Week 36 Critical Insights Session

Transcription

1 Week 36 Critical Insights Session with Ruth Buczynski, Ron Siegel and Kelly McGonigal Dr. Buczynski: Hello everyone and welcome back. This is the part of the week where we get together and synthesize the ideas from this week. I m joined, as I always am, by my two good buddies, Dr. Ron Siegel and Dr. Kelly McGonigal. We re going to jump right in, with the question we always start with: what stood out to you this week? Dr. Siegel: Well, what stood out for me is, Wow there really is a very strong connection between trauma and shame, particularly the notion that what s so often damaging to people is not the traumatic experience per se, but the assumptions about me as the traumatized victim. What s so often damaging to people is not the traumatic experience per se, but the assumptions about me as the traumatized victim. People feel that they re weak, that they re disgusting, that they re bad, that they didn t do what they were supposed to do, that it s somehow their fault, and on and on all the litany of shameful thoughts that people have when they ve experienced some kind of trauma. And perhaps those negative narratives about the self are even more damaging than the other narratives that can come out of trauma, which is that the world is a dangerous place and that you can t trust others, or that others won t be there for you when you need them. It s also interesting that shame is associated with the parasympathetic shutting-down response, this response of the mouse in the cat s jaw. Yet in trauma we know that people have two kinds of responses and they often alternate between the two they either get hyperaroused, in which there s a lot of sympathetic activation and a lot of strategizing about how to fight or flee, or they have this parasympathetic shutdown response. So I just found it interesting to start thinking that, when people are experiencing the shame dimension of trauma, maybe that s when they re more in this hypoaroused state. Shame is associated with the parasympathetic shutting-down response. Sometimes the fear of shame will create a kind of anxious hyperarousal. Although sometimes the fear of shame will create a kind of anxious hyperarousal; that, Uh-oh. I m going to think of myself in this shameful way, or people are going to think of me in a way which is shaming. And that generates anxiety and often taking action to try to avoid that. So there s this complex interrelationship between hyperarousal, hypoarousal and shame and trauma.

2 The other thing that stood out to me as a take-home point was the variety of different methods people put forth. Bessel talked about EMDR (eye movement desensitization retraining) being helpful for relatively simple trauma. And he talked about psychodrama actually acting out the scene as a way to make it visceral and make it come alive. Pat Ogden had a very different approach with the different body postures the person who s sunk backwards and in a shame posture (perhaps after trauma) might try to practice literally pushing back with the body. That could be effective. And Peter Levine talked about the 45-degree chairs as a way to give people space, which I thought was very useful. Then, finally, Dick Schwartz was talking about the various parts, and I m sure we ll revisit that. And they all seem sensible, they all seem plausible. So it left me with the take-home point of it s probably helpful for clinicians to have a diverse toolkit and to be able to approach shame from a number of different angles. Dr. Buczynski: Right. Kelly, what stood out to you? It s probably helpful for clinicians to have a diverse toolkit and to be able to approach shame from a number of different angles. Dr. McGonigal: What really stood out to me was also the diversity of approaches they all seemed to be about trying to go back and make some kind of compassionate contact with the self who is traumatized, whether it s going back and talking to that child and giving that child a different relationship with the parent that he or she needed; or having a kind of inner dialogue with the self who was traumatized and what he or she is feeling in the body. The big challenge of self-compassion is having a relationship with the self who s suffering. It just reminded that the big challenge of self-compassion is having a relationship with the self who s suffering. When I thought about what everyone was doing, they were trying to create a context or a conversation in which the person who has been traumatized is in that moment identified as a self who is not traumatized and a self who is traumatized. And they were trying to find that first point of what is it like to be in a relationship, in a caring relationship to the one who is traumatized? The idea of going back and working with the wounded child is dismissed in some of the more scientific circles, and yet it makes a lot of sense when you think about what is required to deal with shame, and this incredible sense of the self being tainted. Dr. Buczynski: Yes. Let s move on and think about this some more. I want to bring up a question about something Peter Levine said, and I d actually like to hear both of you on this. He said that psychotherapists can inadvertently increase a person s shame by being overly kind and supportive of them. So I want to hear what you think about that, and if you think there are other ways that psychotherapists can inadvertently increase a person s shame.

3 Dr. Siegel: An under-recognized foible that we can get into trouble with as psychotherapists is that love cures all but only when it s tempered with discernment. In some of the world s wisdom traditions, for example in the Buddhist tradition, there is the idea that wisdom and compassion are two wings of a bird that the bird is not going to fly without both wings. And sometimes as therapists, we move in with compassion naturally, we care about the suffering of the other and we want to alleviate it. But we might move in without the wisdom of realizing that the love that we re bringing into the room might actually be destabilizing or might actually be toxic for the client or patient. An under-recognized foible that we can get into trouble with as psychotherapists is that love cures all but only when it s tempered with discernment. My friend Chris Germer uses the term backdraft to refer to what goes wrong here it comes from firefighting. When a firefighter opens a door to a room where there s a flame, oftentimes that opening of the door lets in oxygen and then there s a huge conflagration and things get quite out of control in that moment. I think we therapists run into that a fair amount of the time, where we move toward the pain. And we run into it particularly around shame because, while ultimately air and light is what will cure shame, in the short run, when you bring air and light into shame, it flares up because it is so painful for people to be seen as being in their shame. It becomes really important to find a way to move into this gently. And we ve seen various glimpses of this we have Linda Graham saying, I don t even call it shame. And I think that s to avoid this kind of backdraft. And Dick Schwartz talked about the importance of honoring the critic and honoring all the parts that are trying to keep us from the vulnerable shame part. So I think that this is a very important part of the work. Eventually I think we move to a point where we can feel it, acknowledge it, and bathe it in self-compassion and compassion from the therapist, others, and air and light as healing. But we ve got to pace ourselves. Dr. Buczynski: Yes. The idea of something that we normally train ourselves and our graduate students to do being inadvertently harmful is a really important point to talk about. The right emotional response at the wrong time is the wrong emotional response. In addition to wisdom and compassion, I would add timing. I think timing really matters. And sometimes the experience is overstimulating for someone, as well as making them feel vulnerable and weak at a time when they maybe aren t able to feel that and don t have a good enough rapport. Dr. Siegel: Yes. I remember being taught early in psychodynamic training that, The right interpretation at the wrong time is the wrong interpretation.

4 And I think there s an analogue to this, which is, The right emotional response at the wrong time is the wrong emotional response. Dr. Buczynski: Yes. What are your thoughts, Kelly? Dr. McGonigal: I was definitely thinking about the backdraft phenomenon during Peter s comment. It was the first thing that I thought about because I see a lot of backdraft in compassion and self-compassion training also. Paul Gilbert, who s done a lot of work on both trauma and self-compassion, has found that there is a link between early trauma and insecure attachment (or early caregiving struggles), and fears of compassion (it s threatening to be the recipient of other people s kindness and caring) and also fears of other positive emotions fear of happiness, fear of love, fear of gratitude many positive emotions feel threatening and unsafe. There are all sorts of reasons people can give, like, If I let myself be happy, they ll be taken away from me, or, God will punish me. People come up with all sorts of reasons to explain it, but it seems to be based on something very primitive that an individual didn t learn that it was safe to feel connected to others, or to feel at ease. So when those emotions come up, even something like gratitude and the sense of interdependence you might have with another person suddenly feels unbelievably vulnerable and threatening. And I have seen that come up quite a bit in compassion and self-compassion trainings. Since I m not a clinician, I m often very consciously trying to not bring in the kind of therapeutic alliance that a clinician might. I often very much try to hold myself back from having a deep personal connection with individuals who are in a group in part for that reason. I m often very consciously trying to not bring in the kind of therapeutic alliance that a clinician might. When it feels really individual and social and intimate, especially when we re talking about things like compassion and self-compassion, I m very aware of how that can exacerbate backdraft. So there s a connection that is rooted more in groundedness rather than a lot of warmth that I think works so powerfully in a clinical relationship. So I don t know exactly what the solution is in a clinical and a one-on-one situation, but I know that I m often consciously thinking about trying to be a grounded presence that has some warmth but is not characterized primarily by warmth, if that makes sense. Dr. Siegel: Yes. I ve heard Marsha Linehan talk about this also. When it comes to treating people who are very emotionally volatile (folks who might have borderline personality disorder), a big frustration of Marsha s is that therapists are most comfortable leading with love. But this can be destabilizing for that population.

5 And it kind of makes sense that population typically has a lot of trauma history and not a lot of secure attachment history. Dr. Buczynski: Right. Ruth Lanius used to talk about people who have early childhood trauma and neglect had a hard time with eye contact that if you look at them in the eye, they feel known and disgusted, and they really find it way too hard to tolerate. So I guess it makes me think that anyone who thinks they can do therapy without the training really is unwise because there are so many ways that a good idea is a good idea when it s a good idea and not at other times. Dr. Siegel: And this is where Peter Levine s structural intervention of, Let s sit at a 45-degree angle is a very nice idea because it allows more flexibility and allows the client to take the lead in showing us just how much intimacy they would like at this moment. The function of eye contact in supportive or positive social interactions is that it starts to trigger the release of oxytocin and other neural hormones that help people bond. Dr. Buczynski: Right. And yes, they can control the space. Dr. McGonigal: The function of eye contact in supportive or positive social interactions is that it starts to trigger the release of oxytocin and other neural hormones that help people bond. That doesn t always happen with people who have a history of trauma or abuse but it s more likely to happen with an animal than with a human. I think about these great studies showing the benefit of gazing at a dog or gazing in a horse s eye. Can you make eye contact with both of a horse s eyes at the same time? I don t know I haven t worked with equine therapy. But it makes me think about what a powerful practice that is for many people who ve experienced abuse or trauma that the ability to accept a loving or accepting gaze could come from an animal first. Dr. Buczynski: I think that s a really important point. Ron, Dick Schwartz is known for his work with the inner critic. He talked about the inner critic and how invested that is in protecting the root of a person s shame. What are some other effective strategies for working with a client s defense system in treating shame? Dr. Siegel: I ve never been formally trained as an internal family systems therapist but I ve had the pleasure of having a number of friends who have been. And when we ve been setting up demonstrations of various sorts, I ve been able to be their patient I actually even had Dick Schwartz once fix what he thought was an error that one of my friends made in a public demonstration, so I had the benefit of him as the therapist. And it is very powerful. So I think he is really onto something very, very helpful here. Dr. Buczynski: Yes, I do too. Dr. Siegel: Especially for sorting out the various inner conflicts these different parts of ourselves that have rather different points of view about what we want at a given moment.

6 The wonderful thing about Dick s approach, which leads into your question of other approaches, is it s an approach based on radical acceptance. If every one of these parts of us including the critic, the judge, the inner autocrat are there for good reason and developed because it was some way in which we as an organism were trying to deal with our suffering, then they re all okay and they re all part of the story. All these things that say, It s all okay. Fundamentally are very, very useful to us. And we get back to whether we look at it as the acceptance being the precondition of change, or as mindfulness practice where it s about being aware of presentation experience with acceptance, or the idea of being able to hold the totality of our experience all these things that say, It s all okay fundamentally are very, very useful to us. I think it s particularly important when we feel shame, because shame is all about this instinctual reaction, as though some aspect of me is not part of the human family that what motivated me to behave in a certain way, what makes me appear in a certain way, what makes certain emotions or thoughts arise in me is not allowed and it should somehow be exorcised. So, keeping in mind the principles of pacing we were talking about earlier I think any therapeutic approach that basically says, No, we re not going to exorcise anything. We re going to discover what all of these different elements of our experience are about and how they may be part of the complex tapestry which is a human being, and find some way to love and accept them all, is going to be helpful. Even as a non-ifs therapist, I ll very often ask people to talk in terms of different parts. For instance, with the person I spoke about before, who had the sexual encounter with his sister, I d say, Well, can you remember being that kid back then? And can you remember what you felt you needed from her? which was really identifying the part and have him be able to speak from that part. And, Ruth, I know you were trained in a lot of Gestalt techniques. Gestalt therapists do this all the time with setting up the different parts, if you will, in different chairs, and having dialogues or trialogues if there s such a word! with the different parts. So I think that one needn t be an IFS therapist to borrow from the wisdom of the tradition in terms of radical acceptance and identifying all of the different conflicting impulses and feelings, and validating and accepting them all. Dr. Buczynski: Thanks. Kelly, let s get into something Pat Ogden talked about. She said that she reached her hand out to her client, and it had a tremendous impact on her. She referred to something that Ron Kurtz used to refer to as missing experiences. What experience are most people missing that would help them transform shame, particularly shame that is associated with a past trauma or transgression? I d like to get your thoughts on this idea of missing experiences and how do we help people find their own missing experiences? Dr. McGonigal: I was quite struck by that phrase, missing experience, and it made me contemplate, What

7 experience are most people missing that would help them transform shame, particularly shame that is associated with a past trauma or transgression? And Ron has just said we re not going to exorcise anything, but I think exorcism of some type is an experience that many people are missing that is prevalent in a lot of cultures but not necessary Western or modern psychology. Just to give you some examples of what this can look like, there s a Shamanic ritual in which people write narratives about traumas or transgressions in a group, possibly to share those narratives in a group, and then a ritual of fire to burn and release that past experience. There is a ritual that is derived from Zen practices in which women who ve lost a child to miscarriage or abortion create a statue that is childlike and perhaps some adornment for that statue, and then go through a series of chants and prayers, and place that statue in a garden with dozens or hundreds and thousands of other statues made by women who ve lost a child to miscarriage or abortion. And there are also cleansing rituals in post-conflict regions in Africa, like Sierra Leone or Uganda, where communities come together with children who have been forced to become soldiers and to commit horrific acts, and they are welcomed back in the community through these processes of cleansing and acknowledgment and reconciliation they acknowledge the good that is in the child and welcome them back in and let go of the past. I feel like that is a missing experience in our culture, and what all of those rituals have in common is that it s not just, I m letting it go, but that you re bringing the stigma out into social community, so it s not just me, it s not just you. That common humanity that Ron keeps referring to, you cannot deny it; when you re in a circle or it s your statue placed next to hundreds of other statues, it s not just me. And then there s also support from your community in saying, Okay, this is real and it s true and we re also moving forward. Dr. Siegel: Well, you have an excellent point which is exercise/exorcism either. Dr. McGonigal: Yes. Dr. Buczynski: Okay, that wraps us up for this week. Thank you both of you. We ll be back next week to talk about the ideas that you ll start getting on Monday.