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.

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.

Smoothies to delight you!

Everyone is doing juicing and smoothies it seems so I thought I'd add a few recipes plus a few suggestions for supplements to add to those. My main belief is that they should taste yummy and be full of nutrients. No point forcing yourself to drink things that are unpleasant!  I have my own breakfast cereal too which I've included in the recipes.

 

Tricia's breakfast booster:

1 cup organic oats

1 tspn pumpkin seeds*

1 tspn sunflower seeds*

1 tbspn chia seeds*

1 tspn ground flax seeds*

a few organic cranberries

3-4 brazil nuts ground with 1 large date

a few hazenuts

some coconut flakes and dessicated coconut to taste

7-10 almonds ground and with water added for almond milk

1/2 tspn raw cacao powder

1 tspn maca or lacuma powder

* these amounts are roughly right. I tend to make up a batch and just add the 'almond milk' concoction fresh each day.

leave it to soak for 20 mins before eating. it's delicious and fills you up!

 

Annette's New year Breakfast on the go Smoothie:

Half a carrot

1 Small handful of kale

1 apple

1 Handful of fresh pineapple chunks

4 teaspoons of ground almonds( for protein and keep me full)

1/4 pint coconut water

Topped up Mineral water to the load line on the blender cup( which is just under 1/2 pint)

Table spoon fresh chopped coriander (good for cleansing the blood )

1 inch chunk of cucumber.

Here's some from cyptoplan a not-for-profit supplement supplier who I work with:

 

Deconstructed Black Forest Gateau (Serves 1, as a meal)

20 whole almonds (preferably soaked overnight)

10 cherries

100 ml coconut cream

100 ml filtered water

2 teaspoons of cacao powder

Beetroot Brain Boost (Serves 1, as a meal)

1 red beetroot

5 walnuts (preferably soaked overnight)

40g of blueberries

40g of raspberries

½ avocado

300ml of filtered water

Cocoa and berry smoothie (Serves 1, as a meal)

½ avocado

Tablespoon raw cacao (or unsweetened cocoa)

1 desert spoon mixed seeds

Handful berries (eg raspberries or blueberries, frozen is fine)

Handful of spinach

1 desert spoon olive oil or teaspoon coconut oil

Juice 1 lemon or lime

Piece of fresh ginger

100ml Coconut or Almond milk

 

Enjoy people!

The hidden dangers of GMO's

You've no doubt heard of the fact that genetically modified organisms (mostly bacterial DNA) have been incorporated into some food crops in order to make them resistant to herbicide. The idea behind this technology was to enable farmers to spray their fields with glyphosate based herbicides which would then only kill the weeds and not the crop. This sounds all well and good on the surface. But there is a terrible cost to us which is only just beginning to surface as our understanding of what goes on inside our gut becomes more well-known.

We are a community of micro-organisms. They reside on our skin, and inside our guts. They constantly breed, metabolise (providing us with a host of organic chemicals like vitamins and neurotransmitters) and most importantly for this discussion interchange their DNA with ours. Now if you put foreign DNA into these bugs (as happens with GMO's) they begin to interchange with our DNA. We start to get leaky gut symptoms as our mechanisms for regulating the opening of spaces between the gut 'skin' or epithelium are largely controlled by the metabolites of our gut flora and the interaction with food molecules.
In other words when you start messing with our food you cause irrevocable changes to our own DNA and cellular functioning. Hence we start to get sick.

Sickness of workers in developing countries where GMO's were largely trialled first pointed to the problem. Their kidneys began to fail due to the build of toxins which they were unable to get rid of as glyphosate, the active ingredient of Roundup, chelates (binds) minerals in their bodies and prevents absorption. Now it is beginning to be felt in western nations, particularly the US. However, such are the vested interests of the pharma/agribusiness monopoly, you are unlikely to hear about it in national newspapers or magazines.

When our gut flora are imbalanced we cannot absorb our food properly, we are undefended against attack by pathogens (bad bugs). and our mental health suffers as most of the neurochemicals in our brains are made in our guts. The rise in depression, anxiety, obesity (due to unregulated eating), and a whole host of chronic illnesses like autism, auto-immune conditions, are linked to this problem.
The best solution is to eat organic, non GMO food. And heal your gut with a proper protocol of nutrient rich food and supplements. De-toxify with support for your liver, sunshine  (for Vitamin D), sleep and infra-red saunas.  I'll be covering that in another post.. This isn't a luxury, it's vital if you want to live a happy, healthy life to old age.

The leading researcher of this field, Dr Jeffrey Bland, has called it 'completely irresponsible' to let people eat GMO foods as the pollution of the gene pool through cross-fertilisation is permanently contaminated for all future generations,  See his book Genetic Roulette and his website responsibletechnology.org. I think even he understates the case here. This is a ticking time bomb; our longterm survival as a species is at stake!

This is an extract from the soon to be published book 'The World within; how your gut bacteria make you who you are'

The importance of Lymph on brain function

Listening to a video and reading the article by Dr John Douillard about the importance of the lymphatic system on our health. I think this is probably the issue I had recently. I thought it was something else entirely. but it matches what was happening to me - and you have lymph nodes just above the gut which is where I swelled up.

This article also highlights the importance of the brain's 'glymphatic' system, (lymph vessels around the glial cells) only recently discovered, which drains toxins out of the brain at night - hence the importance of sleep to our overall wellbeing and avoidance of dementia.

Does anyone remember Margaret Thatcher famously only slept 4 hours a night? - and you know how she ended her days.. Probably the same was true of President Ronald Reagan. He also got dementia.

Sleep on your side for best drainage - and try to get 6 - 8 hours.

I shall be talking about this amongst many other fascinating subjects in my next book 'The world within - how your microbiome makes you who you are' due out 2017.

See here for more details on this issue.

Frozen shoulder - the double burden

Frozen shoulder is something that I come across often in my practice. In my initial training as a massage therapist we were taught it was an unexplainable condition that came on suddenly, mostly in women of middle years and would last 1 - 2 years and disappear as suddenly. This intrigued me. How could a condition just disappear?

It is characterised by an inability to move the arm out from the body more than a few inches before intense pain is felt. usually when it first comes on it is noticed in the act of difficulty moving behind the body (as in doing up the bra in women). As it progresses movement will become increasingly limited and painful. What lies behind this symptomology? Is it a trapped nerve, or fascia - and if so how does it spontaneously resolve? What can a physical therapist do to help alleviate? These are some of the questions that have been troubling me.

In my subsequent study and practice of mindbody medicine, there appears to be a more logical explanation. If any of you have come across the work of Peter Levine, author of 'Waking the Tiger' (1) you will know that the mind and body work to keep the organism safe in times of danger or trauma. But, unlike the rest of the animal kingdom, we often do not discharge this energy after a brush with danger. The instinct to shake is often suppressed as we are told to 'pull ourselves together' or have a stiff drink. But in fact this normal body movement is necessary to remove the energy of the stress response from out of the muscles and if we don't do it, or can't do it we can get 'stuck' in an unresolved mobilisation to stress.

Now it is a fact that muscles move in concert with one another. Any movement needs the controlled response of two sets of muscles- the agonist and the antagonist. It is also true that emotions play a part in mobilising this response. Say for instance you are involved in a car crash and you go to move your hands up to protect yourself but they are held by the seatbelt. your instinct is thwarted. your life or the threat of injury has undoubtedly been saved but there may be a lingering response in your brain which is not discharged. It appears that this may be what lies behind such conditions as frozen shoulder. As Peter Levine himself states "the motor expression of two intense instinctual responses creates a conflict and results in frozen states... the energy bound in inhibited (thwarted) responses  is so powerful that it can cause an extreme bracing that often has profound effects" (2, P196).

But it's not only extreme trauma like accidents or shell-shock under war conditions that create stress in the body. I have already written extensively about 'everyday trauma' of common events like poor parenting, bullying, surgery, etc in my recent book (3). These stimulate our stress responses too. And it may be that when this is not cleared from the mind body of the person that conditions like frozen shoulder, or sciatica represent those undischarged muscular and nervous responses to threat.

What can we do then as therapists - or sufferers ourselves to help discharge and heal? Well, there are many ways but all of them involved becoming more aware of the body and helping to tune in (interoception) to the movements our body is trying to make. With frozen shoulder it is suggested to make the small movement you can make without pain extremely slowly while concentrating on what your body is telling you. with gentle encouragement you are often able to increase the range of movement when you discover what messages are being sent to the muscles which are stimulating both the agonist and the antagonist at the same time to lock the range of motion. Go even slower and do it again. The answers will often come spontaneously as a wave of shaking, crying or sweating relief - the is I sympathetic activation and shows you that your body is releasing. obviously for some people this happens spontaneously within 1 - 2 years. but to be able to do this yourself means you don't have to suffer so long.

Peter describes these techniques in much more detail in his books - but for now I leave you with one thought. As an example of how this ant/agonistic muscle stimulation happens - people who jump from burning building often break their legs before they hit the ground (or the net) due to the simultaneous in tense contraction of the leg muscles putting intolerable strain on the leg ,bones!  (2, p198). Food for thought how smaller but perhaps more chronic stresses, especially in a helpless situation may change the brain to lock the body in a protective response cycle. This, I believe explains frozen shoulder than any other explanation I know of. And it may explain too, why women suffer far more from this than men. helplessness is a state characterised by childhood but also by some women (and men of course) in their adult lives. A bullying boss, husband or just the intense suffering caused by living in a world that does not support or encourage you can be enough. Food for thought indeed.

Copyright Patrica Worby 2016. www.patriciaworby.co.uk and www.alchemytherapies.co.uk

1. Levine, Peter (1997). Waking the Tiger. North Atlantic Books.

1. Levine, Peter (2010). In an Unspoken Voice; How the Body releases Trauma and Restores Goodness. North Atlantic Books

1. Worby, Patricia (2015). The Scar that Won't Heal; Stress, Trauma and Emotion in Chronic Disease. CreateSpace.

The Neuroscience of Being 'Us' - Part 2 How threat and unresolved emotion changes the brain

Interactions between the cortex (frontal lobe) and limbic system; the anterior cingulate and insula

(Part 2 of a 2 part series see here for part 1)
There is another important part of the mid-brain (adjacent to the amygdala) that has a function in registering threat and helping to lay the foundations of trauma. It’s called the Anterior cingulate cortex (ACC) and is important as a filtering system. It is another part of the brain that is functionally degraded as a result of trauma. It possesses structures called spindle cells which wrap around the nerve bundle of fibres linking the left to the right sides of the brain. These connections between left and right may be very important for how emotions are integrated and the meaning made of the emotional events in our lives– and it may be key to why techniques such as EMDR which stimulate better integration allow re-wiring to occur .

The Anterior Cingulate Cortex ACC is primarily involved in fear conditioning as it normally inhibits the amygdala, which as we know is the primary area for threat encoding. However, it also appears to play a role in emotionality, selective attention, and certain social functions, including emotional attachments and parenting, as well as generation of the concept of the self in relation to society. It is my contention that this is the part of the brain that fails in attachment disorder, and other more chronic relational trauma disorders. I have particularly noticed that the sense of self is often highly distorted, even in very outwardly functional people. They operate despite their own self-loathing to become very respected/hard-working/ achieving people but when questioned they cannot see that anything they have done has any worth. If you press them they will acknowledge grudgingly that it might have value but they do not feel that emotionally, it is more of an intellectual awareness. The ACC might be the part of the brain that we bring ‘online’ in trauma treatment, as when we do EMDR. We rewire the responses by a process of extinguishing the conditioned response of self-hating or limiting. I will discuss this within the tools section.

The insula (another part of the cortex just behind the PFC) is an area that helps interpret incoming sensation, rating it dangerous or not. It is highly involved in our subjective experience of pain, for example, and can become active just by imagining pain as well as in more pleasant experiences like music appreciation. It monitors incoming signals from the body (particularly the physiological experience of emotions like sadness, fear, anger, etc) and combines this information with the limbic system and brainstem to generate appropriate responses. As we will see later, when the signals get scrambled by unresolved emotional memory, stress is able to overwrite any inhibitory stimulus and most incoming signals are interpreted as painful, dangerous or life-threatening, causing all sorts of chronic pain and stress-related diseases.

Left and right sides; the Corpus callosum connection

Despite the fact that the cortical structures are split into left and right hemispheres, the brain remains undivided at the level of the lower reptilian brain structures - sometimes referred to as the ‘subcortical bridge’ In treatment, the client and therapist may also be able to capitalise on this. Nonverbal information, including “unconscious or preconscious codes, nuances we can never attach a name to,” cross most readily (Austin, 1999) . Using somatic experience as an entry point in therapy and maintaining mindful awareness of the body may facilitate information processing by enhancing information transfer between the hemispheres. This is what is aimed for in clinical hypnotherapy intervention by engaging the imaginative right hemisphere. However, there is controversy in hypnotherapy as to the nature of hypnosis as we have already shown with regard to whether it is a state separate from normal everyday experience or not. This was developed further by the great hypnotherapist and psychologist Pierre Janet.

We have already intimated that in subjects with PTSD and other lesser traumatically encoded states, the amygdala may become hyperactive towards “a generalisation of the fear response” or conversely underactive which “may allow continued functioning in situations characterized by ongoing threat” such as that experienced by a child who is under threat from their caregiver. That this may be in part to do with the alteration in function of the left and right hemispheres and specifically their inter-communication is an ongoing debate with psychotherapy.

This is an extract from my book The Scar the Won't Heal - available now on amazon. In the next instalment I look at Interactions between the cortex and the limbic system.