When trauma settles into the nervous system

When trauma settles into the nervous system


Several weeks back I had fascinating conversation with a fine art and publicity photographer.  He takes exquisite photos, the type of photo where you believe you are peering into the soul of his model. Interestingly, he remarked that there are instances when he sees beyond a natural anxiety or awkwardness in a model even as she (or he) is able to pose and smile - that somehow the face seems frozen.

The emerging neuroscience of acute stress and trauma may help to explain what, in part, the photographer sees.

We are fortunate that our nervous system is organized to protect us from danger.  Say, for example, you happen to see a Gray Wolf in your path as you walk through Yellowstone National Park.  A natural threat response will activate to ensure your survival. One part of your nervous system automatically releases a cascade of stress hormones designed to shut off the portion of your brain that thinks and plans, because stopping to consider your next move would surely be deadly. Concurrently, your body will attempt to flee or hide. Your heart rate increases, pupils dilate, and muscles tense. None of these changes are actions you choose freely - it’s how our nervous system is designed to respond to life threatening situations.

But what if the threat is your home?  What if the Gray Wolf is a human predator upon whom you rely for safety, security, and love?  That complicates the story.

Human children will first reach out to someone close to them when they are afraid - a parent, a family member, or (in adulthood) a partner.  If these people are not safe, that fight/flight response will engage. Unfortunately, for children living in homes characterized by chaos or abuse neither fight nor flight is usually possible.  Children are then left unsafe and with no way out, creating an unsolvable dilemma in which the biological drive for protection takes them to the source of danger from which they are trying to escape.  Their traumatized physiology moves into a collapse mode as a way of self-protection. Traumatized children are chronically afraid - frozen, with a compromised ability to think, rationalize, and respond - and may grow into adults who view vulnerability in close relationships as dangerous.

A frozen state is visible in our faces, faces that lack the relaxed facial muscles, natural movement, and warmth necessary to make and sustain human connection.  It is reflected there because our nervous system connects to specific muscles in the face and neck that communicate interest, amusement, responsiveness, as well as a host of other emotions - including fear.  A face that reflects chronic and long lasting fear is dangerous for us because we are wired for belonging. Feeling frozen contributes to isolation as it inhibits our ability to form meaningful relationships.

Fortunately, change is possible. Your reaction to acute stress is the natural adaptation to the situation in which you lived and, as such, it is learned. The good news is that something that is learned can be unlearned.  One essential piece of trauma work is becoming attuned to the ways in which you hold your experiences in your body. What do you notice about your breath? Your posture? The muscles in your face? What do you notice when you scan your body from head to toe? As you begin to listen to your body you can work with what you’ve learned, so that you can live freely with less anxiety and fear.

Mindfulness on the move

Mindfulness on the move

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It’s a wonderful day when I am inspired by a client. Just a few months ago I was sitting with a curious, highly active, and spirited young woman whom I will call Juliana. We were discussing ways to manage debilitating anxiety and sudden flashes of anger, and I explored with her the possibility of developing a mindfulness practice as one element in a program to regulate these emotions.

Cultivating mindfulness is highly beneficial. The research is clear. Brain scans show positive changes in areas associated with concentration, focus, memory, and emotional control. And yet people are often reluctant to begin a practice because they feel they cannot do it right.

The good news is that there is no incorrect way to “do mindfulness.” The goal is not to be thought free. In fact, we need thoughts to intrude in order to develop the skill. When we notice a distracting thought without judgment and return to our focus, we are practicing the exact skill we hope will generalize to our life.

But Juliana said something different.  After working to develop her practice, she noted that sitting still increased the emotions she wanted to manage, and that she actually felt worse with practice.  She wondered about adjusting her practice to align with her natural activity level.  

A moving meditation?  That’s a term typically associated with practices like qi gong or tai chi.  I asked Juliana what she thought she might do.  She responded quickly that she would practice the skill on her motorized skateboard, eyes open of course!  

Following several weeks of daily practice Juliana reported a significant and positive change - and in fact, she stated that she has a sense of internal calm she’s not felt before.  She feels more in control, with less anxiety and fewer outbursts.

A terrific outcome!  And more importantly, a lesson: 

It’s possible to adapt a mindfulness approach to your temperament or activity level. You do not have to adjust yourself.

In the consultation room: First steps

In the consultation room: First steps


I don't know what to ask when I'm interviewing a therapist.

It’s difficult to begin a search for a therapist even when you have had psychotherapy support before. Interviewing clinicians in your quest to find someone with whom you feel comfortable and who demonstrates expertise for your specific concerns is essential.  This step is important for all types of issues or presenting concerns, but is vital for someone with Complex Trauma (or C-PTSD).

But what else might such a consultation entail?

A conversation with a client earlier this week, an astute and articulate young woman, helped shed light on this question.  She was speaking about some previous therapy experiences: what worked and what didn’t, how she knew the therapist had the requisite skill set for her concerns -- and then about times she knew straight away that a therapist was not for her.

I know it’s not right when a therapist is too fascinated by my trauma story. 

It feels like disaster tourism.

Disaster tourism?  The understanding of what she meant hit me in the way any sudden insight brings that “aha!” moment of clarity.

Disaster tourism can be understood as the practice of visiting environmental or man-made disasters in order to observe but not necessarily to help.  So, in other words, the client noted that when a therapist treated her like a disaster area and engaged with her in a way that felt voyeuristic rather than empathic, she knew that it was a poor fit.

She coined the phrase “trauma tourism” and we agreed that therapists who engage in trauma tourism ought to get some more training or not work with survivors of PTSD or C-PTSD at all.

I’ve been thinking about our conversation since we met. Clients’ perspectives often enrich my own, and in this case our discussion about trauma tourism has helped me to articulate two questions that might be helpful to ask yourself during a consultation meeting:

·       Do I feel the therapist is more interested in the details of my story than in me?

·       Do I have autonomy in the initial session to determine the pace of the details I disclose?

There are, of course, other questions to ask in an initial meeting about therapist experience, theoretical orientation, cost, or scheduling. But the two questions above can guide your evaluation of your comfort level and serve as the starting point to begin your assessment.


Distraction as a tool in eating disorders work

Distraction as a tool in eating disorders work

I work with some very impressive young women – bright and courageous warriors – who are doing this very difficult work to improve their lives.  Therapy for eating disorders is a multifaceted approach that often includes individual therapy and group therapy, as well as work with a registered dietitian and a medical doctor.  If you are doing this work now, you know how time consuming and emotionally draining it can be.

There are some common things I hear from clients - and the most common is the notion that using distraction when overwhelmed by intense feeling is the same as avoiding these feelings altogether.  Often clients are instructed to “lean into" feelings, or to learn to sit with them.  The suggestion worries me because there are times when leaning into feeling can reinforce the belief that you do not have control over your body.  If that happens, healing cannot occur.

Some discomfort when experiencing difficult emotions is important - even necessary - for growth.  Becoming overwhelmed is unwise, even dangerous. If your feelings are too overwhelming it is okay to back out of them and then go back in gradually. In fact, it’s smart. 

But how do I distinguish between strong uncomfortable feelings and overwhelming feelings?  Here’s what I tell my clients.

Leaning into your feelings is appropriate for the discomfort associated with stress and some levels of anxiety.  But it’s not a great choice when an emotion like anxiety floods your system to the point where you are fuzzy or confused or dissociated.  At that moment you do not have the ability to sit with feeling in a way that is helpful to you in the long term.  At that moment you need tools to help you temporarily reduce the intensity of your experience and harness the ability to tolerate feeling in a growth-oriented way.  

Learning to live with really intense feeling is a process in which we titrate – or expose ourselves gradually – to overwhelming emotion so that we do not become destabilized. Distraction is an important distress tolerance skill in this process. 

That is, it is appropriate to use distraction in a skillful and mindful way when you are experiencing an overwhelmingly intense emotional experience so that you can reduce the force of the emotion temporarily

What are some examples of skillful distraction?  The answer is different for everyone – but could include skills like meditation, reading, taking a walk, watching TV, making music, visualization, art, dance, and reaching out to a trusted friend.  The key is to use it intentionally to take a break and focus on something else for a while. 

I'd be glad to speak with you if you have additional questions!  Please contact me for a no-cost consultation.


Reprocessing Trauma Memories with EMDR

Reprocessing Trauma Memories with EMDR

Jennifer felt as though her insides had been shattered and glued back together with the wrong adhesive.  No matter how hard she tried, she could not settle her nervous system.  Jennifer felt afraid, on edge, and had difficulty sleeping.  She was easily startled and sometimes had strong and sudden emotional outbursts.  Her perception of herself as powerless and others as untrustworthy permeated her experience.

That’s how Jennifer described living with trauma during our third therapy session. Following EMDR, she reported that the memory felt less emotionally charged, her body felt calmer, and she viewed herself more positively.  She felt able to engage in her life in a way she had not before.

Perhaps you too feel forever changed by your trauma history, or that you are very different from other people.  Or, you may feel as though you are just moving through life or that your world lacks color and energy. 

The effects of trauma may feel permanent, but they do not have to be.  You can feel better. Sometimes insight into the reason for your disturbance is simply not enough to manage your symptoms.  It still might be difficult to calm yourself or to change the way you think and feel.  I believe that this is because trauma is an invisible injury that resides in both our mind and our body.  Insight-oriented talk therapy and education about the effects of trauma are central to the process but I have learned that an effective approach must also target and release those disturbing symptoms that feel locked in your body.

What is EMDR?

EMDR is a trauma reprocessing therapy that often brings symptom relief more rapidly and effectively than other forms of therapy.  Sometimes a traumatic memory is so overwhelming that it is not adequately processed by the brain.  When that happens the memory can become trapped in your nervous system with all the negative thoughts, feelings and sensations of the original incident.  EMDR uses bilateral stimulation (right/left eye movements or tactile stimulation) to activate opposite sides of the brain so that traumatic emotional experiences can be released and processed through.  Following EMDR therapy, you may find that the traumatic incident has lost its emotional charge, that you are able to speak about it more easily, and that your body feels calmer and you feel generally more at ease.

How long will EMDR take?

That depends on the nature, type, and severity of your trauma you experienced.  The effects of single traumatic episodes may improve in 6 to 10 EMDR sessions.  Transforming complex trauma histories will require more sessions.

EMDR sounds like a gimmick – is there any research to show this works?

There is over 20 years of research to support the efficacy of EMDR as an empirically validated treatment for trauma.  EMDR Therapy is endorsed by:

Department of Defense/Department of Veteran Affairs

International Society for Traumatic Stress Studies

American Psychiatric Association

American Psychological Association

Substance Abuse and Mental Health Services Administration (HHS)

 National Institute of Mental Health

World Health Organization

I’m still not sure – I have more questions about EMDR.

I would be happy to meet with you to answer your questions!  Click here to contact me for a free consultation.

Trauma-informed care when your partner struggles with sexual compulsion

Trauma-informed care when your partner struggles with sexual compulsion

When I moved into private practice I met a bright and delightful woman who had just discovered her husband’s secret history of sexually compulsive behavior.  She learned about it in a devastating way, finding an open computer and seeing ongoing correspondence with a prostitute.  A bomb had gone off in the center of her universe and she sought psychotherapy to work through the impact and implication of this discovery.  She was engaged, motivated, wounded, and deeply in love with her husband. 

The sudden rupture in her attachment relationship triggered post-traumatic stress symptoms for my client.  She was anxious and fearful, and felt chronically on alert.  Her beliefs about safety and trust were shattered.  Ironically, despite describing her friends and family as generally loving and supportive, she did not find their reactions at all helpful.  In fact, others’ insistence that she should leave her husband immediately only contributed to her distress.  She understood intellectually that members of her support system meant to be helpful; however, she felt further isolated when she reached out to them.

We discussed that, although some helping approaches view partners of sex addicts as “co-addicts” or “codependent”, conceptualizing these individuals as survivors of an acute relational trauma would address the core issue more effectively.  When trauma hits any of us, we look for ways to feel safe and grounded in the chaos.  Often these strategies are automatic because in trauma we can lose the ability to choose action purposefully.  Therefore, recognizing a person’s tendency to look through her partner’s phone as an instinctive safety seeking behavior is imperative.  Once therapists help clients understand how certain reactions become automatic, clients can be helped to work in therapy to reconnect with the ability to choose action and to act deliberately. Using a trauma-informed lens to support these partners seemed more appropriate and certainly more empathic.

The shift in approach was extremely helpful to my client as she worked through her trauma, and yet she needed more: she still felt very alone.  Her need for understanding led me to begin a support group for partners of sex addicts. I run these trauma-informed support groups to offer individuals a safe place to learn, struggle and help one another in a collaborative and non-judgmental way.  Group can be a terrific adjunct to individual therapy for just this reason – individuals in a similar struggle can feel less alone, and can receive support from and provide support to one another. It’s invaluable.

I'm not sure - I have more questions about group therapy.

I would be happy to meet with you to answer your questions!  Click here to contact me for a free consultation.

Values assessment as a first step in career counseling

Values assessment as a first step in career counseling

Career counseling/coaching is an extensive process with any number of directions -- career choice, job search, vocational adjustment, career development, and career change.  Regardless of your overall objective for career work, self-assessment is the requisite first step because when self-knowledge drives decision making we tend to make better choices.

Vocational self-assessment itself includes a several factors, one of which is frequently overlooked. The articulation of work values is central to the self-assessment process whether you are looking for a new job in your field, seeking to move ahead within your field, considering a career change, or selecting a college major. 

I have found that most people can communicate their basic values pretty readily.  What is important to me?  What values do members of my family hold?  These questions are essential to ask in career work as well.  Translating these beliefs to the workplace is an important consideration because they are the principles that motivate us.  When workplace values are out of sync with our own set of values we tend to feel discontented, even if we enjoy work tasks themselves. 

The values we hold influence our overall job satisfaction.

Some of your work values may reflect conditions offered by the organization. Others may align with your intrinsic value system.  And still other work values are those which permit you to make specific lifestyle choices.  Good career counseling/coaching ought to

(1) present you with the opportunity to generate a vast array of values,

(2) consider the ideals most important to you,

(3) examine how conflicting values may affect career decision making, and

(4) arm you with the self-information necessary to help you make wise career decisions. 

We spend a great deal of time at work.  The Bureau of Labor Statistics reports that, on average, working adults spend about 35% of our time in work related activities.   Good preparation is essential to maximize vocational satisfaction and motivation.  When you understand how your core set of values relate to the workplace you increase your ability to choose a path that really suits you.

I'm not sure - I still have questions about how career counseling could help me.

I would be happy to meet with you to answer your questions!  Click here to contact me for a free consultation.

A mindful approach

A mindful approach

Mindfulness is getting a lot of focused attention these days.  We’ve heard about mindfulness meditation in popular culture for years, but now it’s finding support in the scientific community as well.  Researchers, including Harvard neuroscientist Sara Lazar and her colleagues, are publishing findings on the neuroscience of mindfulness.  Not only is mindfulness associated with reduced stress, but it can also change the brain in some really important ways.  With just an eight week program Lazar has seen increases in areas associated with memory, thinking, and emotion regulation; and reductions in areas linked to anxiety, stress, and fear.  

Moreover, we know that when people experience or even just recall distressing or traumatic events, certain things happen in our brains.  Specifically, highly upsetting events can cause our fear centers to become more active and the thinking part of our brain to go “off line” – that is, to become less active or even shut down.  When that happens we tend to react from fear.  Mindfulness practice can be an essential part of helping all parts of your brain to stay “on line” so that we can both think and feel, and have the freedom to choose our response.

The main components of mindfulness include focused attention in the present, accepting without judgment that your mind will wander, and bringing your attention back to the present when it does.  Although people often feel as though they’re not doing it right because they become distracted, the distraction is actually an important part of the practice.  The act of noticing this shift and bringing your attention back in an intentional way is a significant transferable skill.  In fact, I believe it might be what is most helpful to you when your thoughts or emotions are hijacked under times of stress.

So, what kinds of activities constitute mindful practice?  While a yoga or meditation program are certainly encouraged, you can think about choosing other activities that help you to feel calm, focused and contemplative.  Some clients with whom I work knit or make jewelry, and report that engaging in creative activities allow them to achieve the same benefit as others who have an established yoga practice. There is increasing evidence published in professional journals that other forms of creating -- including cooking, puzzles, or making music – have positive effects on our nervous system.  Think about what appeals to you, creatively, and try it for at least 30 minutes at least three times per week -- and see what you notice!

I'm not sure how mindfulness could be helpful to my particular concern.

I would be happy to meet with you to answer your questions!  Click here to contact me for a free consultation.

Eating disorders serve a function?

Eating disorders serve a function?

I became interested in the complex world of eating disorders when I was a doctoral student working as a teaching assistant for an upper level psychology class.  Students in the class selected articles in the Journal of Counseling Psychology to review.  Part of the assignment was to describe why the article appealed to them and to relate personally to their chosen topic. The vast majority of the female students chose articles about eating disorders and I read dozens of papers about students’ own struggles, or the struggles of their friends, sisters, cousins, and mothers.  I felt overwhelmed by the numbers and by the stories.  People were really suffering.  The experience led me to seek clinical training in this area so that I could make eating disorders an area of expertise.

Through reading, training, and working with clients over the years I’ve learned a few things.  An eating disorder is really about so much more than the shape of your body or how much you weigh. True, it typically begins with a preoccupation with food or weight.  People often say that they believe they can be happier if they change their bodies, and that if their bodies were smaller they’d get that job, that partner, that life would be great, that they would value themselves.  The promise is alluring, but unfortunately it’s not real.

The control of food can be one way that we try to feel better, stronger, more competent, or to cope with painful feelings. Restrictive dieting, bingeing, and purging begin as a way to manage difficult emotions, but they are dangerous to your physical and emotional health, self-esteem, and sense of control.  In fact, these behaviors can be life-threatening.

We can try to change our bodies but it doesn’t change our insides.  The real change comes when we tune inward. Sometimes the task is to identify what we need and to ask for these needs to be met.  Sometimes it’s to cope with overwhelming feelings associated with painful feelings of rejection, or histories of sexual abuse and other forms of trauma. Often it’s to learn about who we are and learn to value that.  Sometimes it’s all three.  It’s hard work, for sure, but it’s the work that can create a positive and lasting impact.

I'm still not sure.  I have questions about therapy for eating disorder recovery.

I would be happy to meet with you to address your questions!  Click here to contact me for a free consultation.