Transforming Shame and Self-Loathing

Transcription

1 Transforming Shame and Self-Loathing in the Treatment of Trauma March 23, 2013 Janina Fisher, Ph.D. The persistence of shame responses even after years of treatment poses a barrier to final resolution of the trauma. Full participation in life, pleasure and spontaneity, healthy self-esteem are counteracted by recurrent shame states and intrusive thoughts Shame is not only triggered by criticism, normal mistakes, and less-than-perfect performance but also by success, being seen, self-assertion, self-care, asking for needs, and feeling proud or happy Fisher, 2011 Shame is a survival response, as crucial for safety as fight, flight, and freeze when submission is the only option Not only is shame a powerful body response, it is accompanied by meaning-making that exacerbates the body responses and creates a vicious circle of shame Whereas fear focuses on the source of threat, shame feels personal: it s about me Shame is often reinforced by other trauma-related schemas, such as It s not safe to succeed to be selfassertive to have needs to be happy Fisher, 2010 Do Not Copy without Permission 1

2 The Role of Shame in the Context of Trauma [When] a relationship of dominance and subordination has been established, feelings of humiliation, degradation and shame are central to the victim s experience. Shame, like anxiety, functions as a signal of danger, in this case interpersonal or social danger. Judith Herman, 2006 Like anxiety, [shame] is an intense overwhelming affect associated with autonomic nervous system activation, inability to think clearly, and desire to hide or flee. Like anxiety, it can be contagious. Herman, 2006 Shame as a Survival Resource In conflict situations, there are just two basic choices: to escalate or deescalate.... The inhibitory functions of shame suggest that shame functions as a defensive strategy which can be triggered in the presence of interpersonal threat.... Gilbert & Andrews, 1998, p. 101 Do Not Copy without Permission 2

3 Shame signals (e.g., head down, gaze avoidance, and hiding) are generally registered as submissive and [appeasing], designed to de-escalate and/or escape from conflicts. Thus, insofar as shame is related to submissiveness and appeasement behavior, it is a damage limitation strategy, adopted when continuing in a shameless, nonsubmissive way might provoke very serious attacks or rejections. Gilbert and Andrews, 1998, p. 102 Brain scan research demonstrates that traumatic memories are encoded primarily as bodily and emotional states rather than in narrative form But, when trauma is remembered without words, it is not experienced as memory. These non-verbal physical and emotional memory states do not carry with them the internal sensation that something is being recalled.... We act, feel, and imagine without recognition of the influence of past experience on our present reality. (Siegel, 1999) Fisher, 2009 The human body doesn t just react to events: it also reacts to threat, to the possibility of something bad happening. We call this response triggering or getting triggered The body automatically responds to all danger signals it has known before: times of day, days of the week or times of year, particular kinds of people and places, a color that was on the wall, a smell or sound, weather conditions, a tone of voice or body language, even triggered feelings When we get triggered, we experience sudden and overwhelming feelings, sensations, and impulses. This feeling of danger is misinterpreted as meaning I AM in danger, not I was in danger then Fisher, 2010 Do Not Copy without Permission 3

4 Feelings of desperation, despair, yearning to die Feelings of panic and terror, dread, apprehension Ashamed, depressed or submissive states: numb, spacy, paralyzed, hopeless and helpless, self-loathing Yearning for contact, painful loneliness, and a felt sense of abandonment Fight-flight responses: feelings of rage, impulses to run or get out, violence turned against the body Body sensations: rapid heartbeat, constricted breathing, tightness, shakiness, physical collapse, nausea Fisher, 2008 When the images and sensations of experience remain in implicit-only form..., they remain in unassembled neural disarray, not tagged as representations derived from the past... Such implicit-only memories continue the shape the subjective feeling we have of our here-and-now realities, the sense of who we are moment to moment, but this influence is not accessible to our awareness. Siegel, 2010, p. 154 Hyperarousal-Related Symptoms: Anxiety, panic, terror, dread, racing thoughts Fear, anger, and longing are predominant emotional states Hypervigilance, mistrust, resistance to treatment Response to triggers is action: fight/flight, self-destructive/addictive behavior Sympathetic Window of Tolerance* The frontal lobes Optimal Arousal Zone: shut down Parasympathetic Ogden and Minton (2000); Fisher, 2009 *Siegel (1999) Hypoarousal-Related Symptoms: Depression, sadness, numbing Preoccupation with shame, despair and self-loathing Mistrust disguised by automatic compliance Response to triggers is inaction: giving in, passive resistance, inability to say No Do Not Copy without Permission 4

5 [Shame] perhaps more than any other emotion is intimately tied to the physiological expression of the stress response.... This underscores...the function of shame as an arousal blocker. Shame reduces self-exposure or self-exploration. Schore, 2003, p. 154 Researchers observe that infants do not suffer from shame. In an attuned attachment relationship with the caregiver, infants distress states are interactively regulated by the caregiver and transformed into states of excitement, pleasure, delight in gaze-to-gaze contact. Elevated serotonin and norepinephrine ensure heightened but pleasurable arousal. Once able to walk, the child s ability to move and explore is an exciting experience accompanied by increasingly willful behavior OR a euphoric hey, look at me look at how cute I am engagement with the world or both Fisher, 2011 Shame appears around months right around the time that infants become toddlers and gain the ability to explore the environment. From an evolutionary perspective, this is a dangerous time. Mobility exposes the child to potential dangers when the frontal cortex is not well enough developed to act as a brake on exploration In the context of a safely attuned interpersonal environment, exploration, willfulness, and social engagement all contribute to healthy self-development when balanced with limit-setting that keeps the child safe and increases the capacity to self-regulate Fisher, 2011 Do Not Copy without Permission 5

6 Before the development of greater top-down control over their actions, children need for their own safety to respond quickly to inhibitory cues. Allan Schore hypothesizes that shame develops at this developmental stage as a neurobiological regulator that serves the purpose of helping children inhibit behavior. Action and excitement are both driven by the sympathetic nervous system. In a state of high energy and actionorientation, children are more impulsive. To inhibit such behavior, they need the parasympathetic system to act as a brake. Fisher, 2011 The subjective experience of shame is of an initial shock and flooding with painful emotion. Shame is a relatively wordless state, in which speech and thought are inhibited. It is also an acutely self-conscious state; the person feels small, ridiculous and exposed. There is a wish to hide, characteristically expressed by covering the face with the hands. The person wishes to sink through the floor or crawl in a hole and die. Herman, 2006 While major disruptions in the attachment system produce fear, by the second year of life the child reacts to more subtle disruptions with shame.... Schore (1998) conceptualizes shame as toddler s response to a disappointed expectation of sparkling-eyed pleasure in the maternal gaze. [When the] child s abashed signals elicit a caring response, [t]he child learns that shame states do not signify complete disruption of attachment bond and that they can be regulated. Herman, 2007 Do Not Copy without Permission 6

7 When shame acts to down-regulates excitement and impulsivity, the child freezes momentarily in his/her tracks, then inhibits the forbidden action. Sympathetic high s are interrupted by rapid parasympathetic deceleration When these shame experiences are repaired by the parent with soothing and clarification, resilience increases (Tronick) But, in unsafe environments, shame must be over-used to down-regulate fight/flight reactions and other behavior unacceptable or unsafe in the environment. Under conditions of neglect and/or abuse, shame states are not repaired by the caregiver, decreasing resilience Fisher, 2011 Procedural memory is the implicit memory system for functional learning: skills, habits, automatic behavior, conditioned responses. Driving a car, playing an instrument, swimming or playing tennis, riding a bike, shaking hands and making eye contact, even dissociating or switching, are all examples of procedural learning. Procedural learning allows us to respond instinctively, automatically, and non-consciously, increasing our efficiency at the cost of a loss in reflective, purposeful action Fisher, 2006 Do Not Copy without Permission 7

8 Annie on the topic of shame: When I was young, my parts built their own little world that explained what was happening to them. And what was their explanation? They thought, if I wasn't so bad and ugly and if I didn't cause other people to be angry, these things wouldn't be happening to me. " What were the advantages of that explanation? "It limited how much people could get to them. If something is wrong with you, you can work on you. You don't have to try to figure out why the bad things are happening because you already know. As part of its role in downregulating activation, shame helps to drive the animal defense of submission: shame responses cause us to avert our gaze, bow our heads, and collapse the spine In an environment in which self-assertion is unsafe for the child, shame enables the child to become precociously compliant and preoccupied with avoiding being bad This avoidance of potentially dangerous behavior and procedurally learned submissiveness is adaptive in traumatogenic environments Fisher, 2006 Annie F.: Blame' and 'shame' are best friends. When my parts blame themselves for what was done to them, they are saying that they did 'something' wrong. And that 'something' had consequences... such as that my body was bruised, or eyes swollen from crying, or hair messed up and tangled, and even a fat belly from a rape. That 'I' was to blame for looking and feeling so badly was just the beginning of my shame. Annie F. s epiphany describes blame and self-loathing as essential ingredients of shame as a survival response. The blaming thoughts instigate shame responses followed by automatic submission responses Fisher, 2010 Do Not Copy without Permission 8

9 Procedural learning facilitates automatic responding [Procedural] memory shapes how we experience the present and how we anticipate the future, readying us in the present moment for what comes next based on what we have experienced in the past. Siegel, 2006 In the context of trauma, procedurally-learned shame responses become automatic and unconscious: when threat stimulates terror, shame regulates the fear response. When abuse evokes anger, shame wet blankets the anger so that it doesn t endanger the child. When tears come, shame stops them in their tracks. When happy feelings evoke impulses to smile, shame stops them cold Because both positive and negative feelings evoke anger in caregivers, the child may learn to respond to most if not all affects and arousal states with bodily and affective shame reactions Fisher, 2010 The imprint of the trauma is... in our animal brains, not our thinking brains van der Kolk, 2004 Do Not Copy without Permission 9

10 Sensorimotor Psychotherapy Sensorimotor Psychotherapy is a body-oriented talking therapy developed in the 1980s by Pat Ogden, Ph.D. and enriched by contributions from the work of Alan Schore, Bessel van der Kolk, Daniel Siegel, and Ellert Nijenhuis. Sensorimotor work combines traditional talking therapy techniques with body-centered interventions that directly address the neurobiological effects and procedural learning of trauma. By using just enough of the narrative to evoke the unresolved somatic experience, we attend first to how the body has remembered the trauma and attachment failure and later to cognitive and emotional meaning-making Ogden, 2002; Fisher, 2006 Previously adaptive responses encoded in procedural memory are challenging to modify [The procedural memory] system involves a relatively slow, incremental learning process.... With repetition, performance of procedurally learned processes becomes increasingly automatic.... Procedurally learned behavior may be altered, albeit slowly, [but] it is relatively resistant to decay. Grigsby & Stevens, 2000, p. 93 Notice the client s repetitive responses: changes in autonomic arousal, body language, tension, movements or gestures Interrupt trauma-related patterns: provide psychoeducation about trauma symptoms and procedural learning, challenge old patterns by encouraging the practice of new patterns Encourage non-judgmental observation of these patterns as triggering or just body sensation experience, appreciate the procedural learning as a survival resources Become curious and encourage the client s curiosity about how the body remembered the trauma. Invite the client to focus attention on how the body responds now to reminders of the trauma Fisher, 2011 Do Not Copy without Permission 10

11 The most direct way to effect change is by working with the procedural learning system, rather than with declarative memories [Grigsby & Stevens, 2000] We can address procedural learning in two ways: The first is to observe, rather than interpret, what takes place, and repeatedly call attention to it. This in itself tends to disrupt the automaticity with which procedural learning ordinarily is expressed. The second therapeutic tactic is to engage in activities that empathically but directly disrupt what has been procedurally learned and create the opportunity for new experiences (Grigsby & Stevens, 2000, p. 325) Mindfulness: helping the client to notice the shame rather than be it. What happens in the body when those thoughts of worthlessness come up? Notice what it s like to observe the shame just as body sensation... Dis-identification: challenging the identification with the shame as who I am. Thoughts are just theories let s be curious about this theory that you re stupid. How would that theory have helped you survive? Reframing the shame: attributing meaning and purpose to the shame as a survival resource (Ogden et al 2006). The shame was the hero of your story... Fisher, 2011 Change happens through discovering how a client habitually organizes experience in response to selected stimuli and then changing how that experience is organized... The tool that we use to discover and then [transform] the habitual organization of experience is mindfulness. Ogden, 2005 Do Not Copy without Permission 11

12 Notice... Be curious, not judgmental... Let s just notice that reaction you re having inside as we talk about your boy friend Notice the sequence: you were home alone, bored and lonely, then you started to get agitated and feel trapped, and then you just had to get out of the house... What might have been the trigger? Let s go back to that day and retrace your steps Fisher, 2004 In traditional talking therapies, we tend to treat thoughts, feelings, and body sensations as if they were one and the same. But when clients say, I feel worthless, The words could convey a cognition: I believe that I am worthless They could communicate an emotion: I m feeling sad and depressed They could reflect bodily sensation: I feel a heaviness a weight on my shoulders a sick feeling in my stomach Fisher, 2007 When you feel the panic come up, what happens? Do you feel more tense? More shaky? More frozen? As you feel that anger, is it more like energy? Or muscle tension? Or does it want to do something? When you talk about feeling nothing, what does nothing feel like? Is it more like calm? Or numbing? Or like freezing? Ogden 2004 Do Not Copy without Permission 12

13 Does that [thought/feeling/action] feel good or bad? Is it more pleasurable or unpleasurable? Does that danger feel like something that will hurt you from the inside or the outside? When you say those words, It was my fault there must be something wrong with me, do you feel better or worse? Ogden 2004 Shame is a relatively wordless state, in which speech and thought are inhibited. (Herman, 2007) Words put to nonverbal shame responses reflect the bodily experiences of feeling small, exposed, overpowered, degraded, disgusting. With repetition, blaming and shaming words become belief systems that explain subsequent experience. As both good and bad life experiences occur, each is interpreted through these cognitive schemas of defectiveness and worthlessness inextricably linked with affective and bodily states of shame. Each time, the shame and self-blame feel confirmed by this new evidence Fisher, 2011 Human beings are meaning-making creatures. Early in life, before we have words, brain and body make meaning of our experience. With language, we begin to attach words Echoing what they heard from caregivers, our clients have attached words of blame: You stupid idiot how could you be so dumb? You re disgusting Loser! The words of blame serve to re-evoke the shame, enforcing compliance needed to preserve safety/attachment But children believe the words of blame as truth about themselves. The self-loathing does its job at the cost of their self-esteem Fisher, 2010 Do Not Copy without Permission 13

14 Self-blame serves the purpose of putting the brakes on behavior that will be punished by others. In self-blame, we yell at ourselves, inducing shame. We warn ourselves never to do that again; we silence ourselves; we withdraw. The key here is that shame is active and protective Internalizing the punitive role ensures safety and a greater sense of control at the cost of punitive introspection. But self-hatred is a small price to pay for greater safety. Once self-hatred is procedurally-learned and encoded in the body and mind, it feels true. It continues to exert an influence on self-esteem and healthy self-assertion long after its job is over Fisher, 2012 Studies have shown links between PTSD symptoms and shame-evoking attributions in Vietnam vets, disaster survivors, and victims of abuse and neglect To the extent that factors outside the victim s control are seen as the cause, PTSD symptoms and shame are reduced: I did the best I could, but he was too strong. To the extent that factors inherent in the individual are seen as causal, both PTSD symptoms and shame are exacerbated: I should have fought back. And internal attributions of negative events (i.e., it was my own fault ) tend to go hand-in-hand with external attributions of positive events ( I was lucky ) Fisher, 2011 Rather than make suggestions or plan coping strategies, the sensorimotor therapist uses experiments to test out new options. The experimental approach encourages thoughtful trials of new skills or responses and nonjudgmental observation of their impact. Experiments are inherently mindful: they are conducted without investment in a particular outcome. Right" and "wrong" answers irrelevant: only curiosity and an open mind are important. Once the decision is made to try an experiment, therapist and client run the experiment in the office first to observe its effects Do Not Copy without Permission 14

15 Some of our thoughts are creative, enlightening, expansive, encouraging. Some thoughts activate procedurally-learned body responses that de-resource us A resourcing thought creates a sense of greater aliveness, lightness of being, solidness, confidence, playfulness. A de-resourcing thought feels heavy, suffocating, numbing, anxiety-provoking, and automatic Clients can learn to notice thoughts and to label them as resourcing or de-resourcing depending upon their impact on the body. Resourcing thoughts can then be practiced and de-resourcing thoughts dropped Fisher, 2011 Treating the shame as memory: Those shame memories are so strong, aren t they? What happens if you fast-forward through your childhood for 30 seconds and notice where the shame fits? Redefining shame and self-loathing as child parts: Typically, shame reflects a relationship between two parts of the self: a part that judges and a part that feels judged. When the critical part echoes the negative messages heard in childhood, younger parts feel the same sense of shame as if it were then. In the body, the experience of shame is re-enacted over and over by these parts Fisher, 2011 Do Not Copy without Permission 15

16 If we assume that old beliefs are cognitive memories, conclusions made in the context of neglect and trauma or adaptive responses to danger, how do we work with them? Work with the beliefs as just thoughts or just theories can increase the client s ability to dis-identify with them and to identify them as I m having a thought... rather than I feel sick about myself Work with discriminating thoughts vs. beliefs: increase client s ability to notice a thought as just words. Ask, What are the words of that thought? When you hear those words, what happens? Fisher, 2011 Capitalizing on the neurobiological assumption that every symptom is a valuable piece of data about how the client survived, shame can be challenged by reframing it as a valiant attempt to cope in a dangerous world Look for what the symptom is still trying to accomplish now: Maintain compliance? Combat anger and assertiveness? Keep the client from being out in the world? Cement relationships by fueling compliance and self-sacrifice. Admire the shame as a survival resource! Fisher, 2007 Patient symptoms or crisis Mindful Curiosity Mirroring and Validation Re-framing: study the defensive purpose of the response Patient: I don t even want you to look at me I m too ashamed I can t face anyone, I m overwhelmed Therapist: Can we be curious about the shame? And curious that something nice triggered it? Therapist: I m noticing that the shame keeps your head down, makes you very quiet, keeps you from saying very much. Very clever! Therapist: Let s be curious right now: when the shame takes you down, down, down, what does it achieve? What s its mission? It s so powerful! Do Not Copy without Permission 16

17 If the shame is reinforced or exacerbated by body experiences of collapse, loss of energy, feelings of revulsion, curling up or turning away, then shame can be mitigated by changing body posture Lengthening the spine and grounding through the feet both challenge shame. If the client s head is bowed or averted, bringing the head up or asking the client to begin to slowly turn the head and lift the chin can begin to increase feelings of confidence and fearlessness. If these movements are triggering, they can be executed piece by piece over time Fisher, 2009 Shame-related Reactions: Flushing Head averted Eyes closed: I m invisible Collapse in the spine Self-blame. judgment Ruminations re. worthlessness Resources: Deep breath or sigh Orienting movements Therapist closes eyes Lengthening the spine Hand over the heart Dropping the content, practice of new words Ogden, 2000; Fisher, 2011 Ask the client to assume that the belief is held by a part of the self: What part believes she is worthless and undeserving? What part believes it isn t safe to trust? When that part feels shame, what happens in your body? Increase the client s mindful curiosity: How would it have been adaptive for that part to be convinced that she is worthless and undeserving? How did that affect your/her behavior in your family environment? Most often, the belief served a defensive function. It was a survival resource: Yes, the ashamed part is the hero of your story, isn t she? She kept you safe... What happens inside as she takes that in? Fisher, 2009 Do Not Copy without Permission 17

18 When we re-frame shame or self-hatred or schemas as just a part of the self, we interrupt procedurally-learned automatic shame responses and increase curiosity The language of parts also increases mindfulness: I is the first word in a narrative about the shame, while the language of parts encourages noticing internal experience If there is a part that holds shame and a part that holds blame, by definition there is a part that sees those other parts (an observing ego). There may even be parts that hold a more updated view of who the client really is Fisher, 2011 Client: I feel so ashamed. I don t want to face you Therapist: So, there is a part of you that is feeling shame right now because you ve told me something so very personal. Could we be curious about that ashamed part? Is there another part that is shaming the ashamed part? A part that judges you or other parts? Or is the ashamed part remembering being judged? (Remember that where there is an ashamed part, there is generally a part that judges behavior that would have been unsafe then) The therapist s job is to help the client separate from the shame and name it as a child part Fisher, 2011 In Sensormotor Psychotherapy, we ask: what is this part s missing experience? What does the ashamed part need to find relief from self-loathing? To feel proud of how he protected the other parts?? Or to hold her head high and look people straight in the eye? The therapist may be drawn to offer the missing experience directly to the client, but rarely does that seem to work. As we say, You have nothing to be ashamed of, the client answers, You don t understand. But when clients have missing experiences (such as being proud of an ashamed part), they feel differently about themselves without needing our validation Fisher, 2012 Do Not Copy without Permission 18

19 Shame: Submit s shame is best addressed as a somatic resource. Explore its role in how the client survived: how did it serve to regulate fear? Or anger? It couldn t stop the perpetrators, but how did it protect the child? Did it support the child being seen and not heard perhaps? Shame and self-loathing-related cognitions: shamerelated beliefs enforce submission responses. But when re-framed as survival beliefs held by parts, they lose their power. How did it help that the ashamed part believed that she deserved the abuse? What would have happened if she had believed he was wrong? What would have happened then? Fisher, 2011 Wise Mind: curious, compassionate, calm, creative, clear perspective The medial prefrontal cortex allows us the capacity for non-judgmental awareness and thus compassion. Left Brain: Going On with Normal Life Part of the Personality While Going On with Normal Life part often mistakes the shame as her own, this left brain part of the personality can benefit from psychoeducation to increase empathy for the ashamed part Right Brain: Emotional or Limbic Parts of the Personality When ashamed parts feel that they are under the wing of someone older and wiser, they are not so desperate. When their feelings are not so intense, it s easier to go on with normal life. Fisher, 2012 Trauma alienates us from ourselves and our parts from each other. To combat shame requires welcoming ashamed parts and evoking mindful curiosity about their feelings, thoughts, and impulses. Bringing them alive naturally enhances empathy: How old might this part be? Very young? Middle-sized? A teenager? Is this part more emotional or logical? As curiosity challenges the automatic animosity toward parts and they come to be better understood, the therapist can ask an Internal Family Systems (Schwartz, 2001) question: And how do you feel toward that part now? Fisher, 2012 Do Not Copy without Permission 19

20 How do you feel toward this part now? is a question that naturally invites compassion and is also a litmus test for mindfulness: does the client have enough mindful distance to feel curiosity or compassion for this part? If the client responds with hostility, we can assume that she is blended (Schwartz, 2001) with parts that judge the ashamed part as weak or shameful. If the client responds, I feel badly for her or I want to help him, we know that a relationship is beginning to form. The key to establishing compassion for ashamed parts is the appreciation of their role in survival Fisher, 2012 Therapist away on maternity leave: I don t think I can make it by myself Ashamed Child Adult Elizabeth Critical Part Suicidal Part These threats retrigger the child part and re-ignite the cycle I can t do it by myself I m too weak and stupid That s true there s no hope for me Get a grip! Stop that whining! Shape up, loser! You deserve to die---your body is worthless anyway Fisher, 2006 Adult Elizabeth It s OK I m here for you both. Critical doesn t have to worry about the little one, and the little one doesn t have to be so afraid Ashamed Child I m scared I m all alone now Critical Part Get a grip! Stop that whining! Shape up, loser! Suicidal Part Not needed now, the Enforcer can be on stand by alert status Fisher, 2006 Do Not Copy without Permission 20

21 The social engagement system is body-dependent, not verbally mediated: it relies upon the muscles that give expression to our faces, allow us to gesture with our heads, put intonation into our voices, direct our gaze, and permit us to distinguish human voices from background sounds. (Porges, 2004, p. 21) Clients with histories of neglect and trauma come to therapy with social engagement difficulties: difficulty making eye contact, blunt affect, head bowed, gestural language limited, and difficulty discriminating our kindness from others cruelty Ogden, 2004; Fisher, 2011 To stimulate the client s social engagement system, the therapist can make use of his or her social engagement muscles, making sure to utilize facial expression, head movements, intonation, and gaze to evoke the client s social engagement system When shame is an issue, we must avoid drawing attention to these patterns directly and instead attempt to use our bodies to socially regulate the shame. Each time we respond to shame, self-blame or hatred with a change in expression or body language, we effect a bigger change than we can with words Ogden, 2004; Fisher, 2011 "If I accept you as you are, I will make you worse. If I treat you as though you are what you are capable of becoming, I will help you become that." Johann Wolfgang von Goethe Do Not Copy without Permission 21

22 Neurobiologically regulating shame states in psychotherapy It does not mean that the therapist is responsible for convincing the patient not to be ashamed What it means is that the therapist regulates or repairs the shame, just as healthy parents should have done: i.e., experiments with making contact with the patient in some way that mitigates the shame, such tone of voice, energy level, empathy vs. curiosity, providing psychoeducation, waking up the frontal lobes, re-framing the shame as active and heroic Effective neurobiological regulating requires paying more attention to how we are affecting the shame than we pay to addressing the words or issues Fisher, 2009 The Social Engagement System of the Therapist, cont. As our shining eyes communicate that all parts are welcome and valued, the client begins to increase the capacity to turn shining eyes on younger selves The Adult self of the client has inside information about the parts and their unmet needs, facilitating integration of the therapist s empathy with an intuitive understanding of the part: No, she isn t afraid to be alone; she s afraid that she ll be rejected As our faces soften and our voices become warmer, the client begins to soften as well, relaxing the body and creating a pervasive sense of warmth. Our acceptance becomes internal acceptance. Fisher, 2012 Do Not Copy without Permission 22

23 As a single footstep will not make a path on the earth, so a single thought will not make a pathway in the mind. To make a deep physical path, we walk again and again. To make a deep mental path, we must think over and over the kind of thoughts we wish to dominate our lives. Henry David Thoreau A Monthly Webinar Series on Complex Trauma and Dissociation A ten-month remote-learning webinar program for mental health professionals interested in developing greater comfort and expertise in working with complex trauma and dissociation while staying abreast of recent trauma-related research and treatment advances. All programs are recorded and available for later viewing online. For more information or to register, Dr. Fisher or go to Janina Fisher, PhD. is a clinical psychologist specializing in treatment of complex PTSD and dissociation. She is also an instructor & supervisor at the Trauma Center, past President of the New England Society for the Treatment of Trauma & Dissociation, a trainer for the, an EMDR Approved Consultant, and an international presenter on the neurosience research and treatment of trauma-related disorders. Do Not Copy without Permission 23

24 For further information: Janina Fisher, Ph.D College Avenue, Suite 220C Oakland, CA USA Do Not Copy without Permission 24