Sympathetic Activation A R O U S A L Optimal Arousal Zone Window of Tolerance* we can think and feel at the same time Parasympathetic Activation Ogden and Minton, 2000; Fisher, 2009 A R O U S A L Sympathetic Activation No development Parasympathetic Activation The child s body responds with fear, flight, or fight states Window of Tolerance* Or the child becomes submissive, checked out, depressed, nonresponsive Ogden and Minton, 2000; Fisher, 2009 Do Not Copy without Permission 1
Frightened Behavior Backing away Frightened voice Dazed expression Exaggerated startle Withdrawn Non-responsive Frightening Behavior Looming, attack postures Sudden movements Mocking, teasing Intrusive Emotionally reactive Loud, startling noises Lyons-Ruth, 2000; Fisher, 2003 Do Not Copy without Permission 2
Traumatic attachment raises the question: is it safe to be attached? Safety It s safe to be close, and it s safe to be by myself Don t trust! It isn t safe! Keep your distance... Impulses to fight or flee Parent Figure Danger An internal struggle takes place: do I run toward? or do I run away?? Do I communicate or avoid? I don t want to be abandoned I just want to be loved and protected... Impulses to attach to someone for survival Copyright 2007 Janina Fisher, Ph.D. Brain scan research demonstrates that traumatic memories are encoded in the amygdala as implicit bodily and emotional states 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 or threatening cues it has known before: times of day, days of the week or times of year, gender and age, facial expressions, colors, smells or sounds, weather conditions, a tone of voice or body language, touch, even emotions 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
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, a felt sense of abandonment, separation anxiety, feeling unseen 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 Hyperarousal-Related Responses: High activation resulting in impulsivity, risk-taking, poor judgment Chronic hypervigilance, post-traumatic paranoia, chronic dread Intrusive emotions and images, flashbacks, nightmares, racing thoughts Obsessive thoughts and behavior, cognitive schemas focused on worthlessness and dread Sympathetic Hyperarousal Window of Tolerance * Optimal Arousal Zone Parasympathetic Hypoarousal Ogden and Minton (2000); Fisher, 2006 *Siegel (1999) Hypoarousal-Related Symptoms: Flat affect, numb, shut down Cognitively dissociated, slowed thinking Cognitive schemas focused on hopelessness Disabled defensive responses, victim identity The Neurobiological Legacy of Trauma When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over. Judith Herman, 1992 Do Not Copy without Permission 4
Orienting to danger: heightened sense of threat, vulnerable to distortion, expecting the worst Fight/Flight responses: anger, running or distancing, devaluing others, and/or judging one s self Chronic despair and self-loathing: submissive, overly compliant, ashamed, feels degraded, defeated, powerless Chronically searching for rescue: sensitive to separation and fearful of loss, the client searches for the right partner, but the right one is never there Fisher, 2006 In relationships, the feelings and body sensations triggered by normal conflicts/hurts are misinterpreted as indicators that the individual is still in danger Divorced from their original context in childhood experience, these reactions are interpreted as data about the partner or the relationship: He is abusive, She can t be there for me, This isn t safe When triggered sensations are interpreted as threats, past and present become confused.. The client s subjective sense is: I m still alone I m still at risk Fisher, 2007 Traumatic Attachment in Adults Autonomic dysregulation: easily dysregulated, they alternate between hyper- and hypoarousal responses: they under- or over-react Proximity-seeking alternates with triggering and fight/ flight responses, e.g., anger, destructive behavior, threats to leave Internal conflicts re. distance and closeness: alternately idealizing and devaluing the other, pattern of multiple or long distance relationships, demands closeness but cannot tolerate it Deficits in object permanence and object constancy: can I trust? Am I really loved? The other s love cannot be internalized Deficits in identity and self-development: am I angry and difficult? Or vulnerable and needy? A victim or a victimizer? Fisher, 2007 Do Not Copy without Permission 5
The essential characteristic of disorganized attachment is an internal battle between the instinct to attach/connect versus drives to fight or flee connection Some of our clients have disorganized/unresolved attachment with preoccupied tendencies: they long for love but can pursue, then are hypervigilent and suspicious, quick to anger, and experience intense fears of rejection Others have disorganized/unresolved attachment with avoidant or dismissing tendencies: they may long for relationship but keep their distance and push away those who come too close, including the therapist! Fisher, 2011 Traumatic experiences and compulsive behavior are difficult to address at a cognitive level Words cannot integrate the disorganized sensations and action patterns that come from the core imprint of trauma. van der Kolk, 2004 Sensorimotor Psychotherapy is a body-oriented talking therapy developed in the 1980s by Pat Ogden, Ph.D. and enriched by contributions from Alan Schore, Bessel van der Kolk, Daniel Siegel, Onno van der Hart, Ellert Nijenhuis, and Kathy Steele. Sensorimotor work combines traditional talking therapy with body-centered interventions that directly address the somatic legacy of trauma. By using the narrative only to evoke the trauma-related bodily experience, we attend first to resolving how the body has remembered the trauma Sensorimotor Psychotherapy Institute Do Not Copy without Permission 6
In intimate relationships, our attachment drives and defenses are automatically evoked, along with the feeling memories and survival strategies of childhood Because trauma and neglect take place in the context of close family relationships, triggers abound for couples As each spouse gets triggered, s/he will become hyper- or hypoaroused, in turn triggering the other s somatic memories of hyper- and hypoaroused parental behavior Because these intense feelings and reactions occur in the here-and-now, they will be interpreted as threats: You made me feel this way! You hurt me! Fisher, 2007 Couples personalize their different autonomic styles and responses Hyperarousal-Related Symptoms: Quick to tears or anger, preoccupied with emotional availability of mate Emotionally reactive, impulsive, strong fight/flight responses Overwhelmed, anxious, prone to jealousy and separation anxiety Sympathetic Hyperarousal Window of Tolerance * Optimal Arousal Zone Parasympathetic Hypoarousal Ogden and Minton (2000); Fisher, 2006 \ *Siegel (1999) Hypoarousal-Related Symptoms: Flat affect, shut down, non-responsive Overwhelmed by others emotions, especially anger Goes away internally Freeze and submission responses Sensorimotor Psychotherapy Institute Each demonizes the trigger by assuming that the intensity of their reactions is a direct reflection of the other s behavior. Fight responses (anger, judgment, shaming) or flight responses (avoiding, distancing or dissociating, using drugs to alter state) exacerbate the dysregulation and thus the misperceptions of each Each rationalizes their traumatic reactions on the basis of how badly the other behaved. Neither knows that their relationship is not the issue: the issues are the trauma, the nervous system, and the compulsive behavior that regulates them Fisher, 2014 Do Not Copy without Permission 7
What threatens the couple s stability is not just the triggering but the dynamic tensions between their competing survival response models: Her wish to talk about it evokes his flight responses, Triggering her fight responses and pursuit of him When she pursues angrily or needily, it triggers his fear, causing withdrawal She experiences the withdrawal for self-protection as passive aggression and becomes angrier but submits to maintain the connection Each feels unsafe and blames the other Fisher, 2007 The first task in the therapy is to re-frame the struggles: their common enemy is the trauma. The struggles result from triggering, not danger. They are on the same side The second task is to help the couple learn to use the language of triggering, so they can discuss their actions and reactions : When you were late, I got triggered I felt so alone and so scared Triggering must always be defined as no one s fault: it is inevitable that two people close to each other will trigger each other. Fisher, 2007 Therapists must take a strong stand that intimacy is contingent upon feeling safe with one another. This remakes both responsible for safety in the relationship Empathy is built through sharing what didn t feel safe for them as children and what helps to feel safe now Each partner is asked to take responsibility for behaving in safer ways including not critiquing the other When there is a failure of safety, blame is placed on the trauma: If it weren t for that damned trauma, you would feel safe together even when one of you is a jerk! Fisher, 2007 Do Not Copy without Permission 8
Especially when partners have felt chronically failed or betrayed not only as children but in the marriage, it can be more helpful to work symbolically. Have one or both partners pick an object in the room to represent the other person. First, have client orient towards the object representing the partner and study what happens in the body. Does s/he want to pull back? Lean forward? Next, notice what happens in the body when s/he looks away from object or creates more distance from it. See what actions are most resourcing or transformative for them: turning away? Moving toward? Creating a boundary? Ogden, 2006; Fisher, 2014 Cultivate endorphin production: romantic love relies on endorphin production, and loving feelings can be enhanced by increasing endorphins. Humor, positive feedback, smiles, laughter, hugs, amplification of positive moments all enhance endorphin production Avoid words! Increase novelty: ask them to surprise each other with some small loving, spontaneous, funny or playful action (eg, a mystery date, a loving or funny note or gift in a lunch or on a pillow, sending texts about something other than business, playing a prank the other would appreciate) Fisher, 2007 Couples look to each other for neurobiological regulation and then feel threatened or abandoned when the partner cannot regulate them. The couples therapist is challenged to create an optimal level of arousal for BOTH partners from moment to moment throughout the session in the presence of the other Effective neurobiological regulating requires therapists to pay more attention to how we are affecting autonomic arousal than we pay to the details of the couple s communications and to maintain an optimal level of arousal in the room as much as possible Copyright 2006 Janina Fisher, Ph.D. Do Not Copy without Permission 9
Varying voice tone and pace: soft and slow, hypnotic tone, casual tone, strong and energetic tone, playful tone Energy level: very there and energetic versus more passive Empathy vs. challenge: how does the couple respond to more/ less empathy vs. challenge? Do these clients need limits? Amount of information provided: effect of psychoeducation Titrating affective expression: especially with couples, it may be important to help clients contain strong emotions vs. encouraging affective expression to avoid dysregulation Humor and normalization: relationships are not for sissies Fisher, 2014 Expecting the best brings out the best in all of us... "If I accept you as you are, I will make you worse; if I treat you as though you are [already] what you are capable of becoming, I help you become that." --Johann Wolfgang von Goethe Hyperarousal: You had to be on guard, ready to hide, primed to get out now it just makes you anxious... Hypoarousal: It was brilliant to just shut down and go numb when you were a kid then you were seen but not heard and sometimes not even seen... Relational phobias: Staying a bit at a distance or holding back made sense when anything could happen... It s what your body does, huh? Both of your bodies! Phobia of positive experience: It wasn t safe to believe you were loved or believe good things would happen... Fisher, 2016 Do Not Copy without Permission 10
... The earliest phase of [attachment formation] involves calibrating the infant-caregiver relationship in regard to maintaining a positive state for the infant. The parent s role in regulating negative arousal during the first year is not simply to respond with comfort when the infant is disturbed, but to avert distress by maintaining the infant s interest and engagement in a positively toned dialog with the social and physical environment. Hennighausen & Lyons-Ruth, 2005 The primary therapeutic attitude [that needs to be] demonstrated [by the therapist] throughout a session is one of : P = playfulness A = acceptance C = curiosity E = empathy Hughes, 2006 Satisfying relationships are grown, not born I believe that we learn by practice. Whether it means to learn to dance by practicing dancing or to learn to live by practicing living, the principles are the same.... Practice means to perform over and over again in the face of all obstacles, some act of vision, of faith, of desire. Practice is a means of inviting what is desired. Martha Graham Do Not Copy without Permission 11
For further information, please contact: Janina Fisher, Ph.D. 5665 College Avenue, Suite 220C Oakland, California 94611 DrJJFisher@aol.com www.janinafisher.com Sensorimotor Psychotherapy Institute www.sensorimotor.org 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, email Dr. Fisher or go to www.janinafisher.com 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 Sensorimotor Psychotherapy Institute, an EMDR Approved Consultant, and an international presenter on the neurosience research and treatment of trauma-related disorders. Do Not Copy without Permission 12
Just out! Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation Janina Fisher To order, go to: http:// www.janinafisher.com Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation Janina Fisher August 7-11, 2017 Eastham, Massachusetts A weeklong summer seminar that meets from 9-12:30 each morning, leaving the afternoons free to enjoy the beaches, wildlife, woods, and ponds of Cape Cod To register, go to: www.cape.org Do Not Copy without Permission 13