help to kind of be with that process?
I think honesty is important and a willingness to get better and I'm dealing with this at the moment with this 15 year old boy who has said to his parents he doesn't want to get better and we're trying to work out why that might be.
But I think what I find very interesting is you can do a very detailed initial evaluation and get all of your history and your chronology of traumas and so on and it may in some way set your formulation out.
What I find in the process of actually activating information,
Unconscious information is much more valuable to bring to bear and that it creates massive level of insight for patients when they're feeling contained and safe and that trusting relationship is developed to allow this unconscious information to come to the surface because it may have been repressed for many years.
I'm kind of repeating my words.
You mentioned the willingness to work with that and honesty and I think it's quite beautifully put.
Can they be there?
Can they be operating simultaneously?
So on one level there's a patient comes to you or somebody who needs help and has that willingness or that intention to heal and that has a certain sense of honesty.
But then on another level there's protective mechanisms there at play as well.
There are resistances.
There's a yes and a no simultaneously like I want to work with this because I see it's destructive in my life but then there's another part that is invested into holding up structures of resistance because that's what's initially protecting the overwhelming emotions or the overwhelming states of suffering and that gives also a sense of containment again,
However destructive that might be.
So again in my perspective it's pendulating between the two as to addressing the raw traumatic material and then also growing into more trust and more vulnerability and more ability to set boundaries.
Now I'm kind of rambling on a little bit from my perspective.
No,
I think it's a very good point because I have a nice diagram that shows when you have the initial pre-traumatic personality that exposed to a trauma you have the working normal part of the personality that carries on which is in the left brain and you have the traumatic part of the personality which is often stored in the right brain and when more trauma happens that traumatic right brain fragments into different emotions,
The fight emotions,
The disassociations,
The attachment,
The submit part and they will often be encapsulated at particular times in their life when that served a protective function maybe at seven to protect from a violent parent or something.
So if they're in their twenties or thirties and this part of them has been there for a very long time it's not going to be easy to let go of that part until an alternative strategy has been adopted.
I often mention to the people I work with that can you honour the resistance so when disconnection happens rather than attempting to overcome or efforting to get somewhere or even trying to understand can we give a moment to sit with that disconnection and I would use questions like okay when that's happening right now where are you,
Where's your energy,
Where's your gravity point of energy at the moment,
Is it in your head or is it even do you feel it outside of yourself or can you feel that sense of numbness or can you feel that sense of lethargy that just drifted in right now and when you give attention to the disconnection then you're actually you're kind of bypassing that dissociation and opening up a connection to through the disconnection to connection again and from there on.
I think with children there is the great capacity for children to draw those disconnected feelings and recognise them because they're much more creative and imaginative and they're less,
They don't see it as abnormal and I dealt with a little nine year old boy who was being presented to me as his character with hallucinations and hearing voices and it turned out that when he was on his skateboard as Mother was in the shop a dog escaped from where he was tied up and bitten in the face and that caused his whole memory of this experience to become dissociated and he saw these monsters if you like external to him so we were able to create a story and a narrative where he was able to integrate and take control of these nasty monsters and sort of bring them out to sea and put them at the bottom of the ocean.
That you mentioned you used the imagination of the boy to actually access and rewriting the story I like that.
Well put.
Yeah.
And he was totally taking charge of his experience and he came into me with the good monsters and the bad monsters and how he was going to make friends with them and he said in the end that he enjoyed working with me because I helped him to tap out the voices and the monsters from his blood and not be worried about them.
So I think as I work primarily or have worked a lot with children I'm exposed to their great imaginative capacity and as you get older you often lose that ability or it may be not as easy.
Less accessible.
But if you have someone with a particular memory of where some of these personality fright became partitioned as younger you can actually help them process at that age.
So if it's something that happened to them say as a seven year old you can actually help them process it as if they were still seven because that's how it will often be stored in their memory.
Interesting yeah.
And do you work,
Have you worked much with children?
In the past,
At the moment I'm quite focused on adults.
My average clients are between 25 and 60.
But before I come as I mentioned in our earlier conversation I worked a lot with craniosacral therapy and somatic emotional release and there's a lot of similar work what you just described also in somatic experiencing of how to engage the imaginary or imaginative part and you use that as a constructive narrative and with craniosacral therapy you use also hands on to unwind also on a physical level the nervous system.
I just came up with a nice analogy of a mascot and it was about manipulation of the affect in the body to shift the consciousness.
Would you explain what affect is?
I mean I can get you but.
I sort of describe as expressed emotion.
So where you feel it really it's the felt sense but it can be it would be the sort of expression where do you feel that in your body.
I take a broad understanding of it really but it's essentially expressed emotion and it's often difficult to fully disentangle emotion from feeling and there's a lot of debate about that.
But I think affect would be the body's response to what you're experiencing and what I feel that is very important as I've developed this therapy approach is that it tends to start off at a gut level because we all talk about and politicians would say I feel this in my gut or I'm sick to my stomach and you know if you think of that from a physiological point of view when animals or when we're particularly worried about something we would have vomiting or diarrhea because it's core to our sensory experience and it relates to food as well.
So that gut feeling is our sort of instinctive primitive registration of an emotion and a feeling and my experience has been as people process that it travels up through the energy centers and through the nervous centers and then will filter into the cortex and actually right.
I mean it's bi-directional as you know of course from the gut to the brain through the vagus nerve and then also through the central nervous system down and I mean I've chosen quite a wide topic so we can't cover all of it and what we haven't really gone into are the physical and mental health problems that causes those activations or hypo and hyperactivations but in the light of our conversation I think we have to kind of put some boundaries here and keep that for our next conversation.
It would be really good to because I think we're very much on the same wavelength in the approach that we take and I think we can it's this idea of top up I think a lot of people are very much top down and not bottom up exactly but if you integrate the two you get a much more improved function I think so yeah absolutely what I call cognitive and somatic approach combined together just different words but it boils down to the same thing.
.
