PLEASE NOTE: normally I encourage you to dip in and out of this blog. On this page there are a number of links to other parts of my blog. Please follow each link (and others!) if you are researching helpful treatment for trauma-related symptoms.

You are taking an important step and I want to use my own influence to ensure this research is done with great care. The findings of researchers and practitioners I mention on this page are well worth consulting.

Elvin Semrad was Bessel van der Kolk’s mentor as he trained in psychiatry in the States. In his book, The Body Keeps The Score (2014), van der Kolk quotes his mentor saying:

“The greatest sources of our suffering are the lies we tell ourselves“, going on to say that people never get better without knowing what they know and feel what they feel. The Body Scan is a safe experiment to help me explore what I know and feel what I feel.

To explain more, Semrad’s reference to “lies” was not a criticism of his patients. He was referring to specific post-trauma responses; to an apparent paradox in trauma work. Some people who experienced trauma were able to initiate strong emotions and, in turn, those reactions appear to block other feelings – the pain connected to the event at the time, or shortly after.

It’s as though there is value, for some, in reproducing strong emotions. Blocking our pain that way can become the lesser of two evils. The theory was that the recall of events – and the associated strong emotions – released morphine-like substances manufactured in the brain. These provided some relief and become a ‘preferred’ strategy.

Therapy is helpful in finding alternative strategies to uncontrolled ‘revisiting’ of trauma. That is particularly so where the blocked ‘pain’ is more psychological, e.g. when deep shame and guilt lie behind our survival after any trauma.

An example from van der Kolk’s text might help. Dogs knowingly traumatised in experiments by Martin Seligman (and others) failed to escape from their cages when the doors were opened. It emerged that those dogs secreted excess amounts of stress hormones, such as adrenaline and cortisol, long after the danger had passed. This kept them ‘frozen’ in their cages and oblivious to the available escape route.

What we now know is that the body thrives only on release of short bursts of those morphine-like hormones when the threat is present. The longer term damage created by persistent release of them is not good for our health – a series of rather large defeats can be easily overlooked. The logic is that the response worked in the short term, so that’s OK. In fact, the level of hormones needs to lessen steadily after any event if our system is to return to equilibrium.

In time, it was possible to show that one indicator of trauma is the persistent retention of stress hormones. Later it emerged that one way to achieve change – to dissipate those hormones – was to act. To break the immobility show by Seligman’s dogs, required drastic action: to “repeatedly drag them [the dogs] out of their cages so they could physically experience how they could get away“. A good therapist will not do this …. but s/he can direct your efforts to the relevant safe experiments.

The value of ‘safe experiments’ encouraged by therapists has emerged from decades-old observations. It pays to act, to get out, and to do something. Even so, I still repeat the need to design experiments with professional support as action is not all.

Another reason for using professional support is that safe experiments cannot be guaranteed to produce small victories. Indeed, treating trauma by small safe experiments may – unintentionally, or not – generate potentially large defeats. These defeats will arise because we take unskilled actions when we try something different. How long did it take you to ride a two wheel bike?

So, there is much about treatment for trauma that is not common-sense. Professional support can help identify and articulate those “lies” we might tell ourselves. That does not mean you need the best qualified, ‘top’ doctor. You need some-one who can give you confidence that you will find a way to do something a bit different. That said, suitably qualified people, with additional training in trauma management should be recruited. Please research carefully when choosing some-one to work with.

For my part, I begin to negotiate an end to therapy as and when it is evident that the other person has ‘got’ the insight into their pain and can give voice to it. Therapy can move towards closure once the significance of any pain is appreciated, and a ‘proper’ place is found for it in our body and in our matrix memory.

Looking pain in the eye is particularly difficult when we feel guilt and shame.

Return to:

welcome

How to give yourself a nudge

The obvious text to mention here is:

Nudge: Improving Decisions About Health, Wealth, and Happiness.

by Richard H. Thaler and Cass R. Sunstein

Publisher: Yale University Press
ISBN: 9780300122237: Number of pages: 304

The notion of how to ‘nudge’ was brought to the fore by this 2008 book.

The primary complication with their text – written from the perspective of economists – arises from the assumption that you can help other people to nudge some-one else.

This text highlights how we make decisions about our lives but – too often – we choose poorly. This approach to ‘nudging’ is not so respectful of the ‘small defeat’ and the ways in which we ‘have’ to get it wrong in order to get it right.

Thaler and Sunstein are helpful in showing how humans are susceptible to various biases that can lead us to blunder. They say we can do things differently if we take humanness as a given and work with it – rather than against it. They invite us to enter an alternative world, They show that by knowing how people think, we can design choice environments that make it easier for people to choose what is best for themselves, their families, and their society. However, this view neglects the fundamental issue: who designs the experiment and how can we learn from the results. Mistakes do not always make us poorer; the scenic route, with small defeats and small victories. is able to teach us important lessons.

There is a web site addressing the larger political issues relating to nudging:

http://nudges.org/

This web site highlights how ‘nudging’ arose from a wish to change others – it’s what politicians do – and it may well be an important motivator for people to go into politics! I want my own web site to provide an antidote to this paternalism by asking you how you will design experiments based on the victories and defeats you will experience.

Crises generate anxiety. That anxiety, however, is likely to be ‘right’ for that moment. It is ‘situationally appropriate’, as people like me say.

The anxiety that arises for no apparent reason is another thing. This is termed ‘generalised anxiety’ and, as it persists, it can become a disorder. The experience you have in your body may be much the same for both anxious experiences, but the safe experiments that are required to work with crises and generalised anxiety are very different.

Let’s examine some of the similarities and differences:

SIMILARITIES

• Although anxiety will tend to make us feel bewildered, unreal, or unsteady, these feelings are normal bodily reactions to threat.

• Having these sensations does not mean you are ill. They may be unpleasant and even frightening but they are not a problem in the short-term. Usually, nothing lasts for ever.

GENERALISED ANXIETY

• In this situation, we experience our anxiety as, indeed, lasting for ever. This arises when we magnify our feelings – unintentionally or not. Often this happens out of context – there is no obvious reason for the feelings and sensations. This rather normal reaction is often labelled ‘catastrophising’. In common language, we talk about getting things out of proportion. However, to an anxious person those words can be an irritant; their feelings are real and reassurances do not ease the discomfort.

Catastrophising here and there need not be a problem; newspapers do it all the time. However, when the sensations you experience in your body persist, it has the potential to do emotional and even physical harm over the longer term. Why is this? The anxiety created when our alarms goes off is intended to last only a short time; the time it takes us to kill off a threat, or escape from it or, sadly, to be killed by it. When those reactions persist and do not decay, then physical and emotional harm is feasible, e.g. making us withdraw from company, argumentative and difficult to live with. Unfortunately, the thoughts racing around our smarter and younger sibling can keep things going after the threat has diminished. We are able to generate a virtual reality of woolly mammoths and sabre-toothed tigers.

CRISES

The big difference about crises is, indeed, a real threat to our safety and security. It will create an immediate need for action. Anxiety exists to give us the energy to act; to move instantly with a laser-like reaction. However, it can tempt us into actions that, in the cool light of day, may be regretted. In the section on Flight, Fight and Freeze, I have made a virtue out of action. That said, some actions will be impulsive – not always under conscious control – and this can create unwanted and unintended consequences. I use the example of domestic abuse – in which some-one hits out – as just one such unwanted outcome.

Therefore, in developing your safe experiments, be aware of different forms of action:

1. those that are immediate, impulsive and seemingly outside your control; they may or may not get you to a safe place.
2. the temptation to act impulsively after the event because you are remembering the receding threat.
3. a considered action based on evidence that the action is likely to have a preferred and valued result.

An obvious example is the temptation to leave a job or home because it seems the ‘only’ solution. Keep in mind that you can still leave home and job if, indeed, it proves the considered thing to do. Even so, in the immediate aftermath of any incident, take time to think this through and, preferably, talk it through with some-one who is trustworthy and discreet.

PLEASE NOTE: this is not a recommendation for NOT running away in certain situations. If you feel unsafe, running away to a safer place is likely to be the right course of action. The point here is: can it lead you to explore other safe choices, rather than up a cul de sac from which it is difficult to escape..

SOME PRACTICAL SAFE EXPERIMENTS

• Don’t run away from your experiences after the event. Can you ‘look them in the eye’? Notice what is really happening to your body at the moment, and what it is telling you now. Just notice your thoughts and experiences. Say ‘hello’ to any of the self-critical messages without dwelling on them.

• In particular, notice the sensations, however uncomfortable they may be. If necessary, talk to them as ‘part’ of you (they are part of you – like it or not, even if not your best friend!)

• When you feel anxiety: use breathing exercises to relax, and let go. Make yourself as comfortable as possible. Sit for a while. Do not drive or be prompted into hasty actions. Take your time.

• If necessary, describe the outside world. What you can hear and see, or what is going on it.

• As you wait and watch just notice that things can change. How do they change and in what way? Use the Subjective Units of Discomfort (SUDS) on a scale of 1 (for little) to 10 (the very most) to monitor how the strength of feelings go up or down. Less often will they stay the same.

• Be curious and do lots of safe experiments. What do you learn from the things that seem to go wrong as well as the successes in your life.

• Be aware of ways in which you can be in control of your body and your situation. You may surprise yourself and find some controls you did not know you had.

• When catastrophising, use the diversions and distractions you have designed for yourself. These are less likely to work in the moment of crisis. Indeed, the strategies can become a disappointment to you because they appear not to work. This may deter you from using these strategies at all Diversion and distraction seem best suited to changing your habits (and so need to be practised several times a day in a random fashion, rather than in the heat of the moment). In particular, I would want you to very aware of the outcomes you obtain from your experiments. Clarity of thinking is one things that tends to vanish in a crisis!

With a following wind, we can learn from small defeats and further experiments can increase our confidence in our ability to respect our fears and anxieties.

As I specialise in trauma management, I am often asked about how treatment works. The short answer is that often we do not know!

There are many leading therapists who get good results and this seems to arise because they are well informed and skilful (one reason why I have written the commentary on Person-centred therapy).

I’ve mentioned a few already, but I will focus here on Peter Levine having revised some of his material recently. As with Bessel van der Kolk, Peter looks at the responses of our body and he asks how we can work therapeutically with the body in different ways.

One thing of particular importance is the idea of the flight/fight response. The responses of the lower brain, and the amygdala in particular, can help us run or fight in a threatening situation. We can recover and escape, possibly without long-term physical or emotional damage.

However, if we do not run, the primitive circuits of our older and not so smart sibling can persist and take over. Our ability to function will deteriorate. The potential for post-trauma starts to be set up.

If you can’t fight or flee – you may end up frozen and helpless. You have to work through that unpleasant experience if the trauma is not to to be retained in your body. Therapy can help us to find a place for the experience that makes sense – to place it at the ‘back of our mind’ – rather than pre-occupying us by obstructing the front!

In his writings, Peter talks about the body as a container that embodies all our experiences – everything we think and feel. Simply appreciating that we live in a body, and not in our heads, starts to give us therapeutic opportunities to build a safe environment.

The bodily events happening one after another provide both the story about what is happening and the visceral exponent that ‘glues’ the event in our matrix memory. The story we tell rather depends on the workings of our younger and smarter sibling, This may provide one part of our recovery but only if the way in which we once felt inside is ‘unglued’ – that is, experienced, not avoided.

Once we regard the body as a source of information, and tune into what is happening in the body at any given moment, we may be able to release ourselves from some of the trauma held in the body.

Another way to view this Flight, Fight and Freeze response is to study Stephen Porges’ account of the Polyvagal system. This is so important that I have written up more details at:

https://your-nudge.com/2017/11/30/control-breathing-to-keep-calm-is-it-really-that-simple/:

Polyvagal theory is a large and complex subject to research. It does demonstrate how modern therapy and modern neurology appear to be coming together. It is not a study to take on lightly!

How can we use these ideas in a practice?

When body scanning, just notice the thoughts, feelings and sensations, as described in the main body of my blog. When it feels right, focus on the sensations and stay with the body experience. Start to just notice the intense sensations and feelings as moment-to-moment experiences. Do not divert or distract yourself with starting something different. To do so would take you into a different set of experiments.

Just noticing these responses in the present can become very freeing, even if they seem to invite freezing as well. However, those feelings can transform themselves on their own – without action or the need to play them out.

Compare this with the mid-20th century approach of Alexander Lowen and Wilhem Reich. They recommended that therapy work with feelings by discharging them in some fashion; by acting them out. Today, we are aware that we are able to stay with the feeling and not necessarily express it outwardly. Feelings can still transform; indeed, the neurology of how feelings grow and subside rather require them to transform.

This leaves the issue: when might acting out work or, indeed, leave us stuck with more to come. When is this acting out, or cartharsis, as it is known, not required for healing to take place?

The general answer is that acting out will work in the here-and-now. When it is ‘situationally appropriate’. That is, when the threat is present and immediate. If I find myself in a circumstance that is potentially overwhelming, then it is usually better to act. The alternative to fight or flight is to freeze. It is this state of freeze that can foster stuckness – like the bunny caught in the headlights. Freeze works best when we need to be anaethesised or prepared for death.

I do some work in the area of domestic abuse. Here I notice how angry people do act and may do damage. Often they will speak remorsefully afterwards, but most often, this belated apology appear non-genuine. Furthermore, they are likely not to feel their anger after the event. They have acted; their feelings are dispersed. That action, anti-social though it may be, is defensive. Instead of just feeling the anger, it is enacted and minimal residual feelings are left. It would be handy if some genuine shame could survive, but with some people this does not happen.

So, in brief, how do you develop a sense of the body as a source of safety, rather than a repository of threat? Everything keeps changing but the body is still here; awareness is still here. We can tap into that. The body is a source of information – by tuning into what is happening in the body by body scanning we can look our fear in the eye – not as our best friend, maybe, but as a powerful tutor.

I have been told that my approach is person, or client-centred. To some extent this has to be true in the sense that any effective therapist has to demonstrate client-centredness to the person in front of them.

That said, I am not convinced that I am person-centred in the traditional understanding of the ‘person-centred school’. This perspective can be tracked back to the work of Carl Rogers (assuming you do not want to travel back to the Greeks!). You can find a summary account of Rogers’ life and work at:

https://en.wikipedia.org/wiki/Carl_Rogers

The reason why I am reluctant to accept a person-centred label is that I may adopt an humanistic stance in my work, but that’s a rather vague phrase. I am less convinced about the contributions made by the core conditions that emerged from Rogers’ clear and incisive writing. When I say this, I am referring not only to his three core conditions that are well-known, but also the three less well publicised conditions laid down in his texts.

My understanding of the six conditions, in brief, is:

1. that a relationship between client and therapist must exist and that each person’s perception of the other is important.

2. that incongruence exists between the client’s experience and awareness. This is a normal human condition, but one that motivates clients to seek to change.

3. the therapist needs to be congruent within the therapeutic relationship. That means the therapist is not “acting”. They can draw on their own experiences to facilitate the relationship. Traditional therapies were doubtful about therapists’ sharing their own experiences so Rogers was breaking ground here in the mid-20th century.

4.the therapist accepts the client unconditionally, that is, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted by others.

5. the therapist seeks to experience an empathic understanding of the client’s inner world (or internal frame of reference, as it is termed). The therapist’s accurate empathy helps the client see the therapist’s unconditional regard for them.

6. The client perceives, at least to a minimal degree, that their therapist’s unconditional positive regard and empathic understanding is present.

These conditions have been labelled “necessary and sufficient” for effective therapy. For myself, I regard them as a global basis for working towards being an effective therapist – they are, indeed, necessary but the six conditions are not sufficient.

Why do I think is this? The six core conditions minimise the therapist’s knowledge and understanding. In my experience, clients do expect their therapists to have some skills and to be active in using them. They do not expect knowledge and understanding to be withheld from them in the name of ‘unconditionality’ simply because they have not asked for it. It is difficult for any of us to ask for what we want if we do not know what to ask for!!

Furthermore, the six core conditions do not allow for any incongruence between the therapist’s experience and awareness. In the ‘safe experimental’ method, a therapist will experience small defeats and small victories, as will the client. All need to be identified, discussed and explored in therapy, between sessions and in the process of clinical supervision. Why? It is not reasonable to expect clients to undertake a process if I, as a therapist, am unwilling to do the same thing. It is not simply a question of settling a ‘good example’: it is demonstrating by example.

On one final point, I would say that self-regard in a client is increased not simply by gaining insights into their own current self-worth. They will also be enabled here when their therapist identifies how their own self-worth is distorted by self and others.

I am used to person-centred people saying these three issues I have listed are addressed by the condition of ‘congruence’ within the therapeutic relationship. This gives the impression that the therapist is given permission to speak their mind – discouraged to put on a professional veneer. Would that this were so. What I have observed, in training and in practice, is that modern therapists can swap the ‘professional face’ of older therapists with a reluctance to commit ask questions or offer an opinion.

The truth be told: there is a time for “acting” when being a therapist. If a client appears to say something important, I can mark it with a verbal or a non-verbal response. The latter are often powerful but require a conscious response from me – to a degree that is ‘acting’; that is, not responding with my first impulse. Some of what emerges from Neuro-linguistic Programming (NLP) demonstrates there is an OK side to ‘acting’.

In my view, the person-centred tradition lost the spirit of Rogers’ attitude or a set of ethics. Over time, training and trainers became wedded to the ideas behind the core conditions. in time, ‘person-centredness’ lost its flexibility and became a ‘school’ – a rather ossified tradition.

In doing so, the school became less motivated to follow the client’s own journey. A person-centred therapist is likely to be enraged by this statement. I can appreciate that most therapists want to walk alongside a client on their journey into a changed future; one that is shaped by that client. It is easy to say those words, and easy to stop demonstrating the difficult actions required to keep two people in a negotiated focus.

I was introduced to this research method by Jamie Murdoch, Research Fellow, at the University of East Anglia (UEA).

The term sounds rather intimidating so let me say more about it as it will help some readers interested in research and ‘safe experimenting’

The term ‘linguistic ethnography’ is an umbrella term for specific approaches to research. Scholars combine linguistic and ethnographic research traditions to our understanding of the impact of our social world on us. It does not take for granted our ways of communicating on our everyday world (our ‘social context’, as it is labelled). Take a look at:

https://www.researchgate.net/publication/304796765_An_Introduction_to_Linguistic_Ethnography_Interdisciplinary_Explorations

……. for more details.

There is a connection here with the information I have provided about Acceptance and Commitment Therapy (ACT). I’m no great philosopher, but ACT authors have described their approach as based on the philosophy of science called functional contextualism. Put simply, this means focusing on things that work and the context in which they are working. You are likely to be less effective – and invite more small defeats – unless you design your safe experiments paying close attention to the context in which you are living your life.

As I see it, the research into therapy undertaken by Charles Truax and Robert Carkhuff, as well as later work on Neuro-linguistic programming, undertaken by Richard Bandler and John Grinder, emerged to some degree from this way of examining what goes on in our world.

The relevance of linguistic ethnography to ‘safe experiments’ is that this research method serves to help us notice the social context within which we operate – just enough to see what changes might be made and how we might go about designing a suitable experiment.

You cannot do a safe experiment unless you want to do something different and, to notice what might be done differently, we need to notice the everyday impact on us of the world in which we are existing.

So, in practice, pay attention to the language you and others use and notice what impact language has on your understanding. Just as important, return to the Road Map safe experiment in How to Give Yourself a Nudge and notice how change is made difficult by our wider world.

Notice how others around us make it more or less easy to create change or even ‘allow’ us to become aware that change is feasible. Schools and colleges are intended to educate us; have you noticed how, sometimes, those institutions contain and reduce or ability to be different. It is precisely those ‘social contexts’ that may need disrupting before you can initiate a safe experiment effectively.

Do you remember the experiment about messages from our parents and grandparents? Most messages sent to us were meant to be well-meaning (sadly, not all). Go back to your records and notice the unintended consequences arising from some of the messages we received.

There is a problem with the method I recommend. It places a lot of responsibility on you to decide the direction of change and how to go about it bit-by-bit.

Therapy has thrived as a profession because individuals possess blind spots that make it difficult to direct your own therapy. The Johari Window demonstrates how Blind Spots can get in the way – as well as a route lifting the veil, so we can see just a little more.

Many people have reported the benefits of having some-one around to help them complete the therapeutic journey. You may well doubt your own judgment as you examined the results of some of your experiments and wondered what to do next. All along I’ve encouraged you to seek a consultation when this happened.

However, there is still more you can do to develop your own self-awareness and to extend the benefits of the ‘safe experiment’. There are ‘doors’ that will help you along and there are others that need to be pushed opened.

You will need to experiment differently as you approach the different ‘doors’. What do I mean by this? Try this:

Consider an issue in your life: a new one or one you already have worked on. Jot it down somewhere in the briefest detail.

• it is likely to be concerned with the way you are thinking,  behaving or feeling. I’m including ‘financial’ matters under ‘behaving’, for present purposes.
• would you say you are some-one more dogged by your thoughts, or behaviour or feelings?  If so, then the one you chose is, for the time, likely to dominate your decision-making. This dominant one becomes your ‘target door’: your response to it requires some attention now.
• according to your personality, you will have an ‘open door’ more available to you –  one of the remaining ‘doors’ you can approach with more confidence, but …….
• the remaining ‘door’ –  the remaining channel – will be your trap door;  the door most likely to trip you up. Starting your experiment here may be less helpful.  You may, in due time, walk towards it – but not at the beginning.

Now, how will this category of ‘doors’ help with safe experiments?

It provides an opportunity to focus our attention on a ‘target’ using the skills already available to you. The ‘open door’ provides an initial way in.

The aim is to reduce the traps right in front of us or to offer us a warning about the things we might miss.

That all sounds rather vague so let’s make up some examples.

An individual becomes more and more aware that his checking behaviour, say, door locking, gets in the way of a quality life; it wastes time. That person is trapped by his behaviour. He is good at thinking; his thoughts are full of “did I check or not“. On this analysis, the man will focus safe experiments on the ‘middle’, ‘feeling door’.  He reacts to the anxiety he experiences when regularly checking.

Only by acknowledging ‘worry’ can we make a plan to address it. It is very easy to return to ‘did I check or not‘, again and again. But it is a thought that may well stimulate further worry. This disrupts the alternative, less-used action/behaviour pathway – the one that promotes planning and the impulse to see the plan in action.

The initial experiments are likely to focus on affect regulation and his observations of the changing levels of anxiety feelings using the SUD scales. This may lead, through practice,  to actions and behaviours that prove more useful; making us more aware and sensitive to other aspects of our existence.

What about another individual – a woman – who finds it difficult to say ‘boo to a goose’? she demonstrates withdrawal in company; her behaviour, the open door, is passive avoidance of company.  Her thoughts provide the trap door that reinforce her actions – ‘I wouldn’t do that if I were you’  ideas, so again, the target door is ‘feeling’. By devising experiments that attend to her feelings, and the changing levels of her SUDS, this woman may learn to improve her self-confidence and manage her feelings differently.

Often, these changed responses will encourage different thoughts such as self-affirmation: “even though I am feeling anxious, I can deeply and completely accept myself ” and she may be more able to act differently when meeting people.