Introduction to the next handful of episodes.

Many clients with complex trauma will come to us convinced that they have already failed mindfulness and that they are about to fail EMDR.  Some of the approaches that I have seen to teaching mindfulness to clients assume a non-pervasively traumatized nervous system. Which is simply something we should not assume. Many approaches throw the client into the deep end of the present, the body, or noticing without much preparation or guidance almost as though they are running every client through the same mindfulness machine.  How we approach a client system with severe trauma needs to be different than how we approach a system that relatively healthy.  Our interventions should match the client we are working with. So, maybe the problem isn’t that many clients simply can’t do mindfulness. Maybe they can’t do it the way we have been teaching it.

Complex trauma is not a special case. It’s nearly the only case we see in community mental health contexts globally. A large percentage of pervasively traumatized clients struggle with even the most basic forms of mindfulness for reasons that we will explore, but also because of how we teach it. And, the easiest thing to change in this equation is how we teach it.  Even in EMDR Therapy, the assumption that “Ok, now we’re in Phase Two and I’m going to teach you these resources so that you can calm down when you get activated.”  This is true, but do you hear the therapist agenda in the way we may be introducing it?  As you will see, when we are working with clients with extreme trauma what we are looking for is information about the client’s nervous system and not necessarily the relaxation response.  I want to show you how to use that information that surfaces in the service of the client’s recovery.

What We are Asking Clients to Do in Mindfulness Feels Like it Goes Against Common Survival Strategies

The Present

Bodies

Noticing

The Mind is Taxed with Survival Tasks

There is Performance Anxiety in What they Know We’re about to Ask

Add to all of these things the performance anxiety of trying a skill focused on these places of discomfort and knowing that the therapist is going to ask them about their experience with it.  These are clients that are accustomed to being what other people need them to be and performance anxiety associated with “Is this working?” “Am I doing this right?”  “What does it mean that I don’t find this relaxing?”  Etc.

Step One of One Way to Do this Differently: Normalize the Difficulties

Normalize the difficulty using all of the information above and all of the information you have learned about the client’s survival. You know how to do that.  Do it.  “Of course mindfulness and the way we have been approaching it hasn’t worked well for you.  Would you be interested trying this differently?”

Step Two of One Way to Do this Differently: Appreciate the Role of Parts and Get Consent

Step Three of One Way to Do This Differently: “Dip Your Toe In” by Decreasing Exposure Time

Step Four of One Way to Do This Differently: We’re Not Necessarily Looking for Something that is Calming

Step Five of One Way to Do This Differently: Recalibrate what “Working for Me” Means—The Car Metaphor

Step Six of One Way to Do This Differently: Bridge Resources

Step Seven of One Way to Do This Differently: Send Clients Home to Practice at their Baseline, Not When Triggered

Putting It All Together

And while there are a lot of other ways to do the same types of things, what we don’t want to do is simply pronounce that the client isn’t ready.  We need to meet them where they are with modifications and accommodations.  Otherwise the client will die not ready.  We need to identify the difficulties, work on them every session and between sessions until they are prepared enough for trauma reprocessing.

Trauma has the potential to promote disconnection from the present, from experience, from the body, from the self, and from more full engagement with the broader world.  These responses were in the service of survival. They may have been essential.  Sensory grounding is a go-to resource in trauma work because our senses bring us home.  They can help bring us into the “safety” of the present when we want to be or when we need to be more present.

Sensory grounding is a needed resource in trauma work, where we ask clients to “glance” at a traumatic memory, but advise them not to fall into a memory.  Sometimes, simply interacting with the memory in any way can cause it can cause us to fall or dissociate into it.  Sensory grounding in the present brings you home.  It brings you into a place where the bad thing isn’t happening right here, right now.

Script: When we have difficult experiences, those experiences may be stored in the part of the brain that doesn’t or can’t know that the experience is over.  Sometimes, accessing a memory takes us out of the present and puts us into an experience when we did not feel safe.  I’d like to show one strategy that you can use to find your way back into the present.  Often the present may not feel “safe,” but it is likely to be safer than the experience from the bad memory.  The exercise will ask you to very briefly engage your senses, one at a time.  We will spend only a few seconds at a time getting information from each of the senses. If we keep it very brief, many people are able to tolerate this exercise well.  If anything difficult comes up, we can stop.  Is this an exercise that any part of you might object to, assuming that we do it quickly and that you can stop anytime you like?

If there is an objection. Stop and explore that objection.  See if there is a way to do this that is not objectionable to that part that allows us to continue.  Otherwise, full stop (parts will need to know that they can stop).

Vision: I invite you to look around the room and notice several things you see.  Notice several objects and notice the color of those objects.  Also notice that if you were to go up and touch these objects, would they be hard, soft, or some other texture?  [Wait 5-10 seconds]

Touch: Place an open hand on the table or furniture next to you for just a moment and notice if it is colder, warmer, or the same temperature as your hand.  [Wait 2-5 seconds]  Good.  Move your fingertips across the surface and notice if it is completely smooth or has a texture.  [Wait 2-4 seconds]  Good.  Move your fingertips across the texture of that surface and just notice if the temperature changes as you move.  [Wait 2-5 seconds]  Good.

Hearing: I’m going to be very quiet, notice whatever you hear in order of loudest first.  [Wait 5-8 seconds]  Good.

Smell: I’ll give you a few moments to smell the essential oil [or other object] that you selected.  [Wait 5-10 seconds]  Good.

Taste: I’ll give you a few moments to taste, smell, or feel the temperature of the drink that your brought to session.  [Wait 5-10 seconds]  Good.

How was that?  [explore] What was your experience with that exercise?  [explore]  Which of those senses seemed to be the most helpful in bringing your awareness more into the present? [explore]

As with all resources with client with complex trauma, send the client home to practice first at their baseline and not when something has happened that has severely triggered them.  Once the nervous system becomes comfortable with this resource, then use it as a fire extinguisher.

Full script for this is at: https://emdrthirdweekend.com/posts/dip-your-toe-in-approaches-to-body-scan

In this podcast, I propose a very simple modification to your calm scene mindfulness exercise when clients have struggled with exercises like this: outsource the calm scene to a YouTube video.  We may be able to use the video as a bridge resource.  Bridge resources are accommodations to standard resources that take into account the difficulties that clients may have with visualization, focus, self-judgment related to the visualization, and allow us to do a version of the resource that lets clients “get to the other side” of the resource rather than falling into the “canyon” of the resource.

What’s important, eventually in a resource, is that the client has a shift in affective state in a way that feels safe and tolerable to their parts.  When clients struggle to visualize, a video library of 17 billion videos immediately accessible to the client’s computers, laptops, tablets, and smartphones is a portable resource we should have been teaching for a while.  When it comes to calm scenes or calm processes, there is no inherent reason why that experience has to be fully imagined in order for it to be experienced.  We want to appreciate the difficulty of the cognitive “ask” of having a client with severe trauma conjure water, waves, sky, clouds, sand, buildings, breeze, smell of ocean air, seagulls, etc, etc.  It’s a heavy lift, as has been discovered by many therapists who try to develop an imaginary calm scene with clients with severe trauma.

What are the Goals of Calm Scene?

What are the Difficulties of Calm Scene?

How Can Outsourcing the Calm Scene to YouTube Help Us?

Scripts for these breaths are at: https://emdrthirdweekend.com/posts/dip-your-toe-in-approaches-to-breath-blue-smoke-and-hand-breathing

Assessing for attachment wounding: When you were young, who was really and consistently there for you?

At the core of EMDR therapy and the AIP model, the difficult stuff has to connect to and metabolize into right now adaptive information.  Shapiro is clear that enough of the needed adaptive information must be present for the difficult stuff to metabolize into it.  You cannot connect a lie to a lie.  Attachment figure resources can help rehearse and model what it might look like for more adult parts to connect with and bring information to younger parts.  Of course, everything that we know about attachment wounding is that starting life in survival mode often increases the chances that survival mode will continue well after childhood finally ends.  Absent opportunities to learn disconfirming information in tolerable ways, the most adult parts often share judgment, blame, or disgust toward child parts.

Attachment figure resources have something important to bring to the most mature and right now parts, but the main point is to bring the possibility of what didn’t happen to the child parts.  The deficits of attachment trauma may be neurobiological.  The absence of attachment may not have allowed the creation of the very pathways that are needed and leveraged by EMDR Therapy.  EMDR Therapy is always parts work.

While this can be a powerful resource, there are a wide range of protective responses against its introduction and absorption as a resource.  My attachment figure script, which is referenced in the notes below anticipates and tries to get ahead of many of these difficulties.  But, there are some categories of blocking beliefs that may make it nearly impossible to develop attachment resources without additional work: I am dispositionally bad, I don’t deserve love/kindness/to get my needs met, and I don’t want to be loved/receive kindness/get my needs met.

With these clients, we may need to try the exercise from the perspective of meeting the needs of someone else other than the client.  This is a dip your toe in modification.  I may ask if the client has a niece or nephew, or knows of a child (or can imagine a child) that could use some additional support.  I try to avoid the client’s own children, since this can bring up a lot of parenting guilt and reinforce themes of defectiveness or unworthiness.  We then develop the attachment figure script using the proxy of this other child, in place of the client’s younger parts.  We are “trying on” these qualities using a less triggering personae than the client himself, the way a child in sand-tray therapy may perform his or her emotional experiences through the persona of a dinosaur figure.

To review, attachment figure resources are a dip your toe in resource that can help facilitate healing in EMDR Therapy and other approaches.  If the client simply can’t resource the selves, find something that it can resource as a substitute for the selves can be helpful while we continue helping the client develop the needed assets for the EMDR journey.  Again, the protections against self-care, self-nurture, and self-directed compassion are survival strategies.  They exist for reasons.  We can’t go at them too directly.  We sometimes need to introduce disconfirming experiences carefully.  We need to dip our toe in.  Get information from that. Sometimes we need to dip our toe into something even smaller first. Leverage that.

Attachment figure resources can be difficult to develop for many clients.  In other episodes I’ll discuss many of these difficulties.

Strategies for working with problems visualizing.

Detailed scripts for this approach are at: https://emdrthirdweekend.com/posts/videotape-approach-script-with-complex-trauma-phases-three-and-four

Strategies for a gentler closure when things are heading in a good direction.