Friday, 24 February 2017

Working with dissociation; some surprising symptoms and their resolution

In the course of my work some things still manage to surprise me. Today I was working with a lovely client who has endured years of chronic fatigue as a result of traumatic dissociation (but who was unaware exactly what was the issue - she just knew she failed to connect with her life somehow). This lady is a delight to work with (as are all my clients really), but she has a very particular way of releasing the pent up energy that has been spent keeping her emotions locked in.

In one of our first sessions as we went through the process of trauma transformation (using a mixture of EFT, EMDR and havening) we got to the point of discharge of an old belief system and its stored energy and she said she felt like shaking. I have come across this discharge response before, both in clinic and in my research (particularly the work of Peter Levine*) and luckily was not perturbed by this comment. I suggested she get up and indeed 'shake it all off' which she proceeded to do. The next few days were remarkable for this lady; previously unable to concentrate on things she succeeded in playing the piano for the first time in years and spent an hour making something in needlework. It was a remarkably quick turnaround. But more was to come...

In another session we were discussing the myriad symptoms of traumatic dissociation including tinnitus, vertigo and ear wax build up and pain. I told her a story of my own problems with my ears, and we got around to discussing how she might move forward. I explained about using Levine's shower techniques where you direct the spray to parts of your body whilst saying 'this is my arm, this is my chest, etc.' Sounds wacky if you don't understand dissociation, but effectively the brain refuses to acknowledge parts of your body if they were involved in some traumatic event in your past. This can be mild like tinnitus where blood supply to the nerve is restricted, or it can be severe as in depersonalisation. My client at this point had an 'ah-ha' moment and told me the story of how, until she had a number of sessions of massage in her thirties, she had never been able to draw anything on the middle of a piece of paper, they always ended up on the left only. This is a classic example of dissociating the right side of your body (represented here by the visual field in the brain). This was her brain's response to an overwhelming trauma at some point in her childhood where she effectively 'cut off' the right side of her sensory perception. The right side of the brain also happens to be the side of creativity and play so I suggested this might be the reason why she had given up all the things she loved to do.

I do massage as part of treatment with some clients, others have a mixture of EMDR, EFT and havening. I chose the appropriate technique for different people. I have noticed that connection with the body is the most important precursor to recovery. But whatever way you do it, the results of release are phenomenal; you gain joyful appreciation, connection to yourself and others, a deep peace that you haven't felt since you were tiny (hopefully). I have witnessed this time and time again with clients- and because I am a HSP - Highly Sensitive Person (see the work of Elaine Aron) I can feel the change in that person that I am working with. Another lady I worked with recently seemed to visibly 'drop' into herself at one point; I swear I felt it happen. I commented - 'you just seemed to arrive back into your body' and she opened her eyes and said that is what she felt had happened also. She has been so much better since then.

The one thing that enables me to do this important work of trauma recovery is to witness people making progress - usually bit by bit (too quick and the change is overwhelming and the threat response is activated)- but sometimes as I've described above it can be remarkably quick. And, when, as today I have 2 clients who are able to sit with me and describe feeling real joy in their lives for the first time since childhood, more energy, and a sense of purpose I know that my work is done. We are all 'work in progress' but with the right tools and person it becomes SO much easier.

Wednesday, 1 February 2017

Attachment - the impact on therapy and the client- therapist relationship.

On Saturday I went to a workshop with Carolyn Spring of the PODS group -  Positive Outcomes for Dissociative Survivors

The workshop was on 'working with Relational Trauma' which included some really useful insights into working with people who have had poor attachment experiences in their childhood. Attuned response from the mother (or other caregiver) changes the baby's brain because it interrupts the flow of stress hormones and helps the baby produce oxytocin and serotonin (the feel-good hormones). What do we mean by attuned? Well the mother understands her baby's needs and responds appropriately. This will usually happen within the first 6 - 9 months and set the pattern for the rest of that baby's life. When it is absent or sporadic, the baby's brain is changed; having less receptors for the feel-good hormones and less connections between the developing front brain (cortex) and the survival brain (brainstem, cerebellum and limbic system). The baby becomes an adult who can have disordered behaviour stemming from inaccurate beliefs about themselves.

I've blogged already about the differences between organised and disorganised attachment strategies (see here) but what was interesting about this particular workshop was the impact it has on therapy and the relationship with the therapist.
we are talking about relational trauma after all- these people were not born this way but learnt how to survive in families in which the primary relationships were not secure. the main feeling in these situations is lack of safety and it is therefore something that the therapist must ensure is present in all dealings with the client.
But more than this there are pitfalls that I know I have fallen into before that occur because the 3 main strategies that I see (insecure-avoidant AV who become 'Dismissing' in adult life), insecure-ambivalent (AM become preoccupied) and disorganised (DIS become unresolved) have very particular failings that will carry through in the beliefs of that person into adulthood. And they have interactions with our attachment styles too

Now, it is a well-known fact that most therapist and clients are NOT the secure style so I will leave that condition out of my matrix.
Peer Relationships
AV and AM tend to be attracted to one another but have difficult communication; AV will close down when under threat emotionally while AM will tend to want to 'have it out then and there' and will chase the AV which closes them down further. AM then feels AV is ignoring them or blocking them out and a destructive cycle ensues.
Therapeutic relationship
As AV clients will tend to intellectualise (they are more thinking than feeling) the style of therapy should emphasise their thoughts more in language and not collude in ignoring their feelings by mirroring emotional control. Boundaries need to be kept soft and one needs to metaphorically and in some cases physically STEP FORWARD in the therapy. Get enthusiastic about their successful negotiation of getting their needs met to help build reliance on others. Allow some self-disclosure that builds trust and shows how emotions can be survived when dealt with well.
.AM clients tend to be all feeling; they will rush to tell you everything straight away with  much feeling of overwhelm. We need to praise their successes as this builds resilience.
Both styles were adaptive at the time of their inception but have become maladaptive in adult life. The therapist acts to build secure attachment over time with consistency and support.

Everyone needs to know that they are not at the mercy of their history - there is hope for recovery. This is my life's work and I am very proud to say I have helped many people achieve release and mastery of their lives.