Sunday, 13 January 2019

Nurturing Resilience

I was lucky enough to be able to attended an amazing training with Kathy Kain in Melbourne called “Touch Skills for Therapists” and, during my Christmas holidays, finally read her book “Nurturing Resilience” (Helping Client Move Forward from Developmental Trauma) co-written with Stephen Terrell.

Too little is known about trauma and trauma informed therapy is unfortunately still underrepresented in the field of therapy. This can have a catastrophic effect for clients with complex early trauma, who often also suffer from physical symptoms such as migraines, fibromyalgia, chronic fatigue, autoimmune disorders, sensitivities to the environment, pain syndromes, insomnia, irritable bowel syndrome, spastic colon, constipation and/or diarrhea.

When not highly qualified it is easy to destabilize this client group further. They often suffer from intense emotional and physical dysregulation with a tendency to be hyper-aroused or hypo-aroused, limited resiliency and a predisposition to dissociate. Attachment and bonding difficulties are often underlying and their symptoms can escalate dramatically out of nowhere.

I  learnt a lot reading this book and can only highly recommend reading it for yourself. The following is just a short summary (some sentences are direct quotes from the book) of what was important to me, and hopefully it will inspire some therapists and health professionals to purchase the book:

When we grow up in an environment which is chaotic and lacks consistent feedback surrounding the safety of a situation, we become confused and then can’t properly differentiate between what is safe and what is a threat. We are then tuning more acutely toward the assessment of danger and limiting our ability to recognize safety when it happens. Then our physiology later in life will constantly prepare for danger, which has a detrimental effect on our health long term as constantly preparing for danger uses up a lot of energy. This means that there is not enough left for e.g. digestion, tissue repair and the immune system. Stress chemicals like cortisol will cause havoc and in the end our physical systems can be completely turned upside down and work against us. Parasympathetic nerve and sympathetic nerve become out of sync and turn on when they shouldn’t. In some cases they may even do the opposite of what they should be doing.

And the thing is, when we are tuned in to danger, we will certainly always find it! This then becomes a self fulfilling loop:  “our dysregulation signals threat, our memory of past confirms that threat is present and our threat response kicks into gear. We will over-respond or under-respond to the experience of threat and others around us are likely to respond as if they too are threatened.... We may even misinterpret healthy sensations and responses or give them a lopsided meaning!"

Hence the biggest importance in therapy is the building of a “safety map”:  learning to track positive sensations to describe what safety feels like (not just cognitively as developmental trauma happened way before the cognitive brain was developed):
“Interoception is the process by which a person notices their internal state. A combination of sensations and perceptions of physical processes are then evaluated by  the person to assess their interior milieu and decipher what it’s telling them about what they are feeling, how they are and even who they are.”

Improving interoception is a big part of building capacity towards resilience and is key in healing from trauma. “Our loudest source of interoceptive information comes from our digestive tract, it sends back a tremendous amount of information back to the brain.”
Interoception and Exteroception together (aka Neuroception) are the body’s holistic responses to tell us whether we are safe or not (this is not a cognitive process!!).Under stress even a healthy perceptive system provides distorted information. So if someone grew up with early trauma the amount of distorted information they have stored unconsciously is tremendous.

In therapy it is most important to develop a somatic vocabulary for positive experiences. Without properly attuned interoceptive language we cannot recognize the felt sense of safety; we cannot tell if we are truly regulated and hence can’t truly regulate ourselves when needed. It is so important to be able to differentiate between threat and excitation (enjoyable-ness without any threat). Clients who lack a “safety map” are only tuned in to a trauma map which will shape all their experiences.
Key element in treatment of developmental trauma is hence helping the client build healthier and more accurate interoception. Clients might not recognize “normal” when they feel it, they may interpret sensations through the lens of potential danger in the beginning instead of checking them out with curiosity and experimentation. “Resilience and regulation often have a quality of quiet that some clients will find unnerving. Quiet in the past signalled to them that something bad was about to happen to them.”

Regular homework to notice when something positive or pleasurable happens is supportive for clients. They need to learn to identify these experiences on a sensation level (otherwise it is too cognitive, too much rooted in higher functions of the brain that weren’t online at the time of the traumatic experiences)

The ACE (Adverse Childhood Experiences) study showed that trauma increases the risk of significant health issues over time. Immune responses and uptake of nutrition via digestion and access to replenishing rest are limited, while survival physiology is ramped up. This means that we than have too much sympathetic activation with inadequate breaking from the parasympathetic system. The body may even works against itself when sympathetic and parasympathetic systems are activated at the same time; and a high dorsal tone means being stuck in a freeze state. “A chronic dorsal state in a client is the mirror image of a chronically high level of sympathetic arousal with secretion of stress chemicals that disrupt bodily systems and don’t support relaxed social engagement.”
Contributors to ACE can be: prenatal and perinatal trauma, hospitalizations, early separation, neglect, domestic violence, alcoholism, falls, anesthesia, exposure to toxins, head injuries (just to name a few).

In the first three years of childhood we build the neurophysiological architecture for regulation and connectivity. The vagus nerve that supports social engagement acts as a break on the sympathetic system. It is responsible for slowing the heart rate without needing to secrete stress chemicals that disrupt other bodily systems. The vagus nerve becomes myelinated in pregnancy and this process continues through to adolescence, though most of it happens in the first 6 months after birth.        “When our early foundation is wobbly, everything built on top of it becomes unstable.”

The goal in therapy is regulation and to expand the window of tolerance. When in the window of tolerance we are truly regulated. We are in the optimal arousal zone, have the ability to self sooth and self regulate. We feel safe and connected; capable to receive, process and integrate information, and have the ability to reach out and have a sense of belonging.

Clients with early developmental trauma use a Faux window instead. They look regulated, but have to use defensive management patterns as a substitute for regulation. This can be via compulsive eating, drinking, dissociation, acting out, self medication, busyness, overworking, obsessive attempts to experience a sense of social connection (eg. constant smiles/ joking) or isolating oneself and withdrawing as social situations feel too overstimulating. In the faux window we create a sense of stability and regulation of arousal by narrowing our range of responses, reducing our flexibility and our ability for vulnerability. 

To give you a personal example: After a counselling session I had with my supervisor where too many old childhood stress chemicals were released all at once, I had to isolate myself from the world for days and overuse my old faux window. I was very aware of it after reading Kathy’s book and worked hard and asked for help to stabilize my own nervous system in order to be able to return to equilibrium and my window of tolerance.

Therapists need to have highly trained observational skills to notice subtle indicators for when a client is in a faux window as a client might look completely calm on the outside and even report feeling calm and normal. But a change of face color, body posture or breathing pattern might indicate that they are actually dissociated or anxious without being aware of it themselves - the  faux window has become the norm for them.  “A clients return to faux window may be mistaken for a return to regulation and the clinician may proceed with further interventions that only serve to strengthen the client’s defensive accommodations... A clinician can easily misunderstand or misjudge the client’s capacity to tolerate more stimulus.”

Therapy with ACE clients needs to be regulation informed, come in small increments and work from the bottom (reptilian brain) up. A therapists own ability to authentically self regulate and co-regulate will be vital.

There was so much more covered in this book for therapists, like the role of touch in therapy, somatic shame, polyvagal theory, the locus of control, the narrative of trauma and over/under-coupling.
I can highly recommend reading this book and can’t wait to read the next book “The Tao of Trauma’” that Kathy Kain has co-written with Alaine Duncan.

I hope that with my summary I contribute to your curiosity in understanding trauma and trauma informed therapy.

I certainly am passionate about this field.

Barbara Schmidt

Barbara Schmidt
Counselling Somatic
Trauma and Nervous System Recovery

If you want to find out more about your nervous system and the incredible healing from trauma I am inviting you to read the short articles on in my blog section  - you can subscribe to my newsletters via my website and receive all future blogs conveniently via email/

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