Embedded Suffering, Embodied Self:

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1 Embedded Suffering, Embodied Self: On the Challenges of Being a Trauma Therapist Milton Erickson used to say to his patients, My voice will go with you. His voice did. What he did not say was that our clients' voices can also go with us. Their stories become part of us part of our daily lives they change us. (Mahoney, 2003, p. 195). 2 A Tale of Caution. The impossible tasks of a trauma therapist Existential crisis Embodied simulation and physiological empathy The rollercoaster of attachment emotions 3 1

2 Trauma Therapy: Doing the Impossible We must resonate with and be receptacles for the client s intolerable affects of rage, shame, fear, disgust, hatred, horror. We must remain non-defensive in the face of rejection, hatred, ridicule, and blame that normally evoke defense. We must be grounded in reality, clearheaded, and highly focused in a context of confusion, avoidance, dissociation, dissimulation, and distortion. 4 Trauma Therapy: Doing the Impossible We must prioritize and hold hope in a context of chaos, urgency, desperation, and despair. We must remain balanced and tolerant of ambivalence in the face of the client s all or nothing, black and white world. We must bear witness to shattered lives without becoming cynical or overwhelmed. We must be willing to lose a client and fail. 5 We must realize unbearable pain and cruelty, without the need to fight or flee or change the facts; and then, we must move forward with that knowing. ~ Steele,

3 Existential Crisis There are few professions in which existential crisis is a focus from hour to hour How does it impact us to live on the edge of the abyss, pondering existential questions that have no satisfactory answer? 7 Existential Issues Isolation and aloneness Meaning Suffering Freedom and responsibility Death and mortality 8 Mirroring and Imitation The mirror neuron matching system enables us to use our experience to penetrate the world of others by means of a direct and automatic process of embodied simulation. (V. Gallese, 1995)

4 Mirroring By means of this process of embodied simulation we can automatically establish a direct experiential link with others at an implicit level. (V. Gallese, 2002) 10 Embodied Simulation As therapists, we need ways to engage in Behavior reading and Mind reading Embodied simulation is the foundation for how we engage in these important actions that foster understanding, collaboration, and connection 11 A Two Way Mirror Our patients must have the positive experience of being attuned to and mirrored by us. But what happens when we simulate in ourselves their negative emotions and suffering?

5 Physiological Empathy Somatic and emotional experiences in the therapist which result from unconsciously mirroring the patient s physiology -- (Wilson & Thomas, 2004) 13 The Physiological Rollercoaster of Attachment Many of the most intense emotions arise during the formation, the maintenance, the disruption, and the renewal of attachment relationships. -- Bowlby, 1979, p The Therapist and the Therapeutic Relationship As trauma therapists, we are continually working in and with troubled relationships, which can evoke both the best and the worst in each of us

6 Negative Transference Most of our work is spent in the negative transference, where we are the object of: Fear Mistrust Rage Shame Need Dependence Misunderstanding 16 Defense in the Therapist It is only natural that defense is our first reaction to feeling fear, shame, disgust, or being overwhelmed. Defense reactions: Increase our heart rate and blood pressure or drop it Activates stress hormones Promotes inflammation 17 Familiar Territory: Defense Against Threat Flight Fight Freeze Collapse

7 The Therapist as Wounded Healer Our own history of trauma or other kinds of suffering may be activated by the patient s suffering, which mirrors our own. Thus, dealing with our own history is essential, to the degree possible, before working with trauma survivors And dealing with new aspects of our suffering that come up in reaction to our patient s suffering is also important 19 Stress in the Therapist Chronic muscle tension leads to muscle dysfunction and chronic pain or headaches and migraines Incidence of chronic respiratory diseases Immune System responses Problems with digestion and eating Altered hormones and sexual function 20 Stress in the Therapist Depression and anxiety Cognitive problems Dissociation and PTSD symptoms Lack of interest in activities Fatigue Sleep problems Relational withdrawal and difficulties Burnout and vicarious traumatization

8 Vicarious Traumatization A disruption in the trauma therapist s perceived meaning and hope (McCann & Pearlman, 1990) VT is acquired through having empathy for our patients Problems with security, trust, self-esteem, intimacy, and control 22 Vicarious Traumatization, cont d. Feeling too much vs. feeling too little Somatic complaints Sleep problems Mood swings Boundary problems with clients Over-focus on work vs. avoidance of work Lack of enjoyment 23 Recognizing VT in Yourself Irritability, depression, anxiety Negative changes in sleep, eating, routine Persistent negative thoughts Reactivation of old personal trauma Withdrawal / isolation Life lived on the surface of consciousness Lack of energy / interest Dreading work, dreading patients Intense dislike of patients

9 The Whole Person of the Therapist We are affected physically, emotionally, and mentally by our patients! 25 Embodied Engagement The art of being present and engaged with ourselves, with others, with our world 26 Embodied Engagement = Presentification (Van der Hart et al., 2006)

10 Embodied Engagement Engagement with self Social engagement Engagement with our world (nature, animals, etc.) Engagement with a perspective of compassion and boundaries that both holds and releases. Acceptance and realization help us cope with suffering, pain, and uncertainty Support acceptance, realization, and emotional regulation 28 Embodied Engagement Embodied Engagement is both the simplest and the hardest thing to do It can be as easy as breathing and as complex as being in the room with a dysregulated patient, while managing your own reactions, and staying attuned and in balance 29 Embodied Engagement Keep your own experience more real to you than your patient s experience of suffering Do not make mental images of your patient being hurt Do not imagine putting yourself in your patient s place Stay in your body Stay present in the moment

11 As I walk, making this road, I have the strangest feeling that my heart has simultaneously diminished and expanded. ~ Steele, 2009.And if this journey, which has both given and taken, be not entirely good, it is most certainly genuine and honest. It is a real and present encounter with each other and our selves. What more could we possibly ask? ~ Steele,

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