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Sensorimotor Psychotherapy Interventions for Trauma and Attachment
Sensorimotor Psychotherapy Interventions for Trauma and Attachment
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Sensorimotor
Psychotherapy
INTERVENTIONS FOR
TRAUMA AND ATTACHMENT
Pat Ogden
Janina Fisher
ILLUSTRATORS
Deborah Del Hierro
Anthony Del Hierro
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For Ron Kurtz (1934-2011), best friend and most influential
mentor, who dramatically changed the course of my life and my
work. Without a doubt, the finest education I ever received was
sitting in on psychotherapy sessions with Ron and his clients in
the 1970s. In all my experience over the last four decades, I was
never again to witness anything comparable to the magic and
power of his clinical work. Ron’s pioneering legacy and the fun-
loving, generous, compassionate presence he so fully embodied
are with me always.
∼ Pat Ogden
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Contents
Introduction
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CHAPTER 22 Reconstructing Memory: Finding Resources in a Painful Past
CHAPTER 23 Dual Awareness of Past and Present
CHAPTER 24 Sliver of Memory
CHAPTER 25 Restoring Empowering Action
CHAPTER 26 Recalibrating Your Nervous System: Sensorimotor Sequencing
CHAPTER 27 Emotions and Animal Defenses
Afterword
Glossary
References
Index
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Introduction
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adjusting it to the unique needs of each client and the dynamics of the dyad.
Suddenly, doors opened, possibilities expanded, and this book was born. In writing
it, I am counting on the therapeutic relationship to provide the context through
which the role of the body in treating trauma and attachment deficits is explored. It
is also essential to understand that this material is in no way intended as a stand-
alone treatment or manualized approach. The selected concepts and interventions
from Sensorimotor Psychotherapy introduced in this book, which by no means
represent the full spectrum of what Sensorimotor Psychotherapy has to offer, are
designed as an adjunct to, and in support of, other methods of treatment. With a
primary emphasis on the therapeutic relationship and on adjusting these ideas and
interventions to the needs of each client, I expect and hope that including the body
in the therapy process will become viable for therapists and their clients. However,
it is important to emphasize that this book is not intended to teach the practice of
Sensorimotor Psychotherapy or to provide comprehensive instruction in this
approach. It is meant to introduce some foundational concepts of this method that
clients can explore experientially through worksheets and exercises under the
guidance of their therapist. Therapists who wish to learn Sensorimotor
Psychotherapy can enroll in the comprehensive trainings in this method that are
offered throughout the world by the Sensorimotor Psychotherapy Institute.
Although Sensorimotor Psychotherapy incorporates body-oriented interventions
common to other somatic psychology approaches, the Sensorimotor Psychotherapy
Institute, founded in 1981, has developed its own unique method of somatic
psychology theory and practice informed by interpersonal neurobiology,
neuroscience, trauma and attachment research. Often referred to as a “body-
oriented talking therapy,” Sensorimotor Psychotherapy blends theory and technique
from cognitive, affective, and psychodynamic therapy with straightforward somatic
interventions, such as helping clients to become aware of their bodies, to track their
bodily sensations, and to implement physical actions that promote empowerment
and competency.
Within the context of an attachment-focused therapy, Sensorimotor
Psychotherapy teaches clinicians to become interested in how the body carries the
legacy of trauma and attachment inadequacies and in how to help clients change this
legacy through somatic awareness and movement. Therapists and clients alike
discover that the natural intelligence of the body can be tapped as a fundamental
resource in clinical practice. Clients are taught to observe the relationship between
the body, beliefs, and emotions, noticing how a self-representation uttered in a
here-and-now therapy moment, such as, “I’m not good enough,” both affects and is
reflected in patterns of sensation, posture, gesture, breath, gait, autonomic arousal,
and movement. The interventions described herein actively incorporate the body,
seeking to change the habits of physical action and posture that keep clients stuck in
the past, and to support a more unified approach to treatment.
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Sensorimotor Psychotherapy: Interventions for Trauma and Attachment
explores selected concepts and techniques from Sensorimotor Psychotherapy in a
way that traditionally trained therapists will find immediately applicable to their
clinical practice. The book will be useful for psychotherapists of a variety of
persuasions: psychologists, psychiatrists, social workers, counselors, and marriage
and family therapists. Some of the material may also be valuable for psychiatric
nurses, occupational therapists, rehabilitation therapists, crisis workers, victim
advocates, disaster workers, and body therapists, as well as for graduate students
and interns entering the field of mental health.
Sensorimotor Psychotherapy: Interventions for Trauma and Attachment
begins with a section that presents foundational premises and orients therapists and
clients to the book and how to use it. The remainder of the book consists of
relatively short chapters, each one designed to educate the reader about a particular
topic relevant to clinical work. A glossary of terms is provided at the end of the
book. Every chapter is accompanied by a several worksheets that are designed to
help clients integrate the material. Each chapter is preceded by a guide for
therapists that describes the main purpose of the chapter, identifies which clients
might benefit most from it, offers tips for integrating the material into clinical
practice, introduces the chapter’s worksheets, and suggests possibilities for
adapting these interventions with dissociative clients. Readers are encouraged to
familiarize themselves with the contents of this book and select and explore those
chapters, interventions, and worksheets that are most useful and appropriate for
their profession and with their specific clientele.
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for how to use the subsequent topic chapters with clients. Several subjects are
explored, including the structure of the remainder of the book, psychoeducation, and
how to use the worksheets; adapting the material for dissociative clients; and
developing a degree of ease with body-oriented interventions.
CHAPTER 3, “Orientation for Clients,” is written specifically for clients. It
explains why this material should be explored collaboratively under the guidance
of a therapist and how to use the subsequent chapters within the context of therapy.
It outlines the structure of the book, defines relevant terms, discusses how to make
use of the concepts and worksheets, and offers special recommendations to those
with dissociative disorders. Therapists should require that clients read this chapter
prior to working with the rest of the book.
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stimuli that was elucidated in the previous chapter. Sensorimotor Psychotherapy’s
approach to mindfulness is explained and distinguished from other mindfulness
practices. Clients learn to focus on the present moment internal experience of their
body sensations, movements, perceptions, emotions, and cognitions, rather than on
the past or the future.
CHAPTER 8, “Directed Mindfulness and Neuroplasticity,” refines the
mindfulness skills learned in the previous chapter by teaching clients to
deliberately direct their mindful awareness toward specific selected elements of
internal experience. This kind of focused attention is thought to capitalize on the
brain’s capacity for neuroplasticity by creating new experiences.
CHAPTER 9, “The Triune Brain and Information Processing,” explores the
possible effects of experience on the functioning of the three areas that comprise the
triune brain (MacLean 1985)—neocortex, mammalian, and reptilian, which roughly
correspond to cognitive, emotional, and sensorimotor (or body) processing.
Learning about these “brains” can help clients better understand why they think,
feel, and act as they do and support integration among these three levels of
information processing.
CHAPTER 10, “Exploring Body Sensation,” builds on the previous chapter to
further distinguish cognitive, emotional, and sensorimotor processing. This chapter
teaches clients to become mindful of body sensations that are usually processed
automatically, a skill that can facilitate understanding of internal states and promote
regulation. Clients will begin to develop a vocabulary to describe physical
sensations, as distinguished from vocabulary that describes emotions and thoughts.
CHAPTER 11, “Neuroception and the Window of Tolerance,” explains Porges’s
concept of “neuroception” as a function of the autonomic nervous system’s capacity
to detect environmental features that are safe, dangerous, or life-threatening (cf,
Porges). Clients learn how faulty neuroception develops, and how reminders of
past threat cause a neuroception of danger even when the current environment is
safe. Siegel’s (1999) concept of the window of tolerance, a zone of regulated
autonomic arousal in which information can be processed and integrated, is
introduced. Dysregulated arousal is described as instinctively activated, rather than
as a sign of weakness or deficit.
CHAPTER 12, “Three Phases of Therapy,” adapts Janet’s (1898) phase-
oriented treatment to provide an overview of the three phases described in this
book: Phase 1: Developing resources; Phase 2: Memory: integrating the past; and
Phase 3: Attachment and beyond: moving forward. Each phase has its own
challenges, goals, interventions, and acquisition of skill. Together, these three
phrases provide an overall structure for establishing immediate and long-term
therapeutic goals. This chapter also orients the reader to the rest of the book, which
is divided according to these three phases.
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SECTION THREE: Phase 1—Developing Resources
This section spells out how to identify, embody, and make use of a variety of
personal resources that often go unappreciated and teaches clients how to develop
new resources, particularly somatic ones.
CHAPTER 13, “Appreciating Your Strengths: Survival and Creative
Resources,” guides clients to acknowledge the strengths that they already possess.
Learning to validate these resources is a potent step in this first phase of therapy
because doing so can increase self esteem, promote regulation of arousal and
challenge perceptions of personal inadequacy. This chapter defines resources,
reframes many symptoms, difficulties, and coping strategies as survival resources,
and helps clients acknowledge and embody their creative resources.
CHAPTER 14, “Taking Inventory: Categories of Resources,” explores a variety
of classifications of resources for the purpose of broadening clients’ appreciation
of the wide range of resources available to them. Clients learn to recognize internal
and external resources in each of the categories that they have already developed
and explore ways to embody these resources.
CHAPTER 15, “Somatic Resources,” introduces clients to how their own
movements and gestures can be sources of stabilization, comfort, and competency.
By identifying and practicing the somatic resources they already possess and
learning new ones, such as centering and containment, clients build confidence in
the role of physical action in supporting well-being and regulating difficult
emotions, sensations, and impulses.
CHAPTER 16, “Grounding Yourself,” describes grounding as a felt sense of
connection to the ground through the foundational support of the legs and feet. This
chapter explains grounding as an essential somatic resource that underlies many
psychological capacities. It contrasts being ungrounded, which can contribute to
feeling unfocused and unsupported, with being overgrounded, which can contribute
to feeling stuck and sluggish. Clients learn and practice a variety of somatic
resources to support being grounded.
CHAPTER 17, “Core Alignment: Working with Posture,” describes the function
of the spine and surrounding muscles, highlighting the important role that posture
plays in how we feel about ourselves, others, and the world around us. Clients are
encouraged to develop a connection to their physical core and practice a more
aligned posture, which in turn supports their psychological core and a positive
sense of self.
CHAPTER 18, “Using Your Breath,” explains the mechanics of breathing,
including how breathing patterns can either exacerbate stress and dysregulation or
reduce stress and support regulation. Clients discover their own breathing habits,
explore how different breathing habits affect arousal and well-being, and identify
ways of breathing that are resourcing for them.
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CHAPTER 19, “A Somatic Sense of Boundaries,” clarifies the importance of a
physically felt sense of boundaries. The difference between physical and internal
boundaries is defined, and childhood experiences that influence the felt sense of
boundaries are explored. Clients learn to mindfully sense the physical indicators of
their needs, preferences, opinions, and limits and how to make their words
congruent with their body language to communicate clear boundaries.
CHAPTER 20, “Developing Missing Resources,” focuses on helping clients
identify resources, particularly somatic resources, that are weak, underused,
undeveloped, or missing altogether. Building on Chapter 14, “Taking Inventory:
Categories of Resources,” it also guides clients to discover and practice new
internal and external resources for each category.
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memory should be strong enough that the unintegrated effects of the memory are
experienced and processed, but not so intense that clients become unduly
dysregulated and cannot integrate what they experience.
CHAPTER 25, “Restoring Empowering Action,” explains how faulty
neuroception leads to dysregulated animal defenses, and how these defenses can be
recognized, processed, and integrated on a body level. Animal defenses are often
impervious to both verbal attempts at resolution and to working with their
emotional components, but they do respond to body-based interventions. Clients
will learn to recognize somatic signs of various animal defenses and practice new,
empowering actions.
CHAPTER 26, “Recalibrating Your Nervous System: Sensorimotor
Sequencing,” directly addresses the strong energies of hyperarousal associated
with traumatic memory by teaching clients to put aside trauma-based emotions,
thoughts, and content and to focus instead on the body. Clients learn to direct their
mindful attention exclusively to the involuntary physical sensations and movements
associated with hyperarousal until their arousal returns to the window of tolerance.
CHAPTER 27, “Emotions and Animal Defenses,” discusses trauma-related
emotions that support the particular function of each animal defense. Clients learn
to recognize the signs of these emotions and why expressing them does not typically
resolve them. Instead, they can be regulated and completed through physical action
and awareness of sensation, approaches taught in the previous two chapters.
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CHAPTER 30, “Making Sense of Emotions,” teaches clients how early
attachment relationships affect their current emotional biases and how these biases
are reflected in the body. Within the context of the therapeutic relationship, clients
learn to recognize the attachment-related emotions that keep them stuck in the past
and explore reconnecting with and expressing emotions they have disavowed.
CHAPTER 31, “Moving through the World: How We Walk,” draws attention to
patterns of locomotion so that clients can discover how the way they carry their
bodies as they walk affects them. They explore different gaits and the feelings and
beliefs that accompany each style of walking. Increasing awareness of their own
style of walking and how it pertains to their personal history helps clients choose
an intervention to modify the way they walk in a small way to support their
therapeutic goals.
CHAPTER 32, “Boundary Styles in Relationships,” builds upon Chapter 19, “A
Somatic Sense of Boundaries,” to focus on boundary styles in relational contexts.
Clients learn about four boundary styles that are formed in the context of
attachment, distinguish the somatic and psychological traits of these styles, and
discover the physical habits of each one. By assessing their own boundary styles
and exploring different ways of setting boundaries with others, clients develop
healthier relational boundaries.
CHAPTER 33, “Connecting with Others: Proximity-Seeking Actions,” explains
how childhood proximity-seeking actions are learned and modified to be used in
adult relationships. If proximity-seeking actions are frightening, undeveloped,
uncomfortable, or avoided, then initiating contact with others, making friends, and
sustaining relationships is impaired. This chapter helps clients discover their
habitual proximity-seeking actions and practice those that support satisfying
relationships.
CHAPTER 34, “Positive Emotions, Pleasure, and Play,” focuses on how to
increase the capacity for good feelings and experiences, which are often
constrained by a childhood marked by trauma or the disappointments and hurts of
attachment. Clients first become aware of physical patterns that hinder their ability
to experience emotions, pleasure, and playful states. These good feelings become
more accessible as clients explore both high and low arousal, positive emotions,
and practice playful movements.
CHAPTER 35, “Challenging Your Window of Tolerance,” the final chapter,
explores the interplay of human drives for both novelty and safety. Clients learn
how to widen their windows of tolerance by experimenting with appropriate risk-
taking activities that challenge their comfort zone and their current capabilities.
They are encouraged to seek new adventures, pursue a greater variety of activities,
go beyond their “norm” to deepen relationships, and develop areas of life that they
may have neglected.
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Afternote
A book such as this cannot do justice to the unique magic of what goes on between
therapist and client in clinical practice. The felt sense of one another that is the
essence of all relationships, including author–reader and therapist–client, eludes
the confines of verbal description. It is what transpires within the relationship that
is at the core of transformation in any psychotherapeutic approach. The profound
work of therapy that has to do with expanding affect array, negotiating enactments,
and the interactive repair of attachment failures can be alluded to, but cannot be
adequately depicted in a practical book like this one. It is also difficult, if not
impossible, to fathom the emotional depths of therapy through reading about
concepts or interventions. All of this requires right-brain to right-brain
communication (cf. Schore, 1994), an ineffable quality of connectedness that is not
learned from the written word or technique. Thus, your capacity for empathic
attunement, interactive repair, negotiating enactments, and generally being fully “in”
the relationship with your client are all essential to carry the work of this book
forward in a way that honors and responds to the inimitable magic of what goes on
between the two of you.
What this book can provide is a selection of concepts, interventions, and
worksheets that can help you create a deeper level of embodied connectedness with
your clients so that change can take place more easily in the hidden recesses of the
self. And since those recesses are not accessible to purely verbal work, because
they exist below and beside cognitive awareness or linguistic formulation,
interventions that work directly with the body can greatly enhance your
effectiveness as a therapist. The intimacy of your journey with your client will be
heightened by thoughtful attention not only to the verbal exchange, but also to what
is being spoken beneath the words, through the body.
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SECTION ONE
Getting Started
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CHAPTER 1
Essential Principles
The body speaks clearly to those who know how to listen. Nonverbal expressions
visibly reveal what words cannot describe: the “speechless terror” (van der Kolk,
1996, p. 517) of trauma and the legacy of early or forgotten dynamics with
attachment figures. The multifaceted language of the body depicts a lifetime of joys,
sorrows, and challenges, revealed in patterns of tension, movement, gesture,
posture, breath, rhythm, prosody, facial expression, sensation, physiological
arousal, gait, and other action sequences. The implicit, automatic physical habits
that developed in a context of trauma and attachment inadequacy, can constrain our
capacity to make new meaning and respond flexibly to the here and now, often
turning the future into a version of the past.
Schore (2011) asserts that it is the brain’s right hemisphere, responsible for
implicit emotional and body processing, that dominates human behavior. Since
explicit verbal language cannot fully describe these implicit processes, it follows
that a therapist’s exclusive reliance on the “talking cure” might limit clinical
efficacy. A “paradigm shift” is indicated in psychotherapy (and is taking place in
many schools of thought) that takes into account the dominance of nonverbal, body-
based, implicit processes over verbal, linguistic, explicit processes (Kurtz, 1990;
Ogden, Minton, & Pain, 2006; van der Kolk, 2006; Schore & Schore, 2008; Schore,
2011). Therapeutic action is conceptualized not only as interpreting and attending to
the client’s narrative and emotions but also as participating in and attending to the
communications that occur beneath the words in a body-to-body tête-à-tête. The
purpose of this book is to elucidate the language of the body, per se, as a vehicle
for understanding human behavior and as a target of therapeutic action. This chapter
provides an overview of underlying foundational concepts and perspectives for the
reader to keep in mind as we begin this journey together.
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operations so complex that they elude the full understanding of even the most
brilliant minds, our brains compare this wealth of current data to memories of past
experience. The most critical purpose of this comparison is to predict the next
moment with sufficient accuracy so that we can make an adaptive physical action
(Llinas, 2001). What we expect to happen in the very next instant determines the
immediate action we make, whether it is reaching out to another person or for an
object, such as a cup of tea.
Our predictions of what will happen next are predicated upon the sense we
make of what is occurring in the present. Making meaning and predicting the
immediate future of a relational interaction begin long before the acquisition of
language and are evident in the behavior of infants. Beebe (2006) asserts:
Early interaction patterns are represented pre-symbolically, through the procedural organization of action
sequences. Predictability and expectancy is a key organizing principle of the infant’s brain. Infants form
expectancies of how . . . interactions go whether they are positive or negative, and these expectancies
set a trajectory for development (which can nevertheless transform). (p. 160)
These trajectories are evident in Tronick’s (2007) Still Face experiments, in which
a mother is instructed to play with her infant, but then, on cue, to stop responding.
When her lack of response continues past a few moments, “the infants disengage,
look away, become sad and engage in self-organized regulatory behaviors such as
thumb sucking to maintain their coherence and complexity and to avoid dissipation
of . . . their state of consciousness. . . . There is meaning and certitude made by and
expressed in his or her posture, actions and affects” (Tronick, 2006, pp. 16–17).
Sometimes in the Still Face experiment, the infant desperately seeks proximity with
eyes, arms, vocalizations, and even the whole body, only to cease such actions,
falling silent and slumping in the highchair, when the mother does not respond. One
of the films shows an infant pulling his mother’s hair, eliciting a fleeting expressing
of anger from her. The infant responds by lifting his arms in front of his face in a
gesture that appears protective, apparently interpreting the mother’s angry
expression as threatening. The mother’s anger is momentary, and she swiftly seeks
to repair the rupture in their connection, making every effort to reengage and play
with her infant. Eventually he lowers his arms, relaxes his body, and smiles—his
body now reflecting a different meaning. However, negative interactions or
nonresponsiveness recur frequently, without adequate repair, the infants’ reciprocal
actions and postures gradually become persistent procedural tendencies that
continue long after environmental conditions have changed, restricting future
meaning-making, expectations and predictions.
Early experiences are remembered “as a series of unconscious expectations”
(Cortina & Liotti, 2007, p. 205). These expectations are all the more potent and
influential precisely because the experiences that shaped them are not available for
reflection and revision. When we do not remember what happened, the memories
remain unchanged yet continue to shape subsymbolic processes that “operate in
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sensory, motoric and somatic systems, as sounds, smells, feelings of many different
sorts” (Bucci, 2011, p. 210). These processes influence not only the developing
brain and the way in which movements are executed, but also the structure of the
body itself. Form is determined by function; repeated executions of particular
movements, such as hunching the shoulders in fear, shape the body’s structure over
time. In 1937, Todd observed, “For every thought supported by feeling, there is a
muscle change . . . man’s whole body records his emotional thinking” (p. 1).
Engrained physical habits of posture, gesture, expression, and gait can be thought of
as “statement[s] of . . . psychobiological history” (Smith, 1985, p. 70), as windows
into our past.
The overarching purpose of making meaning and predicting the future is to
assure that the immediate actions we make will preserve our survival. But
“surviving” is not the same as “living.” Bromberg (2011) clarifies:
Through their anticipatory protective system, people are able to more or less survive. But many are also
more or less unable to live because full involvement in ongoing life is drained of meaning by the affective
residue of developmental trauma that in adulthood serves as a perpetual reminder that stability of self
cannot be taken for granted and requires that life be managed with vigilance rather than lived with
spontaneity. (p. 276)
People come to therapy because they want to move beyond surviving, but to do so,
the restrictive predictions that are rooted in the past must be revised to fit current
reality. This endeavor is a complicated, constantly fluctuating process involving a
host of intricate operations, including physical action sequences, that participate in
making predictions.
The body’s language itself is richly nuanced, mysterious, and multifaceted. It
interfaces with a multitude of systems that together comprise the complex moment-
to-moment process of making meaning and forecasting the future. Tronick (2009)
states: “Meanings include anything from the linguistic, symbolic, abstract realms,
which we easily think of as forms of meaning, to the bodily, physiologic,
behavioral and emotional structures and processes, which we find more difficult to
conceptualize as forms, acts, or actualizations of meaning” (p. 88).
The body and how it makes meaning is one piece of the puzzle. Because therapy
is largely “dependent upon pre-linguistic forms of communication and
intersubjectivity,” (Beebe, 2014, p. 29), exploring the body can enrich and inspire
your clinical practice. But keep in mind that the nonverbal indicators continually
interface with numerous other forms of meaning-making and prediction, implicit
and explicit, dyadic and individual, in a complicated intertwining that remains
somewhat of a mystery. Nevertheless, illuminating clues that shed a bit of light on
this mystery can be found in the enduring physical patterns that reflect one’s history
of trauma and attachment.
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Trauma, Attachment, and the Body
The movement, posture, and physiology of the body adapt automatically, without
our conscious intent, to assure survival and maximize available resources. When a
child’s attachment figures are “good enough” (Winecott, 1958), meaning-making,
predictions, and action sequences “remain to some extent fluid and flexible
throughout life; the nature of the consequences that are anticipated for a given action
will change as the context of interaction changes and with development of the
individual’s powers” (Bucci, 2011, p. 6). Thus, as our brains compare current
information with past data, there is the possibility of an “upgrading” (Llinas, 2001,
p. 38) of meaning and of expectations of the immediate future.
However, schemas become more and more rigid in increasingly less functional
environments, impeding new learning (Bucci, 2011). The legacy of trauma and
attachment inadequacies, with their consequential neuropsychological deficits,
constrains new meanings and obstructs upgrading the forecast. Brains are
conservative in taking the risk that certain actions might be “safe” or gratifying
when they were once “dangerous” or elicited a negative response from others. The
lack of upgrading, of course, serves survival functions (better to mistake a stick for
a snake than a snake for a stick) but can also thwart adaptive action in favor of what
has worked in past circumstances. Forecasts that have become fixed and certain
actions that have become limited begin to reinforce each other.
For example, if proximity-seeking behaviors such as reaching out and making
eye contact were consistently responded to in a misattuned or negative manner, we
will eventually begin to predict that there will be unpleasant consequences if we
seek proximity. Then, we may literally stop reaching out to others and avoid making
eye contact. In turn, others may not notice our desire to connect and thus fail to
respond in an attuned manner, confirming our predictions. If standing upright with
our heads held high brought unwanted attention, abuse, or shame, we learn to slump
or keep our heads down in a nonassertive posture. Such a posture in and of itself
reflects and sustains the early learning, restricting upgrading of meanings and
predictions. Physical actions such as these continue long after circumstances have
changed, even when they are ill-suited for current situations and relationships. The
predictions that shaped these actions are not challenged, or if they are, the physical
habits that reflect and sustain the out-dated predictions often inhibit their full
transformation.
Such actions, along with their meanings and predictions, stem from trauma or
attachment inadequacies and failures, or a combination of the two. Although the
legacies of trauma and attachment are inextricably entwined, they can be
distinguished in their etiology and for the purpose of clinical understanding (Ogden,
2009). Unresolved trauma can be conceptualized as deriving from overwhelming
experiences that cannot be integrated. Trauma inevitably elicits instinctive survival
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mechanisms of hyper- or hypoarousal and subcortical animal defenses. Attachment
issues arise from experiences with others, especially early attachment figures (the
person[s] who looked after us as children, to whom we were emotionally bonded)
that cause emotional distress but do not evoke extreme autonomic dysregulation.
Relational trauma involves interactions with others that are experienced as
threatening and do stimulate dysregulated arousal and animal defense. Although
trauma and attachment experiences are interconnected and cannot be teased apart in
actuality, recognizing the primary indicators of each helps clinicians prioritize their
interventions. These clinical choices become paramount in an integrative therapy
approach.
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detect features in the environment, including behavioral cues from others, that
indicate degrees of safety, danger, and threat. This term is distinguished from
perception, which requires cognitive awareness of input from sensory systems.
When safety is neurocepted, the social engagement system is strengthened. Social
behavior requires the inhibition of the areas of the brain that organize defensive
strategies, and such inhibition is appropriate only in contexts that are safe (Porges,
2011). All human beings require enough safety in the growing-up years to develop
an effective social engagement system in order to build attachment and affiliative
relationships (Porges, 2004, 2005, 2009, 2011).
Attachment formation and social engagement build upon one another. Socially
engaged interactions of attunement and mutual pleasure strengthen attachment bonds
and future capacity for affiliation (Porges, 2004, 2005, 2009, 2011), and a secure
attachment with sufficient interactive repair develops a healthy social engagement
system. In the context of secure attachment, the child attains a greater capacity for
autoregulation, even in early childhood (Schore, 1994), and develops a social
engagement system that effectively facilitates interactive regulation and proximity-
seeking behavior. The neuroception of safety is reflected both in the inhibition of
defense systems and in activation of behavior flexibility that enables adaptive
contact with others: reaching out, grasping, eye contact, holding on, letting go,
pulling toward, and pushing away. This early learning in the context of attachment
facilitates not only relational capacities (Schore, 1994; 2006; Fosha, Siegel, &
Solomon, 2009), including action sequences such as reaching out for help or for
contact with others, but also autoregulatory strategies supported by the body, such
as grounding, full breathing, or an aligned posture (Ogden et al., 2006).
Childhood attachment patterns—secure, insecure-avoidant, insecure-
ambivalent, and disorganized-disoriented—are characterized by certain kinds of
difficulties that are reflected and sustained by particular action sequences
(Ainsworth, Belbar, Waters, & Wall, 1978). It is important to note that even
securely attached clients come to therapy with troubles rooted in mildly
unsatisfactory (in comparison with insecure attachment) experiences such as
inadequate attention from parents who were “too busy,” slightly harsh, somewhat
inconsistent, insensitive, or fault-finding, or whose acceptance and approval was
predicated on performance, such as earning top grades in school. These dynamics
might have caused a degree of emotional distress, but were not so severe as to
result in an insecure attachment. Imperfect yet still secure attachment fosters
“affective competence,” which includes “being able to feel and process emotions
for optimal functioning while maintaining the integrity of self and the safety-
providing relationship” (Fosha, 2000, p. 42). Nevertheless, even in the best of
families in which attachment figures have provided good-enough regulation and
interactive repair, certain emotional responses and somatic patterns are favored
over others.
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All children will instinctively adjust their inner needs and behavioral responses
to parental demands and preferences, learning early on what is expected in
relationships. Parental expectations inevitably leave a young child with two
(nonconscious) choices: One, to remain “safe” and win approval of attachment
figures by meeting their expectations, or two, risk “danger” in the form of ejection,
criticism, disappointment, or worse by failing to meet expectations (Porges,
personal communication, September 13, 2013). When possible, living up to
expectations would be the best choice because doing so usually reduces the
presence and frequency of the behavioral features in the attachment figure that cause
children to instinctively neurocept danger. Thus survival, security, and social
engagement are preserved when meeting parental expectations allows the child to
neurocept safety.
The body will both reflect and sustain efforts to meet the expectations of
attachment figures. For example, a client whose parents preferred compliance over
assertion, might abandon standing proudly upright with a straightforward gaze into
the eyes of another for a slightly slumped posture and more hesitant gaze. She was
willing to acquiesce in order to “stay safe,” that is, not rejected, in her family. In
turn, the slumped posture helped her maintain a compliant attitude, which would not
be supported by an erect, proud posture. On the other hand, a client who was
expected to perform well and be assertive and stoic unconsciously lifted her chin
and stood tall with her shoulders back in efforts to fulfill these expectations. Her
emotions were biased toward frustration and anger as a way to “fit into” and thus
stay safe in her particular family, leaving more vulnerable emotions such as
sadness, hurt, and disappointment unacknowledged and unresolved. These physical
and emotional patterns limit the range of affect and behavior, but do not necessarily
indicate insecure attachment histories.
Clients with insecure–avoidant attachment histories characteristically shun
situations and relationships that stimulate attachment needs. Simple proximity-
seeking actions, such as reaching out or making eye contact, may feel
uncomfortable, awkward, or even dysregulating. Distancing actions, such as
pushing-away motions or avoiding eye contact, may feel more comfortable (Ogden
et al., 2006). Most clients who have developed avoidant or distancing patterns
have low overall autonomic arousal levels and depend upon autoregulation
(Cozolinno, 2002; Schore, 2003a) to self-regulate, typically finding it easier to
withdraw under stress than to take action that would promote interactions with
others (Cozolino, 2002). Emotional expression tends to be minimal (Cassidy &
Shaver, 1999); overregulation reduces the experience of both positive and negative
affects. Such clients usually find it difficult to shift out of low arousal states and
modulate high arousal (Schore, 2003a).
In contrast, those with insecure–ambivalent histories are inclined to maximize
attachment needs, fear abandonment, and sustain higher overall arousal.
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Preoccupied with the availability of attachment figures, these individuals tend
toward enmeshment, clinging behavior, and increased affective and bodily agitation
at the threat of separation from attachment figures, including the therapist. Usually
quite comfortable with proximity-seeking actions, such clients desire closeness and
may find it more difficult to tolerate distance in relationships. Pushing-away and
letting-go actions are less comfortable than clinging, grasping, and reaching-out
actions. People with insecure–ambivalent attachment histories tend to have a
sympathetically dominant nervous system (Cozolino, 2002; Schore, 2003a) with a
low threshold of arousal and concurrent difficulty maintaining arousal within a
window of tolerance.
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conflicting goals are activated simultaneously or sequentially: the attachment
system, whose goal is to seek proximity, and the defense systems, whose goal is to
protect. In these contexts, the social engagement system is profoundly compromised
and its development interrupted by threatening conditions. This intolerable conflict
between the need for attachment and the need for defense with the same caregiver
results in the disorganized–disoriented attachment pattern (Main & Solomon,
1986). A contradictory set of behaviors ensues to support the different goals of the
animal defense systems and of the attachment system (Lyons-Ruth & Jacobvitz,
1999; Main & Morgan, 1996; Steele, van der Hart, & Nijenhuis, 2001; van der
Hart, Nijenhuis, & Steele, 2006). When the attachment system is stimulated by
hunger, discomfort, or threat, the child instinctively seeks proximity to attachment
figures. But during proximity with a person who is threatening, the defensive
subsystems of flight, fight, freeze, or feigned death/shut down behaviors are
mobilized. The cry for help is truncated because the person whom the child would
turn to is the threat.
Children who suffer attachment trauma fall into the dissociative–disorganized
category and are generally unable to effectively auto- or interactively regulate,
having experienced extremes of low arousal (as in neglect) and high arousal (as in
abuse) that tend to endure over time (Schore, 2009b). In the context of chronic
danger, patterns of high sympathetic dominance are apt to become established,
along with elevated heart rate, higher cortisol levels, and easily activated alarm
responses. Children must be hypervigilantly prepared and on guard to avoid danger
yet primed to quickly activate a dorsal vagal feigned death state in the face of
inescapable threat. In the context of neglect, instead of increased sympathetic
nervous system tone, increased dorsal vagal tone, decreased heart rate, and
shutdown (Schore, 2001a) may become chronic, reflecting both the lack of
stimulation in the environment and the need to be unobtrusive.
These initially adaptive responses to immediate danger turn into inflexible and
pervasive procedural tendencies when trauma is unresolved. Once these actions
have been procedurally encoded, individuals are left with regulatory deficits and
“suffer both from generalized hyperarousal [and hypoarousal] and from
physiological emergency reactions to specific reminders” (van der Kolk, 1994, p.
254). Traumatized clients often experience rapid, dramatic, exhausting, and
confusing shifts of intense emotional states, from dysregulated fear, anger, or even
elation, to despair, helplessness, shame, or flat affect. They may continue to feel
frozen, numb, tense, or constantly ready to fight or flee. They may be hyperalert,
overly sensitive to sounds or movements and easily startled by unfamiliar stimuli.
Or they may underreact to stimuli, feel distant from their experience and their
bodies, or even feel dead inside.
From both traumatic and nontraumatic interactions with attachment figures,
children form internal working models (Bowlby, 1969/1982, 1973, 1988),
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comprising representations of self, other, and relationships. Helping them
understand the environment and predict the potential results of their actions,
working models are encoded in procedural memory and become nonconscious
strategies of affect regulation (Schore, 1994) and relational interaction. Far from
being static, these models, with their inherent meanings, forecasts, and physical
patterns, are affected by every subsequent experience in an ongoing spiral of
development. Whether shaped by trauma, attachment, or both, working models and
their procedural patterns of behavior reflect the adaptability of brain and body.
Habitual postures, expressions, movements, and autonomic responses to the
environment echo predictions about what is to come based on the repeated
experiences of the past. Decades after the events, clients exhibit physical patterns
that reflect and sustain their histories. These patterns have become default
behaviors over other actions that would be more adaptive in current contexts.
Thus, the self is not a fixed “thing” but an emergent, associative process “arising
out of a hard-wired disposition to relate to another” (Wilkinson, 2006, p. 155).
Different self-states or “parts” may hold different working models with relatively
fixed meaning-making and conflicting expectations of the future that are not
integrated. The gamut of childhood circumstances—from secure attachment to
disorganized–disoriented attachment to severe, prolonged attachment trauma
(which also includes disorganized–disoriented attachment)—engenders different
degrees of integrative failure, conceptualized as occurring on a continuum. Mild
differences in self-states that everyone experiences are at one end. Integrative
failure increases along the continuum, with trauma-related dissociation existing
more toward the other end. Profound integrative failure is at the most extreme,
manifesting as two or more dissociative parts, each with its own sense of self, often
involving amnesia or lack of awareness for some emotions, thoughts, actions, and
27
memories. As Wilkinson (2006) asserts, to understand the parts of the self that have
experienced relational trauma “the key will be stored in the implicit, emotional,
amygdaloidal memory of the right hemisphere, known only through ways of being,
feeling, and behaving” (p. 158).
Although the differences that occur along this continuum are not fully
understood, this section attempts to elucidate how self-states occur even in the most
secure environments and differentiate them from trauma-related dissociative parts,
recognizing that the boundaries between the two are indistinct. Bromberg’s (2011)
work is a good starting point because he describes how all attachment figures, due
to their own histories and human imperfections, engender self-states in their
children:
A person’s core self—the self that is shaped by early attachment patterns—is defined by who the
parental object both perceives him to be and denies him to be. That is, through relating to their child as
though he is “such and such” and ignoring other aspects of him as if they don’t exist, the parents
“disconfirm” the relational existence of those aspects of the child’s self that they perceptually dissociate.
. . . The main point is that “disconfirmation” . . . is relationally nonnegotiable. (p. 57)
That is, the failure of parents to recognize aspects of their children results in
children’s own disconfirmation of those very same aspects that attachment figures
discounted. Consequently, children form two (or more) working models of a single
attachment figure, one relating to the confirmation of certain aspects of themselves
and another relating to the disconfirmation of other aspects. They also form two or
more working models of themselves. Keep in mind that this disconfirmation is not a
conscious, thought-out process but implicitly lived through patterns of thought,
movement, meaning-making, and expectation. Each part of the self “holds a
relatively non-negotiable affective “truth” that is supported by its self-selected
array of “evidence” designed to bolster its own insulated version of reality”
(Bromberg, 2012, p. 15). The part that is disconfirmed becomes a “not-me” self-
state, because its truth, history, and working models are incompatible with those of
the individual and his or her self-identity.
This disconfirmation itself occurs on a continuum from mild to severe. All
parents, due to human frailty and the legacy of their own unresolved past,
disconfirm aspects of their children, often unwittingly. Most parents, if they knew
they were doing so and understood the negative effects it might have on their
children, would probably attempt to change their behavior. For example, a young
man who seemed to have had a very secure attachment history told that “it was
expected” that he be a high school football star, following in his father’s and
grandfather’s footsteps. The part of him that wanted to be a dancer remained
disconfirmed until, as an adult, he decided to take hip-hop lessons. When he finally
told his parents of his love of dance, they told him they would have been happy to
send him to dance classes “if we had only known.” However, in traumatogenic
environments, disconfirmation is profound. One client, severely abused,
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experienced a profound disconfirmation not only of her physical and emotional
needs but also of her self, resulting in working models of herself as “bad” and her
father as “dangerous.” At the same time, because her father had at times comforted
her when she was hurt, another part of her formed a working model of him as
supportive.
Years later, our adult clients struggle to reconcile their various self-states, often
without understanding the origin or nature of their internal conflicts. For example, a
client might identify as a confident, independent adult and reject (as her parent[s]
did) a needy self-state in which she yearns to be taken care of. Typically, these self-
states do not communicate well with one another, each holding contradictory
working models of the self and of others. As Bromberg (2012) confirms, “The felt
otherness between one’s own states becomes an alien ‘thing’ to be managed
because it can no longer be contained as negotiable internal conflict that is
mediated by self-other wholeness” (p. 274). Clients thus are often unable to hold
the differing “truths” of different self-states in their minds at the same time, so
needs may remain unacknowledged or be overridden. Eventually, because no part
of the self will completely disappear, the part of the self that has been disconfirmed
will find a voice in ways that may be indirect, demanding, confusing, painful or
harmful.
Nontraumatized, securely attached clients dealing with attachment issues will
experience self-states that are less sequestered and have permeable boundaries, but
are in a degree of conflict nevertheless. A creative, spontaneous self-state that
wants to play and have fun may struggle against a structured, nose-to-the-
grindstone, ambitious self-state; parts of the client focused on pleasing others may
clash with parts that want to do what the client pleases. These struggles tend to be
organized around conflict between the familiarity of habitual relational knowing
and self-knowing versus more adaptive or creative ways of being in relationship
and in the world.
Trauma-related dissociation is markedly different, both experientially and
neurobiologically, from the internal conflicts between parts of the self that hold
different working models in nontraumatized clients. For traumatized individuals,
the inability to hold these different self-states in mind simultaneously is much more
profound.
On a neurobiological level trauma-related dissociation is based on
simultaneous activation of both defense and attachment drives, as discussed in the
previous section, “The Legacy of Trauma.” It can be further conceptualized as an
integrative failure of neurobiologically organized responses to threat reflecting two
general types of psychobiological systems: the animal defense systems stimulated
by danger and life threat, and the daily life systems stimulated by nonthreatening
environmental demands (van der Hart et al., 2006, Ogden et al., 2006). These
systems are called action systems because when one of them is aroused, particular
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phsyical actions—along with thoughts and emotions—are galvanized to meet the
goals of that system. Disorganized–disoriented attachment, strongly correlated with
ongoing dissociation (Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997), is
often described as the arousal of two different systems.
To review: The animal defenses—subcortical survival instincts that organize
around the neuroception of danger and life threat—include the cry for help,
designed to elicit help and protection; mobilizing defenses of fight or flight that
organize overt action; and immobilizing defenses of freeze and feigned death that
engender a lack of physical action. The daily life systems, on the other hand,
comprise several subsystems that require a degree of safety, and thus the social
engagement system to fulfill their goals. These systems stimulate us to form close
attachment relationships, explore, play, participate in social relationships, regulate
energy, reproduce, and care for others (Bowlby, 1969/1982; Cassidy & Shaver,
1999; Fanselow & Lester, 1988; Lichtenberg, 1990; Lichtenberg & Kindler, 1994;
Marvin & Britner, 1999; Ogden et al., 2006; Panksepp, 1998; van der Hart et al.,
2006). The goals of the defensive system—to defend and protect—conflict with the
goals of daily life systems—to engage with other people and the environment. Each
category of system stimulates contradictory neurobiological states, including
contradictory emotions, thoughts, physical actions, and senses of self. Responding
to the arousal of daily life systems—such as the needs of one’s children, the
demands of work, or the sexual needs of one’s partner—requires neurocepting
safety and keeping the emotions, thoughts, and defensive responses associated with
past trauma at bay.
The internal experience of traumatized individuals affected by conflicts
between these two systems of defense and of daily life is often confusing and
sometimes overwhelming. When trying to carry on with daily life priorities, these
individuals may be unable to inhibit defensive subsystems in safe environments.
Continuing to neurocept danger, they often experience intrusive fears and phobias,
waves of shame and despair, impulses to desperately seek help, fight, flee, freeze,
or shut down, that sabotage their efforts to function. To the extent that these
alternations between daily life and animal defensive action systems are repetitive
and persistent, clients will experience ongoing failure of integration and increased
compartmentalization. As Steele, van der Hart, and Nijenhuis (2005) state:
[The] action systems of daily life and those of defense . . . naturally tend to mutually inhibit each other.
For example, one does not stay focused on cleaning the house or reading when imminent danger is
perceived; instead one becomes hypervigilant and prepares for defense. Then, when danger has passed,
one should naturally return to normal activities rather than continuing to be in a defensive mode.
Integration between these two types of action systems will more likely fail during or following traumatic
stress. (p. 17)
The phrase “part of the self” is used as a metaphor to describe the failure of
systems to integrate in such a way that an individual has more than one sense of self
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with accompanying thoughts, emotions, physical tendencies, and behaviors. These
parts can act in parallel with the client or can act outside the client’s awareness,
resulting in amnesia (Steele, van der Hart, & Nijenhuis, 2004). Bowlby (1973)
states:
The behaviour to which the activation of one behavioural system leads may be highly compatible with the
behaviour to which activation of another system leads; or it may be highly incompatible with it; or some
parts of one maybe compatible with some parts of the other, whilst other parts of each are incompatible
with each other. (p. 97)
One or more action system mediates each dissociative part, and each part engages
in thoughts, emotions, and actions to meet the goals of that system that may be
outside the control or awareness of other parts. In trauma-related dissociation, each
has its own first-person perspective, or its own sense of self, which is different
from the other part(s) (Nijenhuis & van der Hart, 2011). The person does not have
different selves, but rather the parts have different senses of self that exist within
the whole (Steele & van der Hart, 2013). These parts are not completely separated
or split—a common misconception. Dissociative systems are complex with various
parts having at least some permeable boundaries with overlapping basic functions
and goals of which the client may or may not be aware.
No matter whether parts emerge from one end of the continuum (nontraumatic
situations of relatively mild disconfirmation of aspects of the self) or from the other
end (severe, prolonged abuse by attachment figures and profound disconfirmation),
a sense of “not me” is experienced. At the former end of the continuum, the self-
states usually tend to be more ego-syntonic. However, with traumatic dissociation,
jarring intrusions of not-me parts occur, sometimes along with lapses in awareness
of what happens when other parts are active. It appears that trauma-related
dissociation can be distinguished from the self-states that occur in
nontraumatogenic environments by the following: the presence of disorganized–
disoriented attachment; the presence of dissociative symptoms (especially those
implying activity of parts, such as hearing voices, amnesia for behaviors in the
present, and so forth); and a first-person sense of self in the dissociative parts, even
if rudimentary (Kathy Steele, personal communication, June 17, 2013).
Without understanding trauma-related dissociation, therapists might perceive
the client to be ambivalent, resistant, chronically relapsing, or identified with a
“false self,” (Winnicott, 1960) rather than to be internally conflicted between action
systems of daily life and animal defenses, or between parts of the self that were
confirmed by attachment figures and parts that were denied. The formation of parts
occurs as a protective and even survival mechanism, but especially in its more
extreme forms, the formation of parts comes with a cost:
The price of this protection is to plunder future personality development of its resiliency and render it into
a fiercely protected constellation of relatively unbridgeable self-states [or parts] each rigidly holding its
own truth and its own reality “on call,,” ready to come “on stage” as needed, but immune to the
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potentially valuable input from other aspects of self. (Bromberg, 2006, p. 33)
Nonverbal Indicators
Bowlby (1969/1982) asserted:
Much of the work of treating an emotionally disturbed person can be regarded as consisting, first, of
detecting the existence of influential models of which the client may be partially or completely unaware,
and, second of inviting the client to examine the models disclosed and to consider whether they continue
to be valid. (p. 205)
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intended to tone down a verbal message. One client tilted her head and smiled
disarmingly as she described how she was not benefiting from therapy.
Indicators that register consciously for therapist or client can be explored
explicitly, along with the associated affect, even while the content they represent
remains unconscious. Grigsby and Stevens (2000) have suggested that recognizing
such indicators and disrupting automatic behaviors hold more promise clinically
than conversing about the history that shaped them: “Talking about old events . . . or
discussing ideas and information with a patient . . . may at best be indirect means of
perturbing those behaviors in which people routinely engage” (p. 361). They
recommend that therapists try 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” (p. 325). Once specific
indicators are observed and named, explicit exploration of them can provide a
direct avenue to discovering and changing the corresponding working models.
The theoretical models described in this chapter can guide these observations
of habitual patterns, steering the therapist to look for indicators connected to
attachment interactions and unresolved trauma. Nonverbal indicators reminiscent of
early attachment interactions are evident in physical expressions of working
through movements, postures, gestures, prosody, and facial expressions. Indicators
reflecting unresolved trauma include hyperarousal (e.g.: tension, rapid heart rate,
trembling, wide eyes) and hypoarousal (e.g.: vacant expression, flaccid muscles,
collapse of posture), terror, panic, or rage, impulsive or dulled reactions, and other
signs of faulty neuroception and animal defenses. Any of these indicators can occur
simultaneously or sequentially to reveal conflicts between self-states and parts.
In the therapy hour, the therapist helps clients to bring the experience of these
indicators into the present moment in order to “activate those deep subcortical
recesses of our subconscious mind where affect resides, trauma has been stored,
and preverbal, implicit attachment templates have been laid down” (Lapides, 2010,
p. 9). In this way, nonverbal memory and associated affect can be felt, regulated,
and explored explicitly even when there are no declarative memories or explicit
content clearly connected to these implicit patterns.
The therapist takes on the dual task of attending to the client’s somatic narrative
along with the verbal narrative. The verbal narrative can be interesting and
informative, and this explicit exchange helps create safety, understanding, and
empathic connection between therapist and client. Although clients can only
verbally express elements of their history and inner dilemmas that are in their
conscious awareness, the manner in which the narrative is expressed reveals a
history that is often not conscious. Bringing these indicators to awareness enables
implicit phenomena, and the historical dynamics they represent, to become a part of
the explicit exchange. By drawing attention to the body’s participation in the verbal
narrative (e.g., “It looks like your shoulders tense when you speak of your father”),
33
the automaticity of both the verbal narrative and the physical reactions are
interrupted so that they can be mindfully explored. This approach represents a shift
in paradigm from “talking about” the issues to engaging mindful awareness of the
evoked indicators as they manifest in the present moment.
Mindfulness helps facilitate this task by teaching clients to orient and focus
awareness on the effects of past events as they emerge in the present moment (Kurtz
1990; Ogden et al 2006).
Mindfulness is commonly described as a solitary, silent, non-verbal, internal
activity, and is usually taught as such. It requires an inner receptivity to whatever
arises in the mind’s eye, as a “quality of attention which notices without choosing,
without preference” (Goldstein & Kornfield, 1987, p. 19). Mindfulness can be
taught as an internal concentration practice (focusing on breath, a mantra, or body
sensation) or as an external concentration practice focusing on a particular stimulus
(such as a candle), or as a skill-building practice such as found in dialectical
behavior therapy (DBT; Linehan, 1993) and mindfulness-based cognitive therapy
(Segal, Williams, & Teasdale, 2002). The “embedded relational mindfulness” of
Sensorimotor Psychotherapy also focuses attention on internal processes; however,
it is markedly different from these common solitary, silent practices because it is a
shared, here-and-now relational and verbal activity that occurs between therapist
and client within the relationship.
Sensorimotor Psychotherapy’s application of mindfulness in clinical practice is
based on the work of Ron Kurtz (1990). Rather than being taught through structured
exercises or an internal practice that excludes the therapist, embedded relational
mindfulness is integrated with, and embedded within, what transpires moment to
moment between therapist and client. Therapists guide clients to notice selected
elements of their internal present experience, and also to verbally report what they
notice as the experience is taking place. Through this process, both therapist and
client are mindful of the ebb and flow of the client’s present moment experience.
It’s as if clients take the therapist with them into their inner world by describing
their experience verbally as it unfolds rather than describing it after the immediacy
34
of the moment passes. Mindfulness becomes an intimate relational call and
response, encouraged by a slowed pace of mutual discovery and collaborative
curiosity about the components of clients’ present moment experience rather than
the fast pace of conversation.
Critical to this process is the therapist’s purposeful influence on clients to
attend to specific elements of their internal experience. Instead of allowing clients’
attention to drift randomly toward whatever emotions, memories, thoughts
movements or sensations they might be drawn to, therapists purposefully use
“directed mindfulness” to guide the patient’s awareness toward particular elements
of internal experience. Unrestricted mindfulness toward any and all elements can
activate disturbing intrusions and overwhelming arousal for people with PTSD and
thus is often met with dismay, judgment, self-criticism and further dysregulation.
Clients with non-traumatic attachment issues as well often find themselves going
over and over the same problems without resolution, being drawn to familiar
elements of internal experiences rather than to something new. To support
therapeutic goals, mindfulness is directed by the therapist, who carefully and firmly
guides the patient’s mindful attention toward particular elements of internal
experience thought to support therapeutic goals (Ogden 2007; 2009). If the goal is
to develop confidence, mindfulness might be directed toward the length and
alignment of the spine. If it is to delve into sadness, mindfulness might be directed
or toward a dejected downward turn of the head. If an internal image of past trauma
or an external traumatic reminder such as the sound of a siren causes hyperarousal,
mindfulness might be directed to the sensation in the legs to promote grounding
rather than to the internally generated image because grounding supports regulation.
Thus, mindfulness is “an active search process, a purposeful seeking in the field of
awareness” (Siegel 2010, p. 108).
Mindfulness itself is “motivated by curiosity” (Kurtz, 1990, p. 111) and thus
“allow[s] difficult thoughts and feelings [and images, body sensations, and
movements] simply to be there . . . to adopt toward them a more ‘welcome‘ than a
‘need to solve’ stance” (Segal et al., 2002, p. 55). The mutual curiosity of
embedded relational mindfulness naturally decreases anxiety and resistance and
opens the mind beyond the limits of what it already knows. The therapist’s ability
to help clients become curiously mindful of their internal experience, rather than
identify with it, leads to new learning (see Chapter 2, “Orientation for Therapists”
for a description of therapeutic skills for mindfulness). Clients shift from being
caught up in the story to being interested in discovering their internal experience.
“No one is ever there for me” becomes “I experience a shield of tension in my
chest, and I have the thought, ‘No one is ever there for me,’ and then I feel sadness
come up.” Both client and therapist become interested in how these elements of
present-moment experience change through continued mindful exploration within
the relationship. Unpredictability is expected and welcomed, often resulting in
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“safe surprises” from which a new reality is co-constructed within the relationship
(Bromberg, 2006).
It is essential that the client’s sense of safety in the relationship increases
overall through the use of embedded relational mindfulness, which can be a
challenge when exploring painful traumatic and attachment issues. In order for
therapy to take place, clients must be able to neurocept safety sufficiently to engage
with the therapist. However, clients might be unable, based on prior conditioning,
to accurately neurocept whether the environment is safe or another person is
trustworthy (Sahar et al., 2001), especially as traumatic material or attachment
failures are stimulated in therapy, whether deliberately or inadvertently. If trauma is
stimulated, clients might implicitly neurocept danger, which activates the brain’s
fear circuitry to stimulate animal defenses of cry-for-help, fight, flight, freeze, or
shutdown. At these times, social engagement is often compromised and must be
reestablished. If attachment issues are stimulated, clients might also implicitly
neurocept danger and either adjust their responses to further push away the not-me
parts that were disconfirmed by their caregivers in order to try to stay “safe” in the
therapeutic relationship, or experience strong negative feelings and reactions
toward the therapist that interfere with social engagement.
Using embedded relational mindfulness, the therapist must simultaneously
accompany clients into the painful present-moment reexperiencing of the past,
facilitate enough safety of the here and now so that therapy can continue,
interactively repair after a mismatch, and relationally negotiate therapeutic
enactments. This concurrent evocation of trauma-related dysregulation and
attachment-related disconfirmations, hurts, and social engagement can result in a
depth of intimacy in the relationship that exceeds that which ensues from
conversation alone. The therapeutic encounter often becomes more deeply resonant
emotionally and the intersubjective moment becomes more palpable. However, for
this to occur, attitudes and interventions that support embedded relational
mindfulness must be privileged over ordinary conversation and discussion (Kurtz,
1990; Ogden et al., 2006) and over solitary mindfulness practices.
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yield discoveries that are “unforced, automatic, and spontaneous” (Kurtz, 1990, p.
69), increasing the client’s sense of the experiment’s impact and validity. There are
no “right” or “wrong” responses to these experiments; they are conducted to find
out “what happens” within the relationship and internally for the client—what
thoughts, emotions, sensations, images, and so on, emerge.
Experimenting with habits of movement, posture, and gesture can change the
implicit communication to others and also to the self. Our sense of self is
determined both by the story we tell ourselves verbally and by the story we tell
ourselves nonverbally through these physical habits. For example, if one’s posture
is habitually curved forward and slumped instead of upright, it conveys implicit
meaning not only to others but also to the individual. The slumped posture itself
might diminish self-esteem and contribute to, if not induce, feelings of shame,
helplessness, or inadequacy associated with the past. Exaggerating this posture
slightly can stimulate associations that then could be directly shared and worked
through in therapy. Or, a more aligned posture could be explored, along with all the
emotions, thoughts, memories, and relational dynamics that would then
spontaneously ensue. In this process, the posture, gesture, movements and
expressions of the body favorably start to change, which in and of itself can alter
the implicit communications to others and to the self.
These interventions go beyond simple body awareness questions such as,
“What do you notice in your body?” or “How do you experience that in your
body?” In Sensorimotor Psychotherapy, body awareness is only the beginning. The
point is to help clients address and change procedural learning—how information
is processed on a bodily level—which requires that the movements, gestures, and
postures that reflect and sustain one’s history are addressed in such a way that they
start to change spontaneously. The Sensorimotor Psychotherapist will guide the
client’s awareness toward particular elements of bodily experience, and then either
follow these elements until they spontaneously change, or initiate a specific action
that causes somatic patterns rooted in the past to reorganize. A chronically puffed-
up chest that communicates a need to keep one’s distance or create safety by
intimidating others begins to relax and open. A habit of lowering the head and
crouching of body posture that signal compliance changes into a lifted head and
upright posture. A dysregulated nervous system recalibrates so that arousal remains
at a tolerable level.
It is important to be aware that simple experiments can elicit a variety of self-
states or dissociative parts that may be “inhospitable and even adversarial,
sequestered from one another as islands of truth, each functioning as an insulated
version of reality that protectively defines what is ‘me’ at a given moment and
forcing other self states that are inharmonious with its truth to become ‘not-me’”
(Bromberg, 2011, p. 69-70). Like new words, new actions such as reaching out can
be viewed as antagonistic by certain parts of the self whose reality and purpose are
37
challenged by such proximity-seeking behaviors. Physical actions can be laden
with trauma-related emotions of terror and rage that accompany animal defenses or
with strong attachment-related emotions, such as resentment, fear, anger, or
disappointment, that were not regulated by the attachment figures in childhood. One
part of the self might have vowed never to reach out again, lest no one respond. Or,
a part may live in terror that reaching out will bring abuse, as it did in the past.
Processing these actions and the associated emotions can increase the ease of
transitions between states, encourage communication and integration among parts,
change the way information is processed somatically, and support a more integrated
sense of self.
The spontaneous, open-ended quality of therapeutic experiments reflects a
larger theoretical principle of the unique, unchartered territory of what transpires
within each individual therapeutic dyad. Although the experiments conducted in
therapy are, in principle, “techniques,” they are neither generic nor manualized. The
inspiration to conduct a particular experiment emerges naturally and unexpectedly
as therapist and client subjectively experience each other. Philip Bromberg states
that most characteristically he does not “plan” in advance what to do or say in the
therapy hour, but rather “finds himself” doing or saying certain things that arise
spontaneously from within the relationship (personal communication, December 21,
2010). His words and actions are not premeditated or generic techniques, but rather
are emerging responses to what transpires in the here and now between himself and
his patient.
Similarly, in my own work, somatic interventions and the way they are
implemented, and even which indicators I am drawn to notice from all that my
client presents, are emerging responses to what transpires in the here and now
between my client and me. It takes training, experience, and practice for the
therapist to “know” which nonverbal cues are meaningful indicators. and which are
not, and how to implement a therapeutic experiment in the therapy hour. This
knowing is not cognitive; rather the therapist finds him- or herself being drawn to a
particular indicator or to trying a particular experiment, often without knowing why,
and only later discovers the connection to implicit trauma or attachment failure. The
interventions are the spontaneous outcome of the affective and somatic
responsiveness to the experience of what is taking place within the relationship that
is not processed cognitively but is known implicitly.
38
be with the patient” (p. 41). The way of being with the client is thus paramount, and
therapeutic change occurs within this context. The starting place of therapy is to
create enough safety within the relationship that clients can embark upon the often-
frightening journey of self-discovery. Kurtz (2010) described beautifully how he
created connection: “My first impulse is to find something to love [in the client],
something to be inspired by, something heroic, something recognizable as the gift
and burden of the human condition, the pain and grace that’s there to find in
everyone you meet.” This attitude of generosity implicitly acknowledges the dignity
of the human spirit, setting the stage with respect and appreciation so that therapy
can commence.
Safety is created primarily through implicit body-to-body affective
communication, rather than through words. As Bowlby asserted over 40 years ago,
“With attachment theory in mind, a therapist will convey, largely by non-verbal
means, his respect and sympathy for his patient’s desires for love and care from her
relatives, her anxiety, anger and perhaps despair at her wishes having been
frustrated and/or denigrated” (1980, p. 180, emphasis added). The therapist tracks
the client’s nonverbal indicators, assesses dysregulated arousal, and adjusts the
pace and process of therapy accordingly to stimulate the social engagement system
and help the client feel safe.
Acting as an “auxiliary cortex” (Diamond, Balvin, & Diamond, 1963), the
therapist becomes an interactive “affect regulator of the patient’s dysregulated
states in order to provide a growth-facilitating environment for the patient’s
immature affect-regulating structures” (Schore, 2001b, p. 264). Keep in mind that if
arousal greatly exceeds the regulatory boundaries of the window of tolerance,
experience cannot be integrated. Effective interactive psychobiological regulation
requires paying more attention to how the relationship and the interventions affect
autonomic arousal than to the content of the client’s verbal narrative. Along with
responding to what is spoken, the therapist responds, often nonconsciously, to
nonverbal signals that suggest a shift from regulated to dysregulated arousal or loss
of social engagement. As these indicators of dysregulation are noted, therapists use
their social engagement systems to regulate when clients cannot do so for
themselves. Therapists thereby help clients regain social engagement, remain aware
of the here and now, and mindfully notice elements of internal experience that
support regulation.
The therapist is “interacting at another level, an experience-near subjective
level” that implicitly processes moment-to-moment socioemotional information at
levels beneath awareness (Schore, 2003b, p. 52). A meaningful nonverbal
conversation between therapist and client transpires as each implicitly emits and
receives significant indicators. ‘Encoding’—giving off non-verbal signals about
feelings, thoughts and needs—goes hand in hand with ‘decoding’—detecting the
other person’s non-verbal signals of the same and perceiving them accurately
39
(Schachner, Shaver, & Mikulincer, 2005). The moment-to-moment physical
movements and adjustments are visible reflections of this nonconscious dialogue.
Each party implicitly interprets the other’s cues and responds with his or her own
nonverbal behaviors: leaning forward, averting or holding gaze, tightening,
relaxing, a deep breath or a holding of the breath—the possibilities are endless.
Beebe (2014) notes, “ Our ability to sense and not to inhibit our own bodily
arousal, attention patterns, affective reactions, orientation shifts, and touch patterns
is key (p. 143). Although as therapists, we can learn to become aware of and
understand our own nonverbal participation, our responses should not be controlled
lest dyadic regulation becomes contrived or impaired.
This nonverbal communication “feeds [the therapist’s] ability to process [the]
patient’s emotions in the implicit mode” (Beebe, 2014, p. 77). The nature of the
ensuing bodily states from this ultra-rapid, implicit dialogue is intersubjective—we
have a “feeling” or “know in our gut” certain things that we find difficult to
articulate. These intuitions are, at least in part, a product of the unconscious
encoding and decoding of indicators of chronic procedural habits as well as the
time-limited nonverbal cues that regulate the relationship, moment by moment. A
childlike hanging of the head or pout of the lower lip might be a momentary plea for
care or empathy, or a chronic habit leftover from a childhood of neglect. Tensing
around the eyes might convey a message of suspicion that could reflect a chronic
distrust of others or a response of confusion or misattunement in the present-
moment interaction. The movement, gesture, and posture of a client deeply affect
that of the therapist, and vice versa, eliciting corresponding actions in the other in
an ongoing, body-to-body call and response (Ogden, in press, 2013, 2011).
Montgomery (2013) notes that “the more the affect management style that
characterizes a client’s typical way of dealing with emotions needs to be changed
and ‘rewired’ neurobiologically, the more at least an experience of emotional
attunement or bonding should occur with the clinician” (p. 34). This attunement is
engendered not only via somatic signals but also prosody and the manner in which
language is used (as opposed to the content itself). In the therapeutic relationship,
“right-brain to right-brain prosodic communications . . . act as an essential vehicle
of implicit communications. . . . The right hemisphere is important in the processing
of the ‘music’ behind our words” (Schore & Schore, 2008, p. 14). Matching
prosody—timbre, volume, pace—to resonate with the client is necessary to join
and connect. From there, the therapist might up- or downregulate the client as
needed to support therapeutic goals. Kurtz (1990) taught his students to speak in the
simplest language possible to facilitate access to a child state of conciousness, and
early memories. Lapides (2010) has commented that it is necessary to “keep
sentences simple as [left-hemisphere verbal] processing is impaired at elevated
levels of arousal and to rely on [right-hemisphere] non-verbal means to connect
with [hyperaroused patients]” (p. 9). The affective, nonconscious, nonverbal dance
40
shapes what happens within the relationship without conscious thought or intent. It
is the essence of therapy, redefining psychotherapy as the “affect communicating
cure” rather than the “talking cure” (Schore & Schore, 2008).
What occurs within the therapeutic dyad will be strongly influenced by the
therapist’s window of tolerance as much as by the client’s (Siegel, 1999; Schore,
2003a, 2009). The therapist’s window is a “critical factor determining the range,
types, and intensities of emotions that are explored or disavowed in the
transference– countertransference relationship and the therapeutic alliance”
(Schore, 2009, p. 130). The two windows together determine what can be
explicitly and implicitly addressed and how it is addressed. Therapists who have a
sufficiently wide window will be able to not only establish safety in the alliance,
but challenge clients to expand their windows.
Whereas safety is essential for clients to begin therapy, therapists also have a
responsibility to help clients expand their capacities by challenging their regulatory
abilities in the face of strong emotion or autonomic dysregulation. If clients’
emotional and physiological arousal consistently remains in the middle of a
window of tolerance (e.g., at levels typical of low fear and anxiety states), they
cannot expand their capacities because they are not in contact with disturbing
residue of traumatic or affect-laden attachment experiences in the here and now of
the therapy hour. However, if arousal greatly exceeds the regulatory boundaries
(Schore, 2009a) of the window of tolerance at either the low or the high end,
experience cannot be integrated. To work successfully at the regulatory boundaries,
clients must be able to simultaneously detect safety while experiencing some
element of dysregulated affect, which thereby foster an expansion of the window
itself. Bromberg (2006) points out that the atmosphere of the therapeutic
relationship must be “safe but not too safe.” See Figure 1.1 for an illustration of this
concept and working on the edge at the regulatory boundaries of the window of
tolerance.
41
FIGURE 1.1
Once the client’s arousal has reached the beyond edges of the window of
tolerance, it is imperative to avoid stimulating additional emotional or
physiological arousal by continuing to execute physical actions or implement other
interventions that cause further dysregulation. The therapist and client must
continuously evaluate the client’s capacity to process at the regulatory boundaries
of the window to assure that arousal is high enough to expand the window but not
so high as to sacrifice integration.
42
of their own windows of tolerance with content that eludes conscious understanding
but is reminiscent of early contexts where relational attunement was absent and
repair was not forthcoming.
As the therapist’s unsymbolized implicit processes interact with those of the
client, unexpected relational encounters can ensue that can be distressing for
therapist and client alike. No therapist seeks out such conflicts, but they happen in
spite of attempts to prevent them. Bromberg (2011) asserts that “there is no way to
avoid these clashes of subjectivity without stifling the emergence [in both therapist
and client] of dissociated self-states that need to find a voice” (p. 57). Therefore,
therapeutic action must include participating in and navigating what is enacted
beneath the words, a negotiation that “can either result in retraumatization, if it’s not
properly processed at the intimate edge between client and therapist, or it can lead
to a better resolution and integration on a higher level” (Stark, 2009). Like
misattunements that are then repaired, these collisions can be reworked in a more
powerful and substantial manner through processing an enactment than if the
enactment had not occurred.
Therapy can be conceptualized as comprising two simultaneous clinical
journeys that therapist and client embark upon together, one explicit and conscious
and one implicit and unconscious (Ogden, 2013). The explicit journey pertains to
the conscious aspects of the relationship between therapist and client and of the
therapeutic process, often supported by theory and technique on the therapist’s side.
On the explicit journey, the therapist intends to “develop the skill of seeing [the]
internal world, and being able to shape it toward integrative functioning” (Siegel,
2010c, p. 223). Therapeutic methods, meant to be learned and then set aside and not
usually considered explicitly in the therapy hour, nevertheless guide interventions
that emerge spontaneously within the dyad but can be justified and explained, if
desired. Therapists can reflect upon the explicit journey, even as it is unfolding, and
make adjustments in presence or technique.
In comparison, the implicit journey is unconscious or only partially conscious
and difficult to articulate because it pertains to what happens when the internal
world cannot be seen or understood but is enacted unawares. Taking place beneath
the words, both client and therapist might have a sense of something being “off”
between them in a vaguely familiar way. Therapists may be explicitly aware that
their efforts keep leading to session outcomes that were neither intended nor
desired. The therapist’s conscious wish not to trigger the client’s shame or anger,
for example, might repeatedly lead to that very outcome, leaving the therapist
feeling baffled and incompetent and the client feeling misunderstood or worse.
What neither therapist nor client realizes is that another conversation is occurring
beneath their words, a body-to-body interchange between the implicit parts of
client and therapist that is not intended, typically reflecting past encounters where
disconfirmations have occurred, or relational negotiations have failed. It can be a
43
tumultuous journey with many crises, collisions, collusions, and enactments that, if
not negotiated within the relationship, can sabotage the therapy or cause a chronic
therapeutic impasse.
Therapists often initially perceive a therapeutic impasse as having to do only
with the clients’ history, failing to understand that the enactment is mutually created.
They occur in the realm where interactive regulation had been absent, dissatisfying,
or hurtful for each of them. In a replay of the earlier disconfirmation, what each
person needs from the other is not provided in the therapy hour, thus proving again
that the need is invalid and will not be met. The two histories collide in a hand-in-
glove enactment. Both therapist and client implicitly re-experience the shame of
having such “illegitimate” needs, reminiscent of what they had felt as children. The
enactment will continue to escalate us long as the therapist believes that the discord
pertains only to the client. Therapists are challenged to “wake up” (Bromberg
2006) and realize that the enactment has to do with their own history as well as
their clients’. This realization usually occurs without reflection, through a stroke of
intuition—the result of “direct knowing that seeps into conscious awareness
without the conscious mediation of logic or rational process” (Boucouvalas 1997,
p. 7; in Schore 2011, p. 13).
What is called for in navigating an enactment is not technique, interpretation, or
explanation, which typically only adds to the enactment. The therapist and client
need to delve together into what is taking place between them and mutually
negotiate the enactment, allowing the meaning between them to be discovered
through their interaction. As Schore (2011) states, “....the therapist’s moment-to-
moment navigation through these heightened affective moments [occurs] not by left
brain explicit secondary process cognition but right brain implicit primary process
affectively driven clinical intuition” (p. 1).
It is essential to understand that enactments are not “mistakes” but are non-
conscious strivings for a higher level of growth and organization and their
negotiations are a function of the developing and emerging relationship. The
processing of each person’s implicit self(s) within the relationship provides the
raw material for new experiences, new actions, and new meanings for both parties.
This intersubjective process of joining and co-creation cannot be defined,
identified or predicted ahead of time, because it occurs within the context of what
transpires unexpectedly within the dyad. This negotiation is “all about developing
the capacity of patient and [therapist] to move from experiencing the other as an
object to control or be controlled by to being able to play with each other”
(Bromberg 2011, p. 18). Fundamentally, the implicit journey holds the potential for
deeper therapeutic change and growth. It is the unformulated, unconscious impact of
therapist and client on one another, including the influences of past childhood
histories of both parties, that often catalyzes the real healing power of clinical
work.
44
All good therapy explores the messy territory of negotiating the inescapable
implicit enactments that sizzle beneath the surface while explicit communications
are taking place. A relational, attachment-focused therapy is a healing process not
because therapists are “treating trauma and attachment” but because they are
“helping to restore belief in the existence of enduring human relatedness. The
process of enactment accomplishes this especially powerfully because it generates
a here-and-now reality that is created by both people in which endangered
attachment becomes reparable right in the room” (Philip Bromberg, personal
communication, March 19, 2013). The relational negotiation of an attachment
requires a creative leap into the unknown in which the outcome is unpredictable
and uncharted for both parties. As Tronick (2003) states: “Co-creativity implies
neither a set of steps nor an end state. Rather, it implies that when two individuals
mutually engage in a communicative exchange, how they will be together, their
dynamics and direction are unknown and only emerge from their mutual regulation”
(p. 476).
Explicit and implicit realms are both essential avenues of therapeutic
exploration. Language, verbal meaning-making, and verbal exchange with others
affect implicit processes, and vice versa. As Tronick (2009) emphasizes: “Adult
and children make meaning in the explicit and use language to make meaning.
Words, insights, and cognitions in awareness are elements in an individual’s state
of consciousness. Working on changing a patient’s explicit sense of their place in
the world CAN produce change” (p. 103). That said, although language and explicit
exchange are obviously indispensable in clinical practice, the wordless but potent
implicit dialogue between therapist and client is critical to the change process.
Emotional and somatic experience comes alive in therapy as we both consciously
and unconsciously respond to explicit and implicit cues in our clients and
ourselves. When we experiment with new actions to challenge outdated procedural
learning, we can address implicit processing, including enactments, both explicitly
through the use of words and also implicitly at a level at which words are not
available and sometimes not needed for therapeutic change to occur. To navigate
this journey, both parties need to muster a spirit of adventure to leap into the
unknown waters of interpersonal relatedness and the underbelly of the self. In
Sensorimotor Psychotherapy, they also need to cultivate a sustained faith that
together they can discover how to draw on the intelligence of the body to move on
from the past and reorganize consciousness at a higher level.
45
CHAPTER 2
46
book because the material can and should be modified to suit the particular needs
of each client. Similarly, age, brain injury, learning disabilities, or developmental
delays are also not necessarily contraindications for utilizing the book but rather
signs that the material may need to be modified in some way—simplified,
demonstrated instead of verbalized, or its introduction titrated.
47
or out of sequence, as appropriate for their therapeutic process. You might
incorporate one chapter and its worksheets every week or two into the ongoing
therapy, or you may leave longer gaps between assignments. You might familiarize
yourself with the various chapters and select specific chapters to work with when
you think their contents would be useful to a client. In a short-term treatment with a
limited number of sessions, you may need to pick and choose a few relevant
chapters and focus on those during the time you have. In any case, you will want to
become acquainted with the concepts of the chapters and their worksheets so that
you can select ones to incorporate into your practice to the best advantage for each
client.
48
regulation and integrative capacity for their successful completion. It was a
quandary to decide whether to include worksheets that encourage clients to delve
into their more painful emotions, to “sit with their feelings” rather than regulating or
resourcing them. However, several worksheets are included in the sections on
Phase 2 and Phase 3 intended to help clients experience and express attachment-
related emotions. Those worksheets in particular should be completed under your
guidance. Since some worksheets are more challenging and evocative, and others
are more regulating, you will need to select those that are appropriate for each
client’s integrative capacity and where he or she is in treatment, skipping some
worksheets and focusing on others. If your client’s ability to self-regulate is high, it
will not be necessary for you to use all the worksheets about regulating
dysregulated arousal. However, if your client is prone to dysregulation, you might
avoid the worksheets that revisit the deep emotional pain of early attachment
inadequacies, or at least wait until more stabilization is achieved before you use
them. Encouraging clients to do more if they are able, or less as needed, as well as
using the therapeutic relationship in an attuned fashion to help clients challenge
themselves without loss of social engagement and the ability to feel safe. To
reiterate, it will be helpful for you to complete the worksheets yourself to gain
firsthand experience that will guide you in predicting which ones are best to
appropriately challenge your clients.
You and your client can determine which worksheets, if any, should be filled
out between sessions and reviewed together at the next meeting, and which ones
should be completed in session. For dissociative, dysregulated, or low functioning
clients, it will be necessary to go over most if not all of the worksheets together to
provide the titration and regulation that will support the integration of the material.
Higher-functioning clients might benefit from completing the worksheets that are
primarily psychoeducational between appointments, and sharing them with you at
the next session. The worksheets that require mindful reflection on the present-
moment effects of the past or simply on here-and-now awareness of thoughts,
emotions, and the body are most effective if they are guided by you in session with
your client, and then filled out together. Those that have to do with attachment-
related emotions are challenging and evocative, and should be completed together
in session for all clients so that you can guide them through the steps described in
the worksheet.
In any case, the worksheets should provide a jumping-off point for reflection
and be reviewed and discussed together after they are completed. They are meant to
develop curiosity and confidence in the body’s wisdom, and support new learning
and integration, rather than to be regarded as assignments clients “should”
complete. Feel free to modify your approach to the chapters and the worksheets so
that they are effective in meeting these goals. Keeping in mind the importance of
collaboration, you may find it helpful to ask some of your clients how they prefer to
49
use the chapter and worksheets. They may want to read the chapter outside of
therapy or during the therapy hour or they may prefer that you both read it between
sessions. They may want to take time to discuss the chapter in session. Perhaps they
prefer to just move immediately into the worksheets. The two of you can discuss
together the pros and cons of completing the worksheets in session or between
session and decide the best way to proceed.
Despite your careful and collaborative presentation of the material, some
clients may not choose to read the chapters or complete the worksheets, or they may
be unable to do so. Rather than being disturbed by such apparent obstacles, you can
be curious to discover together what the difficulty might be and how to prevent it
from compromising the client’s use of the book. Maybe your client was not ready
for a particular worksheet or chapter, and you need to save it for a later date or use
the contents as a discussion point rather than as an assignment. Perhaps your client
is not interested in working somatically, does not understand how it could help him
or her, or did not reap any benefit from completing the worksheets. Your client may
find a particular worksheet (or homework, in general) triggering, unappealing, a
waste of time, or be unable to process the information it contains. Some clients who
have feelings of anxiety or reluctance about doing “homework” might find it more
agreeable if they complete the worksheets in session with your help. For those who
suffer from a language-based learning disability, such as dyslexia, the very format
of the book can be anxiety producing, and these clients may avoid the material or
experience anticipatory feelings of failure or shame. It can be helpful for you to
anticipate any such obstacles, discuss clients’ concerns openly to mitigate
apprehensions, and discover together the best way to use the material. And, for
some clients, it might work best if you yourself read the chapters, complete the
worksheets, and then integrate the concepts into the therapy in an organic way that
fits with their presentation, week to week, without their working directly with the
book themselves.
The chapters and worksheets are based on the principle of neuroplastic change
that requires repetition for new neural networks to be set in place. Thus, they are
intended to be explored more than once to facilitate lasting benefits. You will find
that various chapters and worksheets have different meanings and relevance to
clients at different times in their lives or in their work with you, so they may be
repeated over the course of therapy. It will be helpful for you to refer back to them
often in sessions to reinforce new learning. You may find that some worksheets
seem to duplicate each other, and that concepts are repeated in subsequent chapters.
Keep in mind that the book has been deliberately designed to be somewhat
repetitive in order to facilitate neuroplastic change.
Psychoeducation
Psychoeducation helps clients become informed collaborators so that the material
in this book will be more easily and successfully integrated into their treatment.
Used as needed during sessions, psychoeducation can help clients understand their
reactions to the material and how work with the body might support them in
reaching their treatment goals. Your clients have come to therapy with certain needs
and objectives, and when you use psychoeducation to elucidate how working with a
particular chapter topic might help them meet their goals, they are more likely to be
receptive to this material. For example, if a client reports, “I’m having panic
attacks and I can’t sleep—I just want to get more sleep,” you might suggest
51
something like this: “Maybe we could work with becoming more grounded,
because if you can feel your legs and learn how to let your energy settle, your
nervous system will calm down and you will probably have an easier time going to
sleep. Why don’t we explore the chapter on grounding [Chapter 16, “Grounding
Yourself”] together?”
Similarly, when working with relational issues such as the inability to generate
a support system, you might respond by saying, “It makes sense that you stopped
reaching out to others when you were little because you were really on your own.
But now, even though you want more connection, it’s still hard for you to reach out
and connect with others. If we work with the chapter about actions that everyone
uses to connect to others [Chapter 33, “Connecting with Others: Proximity-Seeking
Actions”], like eye contact and reaching out, we might be able to help you meet
your goal of developing a support system for yourself.”
Psychoeducation about the benefits of working somatically should be balanced
with assuring clients that they are always in control of what goes on in the session.
Some clients may be apprehensive that somatic interventions will require that they
do something physical or move in a way that makes them uncomfortable. They can
often be set at ease when you assure them that they are in charge of whether they
want to work with the body, how they work with the body, and when they want to
work with the body, and that no intervention you might suggest is ever mandatory.
Additionally, some clients may assume that touch or hands-on bodywork will be
used. Explaining that Sensorimotor Psychotherapy is a body-oriented talking
therapy, very different from massage and other body therapies, and that touch is not
necessary to benefit from this book, will clarify this misconception.
It is important to remember to give just the amount of information clients need
in a particular moment to make use of a specific chapter’s concept or intervention.
The simpler the language and the more concrete your presentation of the concept,
the more likely that clients can absorb the information. The intention is to pique
their curiosity and win their cooperation so that they are able to make use of this
material in your therapy with them. Psychoeducation should help clients make
connections between the distressing issues they bring to therapy and the possibility
of relief or resolution offered by a Sensorimotor Psychotherapy interventions.
52
“When we feel panic, our energy is high, our bodies are tense and mobilized
upward, and we often are a little shaky (therapist demonstrates shaky arms and
body with elevated shoulders, shallow chest breathing, constricted diaphragm,
wide eyes). Our energy needs to quiet down so we can relax. How about if we
work with grounding to help everything settle so that you can calm down (therapist
demonstrates relaxing the shoulders and eye muscles, slowing the voice, pace,
and breathing, quieting the shaking, and letting energy settle downward)?” As
you speak, you are demonstrating what panic looks and feels like physically and
then showing the client what grounding and settling down looks and feels like
physically.
The same principle of demonstrating posture and movement holds true for
addressing attachment related beliefs. You can “take on” or illustrate a negative
belief, such as “I have to always work hard to be accepted,” in your own body
(e.g., demonstrate a tense, high-energy, mobilized “ready-for-action” body that
avoids eye contact) that supports the particular belief. Then, you can show how a
different physical organization might support a different belief, such as “I can relax
and people still accept me,” by relaxing your muscles, breathing more fully, and
making more eye contact. Your client is much more likely to understand how the
body itself reflects and sustains beliefs. Using your own body in this way conveys
the psychoeducation point you want to make faster and more clearly than merely
conversation. It effectively communicates ways the body might participate in the
client’s difficulty, and conveys hope that working somatically will help resolve the
difficulty. And your willingness and ability to use your own body in this way
enhances a collaborative atmosphere.
Demonstrations such as these activate the client’s mirror neuron system,
optimizing his or her readiness to perform the same actions you execute. As clients
observe you demonstrating a movement, such as relaxing your shoulders or
reaching out, motor neurons in their brains fire as if they were executing the same
action, essentially “rehearsing” the action themselves (Rizzolatti & Craighero,
2004; Rizzolatti, Fadiga, Gallese, & Fogassi, 1996). It is helpful to capitalize on
mirror neurons by using your own body to model certain actions in order to prime
your clients to execute those same actions in the service of supporting therapeutic
goals.
53
perfectly natural activity for both of you to be doing. If your voice is soft, gentle,
and slow, indicating an abundance of time to sense the body, or filled with wonder
and curiosity to suggest that this will be an interesting adventure, the more likely it
will be that clients can quiet their minds and sense their own bodies better.
Noticing and reinforcing how clients are already able to connect with the body
—rather than how disconnected from it they are—fortifies their confidence and
stimulates enthusiasm for further somatic exploration. Using encouragement or
praise lets clients know that their descriptions of their posture, movement, or
sensation have value. Such positive reinforcement as ”You’re doing fine” or “It’s
wonderful that you can actually feel and describe that tension—some people don’t
have that awareness,” communicates that you are noticing and valuing their capacity
to sense the body and describe what they sense and encourages them to increase
their focus on somatic experience.
54
about seeing her father’s unwelcoming face when she turned to him for comfort, and
at the same time, her posture slumps, her face blanches, and her eyes tear up.
These elements of present moment experience often remain unnoticed by clients
until you direct attention to them by naming what you track. Simple verbal “contact”
statements that verbalize present moment experience, such as, “As you see your
father’s face, it looks like your posture slumps”, or “You seem sad right now,”
bring your client’s attention to these elements as they are occurring. To teach
mindfulness, it is essential to track and contact present moment experience because
mindful awareness can only take place in the present moment (cf Chapter 7,
“Mindfulness of the Present Moment”). If you only verbalize your understanding of
the narrative, clients will assume that it is the narrative, rather than present moment
experience, that is of interest.
After bringing clients’ attention to their present experience by naming it, the two
of you can collaborate to select or “frame” what to explore through directing
mindful attention (cf. Chapter 8, “Directed Mindfulness and Neuroplasticity”). For
example, if you want to explore the client’s posture, you might say, “Let’s find out
more about the slump in your spine that happens when you talk about your father.” If
the client is curious about his or her posture and agrees to explore it, then the two
of you can begin to explore the posture through directed mindfulness questions. It’s
important that deciding what to frame is a collaborative decision between you and
your client—that you both agree on what to explore.
After you track, contact, and frame, you can use mindfulness questions to
specifically guide your client’s awareness. At this point, there is a shift from
conversation to mindfulness that signifies a clear break from the narrative to
mindful awareness of internal experience. Clients’ awareness turns inward instead
of being focused outward as you ask them directly to be aware of internal
experience. Questions like the following clearly direct the client’s attention inward
to find out more about what you have framed together: “As you sense that slump in
your spine, happens internally . . . what else do you notice?” Additional questions
that direct mindful attention toward specific elements of internal experience could
be, “What changes in your body?” or “What emotion seems to go with it?” or
“What images emerge as you sense this slump in your spine?”
Embedded relational mindfulness skills include requiring clients to answer
these questions in the moment while they are mindfully aware of internal
experience. Otherwise, the focus of the therapy returns to having a conversation
rather than mindful exploration. Chapter 7, “Mindfulness and the Present Moment”
will provide a clear map of the building blocks of present experience that will
assist you as you explore directed mindfulness together in Chapter 8, “Directed
Mindfulness and Neuroplasticity.” These interventions of tracking, contacting
present experience, framing, and asking mindfulness questions are consistently
implemented throughout a Sensorimotor Psychotherapy session and will serve you
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well as you explore the topic chapters and worksheets with your clients.
56
and dissociation is usually reassuring rather than alarming to them, especially if
they understand the conflicts between the different priorities and functions of
various parts. To reiterate, it is recommended that you both read the section in
Chapter 3, “Orientation for Clients” on dissociation and discuss its contents
together. With a base of shared knowledge, you might then explore how you can
collaboratively acknowledge the adaptive priorities, functions, and goals of each
part and help increase communication between and among them.
Internal coherence and collaboration are always goals in therapy, whether
clients have trauma-related dissociatively compartmentalized parts, not-me self-
states, or simply mixed emotions. Clients who struggle with dissociative parts in
conflict often find it hard to imagine how internal collaboration will be helpful and
tend instead to want their parts “gone.” This phobic reaction toward parts of the
self requires therapists to hold the clarity that no part of the body or mind can, or
should, be eliminated. When you can help your clients understand that, after trauma,
they might experience such alternations between parts of themselves that want to
engage in daily life and defensive parts that live in “trauma time” (van der Hart,
2012) as if they were still in danger, they can better understand and work with the
conflicts between different parts of the self. The key to increasing their awareness
is drawing their attention to the two “sides” (parts fixated in trauma and parts
engaged in daily life) so they are more likely to recognize when their reactions are
connected to different internal parts and, most importantly, become curious rather
than confused by them.
Your comfort with the idea that dissociative compartmentalization is a normal
phenomenon after trauma, especially following prolonged childhood trauma, and
that these changes in mood, perspective, and behavior represent identifiable parts
of the self and instinctive adaptive drives associated with them is crucial to your
clients’ understanding and ability to integrate those parts. Appreciation of the
internal complexity goes hand in hand with the clarity that clients have one mind
and one body: The parts are not separate individuals, even in clients with DID, but
instead are always part of a whole system that is more than the sum of its parts.
Conclusion
Tracking your clients’ responses to each intervention, making small adjustments,
noticing their next response, and shaping your next intervention accordingly are
essential throughout the therapy process and throughout your exploration of this
book. When our therapeutic efforts are “effective,” it means not only that our clients
have gained a new understanding or experience of themselves but also that they
have integrated this learning so that it continues to deepen and grow in them. We
can integrate past and present, insight and emotion, perceptions and facts, self-
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states or parts of the self, and, perhaps most critical for our purposes, mind and
body. When we work from the “bottom up,” small changes in movement or posture,
with repetition and intention, can eventually lead to big changes. Just as we have
confidence that a baby’s first tentative steps will one day become coordinated,
confident movements, your and your clients’ willingness to work with how the body
learns and how that learning builds on itself will yield meaningful rewards.
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CHAPTER 3
Moving on after difficult events such as trauma or hurtful experiences with the
people who raised us is not easy, especially when those experiences have
conditioned us to view the world as threatening or ourselves as inadequate. Even in
a good therapy with a skilled therapist, it can sometimes be challenging to find
relief or resolution and we may end up feeling discouraged or stuck in our patterns.
Since you are reading this book, you are probably interested in learning new tools
to transform old patterns. The body’s movement, posture, and sensation can provide
a missing link that can help you tap into that innate drive in all living things to heal,
adapt, and develop new capacities. This volume is intended to guide you and your
therapist to draw upon the natural intelligence of the body to lessen the distress and
increase the satisfaction you might experience in your life today. The purpose of
this chapter is to orient you to the structure of the book, how to use it, and to clarify
a few underlying concepts and terms that will help you work together with your
therapist to use the chapters that follow to your best advantage.
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challenges.
The problems above stem from either our attachment history or past trauma or a
combination of the two. “Attachment” is a term used to describe the strong
emotional connection we feel with certain people that endures over time—in other
words, we become “attached” to them. The people to whom we are attached are
called “attachment figures.” In childhood, our primary attachment figures are our
caregivers, often our parents, who are attached to us, too. Attachment relationships
also include anyone else with whom we form an emotional bond, such as siblings,
grandparents, or friends, and as we grow up, romantic partners and significant
others. These relationships bring us great joy but some of them can also be difficult.
Our early experiences with attachment figures provide the initial template for all
subsequent relationships by instilling in us ways of relating to the world, others,
and ourselves. Some of these ways will be constructive for future relationships, but
some will not. Although this template does change with experience, we often find
ourselves somehow repeating the relational hurts and patterns of the past. In
adulthood, the habits that hold us back from engaging fully in our lives and with
others may have their roots in past attachment relationships.
Trauma refers to any threatening, overwhelming experiences that we cannot
integrate. Sometimes our attachment figures are the source of danger, creating a
conflict between wanting to turn to them for support, as we do with all attachment
figures, and needing to protect ourselves from them. Relational trauma can also be
perpetrated by strangers. Rape, bullying, hate crimes, and physical or sexual abuse
are also examples of relational trauma. Some traumas, such as accidents or
disasters, do not involve other people, but are still traumatic. Trauma can be a
single event (e.g., an accident, rape, crime, or disaster) or repeated events. Trauma
can also be a chronic condition (e.g., child abuse and neglect, combat, ongoing
violence, death camps). When trauma occurs repeatedly early in life, especially if
there was no safe person to turn to, or if it was perpetrated by an attachment figure,
the effects can be difficult to resolve. It is important to note that any experience that
is stressful enough to leave us feeling helpless, frightened, overwhelmed, or
profoundly unsafe is considered a trauma. After such experiences, we are often left
with a diminished sense of security with others and in the world, and a sense of
feeling unsafe inside our own skin.
This book addresses the effects of both trauma and attachment wounds. Both
kinds of wounds almost always occur in situations in which protection and comfort
were not available to us, or were not sufficient to prevent enduring negative
repercussions. We rely on the felt experience of the connection with other people to
heal from these wounds. Thus, the work of this book should be a collaborative
effort between you and your therapist. Working together with your therapist will
provide you with the relational support that might have been absent or inadequate in
the distressing situations of the past, as well as the skilled guidance of a trained
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professional.
61
focus on the chapters that will help you regulate them. On the other hand, if you do
not need help regulating your emotions, you may find chapters that help you express
them to be more useful. Based on your particular set of difficulties, strengths,
capacities and goals, you and your therapist can decide together which chapters are
best for you to work with at any given time, how fast or slow to go, when to take
time to integrate what you have learned or experienced, and when to forge ahead to
the next chapter and the next challenge.
In each chapter, you will find examples that illustrate how people who have
suffered from trauma have made use of the concepts and exercises, and examples
that illustrate how people who have suffered from attachment wounds but are not
traumatized have used the material. Some of the examples will speak to you, but
others may be hard to relate to. Just as with every other aspect of this book, you
should take advantage of what you can learn from the examples that resonate with
you, inspire you, or encourage you, and feel free to skim over or skip whatever
feels not useful or relevant.
You and your therapist can decide how much of the work to do together in
session, and how much, if any, you should do independently. You may decide to
read the chapter together during the therapy hour, discussing the concepts and how
they apply to your experience as they come up. Likewise, you and your therapist
may decide that completing the worksheets under your therapist’s guidance during
the session would be the most helpful. Or, the two of you may decide that you
would benefit more from reading a chapter and completing the worksheets outside
of therapy, especially if you need time alone to ponder the assignments. If you do
decide to work independently, then it will be important to bring your completed
worksheet(s) to the next session and to discuss together what you discovered.
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vernacular, “arousal” often refers to sexual arousal, but in this book the term is
used to refer to the level of activation in the autonomic nervous systems. Our
arousal level fluctuates throughout the day within a window of tolerance from being
high when we’re excited to low when we are very relaxed. When our arousal is in
a zone that is optimal for well being and social interaction, it is “regulated” within
a “window of tolerance” (Siegel 1999). The following figure illustrates these three
arousal zones—hyperarousal, hypoarousal, and optimal arousal
The material in this book will challenge you to take risks to explore uncomfortable
territory and try something new that expands the boundaries of what feels
comfortable, easy, or familiar for you. Often these challenges will take your arousal
to the edges of your window of tolerance. But if your arousal goes too far beyond
your window of tolerance at either extreme (too much or too little), then it is
difficult to integrate our experience or new learning. You might feel too unsafe or
dysregulated. You will learn apply skills to regulate your arousal with your
therapist at these times so you can restore a sense of safety and mastery. Each time
you work to bring your arousal into a window of tolerance when it is too high or
too low, get in touch with body sensations, challenge yourself to address disturbing
emotions, change your posture or ways of moving that are more suited to the present
than the past, or address something you have been afraid to deal with, you are
making progress. Taking real and lasting steps toward healing requires not only
creating safety but also taking appropriate risks.
When needed, your therapist will be able to help you identify signs of going too
fast and practice the skills you are learning to regulate your arousal and help it
return to a window of tolerance. He or she will also be able to help you identify
signs of going too slowly, and challenge you at these times to reactivate the painful
residue of the past sufficiently so that you can experience and resolve those
patterns. However, you are the one who knows best how you are feeling and how
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the work is going for you. If you feel centered and grounded and able to tolerate
strong emotion without becoming unduly distressed or unable to function fully in
your life, then you might move more quickly through the material and make good
use of the more challenging chapters and worksheets. If, at any time, you find that
your distress or symptoms are worsening or becoming unmanageable, that your
emotions are too intense, or that you are not functioning well in your life, speak up.
It could be a sign that you are moving too fast and may need to pace your work so
that it is more tolerable. If so, you can focus on the chapters and worksheets that
will help you stabilize your arousal. Needing to slow down and taking your time is
not a problem. In fact, going more slowly can be just as useful (and sometimes even
more useful) as moving quickly and ambitiously.
As you, with your therapist, alternately push yourself just a little beyond your
comfort zone and then use these new body-oriented skills to regulate and return to
safety if you are triggered, challenge yourself again a little bit more, then regulate
once more, you will find your capacities gradually expanding. You and your
therapist together can explore finding just the right balance between safety and risk
that will allow you to challenge yourself enough to grow and change, but not so
much or so fast that you cannot absorb your new experiences.
Trauma-Related Dissociation
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If you have experienced significant trauma or have been diagnosed with a
dissociative disorder, it is especially important to proceed slowly with this book,
under the consistent guidance of your therapist. And to help you work best with this
material it can be useful to understand a little about dissociation.
In the aftermath of trauma, change, challenge, and reminders of the past can
unexpectedly trigger hyper- or hypo arousal. You may lose time, meaning that you
may have little awareness about what happened to you for a period of time. You
may experience dramatically different bodily, emotional, and cognitive states. In
dissociative disorders, these states can become “parts” of the self, and each part
can function outside of your control or awareness some of the time. The language of
“parts” is not intended to imply an actual division of the personality into discrete,
separate physical entities, but to describe the sometimes dramatically different
ways of thinking, feeling, and acting that can change rapidly and are often in
conflict. One moment you might think, feel, and act one way, and the next moment
you might experience very different thoughts, feelings, and actions. These moments
can be really upsetting and confusing, especially without an understanding that such
shifts might reflect different internal parts that were formed to help deal with
trauma.
Generally, dissociative parts of the personality fall into two categories. One
category includes part(s) that live in trauma time, and remain ready to defend and
protect by fighting, running away, or, if these are not possible, by freezing or
shutting down. These defenses come up even when there is no current danger. The
function of this category of parts is to protect us. When something triggers a
defensive part, your orientation in the present moment disappears, at least to a
degree. You may feel threatened, even in the midst of safe and supportive
circumstances, and react in ways that might appear irrational to others, or even
yourself, because a part of you is reacting to everyday life as if you were still in
danger.
The second category includes part(s) that try to get on with normal life by
responding to the needs of family members, the demands of work or school, or
sexual needs and desires. This part usually tries to avoid situations that might be
triggering in order to feel safe enough to remain focused on daily life tasks.
Every internal part has an important purpose to fulfill, and these functions are
often clash. Defensive parts conflict with other parts that want to engage with the
world and try to get on with life. One part may want to go to the movies with your
family, but another part wants to avoid any potential danger out in the world by
staying home. One part may try to protect you by flying into a rage while another
tries to protect you by hiding. If you experience trauma-related dissociation,
different parts of you can have dramatically different reactions to the chapters and
exercises in this book. Once you understand that it is normal to experience profound
conflicts between dissociative parts, you can begin to understand the material in
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this book through the perspective and purpose of different parts of the self.
66
The risks of wide swings in mood and arousal is greater for those of you who
have recently been suicidal or diagnosed with active and severe anxiety,
depression, bipolar disorder, or psychosis; are very recently sober, abstinent, or
battling self-harm or addictive impulses; or those of you who have been struggling
to function or recently hospitalized. If any of these cautions apply to you, you will
want to discuss your concerns with your therapist, and you will also need to
consistently call on the guidance of your therapist to help you manage these
challenges. You and your therapist should carefully pace the work and be sure to
have a plan and support system for managing any feelings and impulses that may
arise in response to this material. Remember that attempting to tackle the material
in this book without professional support could result in a relapse of symptoms, and
whatever healing efforts you have achieved could suffer a setback.
Conclusion
Healing is an ongoing, organic process, not a single “big bang” moment. When we
are physically injured, healing happens by degrees as the body fights infection and
then grows new skin cells that gradually become stronger and finally integrate with
the skin around the injured area. Healing from traumatic or early relational injuries
happens in just the same way. As you work with the material to come you will see
that a tremendous emphasis in placed on repetition of anything new that positively
changes your internal or relational experience and on integration of body
experience with thoughts and emotions. Although it takes patience to repeat new
skills until they become second nature, and it takes courage to risk trying something
new, you will be rewarded with a newfound confidence in your body as a resource
and a deeper level of embodied connection with yourself and others.
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SECTION TWO
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CHAPTER 4
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resulted in unforeseen consequences, such as self-harm or accidents, might begin to
understand that reconnection with the body and its wisdom can help them heal from
the past. At the other end of the spectrum, those who are already connected to their
bodies and who draw on their bodies as sources of enjoyment, competency, or
pride will find that this material validates and deepens their appreciation of the
body’s intelligence. Clients who are not traumatized but have yet to tap into the
body’s wisdom will discover a new avenue of personal exploration.
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your mind and emotions. If you have a somatic discipline, such as yoga, martial
arts, a workout program, dance form, or sport, you might disclose how these
disciplines can provide an outlet for tension, reduce stress, trigger the “feel good”
endorphins, alleviate lethargy or depression, help manage frustration or anger, or
instill a sense of mastery. You might question your clients about how their own
physical activities have helped them cope with challenges or experience pleasure,
validating how they have already drawn on the wisdom of their bodies.
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not have considered. The final worksheet, THE BODY’S SIGNALS, sheds light on
ways in which clients may or may not listen to the body’s signals. Ultimately, this
understanding can foster their ability to pay more attention to the body’s signals and
to take more effective action in response. Clients will benefit from your prompts to
discern the more subtle signals of the body.
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CHAPTER 4
Every moment, little miracles are taking place inside our bodies that require no
conscious attention and usually go unnoticed. Injuries are repaired, harmful germs
are fought off, food is transformed into energy, and new cells are created.
Homeostasis is maintained as our bodies automatically correct imbalances. For
example, our internal thermostat assures that we maintain a steady temperature:
When we are too hot, we sweat to cool our bodies and when we are too cold, we
shiver to warm up. Our brains compare current perceptions with memories of the
past, producing complex bodily signals that guide our actions without any need to
think about them, so that we can safely move about the world. For example, in
response to immediate input from our senses, we instinctively walk around an
obstacle to avoid tripping, or we depress the gas pedal or brake and turn the
steering wheel to safely drive a car.
Right now, as you read this book, a myriad of wondrous brain and body
activities are taking place. Your breath is bringing oxygen to your lungs where it
can be absorbed into the bloodstream . . . your heart is pumping blood carrying
nourishment to all your cells . . . your muscles are working together in synchrony so
that you can hold this book in your hands and turn the pages . . . your brain is
decoding and interpreting the markings on this page to make sense and meaning as
your eyes are working together to read these words. The speed, complexity, and
magnitude of processing that takes place in our brains and bodies so that we can
engage in normal daily activities like reading or driving a car is astounding, yet
most of us take such evidence of the inherent wisdom of our bodies for granted.
When we are able to recognize this wisdom, we can experience the body as a
living, ever-changing source of intelligence, information, and energy that provides
ongoing support for our physical and mental functioning. However, for many of us
our bodies have been objects of criticism, disappointment, frustration, unwanted
attention, abuse, or injury. When that is the case, we are likely to lose confidence in
the innate intelligence of our own bodies, and then it can be difficult to feel at home
in our bodies. This chapter describes how trauma and early attachment experiences
affect the body and introduces ways to regain an appreciation for the natural
intelligence of your body.
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her abuser what a pretty girl she was, and she came to associate being pretty and
feminine with unwanted attention and sexual abuse. She also felt betrayed by her
body’s instinctive pleasurable responses during the abuse. She gradually grew to
reject her body, her femininity, and her natural sexuality. She found herself gaining
weight in an attempt to make herself less attractive, further fueling her dislike of her
body.
Peter was ashamed of his body for different reasons; he blamed his body for not
being strong enough to beat the other boys at arm wrestling contests. His father
teased him for being “weak,” and Peter felt his body had let him down because he
was not physically strong enough to win his father’s approval.
Annette, whose family placed great importance on physical appearance,
rejected her body because she did not believe she was attractive or thin enough.
When she looked in the mirror, she saw an ugly, overweight reflection although this
was not true in reality.
Others might feel critical of or let down by their bodies due to illnesses,
disabilities, or because their sexual or athletic performance does not match their
ideal. We often expect too much from our bodies, unrealistically wanting them to be
“perfect” in terms of looks, health, or performance, without understanding these
pressures as a result of the demands placed on us by our parents, teachers, coaches,
peers, or those who abused us long ago.
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not take care of them. We might discount the signals of bodily needs such as those
indicating hunger, thirst, or fatigue and fail to take care of the body through proper
diet, sleep, and exercise. We may even disregard physical symptoms that should
require a doctor’s attention, or we might abuse our bodies with long hours at work,
sleep deprivation, food, drugs, compulsive exercise, or self-harm.
When we ignore, discount, or override the communications from the body, we
lose the opportunity to get in touch with its innate wisdom. Instead, we may try to
rely on our minds rather than draw upon our natural somatic intelligence in the here
and now. Though problem-solving abilities and insight can be of some help, the
cost of the self-protective mechanisms we have developed in the face of adverse
experiences is often that we lose touch with the potential for healing and growth
that can be found through listening to our bodies.
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CHAPTER 4
79
neutral • agree • strongly agree
Reflect on what you learned about how you view your body from this assessment
and consider if any of your responses were surprising or concerning to you.
Discuss what you learned with your therapist.
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CHAPTER 4
Fears
Examples:
• Reconnecting with my body will feel unpleasant or cause anxiety.
• I won’t be able to reconnect with my body.
• I’ll start having painful memories.
• I’ll dislike what I find.
Hopes
Examples:
• I want to experience more well-being, motivation, or energy.
• I want to develop better physical habits, and feel comfortable in my body.
• I want to feel better about my body and connect better with myself.
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CHAPTER 4
Directions: Draft a letter to your body in which you express your disappointments
about the ways you feel it has let you down, failed you, or held you back. Also
express your gratitude for the ways it has supported or protected you, or helped you
heal, learn things, or enjoy yourself. Think about your earliest memories and
describe the disappointments and appreciations you felt at that time, and then
progress chronologically through your history up to the present moment in your
adult life.
After writing this letter you can decide if you want to share it with your therapist or
if you want to keep it as a personal communication between you and your body.
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CHAPTER 4
Directions: As you think about your relationship with your body, try to pinpoint
what you like and dislike, and describe in the first section below. Then think about
the ways that you treat your body and describe in the second section below. When
you are finished, answer the questions at the bottom of the page.
List what you like about your body. List what you dislike about your body.
List ways you respect and take care of List ways you don’t respect or take care
your body. of your body.
Reflect on the connection between how you feel about your body and how you treat
your body. Which attitudes and actions promote your well-being and which might
you want to change?
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CHAPTER 4
Directions: Think about the times you have listened to and ignored your body’s
signals. Then, answer the prompts below.
1. In the box below, describe a signal from your body that you have listened to
and how you responded to the signal.
(e.g., The signal was tension in my neck and shoulders from a stressful day at
work, and I took a warm bath to help me relax.)
2. In the box below, describe the effect of listening to your body. How did your
body feel after you listened to the signal? How did you feel about yourself?
(e.g., My body felt so relaxed after the bath, and I was in a good mood. I felt
good about taking care of myself and doing something to relieve the tension.)
3. In the box below, describe a signal from your body that you have ignored or
overridden.
(e.g., When my roommate asked me to watch T.V., I felt my body tensing up,
and I looked away. I was tired and yawning, but I stayed up late to watch T.V.
anyway.)
4. In the box below, describe the effect of overriding the signal. How did your
body feel after you ignored or overrode the signal? How did you feel about
yourself?
(e.g., I was upset with myself when I stayed up late because I was tired and
crabby the next day. I couldn’t focus at work and my coworker got irritated
with me. I had to fight to stay alert.)
5. Which signals do you typically listen to, and how do you think you learned to
listen to those signals?
6. Which signals do you typically ignore or override, and how do you think you
learned to not listen to those signals?
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7. How can you listen better to your body’s signals and respond more effectively
to what your body is telling you?
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CHAPTER 5
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the relational connection they desire. Clients who experience dissatisfying
relationships may glean helpful insights about the physical actions and postures that
reflect their “implicit relational knowing” (Lyons-Ruth, 1998), identifying those
that were welcomed and those that were rejected by attachment figures of the past.
91
with clients to highlight the potential benefit that addressing procedural learning
might have on promoting therapeutic change.
It is important that you help your clients understand that the physical habits and
symptoms that were developed as adaptations to extreme or stressful conditions can
be unlearned, and that new responses better suited to current reality can be
practiced. It took many repetitions to create procedural patterns when they were
young, and now it will simply take many repetitions of new actions to create new
patterns.
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particularly useful to you later in therapy when you can revisit the worksheet to
determine what new actions can be practiced to help reconcile thoughts and
procedural learning that are at odds.
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CHAPTER 5
We remember the past not only in words, images, and stories, but also through
chronic habits of tension, movement, and posture. Our bodies continually respond
to what happens to us, how others treat us, and how we feel inside. When, as
children, we feel safe, our bodies relax and we might snuggle, run, jump, or play,
but when we feel scared, our bodies tighten up and we cry and seek out someone to
comfort us. If no one is available to soothe or protect us, we sometimes give up and
our bodies might “go limp.” If we are scared often enough, the tension or the
limpness turns into an enduring physical habit. It takes a long time, but eventually
the body’s repeated reactions become automatic, long-lasting patterns that carry the
memory of a past that our minds may have forgotten, dissociated, or suppressed.
We may not recognize our physical habits as ways of remembering because the
body does not speak in words. Instead it speaks the nonverbal language of visceral
sensations, posture, tightening or relaxing, movements, gestures, facial expression,
changes in levels of autonomic arousal, heartbeat, breath, even physical symptoms.
This chapter focuses on the habits of tension, posture, movement, and gesture that
we develop over time. When we translate the nonverbal language of these elements
into words, we glean insights into behaviors that contribute to difficulties in our
current lives and discover new avenues for changing outdated patterns.
Procedural Learning
Our memory system for automatically performing certain skills, behaviors, and
survival strategies is called procedural memory. A simple way to understand what
this term means is to imagine tying your shoes. Once you learned how to tie them at
a young age, you no longer had to think about how to do it; you just tied your shoes.
When we repeat a movement, a sequence of movements, a posture, tension, or
gesture over and over, it becomes habitual. We “remember” how to do it
automatically, without thinking about it—the procedure has been thoroughly
learned. Procedural memory is different from recalling the events of the past with
words. Our procedural memory is recorded in our habitual posture, gestures, how
we carry ourselves, movements, and tension patterns and has stories to tell that we
can only hear by becoming aware of the language of the body.
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The Effects of Trauma and Attachment on Procedural
Learning
Ella’s body expressed her history of abuse in ways that words could not. When she
thought about her childhood, her shoulders hunched up in fear, and her arms tensed
with anger. A poet, she had written eloquently about the abuse, describing in vivid
language the disjointed bits she remembered about what had happened to her.
Although Ella had explored her trauma and attachment history in talk therapy and in
a weekly women’s group, the tension was still there. Her mind told her to put the
past behind her, but her body told her that she was not “finished.” Her hunched
shoulders reflected how frightened she had been as a child. The tension of her arms
spoke of what her body had wanted to do but couldn’t—fight back and protect
herself from her father. Ella did not understand that tension is a precursor to action,
and chronic tension often tells the story of actions we wanted to make in the past
but could not execute. Until she learned to translate the language of her body, she
was unaware that the tension in her arms represented the impulse to protect herself
that she had held back to avoid making her father mad and the abuse worse.
When we experience trauma, it is natural to want to run away or defend
ourselves, but often these actions are unsuccessful in keeping us safe. Children
cannot run away from their home to escape abuse, and fighting back is most often
ineffective and might even risk the making abuse more severe. Ella’s abuser, her
father, was stronger than she, and even as a small child, Ella “knew” instinctively
that fighting back would have only made him angry and violent. Additionally, her
primary attachment figure, her mother, prized politeness and manners and
considered expressions of anger to be “crass.” So Ella learned that the best way to
please her mother and secure her acceptance, as well as minimize her father’s
abuse was to be compliant, quiet, only speak when spoken to, and try not to be
noticed. She formed physical patterns that helped her accomplish this: hunching her
shoulders up in fear, holding back her anger with the tension in her arms, keeping
her eyes down to avoid eye contact, and trying to make herself smaller as she
moved through the house. As Ella said to her therapist, “I don’t get angry—I get
small. I don’t want to make waves.” Before she was old enough to understand why,
her body had learned to keep her as safe as possible and maximize her mother’s
care and affection. Ella’s pattern of responding provided her with two very
different types of safety: making herself “small” not only minimized the damage of
her father’s abuse but also helped her win the acceptance and approval of her
mother.
Our early attachment with our parents forms the beginning blueprints for the
way we learn to move and hold our bodies throughout life. For example, if you
grow up with parents who value high achievement and encourage you to “try
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harder” at everything you undertake, your habitual posture, gesture, and movement
will reflect this influence. If this value is held above other values, such as one that
communicates “You are loved for yourself, not for what you do,” your body might
become tight, mobilized to “work harder” or “try harder,” and your chin might be
lifted in an attitude of determination. You might become resolved to find the energy
to keep going even if you are tired, and thus override the signals from your body
telling you to take a break. These tension patterns, gestures, postures, and
movements, when repeated throughout your childhood, become procedurally
learned habits that endure into adulthood.
Conversely, if you grow up in an environment where trying hard is discouraged
or where everything you achieve is undervalued, ignored, or dismissed, you might
develop a sunken chest, limp arms, and shallow breath. Your body will reflect the
childhood experience of not feeling confident and of “giving up.” As an adult, these
habits might make it difficult to mobilize consistent energy or sufficient self-
confidence to complete a difficult task. Although such patterns form because they
are initially adaptive, later, when conditions have changed, the procedural learning
remains in operation, whether appropriate to your current reality or not. For
example, even when we know intellectually that we are now safe, as Ella knew, our
procedural learning—now an unconscious automatic habit—can repeatedly warn us
that the painful past experience is about to happen again.
Procedural learning is based on unconscious presumptions that the future will
be the same as the past. The procedurally-learned habits that allow us to
effortlessly drive a car depend on the expectation that ways of maneuvering the car
will have the same effects as they always have. In this case, the unconscious
presumptions, and the corresponding procedural habits are helpful. But some
procedurally learned habits interfere with new responses to current life and take
precedence over actions that might be more pleasurable or more adaptive. Ella
came to therapy because she wanted to get married, but when she thought of
marriage, the hunching of her shoulders increased. Even though her conscious mind
said one thing (“I want a husband, and it’s safe now to be close”), her body
remembered the past when it was not safe to be close to her father. Decades after
her childhood was over, Ella’s body unconsciously predicted that if she hunched
her shoulders, held back her anger, kept herself small, and tried to please others,
she might be safe and accepted. Although Ella desperately longed for a mate, her
hunched shoulders, avoidance of eye contact, and fear of being seen prohibited the
receptivity and trust she needed to pursue an intimate relationship. Like Ella, our
bodies also remember and act from what has worked in the past rather than what
might be adaptive to our current situations and relationships.
It becomes difficult to move on from the past when our bodies automatically
react as if the past were our present reality—like Ella, whose body froze whenever
she thought of going out on a date. Before she could fully realize that she was now
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safe, Ella needed to become aware of the language of her body, both the tension in
her shoulders and the anger that it had held back all these years, and how she kept
herself small and avoided eye contact. She needed to be able to “hear” the story her
body was telling her.
As Ella began to listen to the tension in her body, she realized that it held the
somatic memory of what had happened to her. The tension in Ella’s arms told her
what she had wanted to do but couldn’t: to protect herself by pushing her father
away! As Ella realized it would only have made the trauma worse if she had tried
to defend herself in the past, she gained a new appreciation for her body’s wisdom
that had curtailed those potentially harmful actions. And Ella was also able to
change the physical pattern of downcast eye gaze and careful, prim movements that
she had developed to please her mother. Together, she and her therapist practiced
making eye contact and spontaneous, big movements that countered her habit of
staying small until these new behaviors grew increasingly comfortable. Her
hunched shoulders gradually relaxed and her body began to feel “freed” of its
prison. Through practice, Ella changed her procedurally learned habits.
The verbal narrative and our interpretations of what happened are only half the
story of any experience. The worksheets that follow will teach you that your body
also has a story to tell, one that intertwines with your thoughts and emotions. You
may not have heard this story if you learned to disconnect, push away, or ignore
your body. But even if your body has become a stranger to you (or even an enemy),
you can begin to translate its language. Our self-discovery process comes alive in a
new way when we start to understand not only the verbal story of who we are and
what happened to us, but also the story the body’s procedural learning has to tell.
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Directions: Look at each of the five people and notice the differences in their
bodies. For each picture describe:
• What you notice about the body (e.g., chin is up, feet wide apart).
• What the body might convey to others (e.g., “I’m not open,” “I’m standing firm”).
• What the person might be feeling (e.g., isolated, hurt, confident).
• What childhood experiences might have led to that pattern in the body (e.g.,
maybe it wasn’t safe to be vulnerable or open, maybe he had to be tough or he got
hurt).
Remember, there is no “right” answer. Just write down your first impressions!
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3. b. What might this body convey to others?
c. What might she be feeling?
d. What kinds of childhood experiences might have led to this
pattern?
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Perceptions
3. Think about the people in your life—friends, family, coworkers. Describe any
perceptions you might have based on their body language. (e.g., When my
husband slouches and does not make eye contact, I think he is worried. When
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my boss clenches his jaw, I perceive that he is angry.)
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A GOOD TIME
1. In the picture frame, describe a memory of a good time or good moment in the
recent past (e.g., going to a party, watching or participating in a favorite sport,
hanging with friends, going to a concert, petting a dog, or going to the gym).
2. As you recall that moment, write down how your body responds. (e.g., My
shoulders relax, and I take a deep breath; I feel energized, and I sit up
straighter; my chest lifts; I square my shoulders.)
A BAD TIME
3. Describe a memory of a bad time or bad moment in the recent past in the
picture frame. (e.g., A fight with someone; feeling frustrated with your kids’
misbehavior; getting lost on the way to a special event; or being laughed at or
criticized.)
4. As you recall that moment, write down how your body responds. (e.g., My
jaw tenses; my spine slumps; I tighten up; my shoulders lift; my arms tense
up.)
5. Consider the two memories above. How does your physical reaction to each
memory contribute to how you feel about yourself? (e.g., When I relax and take
a deep breath, I feel confident and playful; When my jaw tenses, I hold my
breath, and I feel angry, but I think I don’t have a right to say anything.)
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Directions: Read the examples below and then think about things that your mind
knows but that your body’s procedural learning seems to contradict. Record any
emotions that accompany your procedural learning. Write down your observations
in the appropriate column and reflect on the differences between what your mind
and body know.
Reflect on what you learned from this worksheet and discuss with your therapist
what new actions might help you reconcile your thoughts and your body language.
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CHAPTER 6
Pay Attention
The Orienting Response
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disapproval.
Clients who fail to orient toward real dangers in the environment or who
hyperorient to reminders of past trauma might discover a correlation between their
orienting habits and symptoms such as impulsive behavior or fight–flight responses,
depression, cutting, or other types of self-harm. Those who experience difficulty in
their families, intimate relationships, and friendships may discover that they
routinely orient toward reminders of the painful elements of their early attachment
relationships, such as cues that might suggest abandonment, disappointment, or
criticism.
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Introduction to the Worksheets
The first few worksheets that accompany this chapter can be particularly helpful for
clients who need some distance to recognize orienting patterns. The WHAT
STANDS OUT worksheet invites clients to notice which elements in the
environment instinctively draw their attention and to reflect on how those cues
might relate to their history and orienting habits. TRACKING YOUR ORIENTING
HABITS encourages awareness of those habits and facilitates understanding of how
they affect internal states. You can use both of these worksheets to help clients
identify orienting patterns that increase their dissatisfaction, stress, or dysregulation
and notice how these habits affect the body. You can brainstorm with them to make
a plan to practice orienting toward elements that increase satisfaction, reduce
unnecessary stress, or help them regulate arousal.
CHOOSING WHAT TO ORIENT TO asks clients to select cues they would
like to orient toward prior to going for a walk, and afterwards categorize what they
noticed and assess whether they were able to focus their attention as desired. Using
the information from the previous worksheets on identifying orienting habits, you
can help your clients in session with the first part of this worksheet by making a
plan together for what they intend to notice, and then review the results at your next
meeting.
The EARLY ATTACHMENT & ORIENTING worksheet helps clients discover
orienting habits they learned in the context of family and other attachment figures
and alerts them to how these habits enhance or complicate their current
relationships. Clients will benefit from your help to notice the ways these habits
affect the body—posture, movement, breath, impulses, and so forth. The last
question helps clients identify elements they would rather orient toward in
relationships and can be used as reference for the next worksheet, CHANGING
ORIENTING HABITS. This final worksheet addresses unsatisfying orienting habits
that have come to light from the previous worksheets by encouraging clients to
identify the habits they would like to change and to practice orienting to something
new.
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unique orienting habits of each part may help clients with reality testing in the
present, with determining which point of view to trust, and with choosing new
habits of orienting that help to reassure rather than alarm the different parts. They
might also discover that patterns of orienting can trigger dysregulated parts and
learn to consciously direct their orienting in ways that reduce triggering.
This chapter can potentially help clients learn the important skill of focusing
their attention in specific ways to help regulate their overwhelming feelings and
sensations. However, orienting exercises involve the physical action of turning the
head and neck to look around at various environmental cues, which can be
frightening or seriously uncomfortable for those who have long-standing patterns of
freezing or collapsing. Equally, shifting focus from a triggering cue to a neutral or
positive one can arouse hypervigilance and anxiety. Proceeding slowly and helping
clients separate the past from the present will be useful with those who may
question the safety of positive feelings and wonder if focusing on something that
feels good will make them more vulnerable to danger.
If there are parts that resist exploring orienting patterns, you can acknowledge
the function of this resistance, discover what the part is afraid will happen if
different cues are chosen to orient toward and explore what kind of orienting might
feel right to this part. It is important to respect the resistance while also teaching
about the skill of orienting. For example, a hypervigilant part might want to orient
toward the doors and windows, toward the exit route, or toward possible dangers.
You might acknowledge the protective function of these orienting habits and
explore, or even encourage, them in session. Having done so, that part might be
more willing to experiment with letting other parts discover or show one another
what they tend to orient toward. The key here is that different parts’ points of view
are of equal interest and importance in therapy. The function of each part’s orienting
habits can be discovered with no pressure for any part to orient in a different way.
That lack of pressure often results in a willingness to try orienting to something
different—ideally, to something on which all parts can agree. Each part, as
tolerated, can explore noticing the orienting habits of other parts.
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Our orienting response helps us select what we pay attention to, moment by
moment, in the world around us. When an external stimulus is found engaging (e.g.,
a beautiful sunset or friendly puppy) or demands attention (e.g., an unexpected
noise or crying child), we “orient” to, or direct our sensory “radar” toward, this
stimulus. Orienting can be a conscious choice, or an involuntary reflexive instinct.
Voluntary orienting has to do with choosing what to pay attention to. Right now, for
example, you have decided to orient toward this book and the words on this page.
But if someone unexpectedly walked into the room where you are reading, your
orienting reflex would kick in, and you would involuntarily find yourself looking up
to focus on that person. Orienting changes moment to moment—one moment you
may be reading quietly, and the next you may shift your attention to a different
stimuli in your surroundings.
All animals, including humans, have an innate “orienting reflex” that is
activated by novel stimuli: a new sight, sound, smell, person, or something we
unexpectedly touch. When this reflex is stimulated, we instinctively and
involuntarily focus our attention toward the unfamiliar stimulus, automatically
turning our eyes or even the entire head and body toward it. This orienting reflex
occurs without conscious thought and reflects the innate wisdom of instincts that
alert us to pay attention to novel stimuli so that we can determine whether they are
safe or dangerous.
As the owner of a restaurant, Jerry worked long hours and was constantly
focused on improving his productivity. His wife accused him of being a
workaholic, and indeed he found that whenever he had free time, his attention went
immediately toward work tasks rather than toward pleasurable or relaxing
activities. When Jerry sat down to dinner with his family, he ignored the flavors,
smells, and presentation of the food, as well as the sounds of the dinner table
conversation. Instead, his attention was focused on his cell phone, and his gaze was
drawn to the alerts of work-related emails. At his wife’s insistence, Jerry decided
to try to change his orienting pattern and began by spending a Sunday afternoon with
his family instead of going over his business finances. He was immersed in an
engrossing game of catch, orienting toward the ball and the chatter of his nine year
old son, when he heard a sudden, loud, unfamiliar sound from the house next door.
Instantly, his orienting reflex was activated: He stopped the game, his ears pricked
up, and his head snapped to an alert upright position. Turning in the direction of the
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sound, his nostrils flared, and he remained perfectly still for several seconds. When
no further sounds occurred, Jerry’s attention returned to the game of catch. Jerry’s
orienting reflex had been triggered, instinctively arresting the activity of catch and
compelling him into a more alert state until he could assess the novel stimulus (the
sound) and ascertain what to do.
By orienting, we consciously or unconsciously select what to pay attention to
from all the possibilities available in each moment. If we do not intentionally direct
our attention to where we want it to go, we will often find that it automatically goes
in familiar directions: toward what we expect, toward what we’re used to noticing,
toward what we were taught to notice, or toward where our impulses take us. Jerry
habitually oriented toward things related to his job, such as his cell phone, rather
than toward his family or other things unrelated to work. Having grown up with a
critical father who punished him if he did not perform well in school, Jerry had
learned as a boy that if he did not work hard and excel, he could become the target
of his father’s disapproval and ridicule. As an adult, the same anxiety he had
suffered as a child fueled his habit of over-orienting toward world-related cues.
Trauma, attachment and other significant life experiences have a powerful effect
on how and what we orient toward. Our attention may automatically go to signals
that suggest bad things might happen; to the things that we learned to dread back
then; to any potential signs of threat, danger, or interpersonal conflict; or to
avoiding such signals. This chapter helps you understand the orienting response and
how to direct your attention where you want it to go instead of where your history
has taught it to go.
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pleasurable, relaxing stimuli (e.g., idle conversations, the vacation brochure his
wife brought home, the novel his son wanted to read with him, the hammock in the
backyard) as unrewarding due to the experience with his critical father who
emphasized achievements and insisted that Jerry be productive rather than enjoy
himself. Even on a Sunday drive with his family, Jerry reflexively focused on things
that would improve the productivity of his business (e.g., the billboard
advertisements of his competitors or the architecture of other restaurants).
Once we orient toward and assess whether a stimulus might be harmful,
beneficial, or neutral, then we take action in relation to it by moving toward it,
avoiding it, or ignoring it. This is an unconscious process much of the time. Often
we have oriented and taken action before we even realize we have made a choice.
This automatic orienting serves an important role in our ability to get through each
day. We are continually bombarded with enormous amounts of information from our
surroundings, far too much to pay attention to at any given moment. The deluge of
information that enters our senses each moment could easily overwhelm us if we
were unable to filter out irrelevant or insignificant information. Selecting relevant
cues and screening out irrelevant ones are fundamental to organizing our behavior
and even to enjoying a productive and rewarding life. If we cannot select
effectively, we may feel overwhelmed or unable to concentrate or focus our
attention. On the other hand, if we filter out too much information or become
compulsively or habitually focused on certain kinds of stimuli, we may fail to
respond to important stimuli.
We all develop adaptive habits of filtering out certain cues and selecting others
to orient toward. However, when outdated, these orienting patterns can keep us
prisoners of the past and diminish our enjoyment of life in the present.
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of meetings afterwards. Until Sam’s therapist helped him recognize that his
coworker’s appearance was similar to that of his abusive babysitter, he was unable
to relax and pay attention during meetings. Sam oriented toward women who
looked like his babysitter out of fear of being abused again. Jerry oriented toward
his work because that would have avoided the criticism of his father in the past.
We may also have habits of orienting to external stimuli that seem to confirm
our negative thoughts and fears and therefore be unable to take in information to the
contrary. Sidney, for example, had unconsciously interpreted his negative childhood
experiences as meaning that he was worthless. Later, as an adult, he was
hyperaware of every cue on his wife’s face that might indicate that she disapproved
of him, such as a furrow in her brow or a narrowing of her eyes. He interpreted
these expressions as meaning she thought he was not worthy of her, although that
was not his wife’s perception.
Without orienting responses that are adaptive for our current lives, we too may
fail to assess safety and acceptance accurately. We may then find ourselves feeling
threatened or unsupported even with people who love and support us. Or, we may
fail to assess danger and risk accurately and repeatedly find ourselves either in
threatening situations or too fearful to engage with the world. However, we can
learn to make deliberate choices about how and where to orient and by doing so
teach ourselves how to take in new information that can help us change outdated
orienting habits.
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observed that the dog was very tiny, covered with lots of long white curly hair with
a snub nose, and she could realize that this was not the same dog that had bitten her.
She next chose to focus attention away from the dog and toward other stimuli, such
as the person she was with or the appealing landscape around them. At first, this
was difficult, but with practice Jeanie found it possible to inhibit overorienting to
the triggers of the past and to deliberately focus on other cues. Slowly, over time,
whenever she saw a dog, Jeanie trained herself to first notice the features of the dog
that distinguished it from the one that had bitten her and then to direct her attention
toward other pleasing cues.
Understanding how our orienting habits were useful in a previous environment,
how they affect us now, and then redirecting our orienting can be liberating. Once
Sam realized in therapy that his coworker reminded him of his abusive babysitter,
he decided to talk with her on his break and he found he enjoyed her company.
Sidney felt great relief that he no longer became triggered in conversations with his
wife, and Jeanie was happy to be able to go on walks without anxiously
anticipating encountering a dog. Jerry gradually found that his productivity at work
did not suffer as he changed his orienting habits to include things that were
pleasurable and not related to his job.
By choosing to change your orienting habits, different responses and new
meanings can emerge, as they did for Jerry, Sidney, Sam, and Jeanie. When they
encountered a reminder of the past, instead of fear and avoidance, they could
experience a sense of competence, empowerment, and satisfaction. Instead of being
driven by outdated orienting habits, we can teach ourselves to become curious and
increasingly aware of our orienting habits, taking the first step toward changing
them. The second step is to redirect our orienting by choosing to concentrate on an
object in the environment that makes us feel “good” or “safe” instead of focusing on
something that makes us feel “bad” or “unsafe.” The worksheets that follow are
designed to help you discover your orienting habits, explore how they were shaped
by your history, and to redirect your attention so that you can begin to focus on a
wealth of cues in your current environment that you may not have been able to
notice before.
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1. What stands out to you about each of the three cues you circled? (e.g., I only
circled people having a nice time; I only circled things and animals, not people;
I only circled people who were alone; I only circled the people who look
unhappy.)
2. What happens in your body as you think about the cues that you circled?
3. Describe the types of cues that you circled. Do they indicate relationship
problems or that bad things might happen? That life is good or the world is safe?
Do they confirm negative thoughts & fears or a positive outlook?
4. Reflect on why you might have circled certain cues. Do they remind you of
experiences you have had in your life or relationships with family or friends? Or
are they things you would like to experience?
5. Look at the picture again to notice all the cues that you did not circle. Reflect on
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why you might not have circled them. Are there any you would like to try to pay
attention to in the future?
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1. What did you orient toward that made you feel good or safe? When you think of
these cues that make you feel good or safe, what happens in your body?
2. What did you orient toward that made you feel bad or unsafe? When you think of
these cues that make you feel bad or unsafe, what happens in your body?
3. What do you want to pay more attention to? How might orienting toward those
cues affect your body?
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Directions: Make a plan to take a short walk during which you can study your
orienting habits. Complete the first prompt before you set out on your walk. When
you return, complete the rest of the worksheet.
3. To get a better sense of the types of things you orient to, try to put the things you
listed in #2 into categories. Circle the categories below that represent what you
oriented to, or write in a category that is not listed in the empty spaces.
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4. Reflect on whether you were able to follow your orienting plan for your walk.
Describe why, if at all, you had trouble orienting toward what you wanted to. (e.g.,
I felt rushed and was only looking straight ahead; I was on the lookout for
danger and wasn’t aware of the nice scenery; I was thinking so much, I didn’t
notice what was going on around me.)
Note: If you were not able to orient toward what you wanted to notice, discuss this
with your therapist.
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Directions: Remember a time growing up when you were with your family (e.g.,
eating dinner together, going on vacation, or playing a game). Follow the prompts
below.
1. As you remember, take time to assess the quality of the interactions among
your family members. Circle the words that apply, and write in any additional
words that apply.
Calm
Accepting
Loving
Supportive
Stable
Happy
Respectful
Lighthearted
Sad
Accepting
Safe
Judgmental
Serious
Critical
Disrespectful
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Mean
Depressing
Frantic
Unpredictable
Neglectful
Demanding
2. Describe how the qualities you selected made you feel when you were
younger.
4. Describe any other cues you would like to practice orienting toward. How
might orienting toward those cues change your posture, breath, or movement?
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Direction: Choose three orienting habits that you would like to change. Describe
how each orienting habit makes you feel. Then describe what you could orient
toward instead to practice changing each habit.
Orienting habit you How the habit affects your What you could orient to
would to change emotions & body instead
• I get hung up on • It makes me feel like she is • I could orient to her
the habitual tone angry at me, like I can’t do smile that indicates she
of my wife’s voice anything right. My jaw cares about me rather
and her abrupt tightens. I don’t breathe. than to her tone and
manner. abruptness.
Orienting habit you would How the habit affects your What you could
like to change emotions & body orient to instead
Orienting habit you would like to How the habit What you could orient to
change affects instead
Orienting habit you would How the habit affects your What you could
like to change emotions & body orient to instead
Orienting habit you would How the habit affects your What you could
like to change emotions & body orient to instead
What effect does changing each orienting habit have on your experiences and
interactions with others?
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CHAPTER 7
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Clients who feel at the mercy of their distress often feel more empowered when
they can name the components of internal experience that contribute to their
distress. Those who live in chronic states of dissatisfaction, depression, fear,
irritability, isolation, or self-hatred but do not understand why can learn to
deconstruct the internal components of their suffering. Doing so can diminish
feelings of victimization, foster self-understanding, and eventually lead to mastery
over their reactions. On the other hand, clients who tune out, minimize, or detach
from their inner world are faced with the challenge of how to feel more connected
to themselves and their emotions. Learning mindfulness skills to become aware of
the different elements of their internal landscape can support them in this endeavor
and enrich the quality of their experience.
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your story, what changes inside?”; “Can you describe your experience—your
thoughts, emotions, images, movements, or sensations?”; “How do your thoughts or
emotions change when you talk about this topic?”
When clients express an emotion (e.g., “I feel afraid” or “I’m hurt and
disappointed”), you can ask them to notice the building blocks that tell them they
are afraid or disappointed. Simply identifying and labeling the building blocks that
contribute to an emotion can help clients take a step back from becoming immersed
in, dysregulated by, or “ruled” by their emotional reaction.
As clients find the words to describe their experience to you, the prefrontal
cortex is stimulated (Siegel, 2007). Tightness in the chest can be observed as a
sensation; images of the attachment figure can be experienced as a five-sense
perception; the impulse to curl up can be noticed as a movement; “I’m a failure”
can be recognized as a thought. In normal daily life, these building blocks exert
their influence on experience and actions, but usually remain just outside of
conscious awareness. Mindfulness brings these elements into consciousness, where
they can be addressed directly.
Clients’ use of words such as always, never, or constantly usually indicates
that they are focused on the past or on future speculations and not on the present
moment. To help them differentiate between dwelling on the past or future versus
mindfulness of present moment experience, you can ask questions that draw
attention back to “right now,” such as: “Are you feeling that right now?”; “Are you
seeing the image of that memory right now?”; “Is your body tight right now?” These
statements are not meant to correct but to draw clients’ attention to the building
blocks that make up their experience in the moment.
Many clients have learned to ignore, disconnect from, or minimize their internal
experience. When the client is detached from emotion and/or sensation and
responds with “I feel numb” or “I don’t feel anything,” various options are
available to you. The approach you select to facilitating mindfulness in these cases
depends on the reasons for clients’ disconnection and their regulatory capacity. For
example, if the “nothing” feeling is the result of past trauma, the sensation itself can
become the stimulus for directed mindful exploration. You might ask: “What
happens when you sense that ‘nothing’ feeling?”; “Can you describe that sensation
of it?”; “Do you feel it throughout your body?”; “Or are there some areas that are
not numb, or that feel less numb?” Offering a menu of words to describe experience
can help clients increase their internal awareness: “Is ‘nothing’ more of a numb
feeling? Or a tightness? Or a spacey feeling?”
If focusing on numbness causes distress, you might ask the client to reflect on
something neutral or pleasant and then become mindful. For example, you might
say: “Let’s just focus on something that feels good, like that memory of your son
hugging you, or the safety of our relationship right now, and see if your sensation
changes.”
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If the “nothing” feeling represents a detachment from emotion and if your client
is not traumatized, you might ask your client to focus on a building block that might
change the sensation. “I wonder, could we come back to the image of your father
yelling at you, and notice if your sensation changes?” If your client has the
regulatory capacity to integrate strong emotions but has learned to avoid them,
focusing on a significant image of a childhood memory such as this, and asking the
client to describe the look on the father’s face, the tone of the “yelling,” and to
notice the effects on present-moment experience, can help mitigate a sensation of
numbness and elicit emotions. Turning mindful attention toward a childhood image
of an attachment figure often intensifies the client’s painful emotions and other
building blocks, which can then be processed in the therapy hour (cf. Chapter 30,
“Making Sense of Emotions”).
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self-critical thoughts, worry about the future, rumination about the past), or, those
who simply want to reduce their stress.
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times every day. Persistent practice over time will increase the ease with which
mindfulness skills are available to them in the days and weeks ahead.
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Adverse experiences can interfere with our ability to be “here” instead of “there.”
We may find ourselves either focusing on painful memories or anticipating that the
future will bring more distress. When we find ourselves dwelling on the past,
disturbing memories might intrude upon the present moment, and we often orient to
cues that remind us of the circumstances we experienced long ago. When our
attention goes to the future, we might imagine the “worst-case scenario,”
anticipating that the future will be fraught with unpleasant, disappointing, or
threatening experiences. Focusing on the past or the future prevents us from directly
experiencing the present moment—here (in this specific place) and now (in this
instant of time). We also might have developed habits of ignoring, suppressing, or
minimizing our own present moment experience, focusing instead on others,
objects, tasks, or the environment. The distinct sense of immediacy, richness,
vitality, and aliveness that is available when we are aware of our experience of the
present moment is diminished when we disregard it or dwell on the past or the
future.
In contrast to the previous chapter that explored orienting to external stimuli,
this chapter explores how to pay attention to our internal experience, in the here and
now, through cultivating mindfulness. When reminders of adverse experiences pull
our attention to the past or the future, or when we ignore what goes on inside
ourselves, mindfulness of our internal experience helps us come back to and
appreciate the present moment.
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points of mindful attention. These building blocks are summarized in Figure 7.1.
FIGURE 7.1
Cognitions
Cognitions are thoughts that can describe our experience and convey
interpretations, meanings, and theories in words. Cognitions may be spoken or only
thought about. Our thoughts include negative interpretations of what happened to us
that can become generalized into erroneous beliefs, such as “I’m bad,” or “I will
never be safe,” or “Other people don’t like me.” We may criticize or blame
ourselves with our words, thinking, “Why did I do that?” or “I’m so stupid” or “It
was all my fault.” Or we may accept and compliment ourselves with thoughts such
as “I’m OK the way I am” or “I just did a great job at work.” Our thoughts can also
describe our attitudes toward others and the world, which can be positive (e.g.,
“The world is generally a friendly place” or “Most people are kind”) or negative
(“The world is a dangerous place” or “You can’t ever trust people”). We are often
unaware of our thoughts, although patterns of thinking play a large part in
perpetuating our feelings (whether positive or negative) about ourselves, others,
and the world.
Emotions
Along with thoughts, emotions shape our moment-to-moment experience. The
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emotions we experienced frequently in the past can bias how we feel in the present.
If we were generally content and happy as children, we tend to remain so as adults.
If painful emotions such as fear, sadness, anger, or disappointment were pervasive
in our childhoods, we may have trouble experiencing the positive feelings (joy,
happiness, contentment) available to us in the present moment. We may relive the
emotional tenor of previous distress, feel at the mercy of our emotions, or blame
ourselves for our out-of-context emotional reactions. Or, we may react to
apprehension of experiencing distress by detaching from painful emotions, which
can leave us feeling flat and empty. If we expect more painful experiences, we are
likely to experience unpleasant emotions such as worry, dread, anxiety, or
loneliness as we anticipate the future.
Five-Sense Perception
The third building block of present-moment experience is called five-sense
perception. When we remember the sensory experiences of the past (the sights,
sounds, smells, tastes, and touch), we reexperience them in the present moment.
Meg liked to conjure up the smell of vanilla because it reminded her of baking
cookies with her grandmother. Jerry was haunted by the sound of his father’s
critical voice whenever he attempted something new. Jane hated remembering the
smell of the Thanksgiving turkey, which she associated with her anxious parents
who took out the stress of the holidays by fighting and yelling at her. Many people
with trauma in their histories cannot fully remember what happened but are haunted
by reminders nevertheless—like Babs, who was terrified by cats but did not recall
that one had severely scratched her when she was a toddler. Others reexperience
intrusive sensory reminders of the trauma. Following a tonsillectomy, Terri was
distressed by intrusive, scary images of the anesthesiologist in his medical mask,
and by the taste and smell of anything that reminded her of the hospital.
Movement
The fourth building block, movement, refers to the physical actions of our bodies.
Movements range from gross motor movement involving large muscle groups, such
as crawling, walking, and running, to the fine motor movements of smaller actions,
such as picking up objects with our hands or wiggling our toes. Movement also
includes facial expressions, changes in posture or the tilt of the head, and gestures
of our hands and arms. We respond to all the things that happen to us, especially
how others treat us, with movement. Over time, as described in Chapter 5, “The
Language of the Body,” we form procedural habits of movement. If being visible or
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expressing ourselves brought criticism or other kids of unwanted attention, we may
keep ourselves small and contained by slumping or looking down instead of
standing with our body relaxed and tall. If reaching out for connection with others
brought rejection or abuse, we may literally cease reaching out.
Body Sensation
The fifth building block, body sensation, encompasses the physical feelings
constantly generated internally from changes in electrical, chemical, and muscular
activity. Our sensations inform us about our movements, even those occurring
within our internal organs, such as racing of the heart, butterflies in the stomach,
nausea, hunger, or those gut feelings. We are often unaware of body sensation,
because our attention is on other things or because we learned to disconnect from
our bodies (see Chapter 4, “The Wisdom of the Body, Lost and Found”) so as to not
experience unpleasant or overwhelming physical or emotional pain. However, we
can usually turn our attention toward our sensation at will. For example, most of us
can become aware of our heartbeat after a few minutes of attention. And most of us
are aware of the strong sensations relating to past distressing experiences, such as a
“rush” of adrenaline, a pounding heart, or muscle tension.
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chest (sensation), an image of himself forlorn as a child emerged (five-sense
perception), and he had that thought that no one was ever there for him (cognition).
Mindfulness of his five building blocks helped him realize that he was experiencing
the present moment as if it were a repeat of his unsupportive childhood, and not an
accurate interpretation of his friend’s temporary inability to provide support.
Although he felt sad when he thought about the loneliness of his childhood, he was
able to separate the past from the present, cease judging himself for being “needy,”
and realize that his friend was only busy, not unsupportive.
One way to start to change the automatic reactions connected to the past is to
mindfully notice these reactions as composed of the building blocks and understand
them as related to our history rather than to the present moment. Mindful awareness
of your building blocks will teach you to work with the effects of the past without
having to relive it. When present-moment cues remind you of the past, your ability
to both be mindful of, and to experience, your internal reaction can help you to
become curious about your thoughts, emotions, perceptions, and body. You might
ask yourself questions such as these: “What is telling me that I’m triggered or
upset? The change in my heartbeat? My breathing? Muscular tension?”; “What kind
of sensations are telling me right now that I’m frightened?”; “What thoughts are
coming up as I see my friend frown?” Through such mindful inquiries, you will
learn to “name” the present-moment building blocks that you experience rather than
only react to them.
Practicing mindful awareness of internal experience can help us be more
present in our current lives instead of reliving the past. The death of Ginny’s close
friend unexpectedly triggered her terrifying childhood memories of a German death
camp, causing body sensations (heart pounding, dry throat, nausea), movements
(shaking, restlessness, impulses to run), and emotions (overwhelming fear and
rage). Thoughts such as “This will never stop” and “I have no one left” led to panic
at times and, at other times, led to a collapse in her spine and the feeling of deep
despair. When Ginny became more and more upset discussing her history, her
therapist asked her to pause to notice the building blocks she experienced as she
told her story, rather than relive the story. Ginny noticed her jaw trembling and
tension “everywhere,” and as she observed and named the trembling and the
tension, they began to subside a little bit and she felt slightly calmer. That “success”
encouraged her to notice other buildings blocks, and she was able to identify her
thought, “I have no one left” as just a thought rather than as the “truth,” and her
painful emotions as information about how she was feeling that moment, rather than
as never-ending pain.
Through practicing mindful awareness when her attention was drawn to thinking
about the Holocaust, Ginny learned to concentrate on and label the present-moment
building blocks. “Right here, right now, what do I notice?” she would ask herself.
“What are my thoughts, feelings, five-sense perceptions, movements, and
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sensations?” Sometimes Ginny would practice attending to the background noises
(the buzz of the refrigerator, the children playing next door), visual stimulation (the
green trees, the cars parked on the street), and her sense of touch (the feeling of
weight on her buttocks as she sat on the chair, the feeling of her clothing on her
skin), all of which changed her experience of her building blocks (her breath
deepened, her body relaxed, her thoughts and emotions settled) and helped her stay
aware of the here and now. Gradually, as she practiced these mindfulness skills,
Ginny’s sense of being possessed by the trauma of her childhood diminished.
Charles, on the other hand, avoided the strong emotions triggered by
relationships by isolating himself and avoiding other people. A latchkey child who
grew up alone, feeding himself on frozen dinners and passing time by staring at the
TV screen, he described himself as “depressed” and said that all he had the energy
for after work was going home to bed. With the help of his therapist, he began to
notice the building blocks that added up to “depression.” Charles said his emotions
were flat and blunted, but he reported self-critical thoughts (“You’re lazy; you’ll
never amount to anything”). He described heaviness in his body as a sense of
inertia when he tried to move. As he differentiated each building block of his
present experience, and named each one, rather than labeling himself as
“depressed,” Charles started to become aware of the fact that his internal landscape
was much more nuanced than he had ever noticed. He realized the critical thoughts
he heard in his head were in his father’s voice and with that realization, his blunted
emotions began to simmer with a touch of anger, which gave him a bit more energy.
He saw an image of himself as a neglected child, subject to his father’s criticism,
and he felt compassion and an impulse to protect the boy he had been. Gradually, by
taking the time to cultivate curiosity and interest in his own internal experience,
Charles’s old pattern of depression was challenged by what he discovered.
Meg had not suffered the trauma that Ginny had, nor the depression that had
plagued Charles, but she often felt rejected by Lindsay, her wife, who did not share
Meg’s penchant for an orderly home. Lindsay did not pick up after their toddler, and
it didn’t bother her that the dishes remained in the sink overnight. When Meg woke
up to dirty dishes, she felt tension in her shoulders, a sensation of emptiness in her
chest, and irrational feelings of hurt accompanied by thoughts that Lindsay did not
love her. She often would tearfully accuse Lindsay of not caring about her.
In therapy, as Meg turned her mindful attention to the building blocks that were
evoked when she thought of the dirty dishes, an image of herself as a small, forlorn
girl came up. As a child, her interests and preferences were ignored by her parents,
who focused more on their own needs than on their daughter’s. Through
mindfulness, Meg realized that she had been responding to Lindsay as if Lindsay
were not interested in her needs. She was able to separate past from present and
realized that Lindsay actually did support her interests and needs in every way
except housekeeping. After this realization, Meg decided that when the messy
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kitchen upset her, she would take time to become mindful of her building blocks and
then share what she discovered about herself with Lindsay rather than accuse her of
not caring.
The worksheets that follow are designed to help you learn how to identify your
own building blocks, through mindfulness, instead of becoming immersed in your
internal reactions or ignoring or suppressing them. As you learn to identify the
components or building blocks of your internal experience, you will better
understand the impact of your past on the present moment and on your expectations
of the future. These skills can reduce the power of triggers that catapult you into
reliving the past, diminish your apprehension of the future, and alleviate some of
the stress of difficult moments in your current life. Rather than avoiding or reacting
with agitation to your internal experience, you will be able to become mindful of it
—and even learn to enjoy the richness of your inner landscape.
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2. Take your time to immerse yourself in remembering that good moment, then
describe in as much detail as possible what you notice in each of your five
building blocks as you remember it. Be as detailed as possible.
Thoughts
Five-Sense Perceptions
(Images, Sounds, Smells, Tastes, Touch)
Emotions
Movements
Body Sensations
3. Notice which building blocks best helped youre connect with the positive
feelings of this good moment. Which one could you focus on to help you revoke
the good feelings?
(e.g., The sensation of warmth in my belly; the movement of a deep breath; the
image of my father smiling; the smell of cookies baking; the emotion of
compassion or calm; the thought ‘I am loved’ or, ‘I’m OK the way I am’.)
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When you have a negative thought or emotion, you can name each as a “thought” or
“emotion.” Naming the thought or emotion can remind you that it is not forever but
occurring in the present moment. See the examples to the right.
“I’m having the thought right now that “In this moment, I’m feeling the
nothing ever goes right.” emotion of anger.”
Directions: As you go through the day, notice whatever negative thoughts and
emotions you have that distract your awareness from the present moment. Use the
space below to name them as occurring in the moment (e.g., Right now I’m having
the thought that I’m not attractive; I’m feeling an emotion of sadness in this
moment).
Thoughts
Emotions
How does naming your thoughts and emotions as occurring in the present moment
affect your body?
Do you feel more relaxed, tense, energized, or something else?
Practice naming your negative thoughts or emotions during the next week, and
describe your experience below.
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Directions: Whenever you think of it, practice focusing attention on the sounds
around you—the white noise of background sounds, such as the hum of traffic or the
whirring of a fan; mechanical sounds, such as the revving of a motor; nature sounds,
such as the wind blowing, trees rustling, or water lapping, and human sounds, such
as people talking, arguing, laughing, or playing music. After you have practiced
focusing on sounds, follow the prompts below to practice this skill during a
stressful situation.
1. During a stressful situation—being stuck in traffic, being unable to fall asleep,
after an argument or unpleasant experience, or when you are upset—notice your
thoughts, emotions, and body sensations and movements.
Hearing
2. Then take a few moments to focus on all the sounds around you (without music
or the television playing). Name what you hear to yourself (e.g., I can hear the
whirr of the refrigerator, the din of traffic, a clock ticking, horns honking,
crickets chirping, dogs barking, music playing or a TV in the background,
neighbors chatting, the sound of my own breathing). Be mindful of your internal
experience.
3. Describe your thoughts, emotions, and body sensations and movements before
and after you practiced focusing on the sounds around you.
Before
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Thoughts
Emotions
Body Sensations and Movements
After
Thoughts
Emotions
Body Sensations and Movements
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Sight
2. Then spend a few minutes taking in all the sights in your environment. Look
around, and really notice them, their colors and shapes. Name them to yourself: I
can see the orange wall, the little child in the blue dress and red shoes playing
in the yard, the shape of the trees, the color of the sky, the shadows cast by
buildings, the reflections in the window. Be mindful of your internal experience.
3. Describe your thoughts, emotions, and body sensations and movements before
and after you practiced focusing on the sights around you.
Before
Thoughts
Emotions
Body Sensations and Movements
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After
Thoughts
Emotions
Body Sensations and Movements
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Touch
3. Describe your thoughts, emotions, and body sensations and movements before
and after you practiced focusing on your sense of touch.
Before
Thoughts
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Emotions
Body Sensations and Movements
After
Thoughts
Emotions
Body Sensations and Movements
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2. Then choose something to stimulate your senses of taste and smell—drink a cup
of tea, chew gum, eat a piece of chocolate or a piece of cheese, put on fragrant
hand lotion, suck on a piece of hard candy, or take a walk outside and notice the
various smells of your surroundings. As you do this, focus all your attention on
your taste and smell. Be mindful of what happens.
3. Describe your thoughts, emotions, and body sensations and movements before
and after you practiced focusing on your senses of taste and smell.
Before
Thoughts
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Emotions
Body Sensations and Movements
After
Thoughts
Emotions
Body Sensations and Movements
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Suggestions for Clinical Use
The idea that clients can deliberately choose to focus attention toward particular
thoughts, feelings, perceptions, movements, and sensations runs contrary to the
tradition of therapeutic free association. When we encourage clients to free
associate, we facilitate open-ended awareness of wherever their attention is drawn.
Directed mindfulness requires that instead of free association, you help your clients
deliberately direct their attention toward specific selected building blocks to
support therapeutic aims.
For example, if an image or memory of past trauma (e.g., the sound of a siren)
or of attachment difficulties (e.g., being criticized) causes hyperarousal or
dysregulating emotion, you might direct your client to become mindful of the
sensation in his or her legs to foster a new experience of grounding, rather than
fixating on the distressing memory. Or, if your client’s regulatory capacity is
sufficient, you might direct his or her mindfulness toward a strong emotion as a way
to deepen the emotional experience and discover the building blocks that correlate
with it. You might ask questions such as these: “What happens in your body as you
feel this anger? What thoughts seem to go with it? Are there any images that arise
when you sense the anger? What movement does your body want to make when you
experience the anger?” In this way, information is revealed that creates a new
experience of the emotion and often supports expression and resolution of it.
A challenge in the use of the chapter may be clients’ misinterpretation of the
material. They might misunderstand your suggestion that they refrain from focusing
on particular building blocks and turn their attention elsewhere. They may think you
are suggesting they avoid or discount their painful experience. In this situation,
psychoeducation is crucial. The point is to help clients understand the difference
between avoidance of distress and mastery over it, and between deliberate focus
versus habitual focus. It may be helpful to reference the chapter’s emphasis on
neuroplastic change, highlighting that habitual focus on the effects of the painful
experience may validate the client’s distress, but it will not create new experiences
or change the brain, and the latter is the goal with this chapter.
Research on neuroplasticity suggests that structural changes in the brain are
dependent upon the ability to maintain focused attention on the novel elements of
experience and on new patterns.
”The discovery that neuroplasticity cannot occur without [focused] attention has important implications.
If a skill becomes so routine that you can do it on autopilot, practicing it will no longer change the brain.
And if you take up mental exercises to keep your brain young, they will not be as effective if you
become able to do them without paying much attention.” (Begley, 2007)
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Introduction to the Worksheets
CHANGING NEGATIVE BELIEFS helps clients identify how they are affected by
negative beliefs by asking them to direct their mindful awareness to the physical
elements, particularly movement and posture, associated with a specific negative
belief, then experiment with performing the opposite physical action and notice the
effect. The goal is to challenge the negative belief by practicing a new, opposite
physical posture or movement that elicits new reactions in the building blocks and
would be more suited to present-day life.
CREATING NEW PATTERNS is a good fit when clients come in with
repetitive, familiar complaints or disappointments because this worksheet helps
them deconstruct a pattern they would like to change into its component building
blocks. Clients then explore creating a different experience by mindfully directing
their attention to something that challenges the old pattern. Unless your clients are
adept at being mindful of the building blocks, these first two worksheets are best
completed in session to so clients can benefit from your prompting and feedback to
assure success. And, clients will need you to remind them to repeatedly practice
what they discover through these worksheets.
The worksheet on HARNESSING NEUROPLASTICITY FOR POSITIVE
CHANGE helps clients become aware of the power of their thoughts to influence
the body. It first asks clients to identify the effects of negative thoughts on the body,
and then direct their attention to a positive experience or something for which they
are grateful and notice the effect on the body. Your encouragement to repeatedly
direct attention to more positive elements of their lives, along with working on the
problems that brought them to therapy, can build new patterns of brain circuitry that
can support clients’ goals. The last worksheet for this chapter, DIRECTED
MINDFULNESS, teaches clients to change their relationship to a current problem
by first identifying how the problem affects their building blocks, and then directing
mindfulness to a specific building block in order to alter their experience in a
positive way. This worksheet will be particularly useful for clients who tend to
ruminate on current difficulties in their lives.
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deliberately alter, their experience. With this skill, they can learn to mindfully focus
on building blocks that are regulating. These clients will need your encouragement
and support to diligently practice this skill because it is difficult to deliberately
redirect attention when it has always been compelled by hyper-/hypoarousal,
dissociation, impulsive action-taking, or shutting down. Each time your client
experiences one of these symptoms, an opportunity is provided to teach directed
mindfulness. You can pause the narrative or interrupt the silence by saying, for
example: “Notice how your body shuts down when you try to describe what
sensations and feelings you were having. What building blocks tell you that you’re
shutting down? Is it more like a numb feeling? Or thoughts getting blurry? Or a
collapse in your body?” Once the building blocks are discovered, you can help
clients practice directed mindfulness with suggestions such as: “Try focusing on
your breath and see what changes. Maybe pay attention to your feet right now, or the
image of your lovely home. Describe what changes inside.”
If your clients are triggered when experimenting with a positive belief or a new
response, you might experiment with selecting and directing mindfulness toward
building blocks that help them feel better. If they are distracted by switching
between parts (e.g., when certain parts monopolize the client’s consciousness or
function involuntarily), mindfulness can be directed toward the building blocks
involved in switching. You might suggest, “Let’s pay attention to what just
happened. What changes inside as this part of you comes forward?” Or you may try
to direct their mindfulness away from a triggering building block to something else.
You might say, for example, “What do you notice when you attempt to put aside that
image and focus on your breath?” Whenever they attempt to direct their mindful
attention to specific internal phenomenon of their choosing, your clients are doing
the work of this chapter.
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Distressing events cause all kinds of changes in the five building blocks that
comprise our experience of the present moment. These changes include: negative
thoughts that provoke shame, hopelessness, self-judgement, or other forms of
discontent; Emotions such as fear, disappointment, anger, or sadness; Sensory, or
perceptual, cues such as distressing images seen in the mind’s eye; Movements such
as turning away, lowering the head, or an impulse to run or leave; Sensations such
as numbness, heaviness, shaking, or tightness. If upsetting experiences are enduring
or repeated throughout childhood, these internal reactions might become so
common that they feel normal or “just the way I am.” Such familiar, habitual
reactions tend to go unquestioned—even when they become the source of our
distress or limit our ability to function fully in our lives. In the last chapter, we
focused on becoming mindful of the five building blocks of present experience as
they emerge moment by moment, and then we learned how to name and describe
them. In this chapter, the emphasis is on how to consciously direct mindful attention
to specific building blocks. By doing so, we create new experiences with the
intention of capitalizing on the brain’s capacity for change and shifting trauma and
attachment-related patterns of response.
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Rather than focusing on building blocks connected to old, disruptive patterns, we
can direct mindful awareness to those building blocks that help us feel calmer or
more energized, centered, or able to act instead of react. For example, if we feel
anxious, rather than asking ourselves, “What am I noticing right now?” (nondirected
mindfulness), we might ask ourselves, “As I feel this anxiety, what happens if I
bring my full attention just to the feeling of my feet on the ground?” Or “What
happens if I focus on an image of my wife’s smile instead of the butterflies in my
stomach?” When you want to create a different, new internal experience, directed
mindfulness can help you deliberately shift your attention to building blocks that are
resourcing for you and change your experience.
Directed mindfulness can also be used to focus on certain emotions, thoughts,
images, or body experiences that might be unpleasant or triggering when you want
to discover more about them. For example, if your habit is to try to relax tension,
you might direct your mindfulness in this way: “Instead of trying to relax the tension
in my shoulders, what happens when I focus on the tension? What can I learn about
it? What images, thoughts or emotions are connected with it?” In this way, the usual
pattern of trying to relax the tension is interrupted, and mindfulness is directed so as
to discover new associations with the tension. By doing so, you can learn more
about the tension, what causes it, and what it needs, rather than just trying to make it
go away.
When we decide to interrupt what we habitually pay attention to internally by
directing mindful awareness to the building blocks we usually do not pay attention
to, we interrupt old patterns and create a new experience. By doing so, we hope to
actually support our brains to change, as they did during our formative years of
early development when nearly everything was a new experience. This chapter
introduces you to some simple practices of directed mindfulness that are designed
to help you take advantage of your brain’s capacity for neuroplasticity.
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building block to help us feel better or at least feel something new.
It is important to recognize that trying to resolve our difficulties solely by
thinking about them is limited because our ability to think up a new solution is
constrained by our habits of thinking and by the beliefs we have formed. In
addition, talking about distressing things can sometimes cause us to feel more
detached or more unsettled, interfering with our ability to think clearly. But, mindful
concentration is associated with increased activity in areas of the neocortex, a part
of the brain that helps us think clearly. Mindful concentration is also associated
with decreased activity in parts of the brain that register upset or distressed states
and reactivity to triggers. Directing mindfulness not only helps us to develop new
patterns of response in our brains and bodies, but in and of itself can help settle
upsetting feelings.
Annie had survived years of severe abuse as a child. She often felt dysregulated
by everyday occurrences in her current safe environment. If she unexpectedly met a
neighbor on the street, she would immediately freeze, her body would begin to
shake, she would feel a wave of flushing that turned her face bright red. She would
momentarily lose the capacity to speak and her body would “go completely numb.”
These types of experiences felt humiliating to her and caused her to withdraw from
friends and neighbors for periods of time.
In therapy, she and her therapist repeatedly worked on developing her ability to
use directed mindfulness when triggered. Annie brought to mind the image of the
neighbor whom she met on the street to evoke her troubling reactions in therapy so
that she could be mindful of them. Mindfulness helped Annie pause and observe,
rather than react to, the shaking and flushing, and the pause itself helped her to calm
down. Then she could begin to focus on the building blocks of her reaction,
deliberately choosing to notice and name her negative thoughts as thoughts but not
to dwell on them. She began to consider where to direct her mindful attention. She
realized she could choose to focus on the sensations and impulses that were so
familiar to her to learn more about them, or she could focus exclusively on the
image of her neighbor’s kind eyes and notice how her building blocks were
affected. Sometimes she decided to focus on an area of her body that was not
activated, such as her back. Each time she directed mindfulness to a specific
building block, she created a different inner experience. Annie felt empowered
when she realized she was not at the mercy of her reaction, but could choose where
to focus her attention.
To review: the first step in promoting neuroplastic change is to mindfully notice
the building blocks comprising our familiar reaction. This noticing naturally puts
the brakes on the reaction. We can then direct mindful attention to other building
blocks that we would typically ignore. If the new focus does not yield a more
settled or pleasurable feeling, we can experiment with different focal points until
there is a desired shift in experience. The final step is to be mindful of how that
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new experience changes our building blocks.
The brain changes slowly, in increments. The same circuits have to fire over
and over again to create a reliable new neural pathway that will lead to a different
reaction. Rather than trying to suppress her distressing reactions, as she had done
for many years, Annie learned to pause, direct her attention to the building blocks
comprising her reactions, and then consciously choose where to focus next. The
moment of pause was critical for Annie, because in that moment of pause, she
regained her ability to choose. Instead of letting herself be driven by her internal
reactions or putting all her energy into suppressing them, pausing to notice them
helped her experience a sense of choice. She could then experiment with new
possibilities. She practiced directing her mindful attention to something new and
more regulating, focusing on the change in her building blocks that was created by
the new experience. Repeating this process over and over gradually decreased her
dysregulated reaction and brought her arousal into a window of tolerance.
Though Mark had not suffered severe trauma as Annie had, he learned as a
child that keeping his thoughts and opinions to himself gained his parents’ approval.
In his current life, he still found himself unable to speak his mind when
opportunities to do so arose. He often became quiet with his friends and did not
spontaneously engage in conversation even when he wanted to. Through using
mindfulness to learn about what was happening inside him when he felt an impulse
to speak but was quiet instead, he noticed that his body tightened, and he felt
inadequate the way he had as a child.
When he was with his friends, Mark experimented with inhibiting the tension
and concentrating on keeping his body relaxed. He tried a new movement of
voluntarily leaning slightly forward instead of pulling back and noticed that, when
he did so, his breathing deepened. As he directed mindfulness to the sensation and
movement of his breath, Mark noticed that the feelings of inadequacy lessened.
Next, he decided to orient toward his friends, their smiles, friendly faces, and the
sound of their voices and notice the change in his building blocks. This further
diminished his feeling of inadequacy. He noticed more relaxation, a feeling of well-
being, and the thought came to his mind, “They accept me.” As Mark repeated these
steps over and over—pausing, noticing his building blocks, then inhibiting his
automatic response of tightening, relaxing his body, and finally directing his
attention to something new—his old pattern of keeping his thoughts to himself began
to change. He began to enjoy his time with his friends more and more. Gradually he
became more participatory and vocal, lessening the impact of his past conditioning
on his present relationships.
Current experiences that remind us of the past activate parts of the brain and
body that drive actions suited for these past experiences. But new experiences alter
these old neural pathways and activate new ones. We can support the remarkable
ability of the brain to reorganize itself by consciously inhibiting old habits and
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redirecting mindful attention to something new. When we notice the building blocks
that contribute to our habitual reactions, and then selectively attend to those we
would not normally pay attention to, we are taking advantage of our brain’s
capacity for neuroplastic change. The worksheets that follow will help you
recognize when patterns of thoughts and movements are keeping you stuck in the
past, and how to use directed mindfulness to create a different experience and lay
down new pathways in your brain.
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1. Describe a pattern you would like to change (e.g.,I feel stupid when I’m in a
class or trying to learn new things).
3. How can you direct your mindfulness to create a new experience for yourself?
(e.g., When I feel stupid in class, I can name my negative thoughts as just
thoughts, not facts, and my emotions as emotions,and focus my attention only
on what I see and hear right now.)
4. What building blocks can you direct your mindfulness towards to create a new
experience for yourself?
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Emotions (e.g., I can remember times when I felt proud and
competent.)
Sensations (e.g., I can focus on the sensations of my breathing.)
Movements (e.g., I can lift my chin and take a deep breath.)
Thoughts (e.g., I can say to myself, “I can learn new things. I’m not
stupid.”)
5. Choose one way to direct your mindfulness from #s 3 and 4 that you found
effective in creating a new experience. Practice directing your mindfulness in that
way many times and describe your experience.
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2. Now think of three things that have gone well in your life (e.g., personal
connections, the ways you enjoy yourself, the things you do well, and whatever you
are grateful for). Describe how your body feels when you think these things.
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well.)
1.
2.
3.
3. Describe one thing you learned from this exercise that you can practice often
with the intention to build new patterns of brain circuitry that contribute to your
well being. (e.g., I will remember to stand up straight and think about how much
my partner cares about me when I find myself ruminating about when I botched
that job interview.)
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3. Decide to direct your mindfulness toward a building block that could change
your experience in a positive way (e.g., your feet on the ground, a good sensation in
your body, take a deep breath, sit up straight and tall, an image of someone you
love, remember a song you enjoy or the sound of your kids happily playing). Write
down what you decide to focus on.
The building block I will focus on is: ______________________________
4. Spend a few minutes directing your mindful attention to this building block and
not on the problem. Below, describe what happens in your thoughts, emotions, and
body sensations/movements.
5. Now think about your problem again, but also direct your mindfulness on the
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building block that changed your experience. For example, if you lengthened your
spine, keep your spine lengthened while you are thinking of your problem. Describe
your experience below.
6. How can you incorporate the directed mindfulness you practiced on this
worksheet in your daily life?
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a particular level of information processing. For example, for clients who have
trouble thinking clearly, understanding that the neocortex might be shutting down in
response to triggers will help them make sense of this difficulty rather than judging
themselves as incompetent or “stupid.” Clients who try unsuccessfully to use top-
down management skills to regulate their emotions or physical responses—such as
trying to convince themselves they are not in danger or should not feel the way they
do—will find an explanation of why such self-talk may be ineffective. Clients who
are emotionally disconnected, reactive, or flooded by their emotions will better
understand how their reptilian and mammalian brains contribute to their emotional
patterns. Learning how distressing reminders activate the amygdala and stimulate
volatile emotions may be a first step toward managing them. Impulsive clients can
be helped to decrease shame and put their impulsivity into better perspective if they
understand that bottom-up “hijacking” by the subcortical brains (Goleman, 1995)
results in the loss of neocortical monitoring. Understanding why their hearts race,
why they experience urgent impulses to take action, or why they have undesired
emotional reactions to certain dynamics of close relationships may help clients to
understand these as related to brain activity without judging themselves, and
without having to act on them. Clients who report being “in their heads,”
“analytical,” “too emotional,” or “not able to feel” might benefit from
understanding that their neurocortex, or thinking brain, is overriding their emotional
brain.
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viability of sensation and movement of the body as targets for therapeutic
intervention.
Understanding how one “brain” may become dominant and interfere with or
override the others can help make sense of difficulties that our clients experience.
Some clients will benefit from learning that activation in the subcortical brains in
response to perceived threat tends to automatically decrease neocortical activity
and increase bottom-up reactions (LeDoux, 2003). As a result, it can be difficult to
think clearly, distinguish cause and effect, process what happened, make plans, or
realistically anticipate the future.
It might be useful to build the concept of information processing into your
instructions to your clients for reading the chapter. For clients who become easily
dysregulated, you might suggest that they explore reading the chapter with their
thinking brain, rather than focusing on any emotional or body reactions. For clients
who are not at risk of becoming dysregulated, you might suggest they be curious
about their building blocks as they read the chapter. They might notice how they are
reacting to the chapter’s contents physically, emotionally, and cognitively, and
perhaps write down their reactions to share with you at their next session.
In clinical practice, it is useful to examine each level of information processing
separately and also observe the interweaving of cognitions, beliefs, emotions,
images, and bodily responses. Typically, as you and your client deconstruct a
difficult experience, you will find that a reminder of the past prompts a sensation or
movement (e.g., an elevated heart rate, or tension and clenched jaw), which is
followed by a thought (“Something’s wrong—something’s not safe” or “I’ll never
be good enough”), which leads to an emotion (fear, helplessness, irritation,
sadness, anger) and a snowballing of similar thoughts, body responses, and
emotions. Throughout therapy, you can refer back to this chapter as clients report
and experience how they think, feel, and act to help them differentiate the impact of
the different types of information processing, and the functioning of each “brain,”
on their experience.
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interact and reinforce or contradict each other in how they process information.
Clients also have the opportunity to notice patterns of dominance—whether they
tend toward emotional, cognitive, or physical reactions. Awareness of how
information processing occurs will help clients to understand how bottom-up
therapy works. HIJACKING OF YOUR NEOCORTEX explores how the triggering
of subcortical reactions can interfere with cortical functioning and cause a variety
of symptoms. This knowledge, in and of itself, can be stabilizing. Clients typically
feel less confused by their symptoms and often stop blaming themselves as they
reframe them as a function of the brain, and also as they consider that hijacking
might serve a useful purpose.
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functioning so you can’t think clearly. It isn’t that you’re ‘stupid.’ ” You can also
help clients notice the effects of being triggered on their building blocks. Since
focused attention activates the prefrontal cortex, directed mindfulness itself can
help clients manage reactivity of dissociative parts better by consciously engaging
this part of the brain.
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Our brains are wondrous, awe-inspiring organs that weigh only a little over 3
pounds but contain about 100 billion nerve cells, or neurons, that can transmit
signals at a speed of over 200 miles per hour. Capable of processing a colossal
amount of information in a split second, the human brain is so complex and
mysterious that even neuroscientists are far from fully understanding it. In this
chapter, a simple model of the brain called the triune brain is described, which can
help clarify how the brain might change after adverse experience. Triune means,
literally, “three in one.” The triune brain model describes three areas within the
brain that are designed to function as a cohesive whole, yet each one has a
particular way of understanding and processing information.
The reptilian brain, the oldest of the three, operates on instinct and is
responsible for the survival-related functions of the body. The mammalian brain, so
called because it emerged with the first mammals, is concerned with our emotional
and relational experience. Last to develop in evolution, the neocortex is sometimes
called the “thinking” brain because it is responsible for our reasoning, self-
awareness, and abstraction abilities. Figure 9.1 illustrates these three brains.
Each of these three brains contributes its own unique understanding of the
world and guides our actions according to that understanding. They each process
information in their own particular way to make sense of things, which roughly
corresponds with the building blocks. The neocortex correlates with cognitive
processing and the building block of cognition. Emotions are the purview of the
mammalian brain and emotional processing. And the reptilian brain corresponds
with sensorimotor processing, which includes the building blocks of movement,
five-sense perception, and sensation. See the following table for an illustration of
the correlations between building blocks, type of information processing
association, and each of the three “brains.”
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FIGURE 9.1
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called the cerebral cortex, frontal cortex, or neomammalian brain) is divided into
the left and right hemispheres, both of which are involved in nearly all our
activities. The more intuitive right hemisphere, fully “online” at birth, sees the
world in a holistic, “big picture” way and is more creative and artistic. It processes
information implicitly and symbolically in a nonlinear, intuitive manner. The more
rational left hemisphere, undeveloped at birth, sees the world in an increasingly
rational way as it matures over the course of childhood and young adulthood. It
processes information in a logical, explicit, analytical, and linear manner and is the
seat of most of our language abilities. The corpus callosum bridges the right and
left hemispheres to facilitate their communication, coordination, and consolidation
of information.
Babies are born with nearly all of their brain cells, but these cells have not
formed the connections necessary for complex thinking or for regulating the
emotions and physiological arousal of the subcortical brains. As the neocortex
develops throughout childhood, children acquire a greater capacity to control their
behavior, reason things out, use their imaginations, and self-soothe because
connections are made from the neocortex to the subcortical brains. The neocortex
keeps maturing into our 20s, enabling us to develop greater social judgment,
regulation of our emotions, and self-awareness to become more stable and skilled
socially, emotionally, and intellectually.
Cognition and cognitive processing—the abilities afforded by executive
functioning skills such as reasoning, abstraction, planning, and problem solving—
correlate with the functions of the neocortex. Operating both intuitively and
logically, these higher cortical areas enable us to collect data, analyze it, develop
insights and theories, and make meaning that guide future decision-making. This
“top-down” processing, which includes planning and drawing on both the left
(logical) and right (intuitive) hemispheres of the neocortex, governs many of our
adult activities. We might consider how we want to spend our time, make plans,
and structure our day to accomplish certain tasks. We can override emotions, such
as frustration, and body sensations of hunger or fatigue or even physical pain, to
continue with what we have planned, following the lead of the neocortex. With this
top-down control, we might be aware of our emotions and bodily experiences, but
we may not allow them to determine our actions. Most of us have had experiences
of using top-down control to study late into the night to pass an exam, overriding
fatigue, hunger, boredom, and impulses to do something else.
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dimension to our experience by letting us know of our likes and dislikes, identifying
what is emotionally significant to us, and adding emotional richness in our lives
and relationships.
Different components or structures of this part of the brain enable us to
subjectively experience our emotions, form attachment to others, feel drawn toward
or away from things, and hold emotional memories of our experiences. The
thalamus receives information from our senses. When that information includes
threat or danger cues, the amygdala signals us to protect and defend ourselves. The
amygdala also alerts us to stimuli associated with reward and good feelings, along
with those related to fear. Our mammalian brain influences our perception of
sensations of pain and pleasure and gives us emotionally based signals so that we
orient toward and respond to meaningful stimuli. The hippocampus remembers
important information and consolidates it into long term memory.
The mammalian brain is essential to our relationships because it generates
feelings that make us aware of the effect of our actions on others and the impact of
their actions on us. In infants, this brain fosters social engagement and attachment
behavior with the people who take care of them (usually the parents) and to whom
they have an emotional bond, their “attachment figures.” The sight of the attachment
figure’s face activates amygdala-driven pleasure and excitement, causing the baby
to smile, coo, wiggle, make eye contact, and begin to mimic sounds, expressions,
and movements of the parents. The mammalian brain will prompt the infant to
initiate these action sequences again and again. These experiences of shared
pleasure are also encoded as nonverbal memories of attachment experiences, laying
down templates for expectations of future relationship.
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as competition, aggression, domination, or a compulsion to hoard resources.
Because the reptilian brain governs basic instinctive actions, it acts very quickly,
much more quickly than the neocortex. If a snowball is thrown toward your head,
you don’t have to think about what to do because your reptilian brain makes you
duck instinctively.
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occurs, we may notice that it’s harder to think clearly, plan, or analyze. Our
neocortext is highly sensitive to stress, and when we are chronically stressed or
anxious, even if not in immediate danger, we will not be able to learn new things
easily. Temporary stress is thought to help us develop resilience, but when children
are chronically stressed from feeling pressure to “do it right” or please attachment
figures, they are not able to learn well because there is less activation in the
neocortext and more in the subcortical brain. Excessive stress can disrupt the
development of the brain.
Over time, engrained habits of response to threat from our subcortical brains
(reptilian and mammalian), such as rapid heart rate, shortness of breath, anxiety,
fear, rage, or other strong emotions, might be interpreted by our neocortex as
indicating that we are not safe in the here and now, even when we are. Or, the three
brains may understand things differently, leaving us confused. As one client
reported, her thoughts, feelings, and body responses did not go together: “I know
my husband loves me, but my heart starts racing when he talks to other women. I
feel angry, but there is nothing to be angry at. He is totally committed to me.” Her
neocortex understood things a certain way, but her reptilian and mammalian brains
assessed things differently.
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Rather than try to talk herself out of her feelings and bodily responses, she began to
consider what was going on in her mammalian and reptilian brains.
First she noticed the feeling of fear and said to herself, “That is my emotional
brain feeling afraid. It does not actually mean that I am in danger right now. It’s not
a fact, it’s just a feeling. I’m with my friends, and they are not dangerous.” Mary
identified the sensations of her increased heart rate and tense muscles as signs of
her reptilian brain preparing her for action. She then paid attention to her shallow
breathing and noticed that her chest was constricted and hunched, so she decided to
relax her muscles and take some deep breaths. By harnessing her ability for top-
down awareness, she was able to identify her emotional and physical reactions and
then choose to intervene on a physical level.
Mary had become curious about how her three brains understood her world,
reflected in her experience of her building blocks, instead of allowing this bottom-
up hijacking to ruin the party. Identifying her fear as her mammalian brain alerting
her to possible danger lowered her heart rate, and changing what was going on
physically by relaxing and breathing deeply helped her fear quiet down. After her
body and emotions had calmed down, and her three brains were working in sync
again, she suddenly realized that one of the men at the party was wearing cologne
similar to that of her father, who had been extremely critical of her and showed
little confidence in her abilities. The smell had triggered her survival responses
and feelings of fear and incompetence. With this understanding, Mary could
appreciate that her reptilian and mammalian brains were doing their best to protect
her from being criticized again and that they had not yet understood that cologne did
not indicate impending threat of devastating criticism in her current life. She was
able to enjoy the rest of the party and give her toast with aplomb.
Top-down and bottom-up processing represent two directions of information
processing, and we can use both to help all three of our brains respond to current
reality, interrupting the habits from the past. Mary first used her top-down ability to
try to control her lower brain responses by telling herself she was safe. When that
was not effective, she used her top-down ability to mindfully observe the building
blocks correlated with the subcortical brains, and she tried to understand the
information from each of them (mammalian and reptilian). She also used bottom-up
interventions of relaxing and taking a deep breath to interrupt her tendency to
tighten her chest and hold her breath, and that quieted her fear.
The worksheets that follow will help you speculate about how each of your
three brains processes information. By mindfully becoming aware of your building
blocks, you can explore which level of processing—cognitive, emotional, or
sensorimotor—will most successfully support your well-being at any given
moment. Using top-down approaches of thinking and mindfulness, as well as
bottom-up interventions of interrupting your physical reactions, can be especially
helpful when the three brains are not working in sync or when your brains are
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responding as if what happened in the past is still occurring in the present.
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What are your thoughts How do you remember How does your body
about each experience? each experience remember each
emotionally? experience?
Neocortex Mammalian Brain Reptilain Brain
Positive Experiences Positive Experiences Positive Experiences
Negative Experiences Negative Experiences Negative Experiences
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3. How do each of these thoughts affect your body [reptilian brain]?
(e.g., When I think, “I have good friends,” hold my head up, I look around at my
surroundings, and I feel warmth and relaxation in my chest. When I think, “I am
too busy,” my shoulders tighten, and I don’t breathe as deeply. When I think, “I
always screw up,” my chest deflates, my head comes down, and the energy drains
out of my body.)
a.
b.
c.
4. Assess whether each of these thoughts affects your quality of life in a positive or
negative way. What steps might you take to address negative effects? (e.g., When I
have the thought, “I’m too busy,” I will assess my activities and see which ones I
can decrease or omit. When I think, “I always screw up,” I will notice when I
have that thought and will change how it affects my body [e.g., take deep
breathes and sit tall] and talk to my therapist about how to address this thought.)
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a.
b.
c.
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a.
b.
c.
3. How do each of these these emotions make your body feel [reptilian brain]?
(e.g., When I feel panic, my jaw tenses and my stomach pulls in, my eyes get
wide, and I feel like I can’t breathe. When I feel playful, my body feels light, I
smile a lot, and I feel energized.)
a.
b.
c.
4. Assess whether or not the reactions of your neocortex and reptilian brain to your
emotions is beneficial to your wellbeing. What steps might you take to address
responses to emotions that you experience negatively?
(e.g., When I feel panic, I can practice changing my body response by taking
deeper breaths and trying to relax my jaw and muscles. I can talk to my therapist
about ways to reengage my neocortex to help regulate the panic.)
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a.
b.
c.
2. How do each of these these body patterns affect your emotions [mammalian
brain]?
(e.g., When I have tension in my shoulders, I get irritated easily. When my heart
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beats rapidly, I feel anxious and scared.)
a.
b.
c.
a.
b.
c.
4. Assess whether each of these body patterns affects your quality of life in a
positive or negative way. What steps might you take to address negative effects?
(e.g., When I get tension in my shoulders, I can practice breathing deeply and
relaxing my muscles. I can find something relaxing to do, like take a bath or go
for a walk. I can think about all the times in my life that others have been on my
side and supported me.)
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3. Why do you think the hijacking happened? Were you reminded of something
from your past? Were you overly tired or stressed? Did you feel misunderstood,
criticized, or rejected?
4. Did the hijacking help you in any way? Did it keep you safe or mobilize you to
take action, for example? Or did it affect the behavior of people around you in a
way that benefited you?
5. How did (or could) such hijacking hinder you? Did it make you feel bad about
yourself, for example? Or did it adversely affect a relationship or cause others to
think you were overreacting or being unreasonable?
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pulled toward past events and future difficulties, learning to notice and describe
their body sensations as they occur moment by moment can help them stay in the
here and now. Those who feel disconnected from themselves, confused by their
reactions, or out of touch with their needs or desires will benefit from awareness of
their sensations. Clients who are overly concerned with their body image (rather
than how their bodies feel) can be helped by tuning in to the experience of their
sensations, instead of their perceptions about how their body looks.
Clients who are adept at attuning to interoceptive cues can benefit quite quickly
from this chapter because they will already be familiar with, and able to learn
from, their sensations. And for those who describe a positive experience,
deepening their physically felt sense of this experience and tuning in to the
interactive relationship between the building blocks of sensation, emotion, and
thoughts can enhance their pleasure.
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who feel frightened can be encouraged to notice the fear as a sensation rather than
as an emotion, as “just your heart beating really fast,” or as “tension in your arms.”
The ability to sense the physical feeling of the body and to differentiate
thoughts, feelings, and body sensations is often a way out of self-defeating feedback
loops. Clients often perceive emotions and beliefs as “truths.” Building on Chapter
7’s worksheet, NAMING THOUGHTS & EMOTIONS, describing a negative
belief or emotion as a “thought” or “emotion” evoked by body sensations in the
present moment can help clients realize that beliefs and emotions are often their
experience rather than “facts” or “truth.”
When clients discuss positive experiences, such as “I’m having a great day,”
they can learn to describe the sensation that contributes to the positive feeling. For
example, one client reported, “When I remember that wonderful trip to the zoo with
my granddaughter I feel ready to smile and an open feeling in my chest. I get warm
all over.” Helping your clients elaborate on the sensation of their positive
experiences in this way teaches them tools to enhance their pleasure.
Your willingness to model curiosity and interest in sensation, to use the
language of sensation described in the chapter during therapy, even to name your
own sensations or those that commonly occur when we are happy, afraid, sad, or
angry is essential. Slow pacing and use of a sensation vocabulary that works for
each individual client will facilitate successful mastery of this skill.
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select words that describe them from the list of sensations already named on the
worksheet. VOCABULARY FOR EMOTION not only teaches clients to put
language to their emotions but also aids them in distinguishing between an emotion,
a body sensation, and a belief. The VOCABULARY FOR BELIEFS & MEANING
worksheet further develops awareness of the interactive relationship among
thoughts, emotions, and sensations, and can demonstrate how beliefs can feel true
because of their impact on the body. BELIEFS, EMOTIONS, AND THE BODY
elaborates on this idea by teaching clients to notice how changes in body movement
can literally change their thoughts, emotions, and sensations.
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with different body sensations that correlate with that part’s emotions and beliefs.
Helping clients track these somatic indicators of parts will eventually help them
with the important task of increasing internal cooperation and coherence. In
addition, some parts of the client may be better able to tolerate sensations, in which
case that part can be encouraged to share this ability with other parts of the client,
so that safety can become better associated with particular sensations. This inner
cooperation can gradually overcome systemic avoidance of sensation.
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or you may be uncomfortable, anxious, or even scared about it. As we have learned
in earlier chapters, many of us disconnect from our bodies because its sensations
are uncomfortable. Hyperarousal can cause intense and overwhelming sensations,
and hypoarousal can cause disconcertingly numb sensations. We may disengage
from sensation to dull painful emotions so that we can tolerate them more easily. If
you have habits of disconnecting from your body, remember that doing so was
originally an adaptive measure that helped you cope.
Becoming aware of body sensations opens up a whole new avenue of discovery
for us, enriching our internal experience and sense of vitality. However, it can
initially trigger emotions that feel out of control, especially after trauma. Your
sensations may make you feel terrified, rageful, panicky, frustrated, inadequate,
weak, or helpless. If this is true for you, your therapist can help you put aside these
dysregulating emotions to gently reconnect with your sensation, to take all the time
you need to tune in to physical feelings in a way that is regulating for you. It may
feel easier to sense a particular part of the body, such as head, feet, or hands, than
to try to sense your entire body. You may find that descriptive concrete words such
as “tightening,” or “sinking,” or “shaky,” are not as triggering as the more general
word “body.” Developing your own vocabulary to describe your physical
sensations as different from your emotions or thoughts can be helpful. On the other
hand, you and your therapist may decide to use your sensations to connect with and
integrate emotions you have avoided. In any case , it is important to acknowledge,
rather than override, any anxiety or discomfort you may experience and remain
curious about ways to increase your comfort level, determining with your therapist
the best way to proceed.
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she could remember, Alexis had “lived in [her] head.” Always moving at a fast
pace, she was concerned about her habit of pushing herself beyond her limits, often
depriving herself of sleep. Her headaches had become worse, and she had a mild
eating disorder. Alexis felt that if only she could connect to her body, these
problems would be resolved.
As she spoke, Alexis leaned forward in her chair, her arms resting on her knees.
Her therapist asked her if she could sense the sensation of contact between her arms
and knees. “Not really,” she said, “I don’t know what you mean.” Her therapist
asked Alexis to lift her arms and then rest them again on her knees, feeling the
different sensations in her arms and knees in each of these positions. “Just notice
the difference in your body sensations when your arms are resting on your knees
and when you lift them off,” her therapist said. “Can you feel the sensation of your
arms and knees touching, and how that sensation changes when they are not in
contact?” Alexis explored this movement several times. Her eyes lit up. “It does
feel different,” she finally said, surprised.
Alexis’s curiosity about body sensation was aroused. She then reported that her
neck and shoulders were often in pain, and she wondered if it had to do with her
poor posture. Her therapist asked her to simply notice the pain, suggesting that
perhaps she could find words to describe the sensation. “There’s a sharp sensation
at the base of my neck, and it moves into my right shoulder,” she said. “I can feel
the beginning of a headache, a dull numb feeling on the right side of my head. It
feels thick.” With her therapist’s help, Alexis experimented with changing her
posture by slowly and gently straightening her spine a little. Alexis felt how the
sensation changed. “The pain gets less, and instead, there’s an odd sensation in my
neck, kind of a tingling, and it moves down my arm. My chest gets warm.” After
these beginning explorations of body sensation, Alexis said, “Maybe I really am
connected to my body. I always thought I was out of my body, but maybe I just
didn’t know how to feel it.”
Take a moment right now to lean forward and rest your elbows on your knees
and tune in to the sensation, like Alexis did. You might experiment with this simple
movement a few times, just feeling the sensations of your arms and knees touching
and how the sensation changes when they are not touching. Can you feel the
different sensations in your back, knees and arms as you do this? What do you
notice? Is there a word or two from Table 10.1, or another word that describes the
sensations you feel? Then try scanning your body, starting with the top of your head,
and direct your mindful awareness slowly down through your face, neck, shoulders,
chest, arms, hands, belly, hips, thighs, calves, and feet. Can you find three or four
words from Table 10.1 that describe what you feel in different places in your body
right now?
TABLE 10.1. Vocabulary for Sensation
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Distinguishing Sensation, Emotion, and Cognition
Often we confuse sensation and emotion. When we try to describe sensations, we
may use words that describe emotions, such as sad or angry, rather than words such
as numb or heavy that describe physical feelings. Developing a vocabulary for
emotions will help you not only expand your perception of emotions but also
differentiate words that describe emotions from those that describe sensations. You
can see that the emotion vocabulary in Table 10.2 is very different from the
sensation vocabulary in Table 10.1.
Take a few minutes right now to become mindful of how you are feeling
emotionally. What words in Table 10.2 describe your emotions? Notice the body
sensations that correlate with your emotion. For example, if you feel calm, you
might feel a sensation of heaviness in your lower torso and a relaxation in your
shoulders. If you feel anxious, you might feel tension in your stomach or pressure
behind your eyes. See if you can find a few words that describe the sensations that
correlate with an emotion you are feeling.
TABLE 10.2. Vocabulary for Emotion
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Just as words for sensations are often confused with those for emotions, words
for sensations can be confused with those for meanings, interpretations, and beliefs.
When asked about body sensations, some people answer “I feel like I’m no good,”
or “I feel it’s all my fault,” or “I’m OK right now.” These words convey meanings
and beliefs, but not body sensations. The language of meaning and belief is very
different from both sensation vocabulary and emotion vocabulary. As you read the
entries in Table 10.3 that describes beliefs, which ones apply to you? Can you think
of words for the emotions and sensations that accompany the belief?
TABLE 10.3. Vocabulary for Meaning and Belief
Positive Beliefs about Self Negative Beliefs about Self
I am okay the way I am. I’m not good enough the way I am.
I’m a decent person. I deserve the bad things that happened to
It’s OK to accept help. me.
I don’t have to be perfect. It’s all my fault.
I have the right to set boundaries. My feelings aren’t okay.
I don’t belong here.
Positive Beliefs about Others Negative Beliefs about Others
I can usually count on others. I’ll be hurt if I depend on others.
My boundaries are usually respected. Other people are just out for themselves.
Most people are decent human beings. People will leave me when I need them.
I can basically trust others to treat me well. No one will ever understand me.
Conflict between people is normal and can Relationships are never safe or stable.
be resolved.
Positive Beliefs about the World Negative Beliefs about the World
There is pain, but also a lot of joy in the The world is a dangerous place.
world. There is no hope for the future.
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There is a place for me here. There is no justice in the world.
Scary things happen, but the world is usually Everything always works against me.
safe. There is nothing that the world can offer me.
I can look forward to the future.
There are resources to help me cope with
hardship.
Beth interpreted the sensation of arousal (rapid heart rate, tension, and a buzzy
feeling) as meaning “The world is never safe.” She had experienced those same
sensations as a child when her parents fought. Whenever she had these sensations,
she felt frightened. Her therapist helped her to direct mindful attention exclusively
toward the sensations, away from the old belief and fear. As she put aside her fear
and belief and only paid attention to sensation, Beth became more curious and less
frightened about what was going on in her body. She became aware of tension in
her chest, trembling in the core of her body, a fast heartbeat, and an overall feeling
of high energy throughout her body. She learned that the sensations themselves felt
more neutral when she used sensation vocabulary to describe them and
differentiated sensations from emotions and beliefs.
Directing mindful attention exclusively toward body sensations and using
sensation vocabulary to name the sensations are particularly helpful when arousal
is dysregulated, or emotions and beliefs take us out of the present moment. If body
sensations like Beth’s are interpreted as an emotion, like panic, each begins to
compound the other. Both the sensations and panic are exacerbated when
experienced simultaneously. When we use emotion vocabulary and say, “I’m
afraid,” we trigger more panic. If, on top of that, the sensations and emotions are
then interpreted as a fact or belief, such as, “The world is not safe,” the tension,
pounding heart, and panic are all likely to intensify.
Beth found her autonomic arousal escalating beyond her window of tolerance
when she experienced all three—the panic, the sensations, and the thought/belief
that “The world is not safe”—at the same time. But when she directed her mindful
attention to just her physical experience and used sensation language to describe it
(“My body just tensed, and I can feel trembling in my spine, and my heart is
pounding”), she recognized that her sensations were only sensations and did not
mean that she was actually in danger, and she began to feel calmer. By
differentiating her body sensation from the emotion and belief, the escalation of
Beth’s arousal was interrupted. As she became mindfully aware of her heart
pounding, tension, and trembling, and realized that “they are just sensations,” the
sensations themselves spontaneously began to change. She became more relaxed,
could breathe more deeply, and the shaking diminished. And, as her body settled
down, so did her emotions and thoughts. She no longer felt panicky. Her bodily
experience no longer supported the belief that the world was not safe.
Beth also sometimes experienced hypoaroused states in which her body felt
numb, with no sensation at all. She felt spaced out and not present. Her therapist
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helped her learn to start moving her arms at those times. This movement helped her
to feel her sensation and bring her arousal up into a window of tolerance. She
described her sensation in this way: “I can feel the general tension in my forearm
and a sharper tight feeling in my shoulder. Most of the sensation is on the top
surface of my arm; I don’t feel much on the lower surface. As my arm gets higher, I
sense a different kind of tight feeling in my shoulder as it starts to engage. If I really
stretch my arm, the sensations increase, and I feel the length of my entire arm. Then,
I take a deep breath, and I feel like I am ‘back.’” Sometimes Beth would use her
hands to squeeze her legs and arms to generate body sensation, which also helped
her to be present.
You can learn to become more aware of your body sensations and develop a
rich language to describe them, as Alexis did. And like Beth, you can also learn to
recognize sensations that herald the beginning of dysregulated arousal or emotions,
rather than numbing out, becoming emotionally reactive, acting impulsively, or
running away from these sensations. The worksheets that accompany this chapter
will help you notice sensations and how they go along with the emotions and
beliefs you experience, discover situations that elicit them, and find words to
describe them. As you explore your sensations over time, your vocabulary to
describe their variety and richness will expand and your confidence in the natural
intelligence of your body will grow.
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1. Circle two words that best describe the pleasant sensations you noticed and
underline two words that best describe the unpleasant sensations you noticed. You
can write in new words that fit your experience more accurately in the empty
spaces.
2. In the first two boxes of the left column, write the words for pleasant sensations.
In the second two boxes of the left column, write the words for unpleasant
sensations. Then, for each sensation, describe, the situation you were in when you
experienced it, and the thoughts, emotions, images, movements, or memories that
seem to go along with the sensation.
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Pleasant Sensation Situation Thoughts, emotions, images/memories, movements
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1. Squeeze up and down one arm with the opposite hand, experimenting with the
pressure, speed, and type of touch. Squeeze firmly, then lightly, quickly, then
slowly, and notice the different sensations.
2. Continue to squeeze up and down the same arm several times.
3. Then pause and feel the contrast between the sensations in the arm that you
squeezed and the arm that you didn’t squeeze. Record the difference in the
sensations of the two arms.
1. Take a moment to become aware of your body. Choose one of your arms and
shoulders to explore.
2. Slowly lift that arm, turning your awareness to the sensations generated by
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your movement. Then explore different ways to use movement to generate the
most sensation in your arm and shoulder, such as stretching your wrist in both
directions, or reaching up as high as you can toward the ceiling.
3. What sensations do you feel in your joints and muscles? Where do you feel
the most sensation? What words describe the quality of sensations that you
feel in different areas—your shoulder, upper arm, forearm, wrist, or hand?
Describe your sensations below.
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2. In the first two boxes of the left column, write in the two words for pleasant
emotions that you circled. In the second two boxes of the left column, write in the
two words for unpleasant emotions that you underlined. Then, for each emotion,
describe, the situation you were in when you experienced it and the thoughts,
images, memories, sensations, or movements that seem to go along with it.
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Emotion Situation Thoughts, images, memories, sensations, or movements
Pleasant
Pleasant
Unpleasant
Unpleasant
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I’m OK the way I am. The world is safe. My feelings are OK.
I can count on others. It’s OK to ask for what I I deserve respect.
need.
I don’t have to perform to be I can do what I want. I have the right to
loved. exist.
There is nothing wrong with My needs can be met. It’s OK to make
me. mistakes.
The future is hopeful. I’m lovable as I am. It’s OK to relax.
I’m a good person.
2. Choose three of the beliefs that you circled, write each in the space below, then
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describe the emotions, sensations, movements and images/memories that go along
with the belief.
Belief/Meaning
• Emotions:
• Sensations/Movements:
• Images/Memories:
Belief/Meaning
• Emotions:
• Sensations/Movements:
• Images/Memories:
Belief/Meaning
• Emotions:
• Sensations/Movements:
• Images/Memories:
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3. Using the VOCABULARY FOR EMOTIONS as a guide, write down the words
that best describe the emotions connected to the belief and related thoughts you
identified.
My Emotions
(e.g., dejected, spiteful,hopeless, sad, angry)
4. Using the VOCABULARY FOR SENSATIONS as a guide, write down the
sensations that best describe what happens in your body as you think about the
belief, associated thoughts, and emotions you identified.
My Body Sensations
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(e.g., constricted, achy,deadened, heavy)
5. Describe any movements your body wants to make when you think about this
belief and the associated thoughts, emotions and sensations.
My Body Movements
(e.g., My body wants to curl up in a ball; my forehead furrows and my
shoulders tense; my head comes down, my spine slumps; my chest and jaw
tighten.)
6. Explore doing the opposite of what your body wants to do (e.g., instead of
curling up, open up and sit tall; instead of furrowing your forehead and tensing
your shoulder, relax them; instead of dropping your head and slumping your
spine, lift your head and straighten your spine; instead of tightening your jaw
and chest, relax them). Notice and describe how this opposite action affects your
sensations, and describe the emotions and beliefs that might go along with this
new movement.
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something” may facilitate an appreciation of impulsive behavior as a response to
faulty neuroception, however self-destructive it might have been. For those who
have been paralyzed by fear, it might be a relief to learn that this can result from
faulty neuroception that elicit animal defenses of hiding, freezing, or becoming
invisible.
Clients whose relational triggers echo unsatisfactory aspects of early
attachment can also benefit from identifying their triggers. If they have criticized
themselves for being overly emotional or reactive, the concept of a faulty
neuroception might help them understand their emotions from a different
perspective. They will learn to recognize the situations and behaviors of people in
their current lives that remind them of the past and cause them to neurocept danger.
Clients will be able to distinguish the bodily signals that indicate that their arousal
is at the edges of, in contrast to outside of, the window of tolerance. Once these
triggers and signs are identified, these clients too will benefit from this chapter’s
instruction to explore alternative responses that bring arousal into the window of
tolerance.
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mechanism governed by subcortical (mammalian and reptilian) areas of the brain,
and asked to speculate what might be happening in all three “brains” when arousal
goes up or down (see Chapter 9, “The Triune Brain and Information Processing).
Since clients may be unable, based on prior conditioning, to consistently detect
whether the environment and you, the therapist, are safe, from time to time you
yourself might become a trigger for your clients. In one moment, clients might feel
safe with you, but then, exposed to an inadvertent trigger (e.g., your tone of voice,
particular words spoken, the way you move, your facial expression), suddenly
neurocept danger. These moments create opportunities for identifying the nonverbal
signals that suggest state changes from regulated arousal (i.e., the neuroception of
safety), as reflected in a calmer body, clearer mind, and emotions within the
window of tolerance, to dysregulated arousal and defensive responses (i.e., the
neuroception of danger and life threat). When you or your client notice these signs
of dysregulation, the skills of present-moment observation, directed mindfulness,
psychoeducation, interactive repair (if you are the trigger), interactive regulation,
and regulating your own nervous system can support clients to again neurocept
some degree of safety with you so that therapeutic engagement can continue.
Clients’ efforts to please you, be a “good client,” or meet the expectations they
perceive that you have of them may be attempts to preserve social engagement with
you and ensure that you will continue to work with them. Safety is assured for
children when they meet parents’ expectations, so they will adjust their behavior to
them; these adjustments may carry over into adult relationships, as well. As stated
in Chapter 1, “Essential Principles,” children have two reactions available to them
in the face of their caregivers’ expectations: either try to meet them and stay “safe,”
or risk criticism, rejection, or withdrawal by not meeting them, which to a child is
experienced as dangerous. For some clients it may be important to address their
attempts to meet your expectations as attempts to stay safe. Exploring neuroception
in this way can help clients examine their behavior and open communication about
the relationship between you.
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clients what stimuli trigger a neuroception of danger or threat. As you and your
clients explore these two worksheets, many will need your input and skillful
questioning to come up with ideas for how to regulate their arousal.
UNDERSTANDING YOUR NEUROCEPTION helps clients understand the
internal components of neuroception by asking them to describe their experience
when they detect safety, danger, and threat, building block by building block. As
you work with this worksheet, it may be helpful to remind clients that it is natural
for neuroception to be biased after trauma or attachment difficulties, but that they
can become aware of such faulty neuroception through mindful noticing of their
building blocks. Returning to previous chapters on orienting to new environmental
stimuli (Chapter 6, “Pay Attention: The Orienting Response”) and on directing
mindful attention to new building blocks (Chapter 8: “Directed Mindfulness and
Neuroplasticity”) can also help clients learn about their change faulty neuroception.
TRACKING YOUR AROUSAL guides clients to become aware of the natural
fluctuations in arousal that occur throughout a particular day, whether tied to
triggers or simply to normal demands in the environment. You can help clients
discover their arousal peaks and valleys so they can predict them in the future and
take steps to regulate as needed. The final worksheet, RECOGNIZING OPTIMAL
AROUSAL, is intended to help clients recognize when their arousal is within the
window; determine the people, situations, or events that promote regulated arousal;
and identify the thoughts, feelings, emotions, body sensations, changes in hearing
and sight, and movements associated with an optimal level of arousal. Hopefully,
once clients have identified “triggers” of optimal arousal, they can call on these
regulating people or situations when they are dysregulated.
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others. Maybe together, we can identify situations in which you might feel calm or
pleasant without so much tension in your muscles, where your breathing feels a bit
deeper and easier.” In this way, you can emphasize the client’s subjective physical
experience that accompanies neuroception of safety without using the words
safe/safety.
For such clients, it may be more helpful to first emphasize mindfully tracking
results of faulty neuroception, the signs of hyper- and hypoarousal, or noticing
which parts have different tendencies. Psychoeducation that trauma sensitizes the
nervous system to detect traumatic reminders and that the faulty neuroception of
parts in response to these reminders is learned as a survival strategy might be
helpful to these clients. You might illustrate this point by tracking the signals of
hyper- and hypoarousal responses associated with a crisis. Generally, a crisis is
most often the result of triggered hyperarousal, stimulating animal defenses of fight
and flight in different parts. Using your ability to track fluctuations in arousal as
signs that different parts are responding to triggers and neurocepting danger, you
will also be able to use your presence, pacing, and tone of voice to help regulate
hypo- and hyperaroused parts. Remembering that dissociative clients need the
information contained in this chapter, even if it takes many months for them to
assimilate it, will hopefully help you feel comfortable repeatedly going over it each
time there is a crisis or a triggered reaction.
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Our autonomic arousal naturally fluctuates between high and low levels throughout
the day. Higher arousal and alertness are needed for invigorating activities, such as
a sporting event, a brainstorming session at work, or a stimulating conversation.
Lower arousal and calm states support relaxing activities, such as listening to soft
music, snuggling in front of the fireplace, or going to sleep at night. We can enjoy
these different high- and low-arousal activities when we feel safe. But when we
feel threatened, our arousal quickly escalates up, sometimes to hyperaroused
levels, to prepare us to flee, fight, freeze, or call for someone to help us. If these
survival defenses are unsuccessful, our arousal may plummet into a state of
hypoarousal in which we shut down and become still and immobile. Along with
trauma, stress related to our attachment figures can cause these survival responses.
We feel unsafe when we feel at risk of being criticized, rejected, or abandoned, and
if we do not have the resources to deal with these stresses, our arousal can become
dysregulated.
Changes in arousal reflect the innate capacity of our nervous systems to
instinctively evaluate whether we are at risk or safe and then help us achieve the
arousal level—high, low, or in-between—that would support adaptive behavior.
The nervous system’s appraisal capacity, called neuroception, occurs
automatically, without awareness, in the primitive areas of the brain. Unlike
perception, which relies on the senses for information, neuroception relies on the
nervous system to recognize genetically programmed behavioral cues from others
that indicate safety, danger, and life threat. This chapter will help you understand
neuroception and variances in arousal levels as adaptive functions of your nervous
system, and guide you to identify your own internal signals of these different
arousal levels. We will also explore how to identify stimuli and triggers leading to
regulated and dysregulated arousal in order to learn how to better regulate the
nervous system.
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perceived stimulus. When we neurocept safety, our arousal fluctuates within a
window of tolerance, a regulated zone within which we can enjoy others and the
world around us because we feel safe. Our innate social engagement system
(controlled by the parasympathetic nervous system) is stimulated when we feel
safe, prompting us to engage in social interaction. Infants are born with this system
intact, but in order for it to develop into a healthy and adaptive system that supports
flexible and stable engagements with others, adequate support from caregivers is
needed. If we experience safe and nurturing caregiving fairly consistently in our
early years, our nervous systems will develop a robust capacity for states of
optimal arousal and social engagement.
Neuroception of danger, instead of safety, can stimulate extremely high or
(hyperarousal), and low (hypoarousal) to promote protective behaviors. We may
neurocept danger when others criticize us, fail to pay attention to us, or are angry
with us. We may defend ourselves in any number of ways in an effort to reestablish
safety. We may withdraw, demand attention, denounce, or try to please the other
person, or justify ourselves and our behavior.
As children we need the acceptance and care of our attachment figures to
survive and we can be frightened when they criticize us for making mistakes, push
us to excel, are disappointed in us, or punish us if we are idle or fail. In these
cases, we neurocept danger because at a primitive level, their disapproval
implicitly threatens our safety. Elevated arousal, or even hyperarousal can be
activated to mobilize us to strive hard to meet their expectations in order to stay
safe, rather than go against their expectations and risk more punishment,
disappointment, rejection, or criticism.
Donnie came to therapy because he was anxious and could not relax. His
hyperarousal was the result of having been pushed by his parents to always try to
do better and to never be complacent or satisfied with his accomplishments. He
mobilized a hyperaroused state not to fight or flee, but to have the energy to meet
their expectations and therefore stay safe and accepted in his family. But, later in
life, his chronic hyperarousal diminished his ability to relax with and enjoy other
people and caused him to misread the behaviors of others as “demanding” or
“intruding” when all they wanted was to interact with him.
Profound loss, such as the death of a parent or a divorce, can also cause a child
to neurocept danger in the absence of an attachment figure. Janice’s father was
killed in a car accident when she was 8, and she subsequently became afraid and
hyperaroused whenever her mother was not with her. Even as a teenager, she felt
anxious when her mother drove away in the car to run an errand. Bonnie’s parents
had survived the Holocaust, both managing to immigrate to the United States, where
they met, after losing their entire families in the death camps. The family
atmosphere was full of anxiety and stress, left over from her parents’ experience of
horror and loss, leaving Bonnie with a continual sense of profound grief and
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impending doom that caused her arousal to remain high.
The neuroception of danger may activate adaptive behaviors to fight, flee, or
cry for help, which all require a lot of arousal and physical actions. In these cases,
our sympathetic nervous system is stimulated, and a mind-body chain reaction is set
in motion. Neurochemicals are released that increase our arousal to fuel the
vigorous activity that might be needed to fight back, flee, or cry for help. Our
respiration accelerates because we need more oxygen. Blood flow to muscles
increases, whereas blood flow to the cortex decreases so that we react instinctively
and swiftly from our mammalian and reptilian brains, instead of spending critical
time thinking about what to do. We experience increased vigilance toward the
environment, and our bodies suppress the physical systems that are not essential for
self-protection. Neuroception of danger sends arousal into hyperarousal to
maximize our chances of survival by mobilizing defensive behaviors that can
restore safety.
If we have suffered inescapable danger such as sexual abuse and other forms of
trauma, fighting back, fleeing, and getting help were all impossible. When we
neurocept that survival is at risk and there is no one to help, no way to escape, no
possibility of success if we were to fight back, the best option is often to shut
down. The hyperarousal that is activated when we neurocept danger will then
plummet to hypoarousal via the activation of a primitive branch of the
parasympathetic nervous system, the dorsal vagal system. This immobilization
defense also called “feigning death” or “playing dead,” causes a decrease in heart
rate and respiration, leaving us feeling collapsed, numb, and often unable to think
clearly. Severe hypoarousal might result in fainting and even vomiting—which
might be why many of us feel nauseous when we think about past trauma from
which we could not escape, fight back, or get help. Figure 11.1 illustrates these
three zones of arousal that correlate with neuroception of safety, danger, and life
threat in relation to the window of tolerance.
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FIGURE 11.1
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occurrences that repeatedly trigger us, we may discover that we are neurocepting
threat over and over—without knowing that we are only triggered and not actually
in danger. When we are triggered, we instinctively “believe” the signals of our
bodies that tell us we are in danger. However, when we are aware that these
sensations and movements are signs of having been triggered, then we have an
opportunity to begin to bring arousal back into the window of tolerance.
Jim did not understand why he became hyperaroused and reactive at work. He
had a good relationship with his boss, and his performance was excellent. But
when his boss used a loud voice when critiquing his performance, Jim neurocepted
danger. He began to anticipate criticism and became hyperaroused at the slightest
indication that his boss might have negative feedback for him. Jim had grown up
with critical parents who frequently raised their voices in anger, and he had worked
very hard as a child to “be a good boy” so that his parents would not become angry
and he could feel safe. With his therapist’s help, Jim identified his trigger—his
boss’s loud voice. He learned to recognize the physical signs of faulty neuroception
of danger that often occurred when he expected his boss to raise his voice in
criticism: tension in his shoulders, shortness of breath, and increase in heart rate.
When he became aware of these signs, Jim could learn to take measured, deep
breaths, sit back in his chair, and relax his shoulders to help him calm himself and
return his arousal to a window of tolerance. As his body calmed down, he was able
to neurocept safety again and could realize his boss was trying to help, not threaten,
him. He could then respond positively to his boss’s critique of his work.
On the other end of the spectrum of arousal, Victoria complained of a lifelong
pattern of being withdrawn, “spaced out,” and unable to sense her body or
emotions. Abused as a preteen, Victoria’s nervous system inaccurately neurocepted
threat on an ongoing basis in her adult life, evoking chronic hypoarousal. She
described herself as “passive,” had difficulty initiating action, and reported
spending long periods of time sitting on her couch “spacing out.” Hypoarousal was
exacerbated whenever Victoria ventured outside her home, and over time she
developed agoraphobia—a fear of open spaces and crowds. She stayed home more
and more, unaware of the triggers that caused her to neurocept threat. With her
therapist’s help, Victoria realized that all men were triggers to her. She learned that
when she ventured outside, she neurocepted threat whenever she saw men walking
along on the sidewalk. Her spine would collapse, her head would turn downward,
and she would feel as if her energy were draining out of her body.
In therapy, she practiced standing tall instead of slumping. She learned to walk
with an assertive gait and to look around, deliberately orienting to all the other
sights around her—the women, children, dogs, and cars on the street—rather than
just the men on the sidewalk. At first Victoria was afraid of standing tall and
walking assertively, remembering that if she asserted herself or even moved during
the abuse, things got worse. Realizing that immobility was a response that had
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helped her in the past, and that the past was different from the present, she was able
to stand tall and walk more assertively. Both this realization and changing her
posture helped to bring her arousal up into the window of tolerance. With repeated
practice of these new actions, Victoria was able to maintain arousal within the
optimal zone for increased time intervals, and she became less and less triggered
by the presence of men.
Like Jim or Victoria, you too may have triggers that automatically cause you to
inaccurately neurocept danger and threat. The worksheets that follow will help you
recognize faulty neuroception and identify the triggers and the signs of your body’s
dysregulated arousal in the face of these triggers. You can then practice new actions
and reactions, as Jim and Victoria did, that will help regulate your arousal so you
can neurocept safety when your environment actually is safe. And when your
arousal is regulated, and you neurocept safety, you can better enjoy your
environment and the people in it.
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2. Using one of the signals you circled, described the difference when your arousal
is a little high and when it escalates to hyperarousal. (e.g., When I am angry and
experience high arousal, my jaw tightens and my voice tone changes, but I can
still think and carry on a conversation. When I am angry and hyperaroused, my
heart starts pounding,I get a ringing in my ears, and tingling in my fingers; I
can’t think clearly,I blow up and start yelling.)
Window of Tolerance
3. Circle the internal signals of your arousal being within your window of tolerance
that you have experienced. Add any signals that are not on the list in the empty
boxes.
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relaxed, or at peace handle challenges and ignore distractions
4. What sensations and movements tell you your arousal is in the optimal arousal
zone?
5. Circle any internal signals of low or hypoarousal you have experienced. Add any
signals that are not on the list in the empty box.
6. Using one of the signals you circled, describe the difference when your arousal
is a little low and when it drops to hypoarousal. (e.g., When I have I low arousal, I
feel spacey, become less verbal, and my body feels heavy and a bit numb. When I
am hypoaroused, sounds are muffled, objects seem to be far away, I am so far
removed from everything that I take a long time to respond or I don’t respond at
all.)
Discuss with your therapist any ways you might increase your tolerance of high and
low arousal and regulate hyper or hypoarousal.
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AROUSAL
Hyperarousal
High arousal
3. What helps you feel better again when your arousal has been triggered into high
or hyperarousal? List several things you could do to bring your arousal back into a
more comfortable zone.
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Low arousal
Hypoarousal
2. Describe the body signals that indicate your arousal has been triggered into low
or hypoarousal.
3. What helps you feel better again when your arousal has been triggered into low
or hypoarousal. List several things that you could do to bring your arousal back into
a more comfortable zone.
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peace, joy
Emotions
terror, despair
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Five-sense Perceptions
see an angry person, hear a siren, smell the same aftershave my abuser wore
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Hyperarousal
High arousal
Low arousal
Hypoarousal
2. What thoughts (e.g., I did a terrible job.), emotions (e.g., frustration, boredom,
joy), people, activities, or situations influenced your arousal over the past three
days?
3. Describe anything that caused your arousal to escalate or drop to an
uncomfortable level.
4. Assess the patterns of arousal you noticed and if your arousal was where you
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wanted it to be throughout each day. If not, what might you do to influence your
level of arousal? (e.g., My arousal slumped after lunch every day, but might stay
higher if I went for a walk.)
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How might you use what you learned about what evokes optimal arousal for you in
#1 and #2 so that you can experience optimal arousal more frequently? (e.g., I
realized that most of the moments of optimal arousal I experience have to do with
music and other people. But I could also do other activities that I listed in #1
that promote optimal arousal, such as sports, yoga, taking a walks in nature, and
reading novels.)
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helpful to discuss this chapter fairly thoroughly together in session, so that you can
provide psychoeducation as needed to assure clients’ comprehension of the model,
address any of their concerns, and plan where to start and how to move forward
with the rest of the book.
As you work with this chapter, it is important to understand that these phases
are not necessarily sequential and should not be implemented in a rigid fashion. For
example, attachment-related emotions are a topic in Phase 3, but often these
emotions emerge in Phase 2 work with memory, and must be addressed when
dealing with past events. Additionally, skills described in one phase can also be
used to support the goals of another phase. For example, the proximity-seeking
actions in Phase 3 may be helpful to treat a client who needs to reach out to others
to regulate around and decrease isolation in Phase 1. Additionally, as you are
working with memory, it is often essential to implement resources learned in Phase
1 to help clients regulate. And it will also be necessary to address strong emotions
and beliefs, described in Phase 3, as they emerge when working with memories.
Clients who become dysregulated when they explore Phase 3 topics of positive
emotion, play, and taking risks will benefit by returning to Phase 1 to deepen their
resources. So it is important to be flexible in your use of this material and in
assessing, moment to moment and session-to-session, which interventions form
which phase will be most useful. Discussing options with your clients in a spirit of
collaboration assures you are in agreement and will maximize their ability to
benefit from the structure provided by these three phases.
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conceptualizes and prioritizes the need for stabilization, resourcing, and self-
regulation that are so lacking in these individuals. Since dissociative fragmentation
tends to be associated with hyper- and hypoarousal, easily activated animal
defenses, and impulsive behavior, Phase 1 treatment is a priority for this
population. For example, if hypervigilant parts of clients perceive you to be rigid,
controlling, and uncaring or see you as the only source of safety, having a treatment
model to guide the therapy will provide you with a format for collaborating with
clients and their parts that is fairly objective. The worksheet for this section not
only facilitates therapeutic collaboration but also provides an objective tool for
assessing the focus of therapy. Using it repeatedly, you can assist clients with
dissociative disorders to identify the markers that inform both of you about which
phase should be the focus of treatment.
Dissociative clients may be triggered by some of the material in this chapter.
Most have a strong conflict between knowing and not knowing about their trauma
history, and this conflict is often held by different dissociative parts. Thus, parts
intensely focused on disclosing memories may be angry when you insist on a focus
on regulation and resources. In this case, you might ask if all parts of the client are
in agreement with doing memory work, or whether some parts are more afraid or
ashamed to do so. And ask whether some parts do feel the need for help with
stabilization in daily life. Once the client understands that he or she has inner
conflicts among parts, the different parts may become more in agreement with the
sequence of therapy.
In Phase 2, the client or some parts of the client, may object to the focus on
implicit rather than explicit memory, intent on “telling the story” without sufficient
attention to inner awareness or recognition of the objections and fears of other
parts. Parts who are phobic or avoidant of memory will be triggered by information
about Phase 2. Some parts might want to skip both Phases 1 and 2 to proceed head-
on to addressing strong emotions and relationship issues in Phase 3 before they
have the resources necessary to address such issues. On the other hand, Phase 3 can
support the integration of parts, leading to resistance of certain parts who are
terrified of integration.
It might be helpful to explore the worksheet from the perspective of different
parts of the client so that he or she can help the parts work through conflicts about
various aspects of phase-oriented therapy. You will have the clinical challenge of
eliciting and listening to the fears and preferences of each part, while
simultaneously using the relationship and the skills clients have learned to regulate
their arousal. Through going slowly and exploring the needs and desires of all
parts, you can meet the challenge of helping the client as a whole learn a paced and
thoughtful approach to the therapeutic priorities, and collaborate with you in
planning their treatment.
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The therapeutic journey of dealing with the past and moving on to a fulfilling life in
the present may seem like an exhilarating challenge or an impossibly daunting task.
You may feel excited to embark on this adventure in self discovery, or you may be
intimidated and discouraged before you even begin. Therapy is a step into the
unknown, full of mystery, surprises, and complexities.
This journey becomes clearer and more manageable if we divide it into steps,
or phases, an approach to therapy that has been used since the 1800s. The
remainder of the book is divided into three sections, one for each of the three
phases of therapy, to explore the legacy of both trauma and attachment. The three
phases are divided as follows: Phase 1, developing resources; Phase 2, working
with memories; and Phase 3, creating healthy relationships and satisfaction in life.
By breaking down the therapeutic process in this way, we can feel encouraged that
each step we take along this journey is part of a larger whole, which, all together,
will help us steadily become who we want to be. We can develop confidence that
addressing the past, and moving on to a brighter future is within our reach.
All that you have learned from the previous chapters has built a foundation of
skills and capacities in preparation for embarking on the three phases of therapy:
developing confidence in your body’s wisdom, understanding procedural learning,
orienting to selected stimuli in the outside world, learning mindfulness skills,
recognizing your arousal levels, and understanding neuroception and a bit about
your brain. The material in this chapter is an overview of the three phases of
therapy that will help you determine how to integrate what you have already
learned and best use the remainder of the book.
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acquired through all your life experiences, both positive and painful, as well as
how to use these resources and new ones to build your capacity for coping with
adversity. You will discover somatic resources that teach you how you can call on
your movement, posture, and gesture to regulate arousal and generate more positive
feelings so that you can continue to expand your confidence in your body as a
source of wisdom and support for your well-being. By acknowledging your
resources, developing those that are undeveloped, and implementing them in your
life, you will learn to draw on your body and mind to regulate your nervous system
and expand your sense of mastery.
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participating more fully in the world and especially in relationships. At this phase,
we start to attend to areas of daily life that might have been neglected due to
dysregulated arousal, old orienting patterns, disruptive procedural learning,
emotional reactivity, or triggered responses. With the somatic skills to regulate
arousal already established and with many memories already addressed, our
confidence in the body as an ally instead of an enemy is growing.
This confidence supports our readiness to turn attention to ways in which the
body can serve as an asset in enriching our everyday lives. The resources learned
in previous phases are used again in Phase 3 to support healthy relationships and
more active engagement in the world. We learn to use our bodies in new ways that
challenge the patterns of the past, such as reaching out to others for connection or
discovering the movements that help us play, explore the world, and meet new
challenges.
Our goals at this phase of therapy include taking up the tasks of growth and
development, overcoming limiting beliefs and how they “live” in the body,
navigating painful emotions, participating fully in work and relationships
(especially intimate ones), and increasing joy and pleasure in life. We will also
focus on challenging your windows of tolerance by taking healthy risks. The feeling
that your present life is dictated by your history is diminished as you learn to
expand your window of tolerance to deepen your intimate relationships and
satisfaction in life.
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You also might find it most useful to skip around between phases, rather than
progressing through them sequentially. For example, you may discover a few
resources in Phase 1 that help you feel ready to address memories in Phase 2, then
work with relational issues using interventions in Phase 3—which may evoke
intense emotions, sending you back to Phase 1 to develop more resources to
regulate those emotions, and so forth. Some of you will move slowly but surely
through all three phases of therapy in a spiral fashion, cycling back to Phase 1 as
needed to deepen stabilizing resources when dysregulation is encountered during
the work of Phases 2 and 3. Others will find the most benefit by skipping around, in
no particular order.
You will probably discover that some of the skills and interventions in one
phase support you in another. For example, strong emotions and beliefs learned in
childhood are discussed in Phase 3, but they might emerge in Phase 2 while
working with memories, or even in Phase 1, when new resources might challenge
these beliefs. So we encourage you and your therapist to be flexible in using this
three-phase model so that it suits your own process and needs. The worksheet that
follows this chapter will help you and your therapist assess where you are in
therapy right now, which phases you have already worked with, and which phase
you are ready for next.
With careful attention to the tasks of each phase and using the window of
tolerance as a guide to assure that arousal is sufficiently (but not overly) regulated,
we can be confident that our progress will proceed at an appropriate pace. How
much time we spend in each phase, and indeed the duration of therapy itself, varies
depending on the severity and complexity of our history, inborn physical and
temperamental factors, and other factors hard to pinpoint. Each one of you should
trust your own pacing as you move more quickly or slowly through the phases. With
the flexible structure of these three phases to guide you and your therapist, and with
pacing that encourages mastery in each phase, you can challenge yourself in just the
right way to ensure satisfaction and growth in working through trauma and
attachment issues.
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habits neglected areas to life
1. Which of these phases of therapy is your current focus? Using the tasks in the
chart above, describe what you’ve accomplished and what is still left to work on
in this phase.
2. What other phases have you been in during your therapy? Describe your
experience of the other phases–successes,struggles, and difficulties. What tasks
remain to be addressed or learned in those phases?
3. What tasks do you think will be important in your therapy as you move
forward?
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SECTION THREE
PHASE 1
Developing Resources
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Clients Who Might Benefit
Clients who suffer from low self-esteem or who judge themselves as lacking will
benefit from this chapter’s focus on their competencies. Destabilized clients who
struggle with such issues as self-destructive behavior, eating disorders, chemical
dependency, and other symptoms that cause shame and self-doubt can benefit by
learning to acknowledge these as survival resources—as attempts to regulate
arousal and cope with distress. Clients with issues related to early attachment, such
as detrimental relational habits and shortcomings, can also redefine their issues as
survival resources or as coping strategies developed in the context of their family
dynamics. For clients who have overlooked or negated their creative resources, the
material can serve as an opportunity to identify and deepen access to capacities that
can increase their internal support and self esteem.
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It might be challenging to help some clients acknowledge their resources when
they are adamant that they have none. It is important to remember that even clients
who struggle to function possess skills and resources. You can increase their
awareness of their resources by acknowledging daily abilities, such as typing on
the computer, driving a car and knowing where to go, working out at the gym, or
fixing a child’s lunch. Clients may not think of these abilities as competencies, and
in fact some have even learned patterns of automatic negation of success or
competence, saying, “Anyone could have done that,” or “That was a fluke.”
It is important that you carefully track your clients’ responses to your
acknowledgment of their resources. Many clients experience difficulty taking in
positive feedback. Studies show that people with PTSD, in particular, tend to
respond to compliments negatively (Frewen, Dozois, Neufeld, Stevens, & Lanius,
2010), and many people hold limiting beliefs that prevent them from accepting
positive regard from others. When positive moments have been absent or invariably
followed by abuse or humiliation, then compliments, praise, or positive attention of
any kind may engender dismissal, fear, or shame, which might also be
acknowledged as survival resources. Asking questions such as “What do you
imagine would have happened if you had been proud and assertive, instead of being
compliant and submitting to the abuse?” or “How do you imagine your dad would
have treated you if you had been laid back and relaxed instead of always working
hard to be the best at everything?” can often help clients realize that the behaviors
they are trying to change were once adaptive responses—survival resources—that
helped them in difficult situations. Clients often view symptoms and certain
behaviors as liabilites. Reframing them as survival resources conveys that these
symptoms and behaviors have actually helped them cope with difficult conditions
of the past.
Qualifying the behaviors clients are trying to change or the symptoms that
destabilize them as survival resources opens up new options for addressing them
and finding other, more creative resources to fulfill their purpose. You may find that
helping clients acknowledge the survival resources that once helped them slowly
opens up an ability to acknowledge other ways they have coped with adverse
experiences. When survival resources are exacerbated in current life, your
emphasis on the behavior as an attempt to resource unbearable feelings or regulate
dysregulated arousal may help motivate clients to manage their stress differently.
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resources, but it also asks them to assess if the resource still has value for them
now. REFRAMING A SURVIVAL RESOURCE is particularly appropriate for
clients who are ashamed of their survival resources or who have self-destructive
survival resources. It asks them to identify a survival resource that they consider a
liability and then describe how it helped, and may still help, them cope with
difficulties.
As mentioned, creative resources often go unnoticed or unmentioned. YOUR
CREATIVE RESOURCES invites clients to discover what creative resources they
already possess, to practice using one of them and notice what effect doing so has
on their body, thoughts, and emotions. As suggested in the worksheet, it might be
helpful to encourage clients to ask someone they know and trust to give feedback on
their creative resources. EMBODYING A CREATIVE RESOURCE helps clients
define a creative resource, remember the last time they used it, and describe how
this resource affects their body. Your encouragement to practice one of their
physical responses to this resource can support clients to integrate it into in daily
life.
Once clients understand how their survival resources have served them, they
may realize they are no longer helpful in their current life. REPLACING
SURVIVAL RESOURCES WITH CREATIVE RESOURCES asks clients to imagine
creative resources that could replace the survival once they commonly use, and then
to describe what the creative resource would feel like physically. This worksheet
helps clients recognize that they have a choice whether to continue to use survival
resources or to replace them with creative ones that have the potential to enrich
their current life.
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creative resources they possess, especially because past trauma and neglect might
result in phobias of positive affect, sense of worth, or positive acknowledgment.
They may shut down, become mute, switch into another part, or actively refuse to
continue with the discussion—all of which are survival resources to avoid what is
unfamiliar or potentially dangerous. Although discussing creative resources with
such clients increases the risk of triggering judgmental or ashamed parts that feel
unworthy, doing so also provides an opportunity to help clients become curious
about what creative resources each part might hold or what creative resources they
have developed to help them function even when parts are triggered and
dysregulated.
Thus, for clients with dissociative disorders, the chapter may be both validating
and triggering. Although the material may be challenging, you have a unique
opportunity to celebrate whatever unfolds as either a reflection of a survival
resource or of a creative one, and to address clients’ negative reactions to
acknowledgment of their resources as needed. You can guide clients to recognize
the interconnectedness of their internal parts through understanding that the
functional resources they each possess in some way serve the entire dissociative
system.
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Personal strengths and competencies are resources that help us maintain our arousal
within a window of tolerance so we can enjoy the activities and relationships in
our lives. All of us possess a myriad of resources. For example, skills such as
operating a computer, riding a bicycle, or reading, are all resources. So are talents,
flairs, abilities, and aptitudes, such as playing an instrument or a sport, navigating
an unfamiliar city, doing a job well, painting, drawing, or having personal style. We
also have internal capacities that are resources, such as the ability to experience
our emotions, be in tune with our bodies, or stay grounded. Almost any capacity,
aptitude, interest, or skill that we have can be a resource if it supports our well-
being, helps us meet life’s challenges, or find relief in difficult times. Certain
resources that helped us tolerate and survive trauma and attachment inadequacies or
failures in the past—such as hypoarousal or keeping silent—may not serve us in
our current lives. But, other resources, such as knowing how to read or enjoyment
of physical exercise, can continue to serve us no matter what the circumstances.
When we experience challenges or stress, our resources help keep us calm and
centered or give us energy to solve a problem or negotiate a resolution. The more
resources we have, the better we can cope with life’s challenges and
disappointments. When we are aware of our resources and know how to draw on
them when needed, we are better able to adjust and respond in a balanced and
creative way to a wide variety of events and interactions, even demanding or
unpleasant situations or encounters with others.
Our resources are often compromised during adverse experiences. Attachment
inadequacies of our caregivers or adult partners may leave us feeling rejected,
unloved, abandoned, or criticized. As a result, we may perceive ourselves as
inadequate, stupid, incompetent, or unworthy. Our resources are overwhelmed or
inadequate to protect us from harm during trauma, which may cause us to feel that
we lack the resources to deal with life in general. Through such experiences, we
may focus more on our shortcomings than our strengths we may develop habits of
self-criticism or ruminate about our negative traits, distressing memories, and
current life situations and relationships that are upsetting or unfulfilling.
We may even view our strengths as shortcomings or feel that we have no
resources at all. However, each of us, even the most dysregulated or unstable
trauma survivor, undoubtedly has many resources that might have gone unnoticed
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and unacknowledged. When we overfocus on negative qualities and experiences,
we tend to forget or overlook all the resources we possess and utilize every day.
This attitude diminishes self-esteem, interferes with our enjoyment of life and can
be destabilizing.
If you view yourself negatively or do not acknowledge your competencies, this
chapter will help you achieve a more balanced perspective. Its focus is to teach you
to recognize and reacquaint yourself with the strengths and abilities you have
developed over your life. Learning to appreciate resources is not meant to deny that
all of us have personal struggles, weaknesses, or shortcomings that may also need
attention. However, your own flaws (which everyone has) and the difficult
situations in your life will be easier to face if you perceive not only your
imperfections but also your strengths. And, resolving the suffering associated with
the past goes more smoothly when you learn to recognize and realistically
associated with that you possess many resources and competencies.
This chapter focuses on identifying and acknowledging the resources you
already have and can use. You will discover and strengthen your “creative”
resources—the ones that help you learn and grow and support your well-being. You
will also learn to appreciate your “survival” resources—those that enabled you to
cope with difficult situations, inadequate attachment, and trauma. Let’s talk about
the survival resources first.
Survival Resources
In distressing situations, we instinctively use resources that ensure that we make it
through the ordeal. These survival resources help us endure and cope with
whatever is happening to us. For example, to freeze, collapse, run away, or fight
back might be survival resources that helped us during trauma. Habits of being on
the alert for danger or being afraid to venture out of the house can be thought of as
survival resources that at one time helped us endure horrible situations.
Survival resources also help us adapt to the demands and expectations of our
families. If you grew up in a family that expected children to be obedient and not
“talk back” or voice their own opinions, you may have embodied this expectation
by rounding your shoulders, lowering your head, and having a meek demeanor that
goes along with not being allowed to be assertive. If you grew up with caregivers
who expected you to challenge people who stood in the way of what you wanted,
you might have embodied this expectation by lifting your chest, setting your jaw,
and squaring your shoulders, all of which support being assertive and
confrontational. These somatic and psychological adaptations can be thought of as
survival resources that helped you avoid the disapproval of your attachment figures
by trying to meet their expectations.
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Nadine’s habit of slouching, pulling in her shoulders, and bringing her head
forward went along with a tendency to become hypoaroused—in short, hold still
and remain quiet. These unconscious habits, coupled with a negative belief (“I have
no right to assert myself”), had helped her navigate the difficult circumstances of
her childhood. Her parents had required her to obey them and had punished her
when she stood up for herself or voiced her opinions. But Nadine’s physical pattern
and the belief that went along with it lowered her self-esteem and had serious
consequences in her current life. As an adult, Nadine could not stand up to the
unwarranted ridicule and emotional abuse from her boyfriend. Although she
tearfully expressed the desire to leave the relationship to her therapist, she had
been unsuccessful in doing so.
At first, Nadine defined her compliance and hypoarousal as a personal
shortcoming saying, “What’s wrong with me? I should stand up for myself. I’m such
a week person.” But with prompting from her therapist, Nadine asked herself,
“What got me through my childhood? How did I survive?” She realized that her
droopy posture and low energy were adaptive responses that had literally made the
painful circumstances of her family more tolerable than they might have been had
she not been so compliant. Reframing the low energy of hypoarousal, slouched
posture, and compliance as survival resources that had helped her cope with a
rejecting, punitive early environment validated them as skills Nadine was forced to
develop. She began to understand her own hypoarousal as an adaptive response.
Recognizing that she had done her best to adjust to her family’s demands, given her
age and circumstances, and that the patterns she had developed reflected an innate
ability to adapt, helped Nadine feel better about herself. She told her therapist, “I
didn’t have any choice but to comply. If I had fought back, my parents only would
have gotten angry and punished me more. The slouched posture helped me comply
and the hypoarousal helped me tune out and not feel how much it did hurt.” Instead
of self-judgment, Nadine began to appreciate that she had been able to utilize these
survival resources when she most needed them. By reframing what she had thought
of as weaknesses as resources instead, she could explore new options more
adaptive to her current circumstances from a place of competency rather than self-
deprecation.
We all develop survival resources to manage painful situations in childhood,
and these patterns often continue in our adult relationships with people who are
important to us. Using anger to push people away could be a survival resource in an
environment in which trusting others increased the vulnerability to criticism.
Becoming a workaholic can develop in a family that stressed achievement. When
expressing how we feel is not valued or is punished by our caregivers when we are
children, becoming emotionally withdrawn is a survival resource. In the context of
trauma, neglect, and betrayal by the people responsible for our care, hyperarousal
and hypervigilance might become survival resources. Or, we might develop
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survival resources in attempts to regulate arousal and overwhelming emotions, such
as using substances to numb the body or to increase energy. Feelings of
powerlessness might lead to thinking about suicide as a survival resource. Wishing
for or planning a way out through suicide might bring relief or increase a sense of
having control. Because trauma is associated with the failure of others to comfort
and protect us, and a need to find some way to regulate unbearable feelings on our
own, survival resources, such as addictions or self harm, can become extreme and
even threaten our safety. Acknowledging such resources for their survival function
is a first step, followed by learning to replace them with more creative resources
capable of supporting regulated arousal and well-being.
Creative Resources
Alongside the resources that help you survive, you also developed personal
strengths and competencies that help you learn new things, develop talents,
integrate your experiences, and grow from them. These creative resources nurture
your spiritual, physical, emotional, and mental development; they help you fulfill
your potential to become the person you want to be.
To identify your creative resources, you might think about competencies, talents,
abilities, or strengths that you possess. Do you work out, hike, or play a sport? Do
you read, write, play music, knit, or draw? Are you a handyman/woman, or a cook,
or a gardener? Are you good at math, history, or science? Are you known for your
sunny disposition, being a deep thinker, or your ability to solve problems? Are you
the life of the party or the person everyone comes to for advice or comfort? Do all
the children in your neighborhood end up at your house after school? Do you have a
special affinity for animals? All these, and many more, are creative resources that
immensely increase our satisfaction in life, enhance relationships, and boost self-
esteem.
Along with honoring your survival resources, you can learn to recognize your
creative resources and enhance them, and practice using them in place of outdated
survival resources. Robert’s father had supported him in his schoolwork and in his
job as a paperboy when he was in elementary school. Some of Robert’s most
pleasant memories of childhood were of doing homework with his older brother,
his father reading nearby, always ready to help. Robert remembered the happy look
in his father’s eyes when he got his first job as a paperboy. His father had respected
his accomplishments and taught him the value of a job well done and Robert
enjoyed sharing his successes, basking in the look of pride on his dad’s face.
However, his father was killed unexpectedly in an accident when Robert was 12,
and his mother imparted a different message: to be modest and “not brag.” Robert
learned to keep his accomplishments to himself, a survival resource.
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As an adult, when Robert thought about how much he enjoyed his work and how
good he was at it, his shoulders squared, his breathing deepened, and his chin lifted
with pride. Typically, that moment of pride would be interrupted by a negative
thought that reminded him of his mother, (e.g. “Now you’re getting a big head,”)
which would trigger a return to his usual rounded shoulders and shallow breathing.
With his therapist’s encouragement to notice these physical habits as survival
resources and the pride in his work as a creative resource, he became determined
to embody how he felt when he acknowledged his competency. He wanted to
reclaim the early message from his father. Robert practiced replacing his survival
resource with the creative one by deliberately breathing deeply, squaring his
shoulders, and lifting his chin. Robert found that he enjoyed himself more and felt a
bit better equipped to deal with the difficulties in his life from this stance of
embodying this creative resource.
The worksheets that follow will help you discover your survival and creative
resources to foster a fuller capacity to self-regulate and an increased sense of
competency. Like Nadine, you can learn to reframe habits that you might have
thought of as liabilities as survival resources that were adaptive responses to
earlier circumstances. And like Robert, you can explore replacing your survival
resources with creative ones to enhance your well being and increase your
satisfaction in life. The first step is to recognize that you already have within you a
rich variety of resources and to become aware of how your body reflects them.
From this recognition, your survival resources can be validated, outdated ones
replaced, and your creative resources acknowledged, deepened, and embodied.
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• Dissociate
• Shut down and become numb
• Comply or submit
• Push parts of yourself away
• Show only those parts of yourself that others will accept
• Become a “workaholic”
• Overdo or keep too busy
• Need to know everything
• Excessive need to excel at school or your job
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• Be hypervigilant
• Experience hyper/hypoarousal
• Leave, flee, run away, or hide
• Fight, get irritated or angry easily
• “Blow off steam” with emotional outbursts
Other:
List any survival Describe any of your How do your survival resources
resources that survival resources that affect your arousal and your
you still use. overlap with creative ones body? (e.g., My arousal
Describe how (e.g., soothing a caregiver decreases if I exercise; I feel my
they are useful or and exercise could be both body again when I hurt it; I
hinder you in a survival and creative become less tense when I take
your life today. resource). care of others.)
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1. Describe the survival resources you chose. (e.g., I work all the time because
that’s what made my dad proud, but it gets in the way of me enjoying my life
and building relationships.)
3. When have you used this survival resource? How did your resource help you
when you needed it? (e.g., I started working hard as a teenager to keep my dad
from criticizing me. When I didn’t work, or just hung around with my friends,
he called me a slacker and said I was lazy. This survival resource helped me
gain the respect of my dad, and kept me from having to hear his criticism.)
4. Describe your thoughts, emotions, and body movements, and sensations when
you think of this survival resource as something that helped you deal with difficult
times. (e.g., I think I was a resourceful 15-year-old. I feel compassion for that
person I was. I should have been allowed to just be a teenager and have fun. I
feel a sense of pride, as well, for having made it through and for the
determination I have. My body feels less tense, and I am able to breathe more
deeply. I have the thought that maybe I don’t have to work all the time to be
OK, that I’m anything but lazy, and the guilt I felt earlier is diminished.)
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Reflect on your creative resources. Do you work out, hike, or play a sport? Do
you read, write, play music, knit, or draw? Are you a handyman, or a cook, or
gardener? Are you good at math, history, or science? Are you the person everyone
comes to for advice or comfort? What other competencies or abilities do you
possess? Write down your creative resources below.
Choose one of the creative resources above that you want to use more in your life
today. Describe three times you have used this creative resource in the past,
starting with the first time you can remember using it.
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Describe how you can practice using the creative resource that you selected.
After you have practiced using your resource, reflect on the effect of using it.
Then describe how this resource affects your body, your thoughts, and your
emotions.
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How does your breathing change? Do you take a deep breath? Does your
breathing slow down or speed up?
How does your tension change? Do areas of your body, such as your jaw or
shoulders, let go? Do you feel more relaxed? Or do you feel more alert or
stronger?
Describe any impulses you have when you embody your resource. Do you want to
smile, reach out, dance, open up, go for a walk, sit back and relax?
How does your posture change? Do you sit up straighter, relax your posture, lift
your chin?
Pick one or two of your body’s responses to remember and practice daily. For
example, if you took a deep breath and lengthened your spine, remember to practice
this whenever you think of it. This will help you embody the good feelings of your
creative resource and draw on it when you need it.
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Work with your therapist to implement these creative resources in your daily life.
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CHAPTER 14
Taking Inventory
Categories of Resources
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can help. For clients who are missing resources in some categories but may have a
number of identifiable resources in other categories, this material can teach them to
deepen the resources already available, as well as spark ideas about filling out the
categories in which resources are sparse, preparing them for the work of Chapter
20, “Developing Missing Resources.”
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together and were able to identify an abundance of creative resources in a variety
of categories.
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Dissociative clients often find it challenging to identify and embody resources in
various categories because they tend to be fixed in their patterns and avoidant of
change. Identifying internal and external resources in each category that are useful
to all parts can be demanding and frustrating. Categories that are regulating to one
part may dysregulating to another, and those accessible to particular dissociative
parts will not be accessible to others. It may be necessary to differentiate parts with
various resources in different categories from parts that resist believing that the
client has any resources at all or from parts overwhelmed by fear, rage, shame, and
self-loathing.
You may need to begin by simply asking these clients to engage all parts in a
dialogue about each potential category of resource. For example, you might ask:
“Have some parts of you ever found it helpful to talk with others, or to write or
draw or listen to music to feel better?”;“Are there some parts that prefer doing
things with your body (e.g., running) and others that prefer doing things with your
mind?”; “Is there any part of you that finds comfort in something beautiful,
enjoyment of nature, or in taking care of others or learning something new?” If the
client is currently unable to pursue interests or activities that were once resources
in various categories, your questions can refer to what the client used to do in the
past. However, this may lead to grief for what has been lost. But if possible, you
can explore together what makes it difficult to use the resource in his or her current
life.
If judgmental or self-doubting parts interfere with an exploration of the different
categories of resources, you might first elicit the client’s curiosity about which part
might have trouble believing that resources are available or even might not want the
client to have them, by asking questions such as, “What belief does that part have
about this category of resource?” or “Why might that part believe it is important not
to use this category?” If you familiarize yourself with all these different categories,
it will be easier to notice and then bring your clients’ attention to the categories
available to certain parts, or to identify those internal and external resources in the
categories that are being drawn upon unconsciously.
You can weave the work of this chapter into the moment-by-moment work of
therapy. For example, if the client is a parent, you can ask him to draw upon his
resources as a father to support or regulate a young part of himself. If the client has
a spiritual life or a love of animals or creative ability, you can spontaneously
integrate those into therapy: “When you think about your Buddhist belief of
acceptance, what happens to that part of you that is ashamed?” Further work can be
done eventually to encourage all parts work together to resolve the conflicts and
protective behaviors that prevent use of resources in each category, and then restore
access to them.
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During childhood, with care and encouragement from our families, we acquire a
personal repertoire of internal capabilities that support our development. These
internal resources include a variety of capacities, such as the ability to recognize
our own needs, ask for support, enjoy ourselves, and so on. We also draw on
external resources, people, organizations, and things from the environment for
safety, support, and learning. Building on the previous chapter, this one is designed
to help you further identify resources you already possess, some of which you may
not have realized you have. Your awareness of the diversity and number of
resources you already have at your disposal will be expanded. Exploring both
internal (within you, part of who you are) and external (outside of you, part of
your environment) resources and grouping them into several different categories
will help you develop, classify and refine your personal inventory of resources.
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her, and listened to her favorite classical music, all of which helped her feel safe
but not less alone. Eventually, she decided to call a friend and invite her for a walk.
They drove together to a beautiful lake, and the movement of walking with her
friend made Jane feel more alive and less depressed. She began orienting toward
the beautiful scenery and to enjoy the smell of autumn in the air, the vibrant colors
of the trees and the cool breeze on her cheeks. She confided in her friend that she
sometimes felt depressed and alone in the world, and she was comforted by her
friend’s empathic response. Jane and her friend discussed how both used to go to
church as children and how walking in such a beautiful place induced a feeling of
reverence and spiritual connection. They talked of their shared love of dance and
discussed enrolling in a beginning jazz dance class together. Jane suggested that
they find a performance of a local dance troop that they could attend together. At the
conclusion of their outing, Jane noticed that she felt energized rather than fatigued
by the long walk. Her breathing was not as shallow as it had been, she felt less
depressed, and was able to formulate a plan for the rest of her day, which included
renting a documentary on the history of jazz dance.
Jane’s ability to recognize and call on her resources contributed to a more
enjoyable and uplifting Sunday. She realized that she had a choice: She could think
about all the things that bothered her: winter, her least favorite season, was about to
arrive; she was middle-aged and not in very good shape, so she would not be able
to dance as she did when she was young; her friend rarely took time away from her
family to spend time with her; her husband had left her for another woman and now
she lived alone. These were a few of the negative thoughts that normally drew her
attention. But if she focused on her resources, her mood lifted, and the things that
normally bothered her became easier to accept.
Notice that Jane utilized many internal resources: the ability to reach out to her
friend, the skills of driving and knowing where she was going, appreciation of
nature, communication skills, love of dance, the capacities to walk, and breathe
deeply. She also drew on a number of external resources: her cozy bed and her
music, her friend, the telephone, the lake, nature, dance classes, her car, and warm
clothes, to name a few.
Jane used internal and external resources from a variety of “categories” of
resources, noted in the classifications on the following page. When we are aware
of the many categories from which we can and do draw resources, our resource
inventory begins to expand almost immediately. Note that the examples provided
for internal and external resources in each category are but a few of many more
possibilities, so you can add to the examples.
To validate and deepen resources in each of these categories, we can first
identify the ones that we have intact, consciously draw on them, and then deepen a
bodily felt sense of how these resources help us. They may regulate our arousal,
shift our mood, open up new possibilities, or otherwise contribute to our well-
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being. One way to do this is by focusing on the resources available in the here-and-
now moment, as Jane did on that Sunday. Focusing here and now (see Chapter 7,
“Pay Attention: The Orienting Response”) often means putting aside the thoughts
and feelings that might be unpleasant and instead orienting toward whatever can be
enjoyed around us. For Jane, that meant feeling the warmth of her bed, the sensation
of the sheets and blankets around her body and listening to the sound of music.
Then, later on, she was able to shift her focus from feeling depressed to the
experience of walking side by side with her friend and looking around to
appreciate the bright fall foliage and feeling the air on her face.
Table 14.1. Categories of Internal and External Resources (with examples)
Relational
Internal: Sense of valuing and deserving friendships and family,
general belief that others can be supportive, the ability to reach out
to others and to set healthy boundaries, communication skills, ability
to give and receive emotional support, a connection with pets
External: Close friends or family, a primary relationship, support
groups of all kinds, group activities, colleagues, different kinds and
ages of friends and acquaintances, such as kids, elderly people,
activity partners or pets
Somatic
Internal: Good health, ability to connect with the body and its
sensation, feeling grounded through the legs, deep breathing, good
posture, supple, toned muscles, enjoyment of sexuality or sensual
activities, the senses, capacities such as walking, running, dancing,
ability to regulate arousal, flexibility
External: Health clubs, gyms, studios, classes in yoga, dance, Pilates,
aerobics, martial arts; sports; running trails, bike paths, ski slopes,
skateboard parks, tennis courts; equipment such as bicycles, roller
blades, skateboards; rocking chairs; health practitioners such as
doctors, chiropractors, naturopaths, herbalogists, osteopaths, body
workers, movement teachers, massage therapists; warm baths and
things that are pleasing to the senses (candles, scents, soft textures,
colors, tastes)
Emotional
Internal: Having access to a full range of positive high-arousal
emotions (joy, elation, passion) and low-arousal emotions
(tenderness, tranquility, contentment), ability to tolerate emotions
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such as anger and sadness, not being stuck in or “run” by one’s
emotions, ability to express and communicate emotions,
appropriately regulate emotions effectively and utilize emotions to
guide action
External: Friends, family, and pets with whom to give and receive
emotional support, circumstances and people that elicit richness of
emotions, people with whom to share the emotional highs and lows
of your life; activities, people, or pets to inspire high-arousal
emotions such as joy, passion, and elation and low-arousal emotions
such as peace, comfort, and tenderness
Intellectual
Internal: Creative thinking, capacity to “think things through,”
problem-solving ability, intellectual clarity, the ability to self-
stimulate cognitively, interest in developing the mind, ability to read
and take pleasure in learning and figuring things out
External: Schools, classes, colleges, universities, libraries, study
groups, workbooks, public television, public radio, documentaries,
crossword puzzles, Sudoku, brain games, computer courses, books,
language courses, books on tape, cognitive training therapy
Artistic/Creative
Internal: Ability to access the creative process within oneself
through music, dance, poetry, writing, sculpture, visual arts, design,
sewing, cooking, acting, crafts, interior decorating, landscaping,
building, or any other creative endeavor
External: Having people to share creative activity with; artistic
material and equipment such as: paints, musical instruments; CD
player; access to music/dance lessons; writing classes or groups,
museums, performances, art shows, theater, movies; cooking
classes; special-interest groups; computer; and pen and paper
Material
Internal: The ability to earn an income, create financial security; the
capacity to enjoy material things, such as a cozy chair, a great car, a
lovely home, or objects that enhance one’s pleasure in life
External: Having a job, a home, utilities, transportation; tools and
labor-saving devices of all kinds, from kitchen appliances to washing
machines; a comfortable bed, and items such as bicycles, pianos,
running shoes, telephones, computers, or art supplies that support
other categories
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Psychological
Internal: Strong sense of self, sense of competency, good self
esteem, feeling safe in the world, ability to notice one’s experience,
sense of being OK, nonjudgmental self-awareness, ability to reflect
on one’s behavior, emotions, or thoughts
External: Having access to a therapist, self-help books, workbooks;
ability to take advantage of what’s offered in the community such
as therapy groups, support groups, or workshops
Spiritual
Internal: Ability to connect to God, the Buddha, Allah, spiritual
guides, or to any form of deity, gods or goddesses, spiritual teachers,
spiritual energy or faith; prayer, the capacity to experience
reverence or sense one’s own essential or spiritual nature
External: Meditation instruction; participation in a spiritual
community, such as church, synagogue, temple, sangha, mosque, or
meditation center; or other activities with a spiritual element, such
as family prayer, Shabbat, or group sharing and ceremonies,
spiritual poetry or readings; access to spiritual teachers
Nature
Internal: Ability to connect to and appreciate the sounds, sights, and
smells in nature, enjoy activities in natural settings, create gardens
or nurture houseplants, use senses to enjoy nature, appreciate the
seasons
External: Gardens, lakes, mountains, nature walks or drives, access
to trails, beautiful scenery, the ocean, sunsets and sunrises, the
moon, rocks, flowers, butterflies, birds, wild animals, or anything else
in nature that you find nourishing
Another way to deepen our connection to our resources is to repeatedly
practice remembering those moments when a resource was most useful or vivid.
Jane drew on the memory of walking with her friend, reexperiencing the images,
smells, sounds, sights, and good feelings she felt emotionally and in her body. She
recalled the beautiful view of the lake and the feel of the crisp autumn breeze on her
cheeks. She especially enjoyed remembering the warmth and relaxation that came
over her as she confided that she sometimes felt depressed and her friend listened
receptively, with compassion. She could visualize her friend’s empathic
expression, hear the comforting cadence of her friend’s voice that helped her feel
less alone and more hopeful, and sense the relaxation in her body and the deepening
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of her breath.
When Jane mindfully noticed her building blocks as she remembered the walk,
she had the thought, “I’m going to be OK.” Deepening and embodying the memory
of these moments helped Jane challenge both her negative belief (“I’m not going to
be OK.”) and the low arousal that characterized her depression. As she
remembered how that walk felt, emotionally and physically, she had more energy
and her depression lifted a bit. Each time she deliberately recalled each piece of
the memory, she increased her capacity for experiencing herself as a competent,
regulated person rather than as someone in a chronic state of distress and low
arousal. The following worksheets will help you identify your internal and external
resources in each category, and then begin to discover what happens in your body,
thoughts, and emotions when you validate, enhance, and embody these resources
that you already possess.
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Emotional
Survival Creative Resource to Use Instead
Somatic
Survival Creative Resource to Use Instead
Relational
Survival Creative Resource to Use Instead
Artistic
Survival Creative Resource to Use Instead
Psychological
Survival Creative Resource to Use Instead
Nature
Survival Creative Resource to Use Instead
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Emotional
Survival Creative Resource to Use Instead
Somatic
Survival Creative Resource to Use Instead
Relational
Survival Creative Resource to Use Instead
3. Practice using your creative resources whenever you feel the impulse to use a
survival resource. Record your successes and challenges below.
Successes:
Challenges:
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Return to parts 1 and 2 of this worksheet often and continue to explore exchanging
your survival resources for creative ones. Discuss your successes and challenges
with your therapist.
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2. Remember a time when you engaged this resource, and focus on the images,
sounds, tactile stimulation, smells and tastes in the memory that stand out.
Describe below.
Images/Sights
Sounds
Touch
Smells/Tastes
4. Notice all the changes in your body as you remember. Describe what you
notice below.
Changes in posture:
Changes in your facial expression:
Changes in tension:
Impulses to move:
5. Mark the diagram where you notice changes in your sensations when you
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remember this resource and then make a note describing the sensation.
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1. Describe one or two things that happened that make it a bad day, and write
down your feelings.
2. As you think about the things that make it a bad day, what beliefs or judgments
about yourself, others, or the world come up?
3. Describe your sensations (e.g., heavy, numb, agitated, tense), movements (e.g.,
rapid heart rate, shoulders lifting up, head turning down, brow furrowing),
posture (e.g., slumped, rigid, collapsed) and breathing (shallow or held).
4. Think about the internal and external resources you have in different
categories that could help you feel better today. Write them down below.
Internal:
External:
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5. Right now, try one of the resources you listed in #4. Write down how this
resource affects you below.
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understimulated by sensory input might benefit from following the chapter’s
suggestions to identify which types of sensory stimulation could be reduced or
increased to promote well-being. Those who are uncontained or emotionally
volatile might enjoy learning containment resources or making greater use of
external somatic resources such as warm baths.
Clients who are easily thrown “off center,” who are workaholics, who
“overdo” or fail to listen to their inner needs can benefit from the centering
resources described in this chapter. Those who have difficulties in relationships,
particularly, inability to self-regulate during disagreements, can explore a variety of
somatic resources that can be utilized in heated moments. Clients who take their
work home with them and are unable to relax after the workday might learn
resources that help them achieve calm states.
Clients who enjoy and take pride in physical activities (e.g., yoga, running,
dancing, hiking, working out) may find it helpful to recognize these activities as
external somatic resources that they naturally use and then focus on more deeply
embodying them.
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also track and bring to clients’ attention the changes in the body when they report a
positive experience by saying, for example, “When you talked about doing so well
on that exam, you took a deep breath, and your chest opened!” Once you have
brought the resource to the attention of your clients, you can invite them to engage it
voluntarily (e.g. to take another deep breath), mindfully noticing the effect of the
somatic resource on their building blocks.
Clients’ appreciation of their somatic resources will increase as you help them
identify the function of each resource and how it helps them (e.g., regulates arousal,
gets them out of the house, supports relationships) or what it tells them about
themselves (e.g., that they are OK, connected, strong, capable, or just “alive”).
However, some clients who are averse to feeling “good” or to self-care may need
you to emphasize that the purpose of these somatic resources is to regulate the
nervous system and increase well-being; they are not self-indulgent.
As your clients practice their own somatic resources or try out new ones that
are suggested in this chapter, you can increase their comfort level and receptivity to
the resources by demonstrating or “mirroring” the same movements and reporting
on your experience. For example, you may say, “Let’s try this together and see what
it’s like. When I place my hands over my heart, I get a feeling of relaxation in my
chest, and I can feel my whole body relax—it is a calming feeling. What happens
when you do this?”
As Gallese and Goldman (1998) write, “Every time we are looking at someone
performing an action, the same motor circuits that are recruited when we ourselves
perform that action are concurrently activated” (p. 495). If you are able to embody
being proud or strong by lifting the chin or lengthening the spine, your client’s body
will most often respond in kind. In addition, mirror neuron research seems to
confirm that imagining a past or future intentional action also activates the body’s
premotor neurons as if the person were preparing to make that same action (Gallese
& Goldman 1998). Even if the client is certain that he or she cannot possess a
particular capability, seeing it in someone else, visualizing it, or imagining how it
would feel in the body may provide support for developing that very resource.
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together in session, and share your experiences with them.
Similarly, the EXTERNAL SOMATIC RESOURCES worksheet offers a menu
to spark your clients’ recognition of their own external resources and help them
recognize otherwise overlooked ones they already use. As you review this
worksheet in session, you might prompt clients by providing some examples, for
instance: “Some people take warm baths, go for a run, snuggle under a warm
blanket, make a cup of hot chocolate, do yoga, and so on. I wonder what physical or
sensory things you do when you feel stressed or anxious, or to just enjoy yourself.”
This worksheet also asks clients to determine whether a resource had an energizing
or calming effect. Or, the same resource might have different effects at different
times, depending on the context.
Several worksheets teach specific resourcing actions to accomplish particular
goals that are described and illustrated in the chapter. It may be helpful for you and
your client to review together the sections in the chapter that are relevant to the
resources taught in a worksheet. The one entitled CENTERING: HAND ON
HEART/HAND ON BELLY provides a concrete, structured way of trying out a
somatic resource for regulating arousal and feeling more centered and connected to
oneself. CONNECTING WITH THE BACK OF THE BODY describes a set of
concrete, physical actions that help clients sense their backs, which often decreases
feelings of vulnerability and provides a felt sense of protection. Since so many of
our clients felt unprotected as children and still suffer from feelings of
vulnerability, this resource may be particularly valuable to them. It can be helpful
to explore the resources on these two worksheets in session, emphasizing the effect
of using a particular resource on the building blocks. When your client finds one
that is most resourcing, you can discuss together situations in which it could be
most useful.
Clients who struggle with how to contain their thoughts, emotions, or impulsive
actions will benefit from the CONTAINMENT RESOURCES worksheet.
Containment is akin to Winnicott’s (1945) concept of the “holding environment” in
which the mother literally swaddles or holds her infant’s body. Without such
containment, an infant has no one to “gather his bits together [and] starts with a
handicap in his own self-integrating task” (Winnicott, 1945, p. 150). Containment
resources can help clients tolerate the physical sensations of their thoughts,
emotions or physiological arousal without behavioral reactivity. Steele and van der
Hart (2001) caution that emotional discharge can exacerbate traumatized clients’
difficulties and this worksheet can help these clients learn to contain rather than
discharge their emotions (cf. Chapter 2 “Emotions and Animal Defense”). It
describes, encourages clients to try out, different containment exercises. Your
reminder to repeat those that are most effective between sessions will support them
in making use of the resource in their daily lives.
The worksheet on ADJUSTING SENSORY STIMULATION gives clients a
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detailed and concrete way to explore a “sensory diet”—a plan for reducing or
increasing various what sensory stimuli can be reduced or increased to help them
feel soothed or energized: for example, soft or enlivening music, earplugs,
darkened room or bright sunlight (Lande, personal communication, June 11, 2003;
Wilbarger & Wilbarger, 2002). Suggestions are offered for all five senses (taste,
sound, touch, hearing, and sight) so that clients can experiment with the potential
benefits of different kinds of sensory stimuli.
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resources) can facilitate compassionate understanding and help various parts begin
to communicate and work together more effectively. Perhaps a somatic resource
can be found that is acceptable to many dissociative parts, or parts that have one
resource that is effective may be open to sharing it with other parts, and discover
those parts that might also become more open to receiving it.
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Somatic Resources
Somatic resources reside within the body. They are the physical functions, actions,
and capacities that provide a sense of well-being and competency on a physical
level and in turn positively affect how we feel. Literally thousands of somatic
resources exist, from basic physiological functions (e.g., digestion, blood flow) to
sensory capacities (e.g., the ability to see, hear, smell, touch, and taste) to
movement capacities (e.g., the ability to walk, reach, run, push away) to self-
regulatory abilities (e.g., grounding or centering) to creative physical activities
(e.g., dancing or playing a sport). Since the movement of our bodies is inextricably
linked with our emotions, beliefs, and general sense of competency, working with
posture, movement, gesture and our senses can directly support our well-being.
You have already practiced two skills that are considered somatic resources:
orienting to new stimuli, in Chapter 6, “Pay Attention: The Orienting Response,”
and focusing your senses in Chapter 7, “Mindfulness of the Present Moment.” This
chapter expands on these somatic resources and the ones introduced as a category
in the last chapter by describing several physical actions and external sensory and
physical activities that you can try out to discover which ones are helpful for you.
We will explore in detail somatic resources of grounding, alignment, breathing, and
boundaries in chapters to come.
Somatic resources are highly individual and should be tailored specifically to
your body, according to your unique needs and goals at a particular moment in time.
What is resourcing for one person may be de-resourcing for another. For example,
one person felt better when she was still; another felt better when she was moving.
In the first case, somatic resources could include sitting still and enjoying that
feeling of motionlessness, or perhaps curling up in a fetal position to feel safe and
comforted. In the second case, somatic resources could include exploring some
kind of movement, such as walking, dancing, or a sport that felt good.
By experimenting with a variety or specific physical postures, movements,
gestures, and activities, you will discover which ones feel right for you. The
barometers to use for evaluating the efficacy of any somatic resource are noticing
how it affects your building blocks when you are using it. If a physical action or
activity helps to bring dysregulated arousal within the window of tolerance or
helps you feel good in some way, then it is resourcing. If it does not, it is not
resourcing for you at that time, and that is OK, because another action or activity
will be. It just takes experimentation to discover the somatic resources that work
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best for you.
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CENTERING RESOURCES
Centering refers to regaining a sense of being connected with ourselves when we
are distressed or “off center.” Being centered is dynamic—when we are thrown off
balance by life’s challenges, we can reconnect with the “home” inside ourselves.
Resources of all kinds facilitate centering. Somatic centering resources involve
locating and sensing the physical center of gravity in the body about 4 inches below
your waist. Your own self-touch can help you contact your center of gravity. Placing
your hands on your lower belly and bringing your mindful awareness to your hands
touching your belly is a centering resource. Some people find that other ways of
using touch are more centering for them. A war veteran found that placing one hand
over his heart and the other on his lower belly worked best for him. A woman who
felt unloved in childhood by her self-absorbed parents felt more centered when she
placed both hands over her heart. Others find that one hand over the heart and the
other on the belly works best. Using a pillow can be especially helpful for people
with trauma in their histories who become dysregulated using their own touch. It
may be more resourcing to hold a pillow against your lower belly, or your heart, or
both.
CONTAINMENT RESOURCES
Our bodies are our containers. They hold everything we experience—all our
emotions, thoughts, sensations, memories, plans, and so on. Containment resources
help us sense the actual physical container of our bodies, especially the skin and
superficial muscles. Containment resources work in two ways. They allow us to
contain feelings and arousal, helping us to regulate before expressing ourselves to
ensure that what we express is not explosive or dysregulating for us. Containment
also allows us to decide how much or how little to express of what we feel,
automatically adjusting our expression according to the responses of those around
us and our internal state.
We know that babies often calm down when they are swaddled firmly in a
blanket, and many of us seek a similar feeling of containment by hugging ourselves,
like Ann did, or wrapping ourselves up in a blanket. Jim, who often felt uneasy in
groups, as if he were “floating away,” discovered a containment resource that gave
him a feeling comparable to wrapping up in a blanket. He noticed that he had
spontaneously tightened his muscles when he was in groups. The tension literally
hardened his superficial muscles, giving him a feeling of being more compact and
less permeable. He felt that he could both “keep things out” and “keep things in.”
Practicing this resource consciously made it easier for Jim to be in groups.
Awareness of the back of the body can also provide a sense of containment and
protection for the vulnerable front part of our bodies. Jim’s therapist taught him to
press the back of his body into the back of his chair to lessen the floating away
feeling when he was in groups. Another person described that awareness of her
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back helped her slow down, sense herself, and change her pattern of overdoing.
Lonnie learned a different containment resource. In a seated position, with her feet
flat on the floor, she crossed her arms and placed each palm on the inside of the
opposite knee. The she pressed her knees hard, pushing inward against the palms of
her hands, while pushing outward with her hands. She felt her muscles tighten
throughout her body, giving her a feeling of being “solid and in control.”
MOVEMENT RESOURCES
Many people respond best to somatic resources that involve movement. A survivor
of sexual abuse discovered that stroking her own cheek comforted her; another
found herself rubbing the tops of her thighs with her hands, which helped her feel
soothed. One woman discovered that pacing back and forth when she was
overwhelmed helped her body to become calm. Being rocked is comforting to
infants and children, and we may continue to use rocking as a resource into
adulthood. One man noticed that he calmed himself down by rocking side to side
when he felt upset; another used her rocking chair, and yet another favored his
porch swing. You might discover other movements that are somatic resources for
you by noticing how you feel if you go for a walk, stretch your body in a way that
feels good, swing, sway, fidget, dance, or move in some other way.
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somatic resource; for example, you might find it soothing to sit in a darkened room
or wear earplugs to reduce auditory stimulation, or you might discover that
listening to enlivening music lessens low arousal or increases your energy.
Janet said she was a “worrier” whose anxiety often prevented her from going to
sleep. She developed external somatic resources to use before bedtime. She turned
off all the lights, lit candles, put on soothing cello music at low volume, and slowly
stretched on her sheepskin rug, enjoying its texture. These relaxing sensory
experiences quieted her nervous system so that she could fall asleep more easily.
Ben enjoyed sensing the strength in his legs, but realized his arms felt weak and
typically hung limply by his sides. He needed more active external resources to
help him feel the strength in his arms. He liked to put a big therapy ball against the
wall to push against or visit the gym where he did pull-ups and lifted weights.
When he was in a public place where these external resources were not available,
he often used the internal resource of pushing the palms of his hands together to feel
his upper body strength.
There are many other kinds of physical activities that can serve as external
somatic resources: Sports, bike riding, skateboarding, swimming, dancing, yoga,
walking, running, massage, petting your dog, cuddling a child, or working in the
garden are just a few.
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INTERNAL SOMATIC RESOURCES
Purpose: To become aware of the internal somatic resources you already use that
help you enjoy yourself, regulate your arousal, or feel good in some way.
Directions: Read the list of internal somatic resources (i.e., postures, movements,
or gestures) that you might use spontaneously below, and write in any additional
somatic resources you use in the empty boxes.
Throughout the next week be aware of whether you use any of these resources. In
the chart below, write down the resources you used throughout the week, the
circumstance and internal experience that led you to use them, and how each helped
you.
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At the end of the week, review the somatic resources you already use with your
therapist. Together you can determine how to call upon these resources in moments
when you need help to regulate your arousal, want to feel more energized or
calmer, or just want to feel better.
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EXTERNAL SOMATIC RESOURCES
Purpose: To become aware of the external somatic resources that you already use,
assess whether they are calming or energizing, determine their effectiveness, and
identify additional resource you could use the future.
Directions: Read the list of external somatic resources below, and notice which
ones you use throughout the week. Add any others that you use in the empty spaces
provided. Put a “↓” by the ones that comfort or calm you and a “↑” by the ones that
energize you. You might notice that the same resource may have a different effect at
different times. Review your list at the end of the week and answer the prompts at
the bottom.
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Floating in a pool Playing with children Bouncing on a therapy ball
Getting a pedicure or Biking Breathing fresh air
manicure
Swinging, rocking in a Lifting weights Doing yoga or stretching
rocking chair
Holding an object (a stone, Getting your hair Boating, canoeing,
a stuffed animal, squishy washed by a kayaking, water skiing
ball) hairdresser
Which other resources could you begin using that you did not use during the
week?
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Somatic Resources
CENTERING: HAND ON HEART, HAND ON B ELLY
Purpose: To explore the centering resource of placing your hands on your torso and
be mindful of the effect of your hands touching your body.
Directions: Follow the prompts to practice this somatic resource and then
complete the chart.
1. Try placing one hand on your heart and one on your lower belly. Sense the
weight of your hands on your torso, the coolness or warmth of your hands, the
movement of your breath under your hands. Take your time to notice what happens
in your body as you place your two hands over your heart and belly.
2. Mindfully experiment with other hand positions on your torso to discover
whether another position is more resourcing for you (e.g., place your hands on
different areas of your torso or place both hands over your heart or over your belly,
or press a pillow against your torso). Take your time to experience the effect of
each position. Notice the quality of the touch, the pressure, warmth or coolness, and
the feel of your breathing. Be mindful of what happens in your body as you compare
these positions to each other and to the position in # 1.
3. Identify the hand position that feels “right” and is most centering for you.
4. Mindfully practice this resource at least three times during the week when you
feel triggered or upset, and record your experience below.
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prompted resource felt triggered?
use
Boss yelled at me Heart pounding; blood Breathing slowed; heart rate
about being late to rushing in my ears; felt calmed; felt more settled and
work very still relaxed in my body
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CHAPTER 15
Somatic Resources
CONNECTING WITH THE B ACK OF THE B ODY
Purpose: To explore resources that help you become aware of the back of your
body in order to support feeling better in some way.
Directions: Try out the resources below that are designed to stimulate sensations in
and increase awareness of your back, or try another way that you think of, being
mindful of the sensations you generate as you use the resource and of the sensations
in your back after you complete each exercise. Then follow the prompts.
Touch and Press or move your back against a Move your spine,
massage your wall, the floor (lying down), or the bending forward and
back with your back of a chair. back, side to side. Try
own hands, or get an undulating motion.
a back massage.
Feel the water on Reach your fingertips toward your Slowly walk backwards
your back in the spine on your middle back, letting in a safe space outdoors
shower, or use a your hands rest on your ribs. Feel or in your home, letting
back scratcher. your ribcage moving as you your back be your
breathe. “eyes.”
3. What emotions or thoughts do you have after you connected with your back?
(e.g., I feel competent and less vulnerable. I have the thought that I can protect
myself. I feel calm.)
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4. Describe what happened in your body after you connected with your back or as
you were connecting with it. (e.g., I felt more sensation in my back, breathed
more deeply, and felt a sense of protection and strength in my back.)
5. Use the resource that felt best to you during or after a triggering situation occurs
and record what happens below.
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Somatic Resources
CONTAINMENT RESOURCES
Purpose: To explore resources that bring awareness to your skin and superficial
muscles in order to better sense your physical “container” and help you tolerate and
contain the thoughts, emotions, sensations, or memories that you experience.
Directions: Try each of the different containment resources below and describe the
effects on your thoughts, emotions, and body. You can try the ones that work best
when you are feeling dysregulated or stressed, and discover which ones are most
resourcing for you. Make a star next to any that are most useful to you and discuss
with your therapist.
Use your hands to squeeze the muscles all over your body—head, face, neck,
arms, back, hands, chest, belly, hips, arms, legs, feet. Then try tapping your body
with your fingertips. Be mindful of the sensations this produces all over the
container of your body.
Thoughts
Emotions
Body
Explore tightening the muscles all over your body, sensing how the tension
literally hardens your container. Sense the feeling of being less permeable, and
perhaps more able to keep things out, and more able to contain your emotions
and thoughts.
Thoughts
Emotions
Body
Use a loofah, washcloth, or soft brush to rub all over your skin on one side of
your body and be mindful of the sensations this activity stimulates. Then pause
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before you do the other side to notice the difference in the two sides. You might
try this resource in the shower or bath.
Thoughts
Emotions
Body
Wrap yourself up in a blanket or a shawl. You can do this in bed or while seated
in a chair. Pull the blanket or shawl as tight as feels good to you in order to
capture that feeling of being swaddled and snug.
Thoughts
Emotions
Body
In a seated position, with your feet flat on the floor, cross your arms and place
each palm on the inside of the opposite knee. Then while pressing outward with
your hands, press your knees inward against yours palms. Hold the pressure as
long as you like, then release and repeat.
Thoughts
Emotions
Body
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CHAPTER 15
Somatic Resources
ADJUSTING SENSORY STIMULATION
Purpose: To identify sensory resources that calm or energize you, and list specific
sensory stimuli that you find unpleasant or that bother you.
Directions: Think about how you intuitively use sensory stimuli and sensory
activities as resources. For each of the senses, put a “↓” next to those stimuli that
are calming for you and a “↑” next to those that are energizing. Add more stimuli
you enjoy in each category that you already use or might want to use. List the
stimuli in each category that bother you. Then write down one situation in which
you might want to use a sensory resource in that category. (e.g., I’ll put on calm
music before bed; I’ll wear an eye mask to see if I fall asleep more quickly).
Sense of Taste
Tastes you enjoy:
• Favorite foods and flavors
• Sweet: fruit, ice cream, honey, desserts
• Salty: pretzels, popcorn, soup, cheese
• Savory: meat, fish, cheese, mushrooms, fermented beans,cured meats
• Sour: lemons, yogurt, sauerkraut, pickles
• Bitter: ginger, dark cocoa, beer, tea, spinach
• Other tastes you enjoy:
List tastes that bother you:
Situation in which you could use taste as a resource:
Sense of Smell
Scents you enjoy:
• Favorite scents
• Candles, soap, perfume or cologne, or lotion
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• Food vendor or kitchen smells you love
• Smells of different seasons or weather conditions
• Flowers, leaves, or freshly cut grass
• The smell of someone you are close to
• Other smells you enjoy:
List smells that bother you:
Situation in which you could use smell as a resource:
Sense of Touch
Tactile stimulation you enjoy:
• Soft fabric, fur, or hair
• Warm baths or showers
• Massage
• Putting on lotion or sunscreen
• Scrubbing your skin
• Food textures and temperatures
• Snuggling with a person or pet
• Running your fingers through your hair
• Other textures or types of touch you enjoy:
List textures or types of touch that bother you:
Situation in which you could use touch as a resource:
Sense of Hearing
Sounds you enjoy:
• Kinds of music you like
• Loud or soft sounds
• Energizing or calming music
• Particular singers, composers, songs, or compositions
• Natural sound recordings
• Silence, wearing earplugs
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• Moving water
• Chanting, repeating a mantra
• The sound of someone's voice
• Other sounds you enjoy:
List sounds that bother you:
Situation in which you could use sound as a resource:
Sense of Sight
Sights you enjoy:
• Bright light, shade, or darkened rooms
• Candles, dawn, midday, dusk, twilight
• Sights you particularly love (e.g., sunsets, the ocean,mountains, the sky, green
hills, rivers, your partner’s eyes, a kind face, the place where you grew up)
• Favorite colors
• Other sights you enjoy:
List sights that bother you:
Situation in which you could use sight as a resource:
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Grounding Yourself
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clients need to regain the internal experience of their own internal foundational
base of support.
Clients who feel chronically stuck, heavy, hopeless, or trapped in a life of
drudgery, with little fun or lightheartedness to counter these weighty feelings will
benefit by learning about being overgrounded. Those with beliefs such as “It’s all
hopeless . . . life is hard . . . things will never get better” might find that being
overgrounded contributes to these beliefs. These clients need to experience a sense
of lightness, energy, and hopefulness through becoming appropriately grounded.
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particularly helpful for being overgrounded (Chapter 17, “Core Alignment:
Working with Posture,” and Chapter 31, “Moving through the World: How We
Walk”). As you and your overgrounded clients study this chapter, you may decide
together that some of the resources described from these future chapters would be
beneficial. In that case, moving ahead in the book to learn those resources instead
of practicing the ones in this chapter would be appropriate.
A single session of practice will not create the neural pathways and somatic
skill to support spontaneous, automatic use of grounding. To ensure that the learning
from this chapter is well integrated so that grounding becomes available to the
clients as a viable resource, it will be necessary to return to grounding exercises in
subsequent sessions. As clients express issues or distress that might be helped by
grounding, you can build on previous sessions by saying “It seemed to help last
time when we grounded. Maybe this time, we can experiment with standing up and
reinstalling a grounding resource . . . maybe that will help the flashbacks [or feeling
of being so scattered or off balance].” To support clients’ efforts at integrating any
resource, be sure to emphasize the value of practice: “Remember, it took many
repetitions to develop this habit of being ungrounded, so it will take many
repetitions to learn how to connect to the ground.” Always, the secrets to success in
teaching and integrating somatic resources is helping the client use directed
mindfulness to discover the results of using the resource and then repeating the
movements that facilitate the desired effects.
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that they identify in the worksheets as un-grounding reoccur in the future.
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avoid grounding because they are afraid to take a stand. To feel solid and strong
might feel frightening to a young part of the client that learned to be compliant or
“seen and not heard.” In this case, it may be helpful to pair this part with a
“stronger” part of the client, so that the exercise can be done cooperatively, and the
submissive part can feel inner support.
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Becoming Ungrounded
When we are shocked or alarmed, whether by sudden trauma, receiving terrible
news, or being unexpectedly rejected or criticized by important people in our lives,
our energy typically rises upward in our bodies, causing us to feel ungrounded. We
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might inhale suddenly or hold our breath, widen our eyes, raise our shoulders, or
tighten our bodies. These are common physical responses that go along with the
neuroception of threat. Right after such an experience, we can feel insecure,
reactive, and easily distracted instead of balanced and connected with ourselves.
We might find it hard to concentrate and fail to recover a sense of our own solidity.
We say colloquially that such experiences have “knocked us off our feet.” They
have ungrounded us.
Feeling ungrounded can continue after such experiences, causing us to feel off-
balance and unable to concentrate. Cindy felt scattered and prone to panic. She
attributed these symptoms to her “defectiveness,” just as she had always thought it
was her fault when her mother was emotionally reactive and abusive. Cindy said
she felt as if she never really exhaled or let herself settle or relax because she was
always on the lookout for danger. Until her therapist noticed the connection of these
symptoms to the tense muscles of Cindy’s lifted shoulders and her energy—which
was directed upward instead of settling downward toward the ground—it had
never occurred to Cindy that her symptoms reflected a childhood of having no
parent who could bring her back to earth and help her develop a solid base of
grounded support within herself.
We can also lose our grounding in other circumstances with attachment figures.
For example, as children we might be anxious for fear of disappointing our
attachment figures or doing something wrong. We might feel constantly on edge and
worried about how we can please them and meet their expectations in order to feel
safe. Our energy may become mobilized up and out, rather than settled downward.
Having learned that we must please others or avoid making mistakes, we may fail
to connect with ourselves sufficiently to develop our own base of support that
grounding provides.
Some of us have grown up in high-energy, high-achieving families, pushed
ahead faster than our developmental skills warranted. Such pressure to achieve can
promote an upward mobilization of energy in our bodies not counteracted by
grounding. Ted, who came from such a high-performance family, tried to follow in
the footsteps of his two older exceptionally successful siblings. Ted remembers his
childhood: “It was like I was always running to catch up—to prove I was as good
as they were—but I never was.” Without support or encouragement to feel his feet
under him or go at his own pace of development, Ted’s forward rush turned to
hyperactive clowning and silliness, which won him the title of “family clown” as a
substitute for the approval of his parents. Years later, his friends complained that he
was always “wired” and could never engage in a serious conversation. His
ungrounded style undermined his work, his relationships, and even his therapy.
An inability to effectively ground can adversely affect our ability to follow
through on our intentions and goals. We may find it difficult to concentrate on or to
finish a task. Perhaps we start out to do something, like answer our e-mail, but then
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discover ourselves doing something else, like surfing the Internet. We may get
distracted or find that our mind wanders. We may be so spacey or so absorbed by
the thoughts inside our head that we lose our awareness of what we are doing or
where we are in time and space. Without the support of a solid basis for our actions
that grounding provides, we may be more vulnerable to accidents like falls or
fender-benders or worse. We cannot fully experience the steadfastness, here-and-
now presence, and solid sense of self that comes with feeling grounded.
Being chronically ungrounded might be reflected physically in a restriction of
the body’s energy flow that makes it difficult to feel our legs and feet. We may
inhibit our breathing, fail to exhale fully, tighten our pelvic muscles, lock our knees,
or tense the muscles of our feet. The energy of the body can feel as if pulled
upward, which can prevent our feet from fully contacting the solidity of the ground
beneath us. We might notice that our legs and feet are cold or numb, which can
happen when tension in the body interferes with circulation, preventing blood from
flowing fully into lower extremities. Unable then to experience a solid foundation
for our bodies through our legs and feet, it can become difficult to feel grounded.
Becoming Overgrounded
If you feel heavy, entrenched, or stuck in a way that keeps you from taking action,
you might be overgrounded. In contrast to being ungrounded, it might feel as if your
feet are glued to the ground or a weight is holding you down. It might feel effortful
to lift your legs and feet to take a step. People who are overgrounded seem overly
rooted, as if their feet are pushing strongly downward without the counterbalance of
lengthening and lifting toward the sky.
Peggy remembered a childhood of drudgery and depression and told her
therapist that she felt stuck and gloomy in her current life, just like she had as a kid
growing up in poverty with no respite in sight. Peggy moved with a plodding,
sluggish gait that went along with an excessive tendency to endure tedious
situations which prevented her from having fun and welcoming change. She seemed
to get through life with willpower and perseverance, remaining in a wearisome,
uninteresting job and a lacklustre dead-end relationship. She held a dim view of the
possibility of future happiness. Peggy literally needed to “lighten up,” take action
on her own behalf, and engage her imagination in fantasizing a better, more
satisfying, and enjoyable future for herself.
Carl became overgrounded as a child burdened with the adult duties and
responsibilities of taking care of his younger siblings. His family valued hard work
and reliability and made little room for fantasy or play. His rounded muscular
shoulders and square body reflected a feeling of “carrying the world on his
shoulders.” He had difficulty saying no to requests for help from others. Although
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he was frequently praised for his responsible character and endurance, Carl
complained of having no fun and feeling that all of life was drudgery. He also
needed to lighten up and get the world off his shoulders.
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enjoyed standing on one foot and placing a small ball under his other foot that he
could press and roll around to increase the sensation in his foot. Our feet are very
sensitive, having over 200,000 nerve endings on their soles, and, as such, are
designed to help us balance and give us information about the surfaces on which we
are walking or standing. Bringing mindful attention to the sole of the foot as he
moved it around on the ball, becoming aware of the shape of his foot and the
sensation he was generating helped Ted become more grounded.
In contrast to learning to connect to the ground, learning to lengthen the spine
upward, push off with the toes of your feet, and swing your arms while walking can
bring a spring to the step to counter overgroundedness. These actions are
thoroughly explored in Chapter 17, “Core Alignment: Working with Posture,” and
Chapter 31, “Moving through the World: How We Walk.” Peggy’s therapist helped
her to notice when she was overgrounded and then to take a breath, feel her rib
cage lift, and lengthen her spine gently toward the sky. Immediately, she could feel a
slight increase in energy in her body. As she practiced this posture whenever she
felt overgrounded, she also practiced letting her feet soften on the ground,
increasing their sensitivity as she relaxed the tension. With practice, Peggy became
increasingly able to ground herself while also feeling the length of her spine and the
energy in her upper body, easing the sense of burden she experienced. Learning to
push off with the toes of her feet as she walked also helped her feel lighter and
have more energy. Peggy explored movement in general—walking, running,
jumping, skipping, jumping, dancing—and found that all these different forms of
motion counteracted her overgrounding and helped her feel more lighthearted and
light in her body.
Carl first explored pushing his rounded-over shoulders and arms back and
saying “no” to counter the excessive responsibility he had taken on to please his
earliest caregivers (a resource as described in Chapter 19, “A Somatic Sense of
Boundaries” and Chapter 25, “Restoring Empowering Actions”). He then explored
massaging his feet with mindful attention to the sensations produced by the touch.
Massage relaxed the tension in his feet and increased sensation, both of which
helped Carl better sense the ground beneath him and the pull of gravity holding him
to the earth. Through his touch and awareness, his feet became more sensitive and
he enjoyed the feeling of walking more lightly rather than heavily. He learned to
elongate his spine, pushing gently upward with his head and lengthening his neck
while sensing his feet on the ground.
Learning physical grounding skills will help you manage and regulate your
emotions as well as help you feel more relaxed and secure in yourself. The
following worksheets are designed to help you reconnect with your legs and feet,
direct your energy downward into the earth, and draw on the support and security
that grounding affords. They are designed primarily as resources for being
ungrounded. However, like Peggy and Carl, you might find that increasing the
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sensitivity in your legs and feet from working with some of these exercises can help
you lighten your step if you are overgrounded.
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GROUNDING RESOURCES, P ART 1
Purpose: To practice grounding resources and discover ones that best help you to
sense a connection with the ground.
Directions: Follow the prompts below to discover what changes you notice after
you try out the two grounding resources. Then use these resources when you feel
ungrounded.
1. Before: Be mindful of your thoughts, emotions, and body and write down your
experience of the building blocks below.
Thoughts
Emotions
Body
3. After: Write down the differences you notice in your body, emotions, and
thoughts in the boxes below.
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Thoughts
Emotions
Body
1. Before: Be mindful of your thoughts, emotions, and body and write down your
experience of the building blocks below.
Thoughts
Emotions
Body
3. After: Write down the differences you notice in your body, emotions, and
thoughts in the boxes below.
Thoughts
Emotions
Body
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GROUNDING RESOURCES, P ART 2
Purpose: To practice grounding resources and discover ones that best help you to
sense a connection with the ground.
Directions: Follow the prompts below to discover what changes you notice after
you try out the two grounding resources. Then use these resources when you feel
ungrounded.
1. Before: Be mindful of your thoughts, emotions, and body and write down your
experience of the building blocks below.
Thoughts
Emotions
Body
Thoughts
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Emotions
Body
1. Before: Be mindful of your thoughts, emotions, and body and write down your
experience of the building blocks below.
Thoughts
Emotions
Body
Thoughts
Emotions
Body
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Grounding Yourself
GROUNDING RESOURCES, P ART 3
Purpose: To practice grounding resources and discover ones that best help you to
sense a connection with the ground.
Directions: Follow the prompts below to discover what changes you notice after
you try out the two grounding resources. Then use these resources when you feel
ungrounded.
Sit Bones
1. Before: Be mindful of your thoughts, emotions, and body and write down your
experience of the building blocks below.
Thoughts
Emotions
Body
3. After: Write down the differences you notice in your body, emotions, and
thoughts in the boxes below.
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Thoughts
Emotions
Body
1. Before: Be mindful of your thoughts, emotions, and body and write down your
experience of the building blocks below.
Thoughts
Emotions
Body
2. Practice inhaling and exhaling to ground yourself.
• Sit tall or stand up straight in a comfortable position.
• Breath naturally and notice your breath. Sense the soles of your feet.
• Then as you breathe in, imagine that you can draw your breath upward through
the soles of your feet.
• As you breathe out, imagine sending your breath down your body, through your
pelvis, legs and feet and into the ground.
• Imagine that your breath wraps around roots and rocks that are deep in the earth
as you exhale.
• Repeat this breathing as often as you like, slowly inhaling the breath upward and
exhaling downward through the bottom of your feet.
3. After: Write down the differences you notice in your body, emotions, and
thoughts in the boxes below.
Thoughts
Emotions
Body
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WHEN YOU F ELT UNGROUNDED
Purpose: To identify a situation that caused you to lose your ground, describe how
you responded, and plan ahead to use a grounding resource the next time you
experience a similar situation.
Directions: Think about a situation in which you felt ungrounded. Take your time to
remember it, and be mindful of your internal experience. Then, answer the prompts
below.
1. Describe what happened that made you feel ungrounded.
(e.g., I briefly lost track of my 4-year-old in a store; I discovered my car was
broken into; I saw a man who reminded me of the man who abused me; my
husband was late to a special dinner I prepared; people laughed at me when I
tried to play drums.)
2. Describe your arousal level in that situation (e.g., high or hyperaroused; low or
hypoaroused).
3. How do you feel in your body as you remember? (e.g., Tense, numb, spaced out,
jittery, pulling away, head down, fragmented, or something else.)
4. What emotions do you feel?
5. What thoughts do you have?
6. Describe a grounding resource you could use to help you regulate your arousal.
7. Imagine the same situation, using your grounding resource.
8. Describe how your experience of the situations might have been different if you
had used this grounding resource.
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Thoughts Emotions Arousal Sensation and Movements
9. Identify three situations that you might face in the future in which this grounding
resource could be helpful.
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Grounding Yourself
REGULATING AROUSAL WITH GROUNDING RESOURCES
Purpose: To explore grounding resources that can be used to regulate your arousal
when it is high or hyperaroused and when it is low or hypoaroused.
Directions: Follow the prompts below to assess when your arousal begins to
increase or decrease so that you can use a grounding resource before it rises above
or falls below the edges of your window of tolerance.
AROUSAL
Hyperarousal
High Arousal
Low Arousal
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Hypoarousal
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CHAPTER 17
Core Alignment
Working with Posture
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lightness and energy can be supported as they learn to lengthen their spines.
The use of this chapter is dependent upon being able to capture your clients’
interest and even enthusiasm to explore their posture. Your ability to confidently
demonstrate a collapsed posture, a rigid posture, and an aligned posture, and to
work collaboratively with them on posture in a standing position will help them
feel comfortable. If you find yourself feeling uncomfortable with the exercises
described in this chapter, it would be helpful to explore your own posture prior to
working with your clients’ posture.
You can explore a posture assessment exercise collaboratively with your
clients to evaluate their alignment (“Secret of,” 1998). The assessment will work
best if you do it together with them, after trying it out yourself to become familiar
with the exercise and evaluate your own alignment. Stand with your backs against
the wall, your heels about 3 inches from the wall, and each place one hand behind
the low back with the palm against the wall, and the other hand around the back of
the neck. If your client can move his or her hands more than an inch or so in the
space between the wall and the body, this chapter will be particularly helpful. If
your own posture is out of alignment, sharing your own discoveries with your
clients as you perform the assessment with them will help them feel more
comfortable with this exercise.
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for your client, instead of looking in the mirror, the client can choose a drawing
from the first two worksheets that is closest to his or her natural posture and then
reference that drawing to follow the directions on the worksheet.
EXERCISES FOR POSTURE & ALIGNMENT affords clients an opportunity
to explore some simple exercises to increase alignment and compare the results to
their natural posture. As you and your client try these exercises together in session,
you can model mindfulness by sharing what you notice internally, and also point out
changes you see in your client, saying things like, “When you bring your shoulder
blades back and down, it looks like your neck lengthens. Do you feel that, too?”
ENGAGING YOUR TVA MUSCLE also teaches simple, practical somatic
resources that increase awareness of the support that the transverse abdominal
muscle, or TVA, provides for the core (Bond, 2007). The benefit of this exercise
can be increased if you contact the changes in the client that you notice, such as
“When you engage your TVA, it seems like your spine lengthens.”
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dissociative disorders who have difficulty tracking their internal states. In
Sensorimotor Psychotherapy, we try to facilitate clients to mindfully notice the
effects of an experiment. Some dissociative-disordered clients need quiet time to
notice the effects of the experiment without your making any sort of comment or
interpretation. For others, your mindfulness questions will help them gradually
develop the ability to notice their own responses and discover how various
dissociative parts respond to a change in posture. As always, be careful not to
force or rush the pacing with any client, especially with this client group. Rather
than encouraging them to take bigger steps or to repeat a movement when they are
triggered by it, slow the pace, take a few steps back to find an experiment that is not
so triggering. You can perhaps demonstrate the movement again to shift the focus
away from them and onto you, or ask clients to notice how their bodies are
communicating that the experiment is triggering, or if they notice how different parts
are triggered. In all cases, exploring alignment resources in ways that are tolerable
for various parts of the client will be more effective than overriding a part that is
frightened of, or very uncomfortable with, alignment.
Dissociative parts fixed in a shutdown or submissive defense or parts that are
very young and vulnerable will typically have a collapsed posture and might need
the support of both the therapist and of a more resourced part of themselves. It is
important whenever possible to have all parts of the client experience the
movement, even if only by observing it, to realize that it is not dangerous in the
present moment. Alignment exercises can be done with the cooperation of different
internal parts, for example, so that a collapsed part might feel the inner support of a
stronger or more resourced part. A part fixed in a “fight” defense might have a rigid
posture and feel threatened at the prospect of relinquishing the rigidity to foster
alignment. This part might be encouraged to watch a trusted other part being able to
relax the rigidity of the posture and see that there is no danger. You can reassure a
fight part that danger can still be neurocepted when necessary. An adult part of the
client should be encouraged to be present at all times to promote integration and
communication among parts as you explore alignment resources.
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CHAPTER 17
How we hold our bodies is rich with meaning, conveying to others our mood in the
moment and providing hints as to how we feel about ourselves and the beliefs we
hold. When we sit or stand slumped, upper back bowed, shoulders rounded, and
head forward, we might appear detached, frightened, insecure, or compliant.
Colloquialisms about being “spineless” or having “no backbone” testify that a
collapse in the spine is associated with shame, low self-esteem, or difficulty with
self-assertion. In contrast, when we have a rigid, tense “military” posture, with
head and shoulders pulled back, knees locked, and muscles tense, we might appear
arrogant, intimidating, adversarial, or inflexible. Terms such as unbendable or
“puffed up with pride” describe a rigidly held spine and a core of the body
characterized by inflexibility. But when we sit or stand tall yet relaxed, with our
shoulders open and our chins level, we appear more focused, confident, and
receptive.
Our posture is dependent on the core of the body–the spine and surrounding
muscles. A strong but flexible core and aligned posture stabilizes us both
emotionally and physically while also supporting our actions. The spine underpins
our movement throughout the day in a dynamic process that adjusts to the variety of
our activities. We need both stability and flexibility in our core to support us,
physically and psychologically. This chapter focuses on how posture develops, the
possible meanings of different postures, and how to increase the vertical alignment
of the spine.
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walking. These curves act like a spring to absorb shock, maintain balance, support
the movement of the spinal column, and hold the body upright. If the curves become
either too straight or too curved, added physical stress is placed on the body, and
the adaptive functioning of the spine is compromised. Figure 17.1 shows the three
spinal curves.
Trauma and other emotionally painful events take their toll on our posture,
especially if we had little or no support from others to deal with them. Closed
postures, where the body is slumped forward or curled inward, protect the parts of
the body that are most vulnerable—the abdomen, throat, and genitals. Animals,
including humans, instinctively curve their spines to protect these areas in
threatening situations. A spine that sags and collapses might also serve to avoid
threatening people who might hurt us or helping us keep ourselves small so that we
are not noticed in negative ways. In some environments, the spine may become
rigid and tense in a “chin up, chest out, shoulders back, stomach in” stance in an
effort to appear invulnerable or to keep fear and other difficult emotions at bay.
Our posture also develops as a result of the expectations of our attachment
figures and other people in our environment. If our parents, or later a coach, wanted
us to be strong rather than needy, our spine might also become rigid. If appearing
weak or needy received the attention we required for support and contact, we might
slump. If our hearts have been hurt and we need to protect them, we might curve our
shoulders inward. If our environments are hurtful to us, emotionally or physically,
these postural adaptations may become chronic.
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FIGURE 17.1 The Curves of the Spine
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Good Posture
An aligned posture lies somewhere between the two extremes of a collapsed spine
and a rigid spine. Good posture varies a bit from person to person, depending on
the physical makeup. But in general the shoulders are relaxed and drawn
downward, the head reaches toward the sky and sits centered over the shoulders,
the chest rests over the lower half of the body, the torso is stacked above the pelvis,
not leaning backward or forward, and the legs and feet are under the body. Good
posture can be seen from the side as a line that passes through the curves to go
straight through the ear, shoulder, hip, knee, and ankle. When these points are in a
line perpendicular to the ground, each segment of the body supports the one above,
and the body is in balance with gravity. Often this imaginary line is jagged as parts
of the body are displaced from optimal alignment. Some bodies are bowed
forward, others are bent backward, the head may jut forward, or the pelvis may be
retracted. When the body is out of alignment, we use more muscular tension to hold
ourselves upright. The more the body is aligned, the less muscular effort is needed
to hold ourselves up.
An aligned core is dependent on the grounding we learned in the previous
chapter. You can try a grounding exercise when you are sitting in a chair by placing
both feet on the floor with your thighs parallel and gently pressing your feet into the
floor. Can you sense how this action not only connects you to your legs and to the
ground but also lengthens your spine?
If your spine is rigid, learning not to depend on scaffolding your core through
muscle tension can be useful. If your spine is bent forward, slumped, or flexed,
working with increasing vertical alignment and strengthening core muscles can be
useful. And if you are overgrounded, lengthening your spine will be a good
resource for you, as described in Chapter 16, “Grounding Yourself.”
It is important to encourage your alignment without using too much muscular
compensation, because that could lead to more effort and another set of postural
distortions. Simply lifting up the spine and holding it upright with muscular tension
and force can make things worse. Instead, you might experiment with very gently
extending the crown of your head upward toward the sky, being sure to keep your
chin parallel to the floor. If you are standing, try pushing downward with your feet
as you push upward with your head to help you develop vertical alignment.
Imagining being lifted upward by the crown of your head, while your feet stay
planted firmly, can also allow the spine to straighten and the chest to lift without
undue tension. This posture may feel awkward initially if you are strongly out of
alignment, but with gentle practice and a feeling of “allowing” the spine to lengthen
rather than forcing it, a more aligned posture will become increasingly comfortable.
Always be sure that these exercises are not painful in any way; if they are, you
should stop.
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Activating core muscles will also improve our posture. The broad, horizontal
sheet of muscle that wraps around the abdomen is a primary muscle for supporting
the core. Called the transverse abdominal, or TVA for short, this important muscle
gently squeezes the abdomen, supports the lower back and organs, and stabilizes
the spine. In a balanced, well-functioning, and pain-free body, the TVA contracts
automatically to stabilize the body before the arms and legs are engaged. Healthy
muscle tone in the TVA, neither too tight nor too lax, often fails to develop for many
of us. Because we use the muscles of our shoulders, back, and neck when the TVA
is not strong, you may experience tension or discomfort in these areas. Working
with the TVA so that it can fulfill its function as a primary core stabilizer can
sometimes help decrease the misplaced tension in these other parts of your body,
alleviating some stress and leaving you feeling stronger. We need the core support
of the TVA especially when we are challenged, when we feel like giving up, or
when we are triggered by reminders of the past. Since the TVA is a primary
stabilizing muscle, the goal is to teach your TVA to sustain a low level of tension so
that your core is consistently supported and stabilized.
We can learn to increase our awareness of the core of our bodies and vitalize
its strength, and in doing so, we may find our spines becoming less collapsed or
less dependent upon tension and rigidity. An enlivened core supports an internal
locus of control—a sense that we are guided into action from the inside rather than
controlled by outside pressures. Becoming aware of the physical core and
exploring an aligned posture are important steps to finding that literal home inside
ourselves where we feel secure in our core. Through the worksheets accompanying
this chapter, you can learn about your own posture and explore resources to support
your physical core to be strong, relaxed, and aligned.
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Core Alignment
CORE ALIGNMENT AND P OSTURE, P ART 1
Purpose: To explore various postures and contrast the emotional and physical
effects of each posture, what message might be conveyed by each one, and which
ones feel familiar or unfamiliar to you.
Directions: Study the postures below and then experiment with imitating each of
them, noticing the differences. Then imitate each posture one at a time, and answer
the questions in the space provided.
Posture #1
In this posture, the shoulders are rounded forward, the head and neck are
forward, and the weight is on the ball of the foot.
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Posture #2
In this posture, the knees are locked, the belly protrudes, the upper body leans
back, the head comes forward, and each part of the body seems to be at an
opposing angle.
Posture #3
In this posture, the tail bone is tucked under, the pelvis tilted, the low back
flattened out, the knees are slightly bent, and the weight is toward the back of
the foot.
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What message might be conveyed by this posture?
Posture #4
In this posture, the weight is on the heels, the chest is collapsed, the head
comes forward and the arms hang limply.
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CORE ALIGNMENT AND P OSTURE, P ART 2
Purpose: To explore various postures and contrast the emotional and physical
effects of each posture, what message might be conveyed by each one, and which
ones feel familiar or unfamiliar to you.
Directions: Study the postures below and then experiment with imitating each of
them, noticing the differences. Then imitate each posture one at a time, and answer
the questions in the space provided.
Posture #5
In this posture, the chest and the spine are collapsed, the knees are locked, the
belly protrudes, the shoulders slump and the head droops a little.
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Posture #6
In this posture, the chest is pushed out, the breastbone is lifted upward, the
shoulders are held back, the chin is up, the spine is rigid, and the whole body is
at attention.
Posture #7
In this posture, the muscles in the shoulders and neck are tense, pulling the
shoulders forward and up, the neck and head are pulled into the shoulders, and
the knees are locked.
How does your body feel?
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Does this posture feel familiar or remind you of anything?
Reflect on what you learned from these two worksheets on core alignment about
your own posture and describe below.
What insight did you gain about another person you know whose posture is similar
to one of these on the worksheets.
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Core Alignment
DISCOVERING YOUR CURRENT P OSTURE
Purpose: To discover qualities of your own posture and the message your posture
might convey.
Directions: Stand as you would naturally and look in a mirror at your posture from
the front and then the side, or have someone take front and side view pictures of
you standing that you can look at.
1. Circle all of the descriptions below that apply to your posture, writing other
postural elements you notice in the empty boxes, and then follow the rest of the
prompts.
2. Read the prompts in the boxes below, then exaggerate the elements of your
posture that you circled: If your head comes forward a bit, bring it forward a little
more. If your shoulders slump, slump them a little more. Stay in this exaggerated
posture for a few minutes reflecting on the questions below. Then answer the
questions.
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How does your body feel?
What message does your posture convey to you about yourself? What message
might it convey to others?
3. Are the messages conveyed by your posture the ones you want to communicate?
If not, what postural changes might help to communicate a different message?
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Core Alignment
EXERCISES FOR P OSTURE & ALIGNMENT
Purpose: To experiment with exercises that can support alignment and contrast a
more aligned posture with your typical posture.
Directions: Follow the prompts below to practice exercises that support aligned
posture.
1. Shoulder roll:
• Shrug your shoulders up to your ears.
• Press your shoulders back and your shoulder blades together.
• Then slide your shoulder blades down your back.
• Do this a few times and notice how it affects your posture.
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3. Contrast the more aligned posture you experienced in the exercises above with
your normal or familiar posture—go back and forth between them a few times.
Describe the difference below.
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ENGAGING YOUR TVA MUSCLE
Purpose: To become aware of your transverse abdominal muscle, or TVA, the
deep, flat muscle along the front and sides of your abdomen, and begin to strengthen
it in order to help stabilize your core and support an aligned posture.
Directions: Experiment with the two exercises below, following the prompts, and
report your findings at the bottom.
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gentle and subtle. Try to relax the superficial abdominal muscles and sense the
deeper TVA muscle instead.
After practicing, describe your experience of sensing and strengthening your TVA.
Include how your posture changes and how you feel about yourself. Don’t be
concerned if you do not feel a difference right away. Practicing this exercise will
support a more aligned posture over time.
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who need to appear tough and invincible may inflate their chests with an inhalation,
but fail to exhale or “let go” fully. This chapter supports all these clients to identify
their breathing habit and explore alternatives.
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different ways of breathing.
You might directly propose experimenting with changes in breathing by
suggesting: “I wonder if we could address this difficulty just by playing with how
you are breathing now and if the depression [anxiety, anger, loss of energy] changes
with different kinds of breathing.” Once you and your clients have identified a new,
more resourcing way to breathe and have practiced it in previous sessions, then
their presenting issues at subsequent appointments can be used as a context for
further practice of these new skills. You can frame moments of emotional stress and
dysregulation as opportunities to experiment with a new breathing resource,
suggesting to your client, for example, “Let’s try out that new belly breathing that
was so calming for you in the last session and see how it affects your level of stress
today.”
As stated in previous chapters, how you engage somatic resources yourself will
impact your clients, due to mirror neurons (Gallese & Goldman, 1998). Your
clients will unconsciously notice the movement of your breath, and a similar way of
breathing may be stimulated in them. You might experiment with changing your
breathing and notice if your client’s breathing changes. For example, if your client
is agitated, you might slow your own breathing or sigh audibly. Your deeper, calmer
breath may regulate your client.
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to them, describe the breathing pattern that felt good, and then consider when they
could use that way of breathing as a resource. REGULATING YOUR AROUSAL
OR MOOD WITH YOUR BREATH encourages clients to track their breath during
their daily life and notice times when their breathing is affected by triggers, and
then experiment with practicing a way of breathing that is resourcing or feels good
physically. The worksheet can be used in session to support clients to recall a time
when their breathing did not feel good, and demonstrate that way of breathing for
you. Your encouragement to explore the impact of a negative experience on
breathing and then discover the effects of a different way of breathing, rather than
focusing just on achieving a particular result, will help clients stay curious even
when they may not experience the immediate gratification of success.
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sympathetic arousal to create a decreased need for oxygen. It can be an effective
way to help a client calm down or stop dissociating (Kathy Steele, personal
communication, June 20, 2013). Once the client is calmer, a focus on breathing can
perhaps commence cautiously.
It usually is best to use experiments that minimally challenge the existing habits
of breathing, or use your own breath to slow down the level of activation or to
increase the energy before trying out more advanced techniques. By exploring
specific breathing experiments to discover what is regulating for each client and his
or her parts and taking very small steps (e.g., “Let’s try half a sip of breath”),
dysregulated and dissociative clients may be able to make good use of breath as a
resource.
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Breathing is critical to life. We can go without food, water, or sleep for fairly long
periods of time, but we cannot go without air for more than a few minutes.
Breathing happens automatically every moment of our lives, typically about 12–22
times per minute. By moving air in and out of our lungs, essential fuel is delivered
to places in the body that need it, and chemical excesses and wastes are removed.
Every cell in the body requires oxygen to convert nutrients into useable energy.
When we inhale, we take in oxygen, without which we cannot move, metabolize, or
transform food into energy. When we exhale, we breathe out carbon dioxide, which
can poison us if it builds up in the bloodstream. Our ability to balance these gasses
automatically is another example of the body’s miraculous wisdom. Our breathing
automatically responds to metabolic needs and continually regulates our energy and
arousal. We breathe faster and harder under exertion, slower and deeper during
relaxation.
Exceptional experiences, magnificent performances, or glorious vistas “take
our breath away.” We pause to fully take them in. Trauma and other distressing
events, too, leaves us breathless, but not in a positive way. When we experience a
threat in the form of shock or even disapproval, ridicule, or the like from our
attachment figures, we often curtail our breathing, hold our bodies still, and may
have trouble “catching our breath” after the situation has passed. We might live
with a legacy of poor breathing habits, such as shallow breathing or chronic
holding of the breath. We may over- or underbreathe, failing to balance inhalation
and exhalation adequately. Our rate of breathing may be too fast or too slow, or our
breathing muscles may be too constricted or too flaccid to promote healthy
breathing.
Although different ways of breathing are appropriate in different circumstances,
we are healthier, tend to live longer, and feel better all around when we are
generally able to breathe in a full and balanced way. We can learn to counteract
limiting patterns of breathing and maximize what our breath can do for us as a
resource. In this chapter you will learn about the mechanics of breathing, discover
your own breathing patterns, and explore some basic breathing exercises that might
help you center yourself and upregulate (increase your arousal) or downregulate
(decrease your arousal) when you wish.
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Breathing Mechanics
Breathing involves inhalation and exhalation, which you can notice right now just
by turning your attention to your breath. You inhale through nasal passages that
filter, cleanse, and moisten the air, which then proceeds down your windpipe into
your lungs. Inhaling is caused primarily by the contraction of the diaphragm, the
flat, pancake-like muscle that attaches to the lower ribs, spine, and breastbone,
separating the chest from the abdomen. Perhaps you can sense that the domed
diaphragm muscle flattens out as it contracts with your inhalation, causing your
abdomen to protrude and your lungs to expand downward. Figures 18.1 and 18.2
illustrate how the diaphragm changes with the breath. The muscles between your
ribs also contract as you inhale, lifting your ribs upward, expanding your chest, and
further increasing the volume of your chest cavity. Pause for a moment and take a
deep breath, letting your belly inflate as the dome of your diaphragm contracts and
flattens out. Do you sense your ribs lifting upward, your chest cavity expanding?
FIGURE 18.1
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FIGURE 18.2
Inside your lungs, there are tubes, called bronchi, which branch out like a tree
into smaller tubes with little sacs on their ends. These sacs transfer the oxygen from
the air you breathe into your bloodstream. They also take in the by-product of
metabolization, carbon dioxide, from the bloodstream, which then travels up
through your lungs and windpipe as you exhale. Can you notice the effort required
as you inhale and contract your diaphragm and muscles between your ribs to take in
air? When we inhale, our sympathetic nervous system, which is responsible for
exertion and increasing arousal, is slightly activated. With each inhale we are a bit
more energized. Exhaling takes less effort and usually no contraction, activating the
parasympathetic nervous system, which is responsible for relaxation. Of course, if
we are exercising or otherwise need to breathe hard, we do need to contract
muscles to exhale. But in normal circumstances, with every exhalation we
experience a letting go rather than a contraction, and a subtle increase of rest and
calm.
Perhaps you can sense that when you exhale, your diaphragm and the muscles
between your ribs simply relax and the volume of your lungs diminishes as they
return to their resting state. Simultaneously, your chest cavity decreases in volume,
increasing the air pressure in your lungs to force the air out. But our lungs never
completely deflate on an exhalation—there is always air left over. Take a deep
breath again, sensing the increased volume in your torso as your lungs expand with
your inhalation. Then just relax and feel the air being pushed out as you exhale,
with no effort. Can you sense a tiny moment of rest in the brief pause before the next
inhale?
Our breathing is controlled automatically by specialized centers in the brain
that regulate the depth and rate of the breathing in relation to our body’s needs. If
we are exercising vigorously, the carbon dioxide level in our blood increases
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because we are metabolizing faster, and we automatically increase our respiration
rate. Although overall we are taking in more oxygen the faster we breathe due to the
increased rate, we take in less on each inhalation. The faster we breathe, the more
carbon dioxide we exhale. When we are at rest, the carbon dioxide level is lower
because our metabolism is slower, so our rate of breathing is also lower. Although
at times the need for oxygen is paramount, it is often the buildup of potentially
poisonous carbon dioxide in our blood that provokes the need to breathe faster,
because our bodies strive to get rid of the carbon dioxide by breathing more
rapidly. However, breathing is affected not only by our physiological state (the
need for oxygen or to discharge carbon dioxide) but also by our emotions.
Amazement may cause us to gasp in wonder, anger may cause jerky breathing, fear
may stop our breath, and deep sadness may cause a choking breath.
Breathing is one of the few bodily functions that can be conscious and voluntary
or unconscious and involuntary. We can decide to hold our breath or to take deep
belly breaths. However, we cannot voluntarily stop our breathing for very long
because our breathing reflex will be triggered. Once the carbon dioxide builds up
in the bloodstream and oxygen drops to a certain level, we experience an
overwhelming urge to inhale. Without this reflex, our oxygen level could become
dangerously low very quickly, leading to brain damage or even death, and the
carbon dioxide levels could become dangerously high. If we try to hold our breath,
the breathing reflex is typically triggered so that we automatically begin breathing
again before we completely lose consciousness.
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or anger management issues, breathing exercises should be used cautiously. Since
changing your breathing alters blood sugar levels, caution is advised if you have
diabetes as well. In any case we recommend a conservative approach to
experimenting with breath so that any breathing exercises are done carefully with
the guidance of your therapist.
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taking little sips of breath and allowing a longer exhalation, which proved to be
calming and regulating for her.
On the other hand, Sayid felt apathetic about life and cut-off from himself. He
wanted to get more in touch with his emotions. In therapy, Sayid discovered an
overall pattern of tense, shallow breathing that increased when he began to
experience his emotions. He realized that breathing shallowly kept his emotions at
bay. With his therapist, he explored taking deeper breaths to help him connect with
his emotions instead of inhibit them. Gradually, with practice, he developed a new
breathing pattern that increased his connection with himself and his emotions.
Generally, emphasizing the inhalation increases arousal slightly and gives us a
little more energy, whereas emphasizing the exhalation decreases arousal slightly
and supports relaxation. If you tend toward low energy or hypoarousal, you can
notice what happens if you experiment with a longer inhalation and shorter
exhalation. Brie sighed deeply with each exhale, which reflected and even
strengthened the feelings of hopelessness that she so often felt. Learning to make her
inhale as long as her exhale helped her feel more vitality and lessened her
depression. If you tend toward being excited, anxious, or hyperaroused, see if you
feel more relaxed if you spend a few minutes emphasizing a long, slow exhalation.
This awareness of how your breath can support more arousal (sympathetic nervous
system) or relaxation (parasympathetic nervous system) can be useful for increasing
the width of your window of tolerance.
The worksheets that follow will help you first discover your own breathing
patterns, as you observe your breath objectively without trying to change it or
evaluate it as “right” or “wrong.” Like Annie, Ted, Sayid, and Brie you can decide
to pay more attention to how you breathe so that you can use your breath mindfully
as a resource to help you regulate your arousal or experience your emotions more
deeply. Remember to listen to your body’s responses and never push yourself when
experimenting with breathing exercises.
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2. Try taking tiny sips of breath. Notice what happens—does this way of breathing
feel resourcing to you or not? Describe your experience.
3. Sitting or lying down, place your hands on your belly. As you inhale, let your
belly push out against your hands. Maybe you can sense your ribs lifting upward
and your chest cavity expanding with each inhale. Describe your experience.
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4. Place your hands on the sides of your ribcage, with your fingers reaching
around the front of your body. As you inhale, see try to sense your hands moving
apart, and as you exhale, sense your hands coming closer together. Describe your
experience.
5. How do you feel when you emphasize your inhale, letting it be a little bit
longer than your exhale? Try it for a few minutes. Is your arousal affected? What
do you experience?
6. As you exhale, imagine just letting the air fall out of the body without effort,
allowing gravity to do the work. Try it for a few minutes, allowing your exhale to
be a little bit longer than your inhale. Is your arousal affected? What do you
experience?
7. Which way of breathing feels natural to you? Which feels good or resourcing?
Which way of breathing might you use in the future as a resource to alter your
arousal or mood?
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1. Describe the moments, situations, or people you were with when your breathing
felt good to you, and what felt good about the way you were breathing. (e.g., I
noticed I took long, deep breaths as I was snuggling with my wife before I fell
asleep; when I was sitting out on my deck in the sun with a cup of coffee, my
breathing felt full and steady; when I was working out, I took deep breaths that
expanded my chest.)
2. What did you feel in your body? Did your emotions or thoughts change? What
was the effect of breathing in this way? (e.g., When I was working out, I felt a
strength in my body, felt my ribs expand in the back of my body. I felt
energized and alert. Emotionally, I felt good and I had thoughts that I was
doing something good for myself.)
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3. When might you use this way of breathing as resource in the future? (e.g., When I
get anxious, I can try taking deep, full breaths instead of short, shallow ones,
and I can be aware of my ribs expanding in the back of my body.)
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Hyperaroused
Hypoaroused
3. How did your breathing relate to your arousal? Was your arousal high, or
hyperaroused, or low, or hypoaroused?
4. For a moment, try on the way of breathing that did not feel good and write down
the effects.
5. Describe a different way of breathing you could use as a resource.
6. Try on the different way of breathing. Describe the effect here.
7. In what situations, or with which people, might you want to remember to use the
different way of breathing?
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This chapter will aid clients who have difficulty protecting themselves, are
repeatedly victimized or taken advantage of, expend more than they can afford
financially or emotionally, cannot set limits, or feel violated or put upon in their
relationships. Some may be unable to discern their preferences for physical
closeness with or distance from, another person, or may engage in physical
intimacy (e.g., hugging, sexual contact) when they would rather not. Others may
have insufficient internal boundaries. They might feel assaulted by the criticism or
feelings of others, unable to screen out the emotions of others, experience other
people as “making” them feel ashamed, sad or angry; or be unable to tolerate others
having different opinions or feelings from their own. Issues of enmeshment or
mistrust in relationships often reflect underlying boundary problems, as well as
tendencies to avoid or distance oneself from others. Some clients may only know
how to set boundaries aggressively, and they will benefit from differentiating
signals that indicate to them that they need a boundary from signals that indicate a
need for aggression.
Clients with boundary issues that emerge in the therapeutic relationship will
also benefit from this material. Some may want to disclose too much personal
information too quickly before sufficient trust has been established, and then react
by becoming withdrawn, clingy, or distrustful. Others might reveal less than you
need in order to understand their internal world. Some clients may test or intrude
upon your boundaries by asking for personal information such as your home
telephone number or challenging the treatment frame or even your competence.
Your own boundaries may feel threatening, unwelcoming or too permeable to your
clients. This chapter provides a jumping-off point to explore these issues.
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like a doormat,” or “People always expect me to do things for them”; by their body
—such as a slump in the posture that goes along with “I can’t say ‘No’”; or by their
tendency to be “too close” to others or override their own needs to take care of
others.
Clients will benefit from your asking them to report the physical signs of their
needs for boundaries or their lack of ability to set a boundary. For example, when a
client says, “I feel invaded,” you can ask what internal bodily signals tell them they
feel invaded. Often, they will report an impulse to pull back, withdraw, or
constrict. Sometimes they might report feeling too open. You can help them
understand that such signals are their body’s communications that signal a need for
a boundary and then use some of the exercises described in the chapter and the
worksheets to explore physical boundary actions that mitigate the sense of feeling
invaded.
Consistently providing choices for clients and reinforcing their ability and right
to choose is useful for integrating this material. You can directly support the
possibility of setting a boundary in session by saying, “You don’t have to divulge
anything you don’t want to” or “It’s fine if you don’t want to ‘go there’ right now—
it’s up to you.” You might ask questions such as, “What feels right to you?” and
“What sensations in your body tell you that that feels right?” The question “How do
you know?” will help clients tune into these bodily signals. For example, when
clients reject a suggestion of yours, saying, “I don’t want to work on that,” you
might acknowledge their boundary by responding with a something like, “That’s
great that you know! I wonder how you know you don’t want to work on that? Does
your body tighten up, or does your breathing change? Your body must give you
some signal that it’s not the right time.” Statements and questions such as these
convey respect for boundaries and help clients attune to their bodily signals.
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identify when their physical distance, energetic, or contact boundaries have been
violated, to pinpoint their somatic reactions, and to reflect on how they handled
these boundary violations. This will be especially helpful for clients who have
learned to ignore violations and their own internal signals. This worksheet lists a
variety of boundary violations, and thus can be evocative and triggering for those
who have experienced trauma, so it is usually best completed in session where you
can help them regulate as needed. INTERNAL BOUNDARIES helps clients
identify their bodily reactions to remembering a conflict in which a person close to
them had a different feeling or opinion from theirs. This worksheet sparks insights
into inadequate internal boundaries, and forecasts what might be different if internal
boundaries were clear and strong.
VERBAL AND NONVERBAL BOUNDARIES explores the difference
between saying “yes” and “no” with words and with the body. It can be especially
helpful if clients’ verbal messages are incongruent with their nonverbal ones
because this worksheet helps them develop congruence between the two. For
clients who find it challenging to tune into a somatic sense of boundaries, the
worksheet TANGIBLE BOUNDARY EXERCISE is a good place to start. Often it
is easier for clients to sense their internal signals of having a boundary when they
can actually see a physical representation of the boundary. This worksheet instructs
clients to explore constructing a boundary that is tangible and visible with rope or
cushions, and can be practiced in session with your guidance. It can be illuminating
if you help clients notice what changes in relationship to you when they have a
tangible boundary.
Finally, the worksheet on BOUNDARIES: RESPECTED AND BREACHED
instructs clients to mindfully study the impact on the five building blocks of two
past incidents: one when their boundary was respected and one when it was
breached. Contrasting these two opposite experiences can clarify internal signals,
because they are very different in each case. Most clients will reap maximum
benefit from this worksheet if you direct their mindful attention to their building
blocks in response to recalling each situation.
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an overactive “cry for help” defense, meaning that as adults they depend on the
nearness and care of others to feel safe, similar to infants who cry for their
attachment figures when they feel frightened. If this is the case, clients may perceive
boundary exercises as meaning that you do not care about them or want distance
from them. When such clients refuse a suggestion or exercise, you can use the
opportunity to reframe the refusal as a boundary, even if it is accomplished in an
animal defense state.
In clients with dissociative disorders, you might discover that different
boundary tendencies are held by different parts of the client. A protector part might
have an automatic “no” reaction, whereas a part that wants closeness and
connection might have an automatic “yes.” One part might be ashamed for setting a
boundary (“That’s not nice or polite”); another might be afraid (“I’ll get hurt if I set
a boundary” or “I don’t deserve to have boundaries”). The adult part might want
healthy boundaries, not too rigid and not too permeable. You can help clients
understand that each part is attempting to maintain some sense of safety by dealing
with boundaries in a particular way a client can also begin to understand that each
part is reacting to how other parts deal with boundaries. For example, the more a
child parts says “yes,” the more an angry part says “no,” or the more a client strives
to set boundaries, the louder an internal voice says, “You don’t deserve it.” As a
result, you might find that boundary exercises, although useful to some parts,
dysregulate other parts.
The solution is to slow the pace and create a sense of experimentation and
exploration, helping clients to be curious to find out how various parts respond to
the idea of setting a boundary. It is essential to help parts understand each other and
begin to work more effectively with each other. You must explore whether the “no”
part can experience what it is like to say “yes”? And can the “yes” part can
experience what it is like to say “no.” Perhaps parts could work together to learn
when boundaries are good to put up, and when they might be helpful to take down.
It is important to encourage communication and collaboration among dissociative
parts so that each one is supported in boundary setting, rather than either overridden
or allowed to take over. It will take time and experimentation to gradually work
toward a somatic sense of healthy boundary setting for all parts of the client.
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Physical Boundaries
There are two types of physical boundaries. The first type pertains to how
physically close or far away we want to be to another person. Our bodies let us
know our need for closeness and distance through visceral and muscular signals.
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Tightening or butterflies might indicate a need for distance, but a deeper breath and
relaxation might indicate a desire for closer proximity. When we have healthy
physical boundaries, we convey our preferences for distance or closeness
primarily through our body language—tensing, grimacing, or moving back if
someone is too close—as well as through words. We are also sensitive to the
signals of others about their needs for proximity or distance.
The second type of physical boundary pertains to touching and being touched
when two or more people are close enough for physical contact. Based on the often
unconscious internal communications via our body sensations, impulses, thoughts,
and emotions, we determine if, when, and how we wish to be touched. Touch
boundaries are conveyed by adjusting our body position—leaning away, turning
away, walking away, and even pushing away—and through verbal requests or
demands, typically used when physical signals are not respected. Physical touch
boundaries protect us by making it possible for us to fend off unwanted touch, say
“no” to a request with words and with our bodies by moving or pushing away, or
moving back when someone touches us or is about to touch us. When we have
healthy touch boundaries, we also are naturally aware of and respectful of the touch
boundaries of others.
Internal Boundaries
Internal boundaries pertain to internal processes such as thoughts and feelings. They
enable us to take in information that is nourishing or educational while screening
out that which is unpleasant or detrimental to our well-being. With healthy internal
boundaries, we can separate our opinions, thoughts, and feelings from those of
other people so that we are not unduly swayed when others try to convince us how
to feel or think. We are open to other perspectives, but we make up our own minds
and allow our feelings to guide us. Internal boundaries affirm and enforce our right
to our own opinions, beliefs, and feelings even if they are different from those of
others. With good internal boundaries, we also do not try to convince others that
they should feel or think a certain way. We can acknowledge and accept differences
in thoughts, opinions and feelings and yet still stay connected to the other person.
When our internal boundaries are strong but flexible, we do not blame others
for how we feel, and we are empathic toward others without taking responsibility
for their emotions or opinions. Instead of feeling threatened by differences, we can
accept and even enjoy them. If a friend fails to understand what something means to
us or has a different perspective or opinion about a topic that is important to us, we
can accept this dissimilarity without rejecting our friend or changing our minds to
agree with him or her. We do not need our friends or family members to agree with
our point of view, or have the same likes or dislikes, or feelings to feel close to
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them.
Healthy Boundaries
Healthy boundaries are elastic and flexible, shifting each moment according to our
needs and preferences. They are different with different people and in different
situations. We have more relaxed boundaries with dear friends than we do with
acquaintances because we want to be closer physically and emotionally to our
friends. If we are tired or stressed, we may set firmer boundaries, but if we are
relaxed and energized, we may have more open boundaries. With healthy
boundaries, we can respond to the moment-to-moment choices in our lives with an
internal sense of being true to ourselves and being able to intuitively discriminate
what is appropriate to take in and what is appropriate to keep out. For example,
when we receive negative feedback that does not feel entirely accurate, we are able
to realize that some elements of it are applicable to us, and that other elements
reflect the other person’s views and are not applicable. However, this is usually not
a conscious process. We automatically adjust, moment-to-moment, intuitively
making choices that support our needs and preferences. Our body sensations,
muscle tension, or movement impulses tell us if we have let in too much, too little,
or just the right amount, guiding us in setting our boundaries.
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override our own boundaries in order to be “responsible.”
Sometimes children have to choose between loving contact with their parents
and honoring their own boundaries. When Bob was 10 years old, he wanted to set a
boundary by refusing to sit on his mother’s lap when she asked. He sat next to her
instead, but she frowned at him and then looked away from him. As a child, Bob
overrode his own boundary and, to keep his mother’s approval and maintain
connection with her, he reluctantly sat on her lap as she wished. When Bob
remembered this incident in therapy, his belly tightened and his whole body
stiffened. He had felt torn between what the tension in his body had told him (that
he did not want to sit on her lap) and how he felt when she frowned and looked
away (sadness and fear at her disapproval and withdrawal).
From such early experiences, we instinctively internalize the different reasons
why we should or should not set boundaries. When parents respect our boundaries
and teach us to respect the boundaries of others, we learn that all people have a
right to their own boundaries. But when attachment figures disapprove of our
setting boundaries, we often internalize a belief that we must do what others want.
We might not want to risk losing important relationships or causing negative
reactions, fearing that the other person will withdraw, be angry or hurt, or punish or
reject us if we set boundaries. If parents viewed our attempts to set boundaries as
controlling or selfish, we might still be fearful of coming across as self-centered,
controlling, or egotistical if we set boundaries. We may feel guilty if we set a
boundary, or we may feel we just do not have a right to do so.
Once we have developed boundary habits, it simply may seem easier to follow
these old habits of being silent, complying, withdrawing or becoming unduly
aggressive than to directly set a healthy boundary. It is important to remember that
even our unhealthy boundary habits were survival resources in the past. But in the
long run, we pay a price for not setting good boundaries. We may allow ourselves
to be emotionally or physically abused, manipulated, or otherwise mistreated.
Without healthy boundaries to support a clear sense of choice between saying “yes”
or “no,” we may feel used or coerced even when others have no intention of taking
advantage of us and would respect our boundaries if we could only set them.
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we are able to set a boundary verbally, our body language may not be consistent
with the verbal message. We may say “no” with our words, but our bodies may say
something else.
Kate, a college student, was confused and ashamed because she often found
herself having sex when she did not want to, even after she told her suitor “No,
please stop.” She was not aware that her body language conveyed a different
message than her words. Her therapist asked her to try saying the word “no”
directly to an imagined suitor while being mindful of her body’s reaction. Kate
became aware that she slumped and looked down and away, avoiding eye contact.
Her body gave a different message from the verbal message. Kate felt that her body
communication said “maybe,” which reflected a belief leftover from her childhood
in which she was taught never to hurt anyone’s feelings and to sacrifice her own
preferences for those of other people. Unbeknown to her conscious mind, her body
seemed to have communicated this belief to her suitors, who then persisted in their
advances until she acquiesced.
Through her therapy, Kate came to realize that setting a boundary did not mean
she was hurting someone else, and that she deserved to honor her own preferences.
Kate practiced standing up straight and saying “no” definitively, in a strong voice,
while looking into her therapist’s eyes. With practice, her body language gradually
became congruent with her verbal message, which gave her a physically felt sense
of setting a boundary that honored her preferences and needs. When she said “no”
clearly with her words and her body, she found that others usually backed off and
respected her boundary.
If we are not tuned in to our body’s cues, we may habitually override them as
Ashan did. Whenever anyone asked something of Ashan, she complied. When she
came to therapy, she was run down and overwhelmed by the demands of the people
in her life. As she learned to listen to her body, she found that her body gave her
many signals telling her that she needed to set a boundary when someone asked her
to do something she did not really want to do; she felt tightness in her chest and
jaw, her breath became shallow, and she started to feel slightly agitated. Once
Ashan learned to listen to her body’s signals, she was able to respond to them by
setting appropriate boundaries.
We may fear that setting boundaries will decrease closeness with others, but
healthy boundaries can both help us protect and take care of ourselves and increase
connection. Bob’s girlfriend habitually dropped by his house without warning. But
he hesitated to tell her that he wanted her to call first when she planned to visit. He
was afraid that she would withdraw or break up with him if he expressed his
wishes. This feeling was reminiscent of his fear of his mother’s disapproval if as a
child he were to tell her he did not want to sit on her lap. As he worked on setting a
boundary in therapy, he decided to maintain physical closeness with his girlfriend
by looking into her eyes and holding her hand as he told her that he preferred that
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she call before she dropped by. To his surprise, when he was finally able to set a
clear boundary in this way, she did not withdraw. She instead apologized for not
realizing that giving notice was important to him, and she said that she would be
glad to call first. To Bob’s astonishment, setting a clear boundary in a loving way
actually increased their connection; he felt closer than ever as his girlfriend
honored his boundary.
You too might have difficulties sensing or reading your body’s signals that tell
you that you need a boundary, or you may remember times when you overrode these
signals. Or, perhaps your attempts to set boundaries have not been respected, or
have created too much distance in your relationships. Developing a somatic sense
of boundaries necessitates that we learn to tune into signals and convey our
preferences clearly with our bodies as well as with our words. When the stance
and movement of our bodies is congruent with our words, we are able to send a
definitive, clear message. With mindful practice, you can learn to read your body’s
signals to better understand your needs and preferences and to communicate your
boundaries clearly.
In the worksheets that follow, you will learn to identify the signals in your body
that indicate the need for boundaries and explore how to set them through physical
movement, body language, voice tone, eye contact (or lack thereof), and other kinds
of nonverbal communication. You can draw on the somatic resources you have
already learned to support your setting healthy boundaries. Centering, containments,
grounding, and alignment resources can all help you set your boundaries clearly and
effectively.
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Purpose: To try out physical actions that signal a boundary; mindfully notice what
thoughts, emotions or memories are stimulated; and assess which actions are
familiar, which ones feel good to you, and which ones do not.
Directions: Try these boundary-setting actions with your therapist or someone you
trust, adding any additional boundary-setting actions of your own in the empty
polygon. Take your time to be mindful of what thoughts, emotions, sensations or
memories arise, and write them in each polygon. Then, complete the prompts
below.
Use your facial expression—frown, sneer, scowl, or grimace
Avoid eye contact
Make a “stop” sign with your hands
Narrow your eyes or glare
Cross your arms in front of your chest
Tighten your jaw
Clench your fists
Lean back and away
Walk away
Say “no” with your body
Push away with your hands
Retract your head—move it backwards
Turn away
1. Which of the actions felt familiar to you? Which felt unfamiliar?
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2. What situations in your past or present do the familiar actions remind you of?
3. Which actions felt good? Which did not? Are there any actions that felt more
aligned with the person you are today, rather than with who you were in the past? If
so, which ones?
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Directions: Think about your experiences with physical boundaries as a child and
adult. Read through the lists below that describe boundary violations and add any.
Check the box next to any that you have experienced and add any not listed in the
empty boxes. Choose three boundary violations to explore, then describe each
situation, your body responses, how you handled it, and how you might handle it
differently in the future.
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Physical Contact Boundary Crossed
Someone brushing up against you
Being hit or pushed
Being held down
Forced physical contact (e.g., being coerced or made to hug, kiss, or sit on
someone’s lap)
Someone grabbing your wrist or arm
Being touched in a car, room or corner where you couldn’t escape
Someone demanding, or forcing sexual contact
Someone touching you when you don’t want to be touched, or in a way you
didn’t want to be touched
Being tickled when you didn’t want it
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1. Think about a time when you had a conflict with someone you care about
because he or she shared a different or opposing opinion, belief, or feeling to
yours. Describe the conflict here.
2. How did the conflict affect your body? How does remembering it affect your
body right now?
3. Imagine having a good internal boundary and acknowledging that you both have
the right to your own thoughts, opinions, feelings, and beliefs. What happens in
your body? Describe the somatic sense of a good internal boundary.
4. Imagine how this sense of internal boundary could affect the conflict, and
describe below.
5. List three possible future conflicts with others in which the somatic sense of
good internal boundaries might be helpful.
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1. Describe what happens in your body when you say “yes” aloud. Say it several
times, noticing the changes in your body. Then try communicating “yes” with just
your body. What changes in your breath, tension, movement, or posture? (e.g., My
body opens up and relaxes, my chin lifts, my chest expands, and I take a deep
breath.)
2. Describe three situations in which you would like to be able to say “yes.” (e.g.,
I would like to say yes to my kids when they want to play, rather than saying I
have to work.)
3. Describe what happens in your body when you say “no” aloud. Say it several
times, noticing the changes in your body. Then try communicating “no” with just
your body. What changes in your breath, tension, movement, or posture? (e.g., My
muscles tighten and pull inward, especially my shoulders; my jaw is set, I
frown, and I feel like I dig in my heels.)
4. Describe three situations in which you would like to be able to say “no.” (e.g.,
I would like to say no to my friend when she asks me to babysit.)
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5. Choose one situation in which you would like to say “yes.” Practice taking on
the body posture of yes, and describe what happens when you imagine that
situation.
6. Choose one situation in which you would like to say “no.” Practice taking on
the body posture of no, and describe what happens when you imagine that
situation.
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After creating a tangible boundary, take a few minutes to sense “your space” within
the boundary you defined, and then answer the following prompts.
1. Describe the tangible boundary you created. What did you use to construct it?
Was it close to or far away from your body? Describe its shape and thickness.
2. How does your body respond to your tangible boundary. Does your breathing,
tension, or posture change?
3. What thoughts, emotions, or memories emerge from constructing a tangible
boundary?
4. How can you use the somatic sense of a tangible boundary in your life? For
example, if you felt more solid in your body with a tangible boundary, how could
you recreate that sense of solidity in situations where you need to have a boundary?
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Reflect on your experience of each of these incidents and discuss with your
therapist.
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Suggestions for Clinical Use
You have been guiding your clients to experiment with resources of all kinds
through the work of this book so far, but this chapter focuses particularly on
identifying and developing the ones whose absence interferes with therapeutic
progress. Helping clients understand the variety of reasons for the failure of
resource development will help them reframe what they might believe to be
inadequacies as missing resources. In traumatic environments, animal defenses,
shame, and fear thwart the development of competencies. When young children in
safe environments are learning such skills as asserting themselves or verbalizing
their needs, some of our traumatized clients were learning automatic obedience or
shutting down and “disappearing” instead. Regulatory capacities, such as being
able to tolerate an emotion or feel an impulse without acting on it, are often missing
resources as well.
When clients lack confidence or self-assertion, are intolerant of their mistakes,
or are apprehensive of new situations, professional success, or close relationships,
you can help them reflect on how the absence of these capacities relates to their
history. As clients realize that these resources could not have developed in their
early attachment or traumatic environments, you can emphasize that these abilities
can be developed at any time in their lives and then practiced until they become
increasingly automatic and available without effort.
For many clients, the idea of developing missing resources will be appealing,
and they will be excited about the work of this chapter. For others, although the
theme might be of interest, the ability to concentrate, process, and integrate this
information might itself be a missing resource. Returning to the exercises of
Chapter 6 “Paying Attention: The Orientng Response” on orienting to new
information might be useful in these cases. But, if your client has learned to
habitually neurocept danger and threat and still does not feel safe, the prefrontal
areas of the brain governing attention and concentration may be inhibited and thus
so is new learning. As van der Kolk (2009) asserts: “Our brains will continue to
take in new information and construct new realities as long as our bodies feel safe.
But if we do not feel safe, we become fixated on the trauma. Our ability to take in
new information is lost, and we continue to construct and re-construct the old
realities.” In these cases, the primary missing resource, that of feeling safe, must be
addressed, often by returning to practicing the regulatory actions and somatic
resources described in previous chapters.
Some clients may benefit from your reminding them that developing new
resources creates a new experience and thus can help the brain to change
maladaptive patterns learned in childhood. Cozolino (2002) states:
The slow development of the brain maximizes the influence of environmental factors, increasing its
chances to survive. . . . That so much of the brain is shaped after birth is both good and bad news. The
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good news is that the individual brain is built to survive in a particular environment. . . . In good times and
with good parents, this early brain building may serve the child well throughout life. The bad news comes
when factors are not so favorable . . . the brain is then sculpted in ways that can become maladaptive.
(p. 12)
Knowing that neuroplasticity allows the brain to change even in adulthood can
mitigate clients’ discouragement about the resource development they have missed.
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Adapting this Material for Dissociative Clients
The complaints and crises of dissociative clients naturally provide you with an
opportunity to introduce this chapter on missing resources. Statements than validate
the complaint and suggest that they can learn new resources are helpful, such as:
“Yes, it’s so hard when people disappoint or fail you—you never had a chance to
develop resources to help you with the feelings that come up or with not taking
things personally. Let’s look at resources that can be developed to help you.” Or:
“It’s overwhelming just having to get up and go to work and manage everything day
to day—especially without the kinds of resources you should have learned in your
family. Let’s find out what new resources you can use to manage all of this.” When
you frame the task of identifying missing resources and beginning to develop them
as part of recovering from trauma, clients’ motivation to work on these capacities
typically increases. They learn that this endeavor is not about their failings but
about recovering from difficult circumstances and the failings of others to support
them.
Missing resources for clients who have dissociative disorders often pertains to
a loss of continuous awareness—an inability to stay present and aware across time
and to choose which aspects of themselves to bring forward consciously, and which
are more private, not to be shared with others. Depending upon your client’s
recognition of these challenges, you might need to identify them as phenomena that
you have noticed and invite discussion about what missing resources might be
developed to help with these problems. Although clients may switch because
something in their environment or a relationship has triggered them, they may also
switch due to conflicts between dissociative parts of themselves. The reasons for
switching should be explored and missing resources developed to help resolve
them.
You may want to vary the worksheet assignments to fit the unique perspective of
clients who have dissociative parts. You can ask clients to notice each part’s most
important existing and missing resource, and help them find ways to share both old
and newly learned resources across parts. You and your clients may discover that
occasionally what is missing in one part may be found in another part, so that
apparently missing resources are not truly absent, but sometimes are “kept safe” or
“hidden” by particular parts. As clients learn to accept and trust all parts of
themselves as their own, these resources may be incorporated more systemically
into the whole person.
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We can never have too many resources. The more resources we have, the better
equipped we are to deal with stress, tolerate our emotions, and live healthy, happy,
and productive lives. We can all learn to broaden our resource repertoires by
reinstating resources that have been lost or forgotten, exploring new ones that were
never learned, and supporting those that are weak, undeveloped, or underused. This
chapter clarifies how resources come to be lost, weakened, or absent and how to
develop them. We will focus on developing “missing” or underdeveloped
resources that can provide additional skills and competencies to support you in
leading the life you want to live rather than a life circumscribed by the effects of the
past.
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compensate for the limitations of the environment. These might include
withdrawing from or clinging to relationships, fear of healthy risk-taking and
change, self-criticism, inability to recognize our own needs or go after what we
want, and lack of confidence in our worth or abilities. Later in life, creative
resources become harder to develop because we have entrenched survival
resources that were necessary in the face of difficult circumstances.
Our family values, financial resources, life circumstances, and parental blind
spots can also limit our resource development. If, as a child, you would rather
draw than read but grew up in a family that valued reading and education over the
arts, you may not have been given opportunities to develop your artistic talent.
Perhaps your family did not have the financial resources to support your talents
through music lessons or sporting equipment. Maybe you grew up in a warm
climate that offered no opportunity to fulfill your passion for snow skiing. Or, if
your parents did not recognize your interest in dance or soccer, you may not have
been offered dance classes or opportunities to join a soccer team. When talents or
interests are overlooked, belittled, neglected, or ignored altogether, we are not able
to develop certain resources that might have come naturally to us. But once you
identify resources that you wish you had, you can take the steps needed to develop
them.
If our early environment is generally supportive, we naturally develop the
somatic resources described in previous chapters. But as we have learned, we all
form procedural habits to make the best of less than optimal circumstances. Mary’s
posture was not slumped. Her chin and chest were slightly lifted, which had helped
her feel a sense of identity, power, and determination, in a family when she needed
to stand up for herself against criticism and sometimes emotional abuse. However,
her body was constricted, and her legs were spindly, seeming out of proportion to
her thick torso, and her knees were locked. She complained of easily being “thrown
off” and scattered; she was missing a sense of her legs supporting her fully. Mary
tended to stabilize herself through tension and rigidity rather than through a flexible,
integrated body with good grounding support through her legs. She found that using
some of the resources in Chapter 16, “Grounding Yourself,” and unlocking her
knees helped her hold her ground, quiet her busy mind, and focus her attention.
Mary’s habit of crossing her arms in front of her torso helped her feel safe, a
survival resource she had needed in childhood. However, this position also made
her feel closed off to others, which went along with not being able to make friends
easily. She complained that when she went to a bar, no one talked to her. With her
therapist’s help, she realized that she first needed good boundaries to feel safe
enough to “open up,” and she practiced using her arms to make a pushing motion.
Her therapist noticed that Mary’s inhalation was deep, but she did not exhale fully.
Many mindfully practiced “letting go” on the exhalation, which helped her chest
relax and feel more open. Mary found that these three missing resources—
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developing a somatic sense of boundaries, becoming more grounded, and relaxing
the tension in her chest by emphasizing the exhale—were key supports in her newly
developing abilities to meet goals she set for herself.
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she was 16. Afterwards, consumed by grief and family upheaval, she lost the sense
of excitement and the pleasure of becoming interested in boys. In therapy, she began
to discover and reclaim this interrupted resource by focusing on the memory of the
time period prior to her father’s death and getting in touch with the feeling of
adventure and exhilaration she had felt about dating as a teenager. For Margo, the
memory of her excitement in discovering the opposite sex was remembered,
reexperienced, and developed as a resource.
Along with reclaiming interrupted resources and developing new ones, you can
also develop a broader range of resources by utilizing “future templates” and
rehearsing future challenges. You might think of anticipated real-life situations and
then be mindful of your reactions. As you bring to mind an image of a challenging
situation, an old habit or reaction might be evoked, giving you an opportunity to
practice using your repertoire of new resources imaginatively before you are faced
with an actual challenge in real life. You will be more successful incorporating
your newfound resources into daily life after practicing them in your mind first.
Each time we inhibit an old pattern and imagine or rehearse a new pattern, the new
resources become a little stronger and more easily available to us. The worksheets
following this chapter will help you reflect on missing or weak resources you
would like to develop, identify when they may be of use to you, and learn how to
acquire them.
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Take the time to remember the positive experience and notice what happens in
your body.
3. How can you reclaim that interrupted resource from your past and use it in your
life today? Maybe you could practice the physical effect of the resource, or
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maybe you could recreate the resource or look for opportunities to use it in your
current life. (e.g., I could look for opportunities to flirt and practice flirting by
making eye contact, smiling more, and initiating conversations.)
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enjoy my
visit with
I will remind
my mother
myself to
breathe and more.
relax.
Anticipated
Challenge
#1
Anticipated
Challenge
#2
Discuss with your therapist how to implement your plan during future challenges.
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SECTION FOUR
PHASE 2
Addressing Memory
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repertoire and practicing those resources will mitigate the effects of implicit
memory on present experience. Clients who unwittingly repeat unsatisfactory
relational patterns or find themselves at the mercy of procedural actions—such as
tightening when confronted, or collapsing when they feel their needs—might
discover that these patterns reflect early implicit relational memories of how to be
with others. Those clients who are chronically destabilized and unable to process
memories without further destabilization will find it helpful to work on a resource
repertoire. Identifying triggered implicit memories, especially those that precipitate
periods of destabilization, will help them differentiate nonverbal remembering and
procedural learning from normal reactions to everyday stimuli.
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Making the connection between their day-to-day distress and implicit
remembering will support clients’ motivation to identify the implicit memories that
are most troublesome for them and then develop a resource repertoire to manage
these implicit memories. To ensure that this goal is met, you can ask clients to refer
to their homework sheets from the previous section and review together which
resources are the easiest and the most helpful, as well as which resources are
needed but still missing. Clients may need your help to identify the most effective
resources to address implicit memories as they embark on Phase 2 work.
Keys to this chapter include your ability to track your clients’ here-and-now
reactions indicating implicit memory, facilitate their mindful awareness of these
reactions, and help them practice resources to create a different experience. In
session, implicit elements of memories will emerge as clients begin to talk about
the past, which usually stimulates the mental, emotional, and physical state that they
had experienced during the event itself. At these moments, you might ask clients to
mindfully notice the building blocks that are evoked by remembering and then
experiment with resources until they regain feeling calm or confident or centered.
And of course, implicit memories will also be evoked within the therapeutic
relationship, as clients orient toward features in you that unconsciously remind
them of past relational encounters, and vice versa. As an enactment (cf Chapter 1,
“Essential Principles of Sensorimotor Psychotherapy”) develops, you may “feel”
that something is occurring between the two of you but not understand what that
something is. At these moments, therapists often try to make meaning of these
implicit dynamics, often to reduce their own discomfort with the relational
unknown. However, it is important to keep in mind that understanding enactments is
neither required nor possible at first, and how to approach what is going on
between you and your client emerges from within the relationship. The meaning is
not comprehensible on your own; it will be discovered jointly with your client as
each of you shares your respective experiences. Bromberg (2010) wisely advises
that at these moments, you might share what is going on for you, in some version of:
“I’m feeling something as I’m listening to you that isn’t quite part of the topic but has a kind of
life of it’s own. It’s almost as if we have another channel of communication that is more about
feelings than about ideas. I’m sharing this with you because I’m wondering whether, if you let
yourself look inside, you might be able to feel anything similar in yourself—something you may
be feeling while we are talking that can’t find words but which might connect us in an even
more direct way if we can each share them.” (personal communication, February 13, 2010)
This opens up the possibility for you and your client to relationally negotiate the
enactment and co-construct the meaning and a new relational experience together.
Although it is necessary to challenge clients to do more than they believe they
can do, you will also need to ensure their sense of control over the pacing,
activation, and emotion. Implicit memories inevitably involve a degree of loss of
control over time, place, boundaries, and resources, so the experience of
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integrating memory must include a felt sense of regaining control. The best
indicator of when it is appropriate to move on to more deliberate accessing of
memory will be your clients’ responses to this chapter and its worksheets and their
ability to utilize their resource repertoire effectively. As clients utilize their
repertoire of resources for regulating the impact of memory on present experience,
their windows of tolerance expand and they are better able to navigate the
challenging territory of integrating the past.
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skills, they are quite difficult to contain, and thus may continue to intrude upon the
client’s experience, keeping the client’s arousal outside his or her window of
tolerance.
It is essential to first help dissociative clients expand the window of tolerance
to withstand the difficult work of integrating the effects of traumatic memory, which
involves getting to know dissociative parts, increasing communication among them,
and strengthening the part(s) that can function best in daily life. Otherwise, Phase 2
is likely to prove more dysregulating and will catalyze a greater number of
dissociative symptoms, decreasing the client’s functioning in daily life. You can
anticipate that a focus on implicit memory will pose challenges for this group of
clients and will require your diligent support to help them work effectively with
this chapter’s material.
However, this chapter can also provide opportunities to increase clients’
integrative capacity as they learn to identify and consistently utilize their repertoire
of resources in the face of implicit memory activation. One approach that can
minimize the degree to which this material is triggering involves first focusing only
on developing the resource repertoire and practicing how to use these resources to
regulate their reactions, putting aside any connection between the triggered implicit
memories and the events that generated them.
For clients with dissociative disorders, it may be helpful to keep in mind that
each part will “remember” in unique ways, display different procedural learning,
show sensitivity to different triggers, and manifest different implicit memories. The
implicit memories of a part that desperately tried to win positive feedback from
parents will be very different from the implicit memories of an angry or ashamed or
frozen part. Each will most likely benefit from different resources. The ashamed
part might experience a shift when you and the client experiment with lengthening
the spine; the part whose separation anxiety intensifies fears of abandonment might
respond to the client’s hand over his or her heart; an angry part might be regulated
by a boundary gesture such as the “stop” movement.
Alternatively, you might find that clients with dissociative disorders benefit
more from resources that decrease intrusion of parts or outright switching, such as
grounding. It is helpful to identify some resources that can be used across various
parts and to facilitate overall regulation when implicit memories are stimulated.
Dysregulated and dissociative clients are more likely to experience intense
dysregulating explicit memories, as well as implicit, and therefore stand to benefit
from developing and strengthening a resource repertoire.
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We may have different, or even conflicting, feelings about dealing with the
memories of what happened in the past. We may be afraid that memory work will
not help us, or that we will not be able to remember what we need to. We may be
reluctant to delve into the emotional pain of early relationships, filled with
apprehension of becoming upset by revisiting the memories, or dread at the
possibility of “reliving the past.” We may shut memories out or shut ourselves
down so that we don’t think about them. Or we may want to confront, head on, the
most painful memories, hoping that by doing so, we will find relief or make the
changes we desire in our lives.
Neither extreme—avoiding the memories or jumping right into them—is
optimal because neither will help us integrate them. Effective integration of
memories can only occur when our resources remain available to us as we address
a painful past, and when we do not just relive the original events but resolve their
enduring effects on our lives today.
It is important to emphasize that our symptoms and difficulties are due to the
effects of past experiences as relived nonverbally through procedural learning,
patterns of relating, dysregulated arousal, painful emotions, and negative beliefs.
Therefore, the goal of memory work, as previously described in Chapter 12,
“Three Phases of Therapy,” is to identify and integrate the effects of these
memories—the impact of them on your well-being and your current life—rather
than to reexperience or describe them.
This first chapter on addressing memories sets the stage for the therapeutic
tasks of this section. Building on previous chapters, especially Chapter 5, “The
Language of the Body: Procedural Learning,” this one will continue to explore the
nonverbal effects of the past that strongly influence us in present time. We will
describe the nature of memory and help you understand why neither avoiding nor
reliving troubling memories is the best option. Developing a “resource repertoire”
from all the resources identified in the previous chapters will support you to
effectively address the effects of the past as you embark on the work of integrating
memories in the rest of this section.
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Memories can be remembered in two different ways, or in some combination of the
two—explicitly (as coherent verbal descriptions of events we can consciously
recall) and implicitly (in nonverbal, nonconscious forms such as habits, images,
emotions, physical patterns, and beliefs, often related to events we cannot recall).
Thus, past events may be remembered and described, only partially remembered,
or only implicitly remembered.
Implicit memories are best thought of as somatic and emotional memory states
that are not accompanied by an internal sense that something from the past is being
remembered. These memory states also called “state-specific memories,” show up
in different ways and affect our daily experience. In moments of mysterious
intuitive” feelings, we might be implicitly remembering something. Our immediate
sense of liking or disliking another person might be based on implicit memories of
previous interactions with someone else. The happy, expansive feeling we get from
being in the country might be an implicit memory of early experiences of parks,
green spaces, or open skies. The calm, centered feeling we have when someone had
kind eyes might be because they remind us of the eyes of a grandmother who
lovingly babysat us when we were infants. A feeling of aversion elicited by close
contact with other people in an elevator might be related to an implicit memory
connected to abuse or embarrassing experiences with others that we do not
explicitly remember. By identifying these feeling states as reminiscent of those we
experienced during significant events in the past, we are recognizing the presence
of implicit state-specific memories in current time.
Our earliest implicit memories influence our future relationships and our view
of how to be in the world. In infancy, we learn about which behaviors are accepted
by our parents or by other people who are important to us, and which behaviors are
disapproved of or punished. The implicit memories of these relationships are all
the more influential because we cannot recall the interactions that shaped them.
Thus we cannot describe them or reflect on them with thoughts and words. They are
“remembered” in relational patterns, emotional biases, beliefs, and physical habits
that are often exacerbated by relationships in our current lives. They are
remembered when we find ourselves in a certain state in a current relationship that
is similar to a state we were in during early relationships that we do not remember,
or do not remember clearly. We might find ourselves responding to specific people
with aversion, irritation, neediness, fear, defensiveness, sadness, or anger without
knowing why we feel that way.
Ashton did not remember much of his childhood clearly, but he vaguely knew
that his patterns in relationships were shaped by an early childhood fraught with
abandonment and loss. His need for nurturing and support had not been met during
infancy and childhood, leaving him in a state of desperation for contact and care,
and he tearfully reported that everyone he loved in his current life left him because
he was too needy. Donna complained that she could not “keep” a boyfriend. Having
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grown up with a father who disdained vulnerability, she had learned to dislike and
disown her own tender feelings. Unconsciously she had become overly assertive
and even aggressive in interactions with men, unwittingly driving away potential
partners.
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abate. She still “remembered” what had happened when she found herself in a state
similar to the state she had been in during her trauma. This state had beliefs (“I’m
not safe”), emotions (fear, shame, and self-loathing), and physical components
(tension, shallow breathing, and hypervigilance) to it.
If you have suffered trauma, you will probably implicitly experience the
memories in dysregulated arousal, as Anita did. In order to integrate your implicit
memories, you must first identify them by recognizing the elements of your current
state that are similar to the elements you experienced when the actual events
occurred. You might ask yourself questions such as, “Am I numb? Am I
overwhelmed or hyperaroused? Are my reactions out of proportion to what is
occurring? Is my arousal outside of my window of tolerance? Could the state I am
in be similar to a state I experienced in the past when I was in danger?”
Intense emotional reactions, or a lack of emotions when we would expect them,
are good indicators that implicit memories are triggered, provided that we are not
experiencing immediate danger. Panic and terror, numbing, rage, or the inability to
move are all states that tend to be related to and triggered by implicit traumatic
memories. Actions such as feeling strong impulses to run, freeze, collapse, hide,
hurt ourselves, or hurt someone else are generally implicit traumatic memories as
well.
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her family sitting around the kitchen table were “safe space” resources, especially
when implicit memories of fear and bleakness typical of how she had felt in her
childhood home emerged.
When memory work became too triggering in therapy, Anita used the
mindfulness skills she had learned. She focused on orienting to the external
environment through each of her senses by looking at all the visual details that told
her where she was in time and space, listening to sounds, sniffing for smells, and so
forth (see Chapter 7, “Mindfulness of the Present Moment”). If that wasn’t enough
to help her center herself, she would concentrate more precisely on what she
noticed. Rather than only note the picture on the wall, for example, she would
notice its fine details and describe them to herself: “There is a background of trees
—lots of shades of green and some blue and yellow—sunlight shining through the
leaves.” Orienting to and naming these details in her environment calmed her
arousal, changed her state, and kept her aware of the present moment.
Ashton and Donna both discovered specific somatic resources that helped them
restrain the effect on their daily lives and relationships of their implicit memories
of childhood attachment wounds. Ashton found out in therapy that if he executed a
gentle “push” motion from the top of his head upward and the bottom of his feet
downward, he experienced a better sense of the core of his body. He immediately
felt less needy and more competent. Ashton practiced this push motion as he and his
therapist delved into his emotional pain around abandonment and loss.
Donna had discovered that her dislike of her tender feelings was reflected in
the defiant lift of her chin, which she realized was off-putting to others. The lift of
her chin had helped her avoid disappointing her father, who did not accept her
vulnerability, but it did not support her desire to be close with her friends and
boyfriend. In therapy, Donna’s therapist suggested she practice deeper breathing to
soften the tension and try lowering her chin slightly by lengthening the back of her
neck in order to ease the posture of arrogance and aggression. These somatic
resources changed Donna’s state so that she could experience more vulnerable
tender feelings with others.
Daniel, on the other hand, found boundaries, posture, and centering resources to
be the most important ones for him. His implicit memories at his enmeshed
intrusive family emerged in his being easily overwhelmed by other people, and he
often avoided group activities and relationships in general. His resources,
practiced before going to work in the morning, were to stand quietly for a few
minutes, lengthen his spine, lift his chin, and draw a big circle around himself with
his arms and hands. He took a few moments to sense the feeling of solidity in his
body as he did so, placing one hand over his heart and the other over his abdomen
(a centering resource). These actions were his somatic reminders that he had
energetic boundaries that differentiated him from others, that their feelings were not
his feelings, and their attitudes were not a danger to him because they were outside
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his boundary. In therapy, as he explored his painful childhood memories, he
remembered to lengthen his spine and sense his boundary. He also practiced the
centering resource of placing his hands on his torso whenever he felt that he needed
to be more centered. These resources mitigated the effect of implicit memories and
helped him interact with others more comfortably.
As you approach the work of addressing your memories, you can begin to
identify your implicit memories by recognizing when you are in a state similar to
what you experienced during trauma and attachment inadequacies of the past.
Having confidence that you can use the resources you have learned in the previous
chapters to manage triggered relationship patterns, emotions, and physical habits of
implicit memories is crucial. Using the following worksheets, you will identify
current states that are, in fact, implicit memories and develop an individualized
catalogue of resources to support your efforts to change those states. With practice
using your personal resource repertoire when implicit memories emerge, you will
be better prepared to access these resources as you embark on the next stage of
memory work.
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take my kids to
the doctor.
•Meditate before I
go.
1. Implicit Memory Past experience to which it Resources that
might pertain could change your
experience of the
implicit memory
2. Implicit Memory Past experience to which it Resources that
might pertain could change your
experience of the
implicit memory
3. Implicit Memory Past experience to which it Resources that
might pertain could change your
experience of the
implicit memory
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2. Look over the somatic resources listed below, and add others you think might be
helpful in the empty spaces. Then try one or more of them and describe the changes
in your thoughts, emotions, and body in each “AFTER” section.
Use your breath Connect with the back of Push your feet into the
your body floor
Align your spine, tighten Self-soothe (hug yourself or Use a containment
your TVA rock) resource
Hand on heart, or hand on
belly
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AFTER AFTER AFTER
Thoughts Thoughts Thoughts
Emotions Emotions Emotions
Body Body Body
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2. In the rectangles on the left, write down your reactions (thoughts, emotions, and
body responses) to this current relationship dynamic.
3. In the rectangles on the right, write down the resources you have available to
regulate your arousal and emotional state when these reactions come up.
4. Finally, draw a line from each resource to the reaction for which you may be
able to use it.
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Resources should be at least as many or greater than reactions to create balance. If
you feel you need more resources to balance your reactions to implicit memories,
discuss how to develop more resources with your therapist.
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CHAPTER 22
Reconstructing Memory:
Finding Resources in a Painful Past
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shame, rage, painful loneliness, freeze or shut down responses may find that as they
pay attention to less disturbing elements of their memories, they way they remember
the trauma changes. Clients who feel unrealistic blame, shame, or guilt for what
happened can benefit from a focus on discovering internal resources surrounding
the traumatic event(s). Clients whose recall of attachment experiences evokes
strong emotions and negative beliefs about themselves, others, or the world can
also benefit from finding and embodying the resources that brought them excitement,
confidence, or comfort surrounding these painful memories. Clients who feel
powerless when they think of the past often feel less helpless and more capable
when they discover personal resources they had used to handle what happened.
Those who feel there were few external resources available to them often realize
that there were many things and people that helped them through painful times,
which can change their tendency to emphasize a lack of support.
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clients’ recall of resources they used by saying something like, “Maybe there was a
person who supported you, or maybe you turned to your favorite TV program or to
sports or some other activity to feel better.” You can also refer back to the material
from Section Three to review resources and spark recall.
Understanding the importance of memory revision fosters clients’ willingness
and perhaps even enthusiasm to explore the resources surrounding a memory. Going
over the chapter in session will give you the chance to reinforce this new concept.
Challenging clients to be curious about finding resources and positive experiences
surrounding memory, along with attuned empathic support and psycho education for
any hesitation or confusion they might express, will assure their success.
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whether they were put aside due to these, or later, events. Those resources can then
be called upon again when needed or may be added to the clients’ repertoire of
resources to develop.
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CHAPTER 22
Many people are surprised to learn that, although memory refers to real
experiences, it is also subjective, reflecting an individual’s personal perspective,
not just “facts.” That is why two people often have different accounts of what
happened when they remember and discuss a past event. Each of us orients to
different elements of the same situation, which directly affects what we take in and
what we leave out. We remember bits and pieces and then put them together in a
manner that makes sense to us, which then becomes our “memory.” Often we
remember only the most disturbing and painful, or the most wonderful and exciting,
bits and pieces because those elements were the most vivid and intense. Our
memory retrieval is therefore not an exact recall of what happened in an objective
sense (meaning, as if a neutral person were simply filming the event), but a recall
of those elements that we selectively oriented toward and registered at the time.
This chapter will describe the “reconstructive” nature of memory and explore
changing how you remember by intentionally discovering positive elements or
resources that you used but may have forgotten or not focused on before, during,
and after a painful memory.
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Memories are subject to revisions and distortions because they are modified
when we think about or talk about them. Our ability to reconstruct our memories is
helpful when we elaborate something joyful, peaceful, or heartwarming because
then we feel those good feelings even more. But remembering a painful,
humiliating, or frightening memory over and over causes us to re-experience our
painful feelings and can worsen our symptoms.
However, if we deliberately think about or talk about an adverse experience in
a different way (e.g., by focusing on positive things or resources that helped us
cope during that time), we create an opportunity to add new information to existing
memory storage and lay down new neural pathways. This deliberate refocus of
attention is very different from revisiting what we already habitually recall. If we
think about the past or describe it in the same words or with the same feelings,
images, smells, sounds, or tastes every single time, we cannot alter its impact on us.
The way we remember does not change. But if we widen our focus to include new
or previously obscure elements of the event in our recollection and description of
what happened, we can begin to change how that memory is stored. Each time we
think or talk about the past, we have an opportunity to broaden our memory of what
happened rather than to further engrave the memory in our brains in the same way.
We change how we remember the past by directing mindful attention to the
features of the memory that we have not focused on before. When we do so, our
brains will automatically modify the stored memory to include the previously
absent features. Thus, we have a chance to reconstruct our memory every time we
tell the story silently to ourselves or out loud to others. The purpose of
reconstructing a memory in this way is not to condone what happened, minimize it,
forgive it or try to change what happened. The intention is to transform our
relationship to the memory by deciding to also focus on the less painful, neutral, or
even positive elements surrounding the event that we may have forgotten or not
attended to before.
527
resources. Without resources, we may have perished or emerged not nearly as
intact as we are today.
Every time we focus on remembering the resources that got us through, neural
pathways in our brain associated with these resources are laid down and
strengthened. Although we can never change what happened, how we remember it
can be revised, edited, and altered no matter how long ago the painful experience
occurred. In short, we have a wonderful opportunity to modify how we remember
and hold distressing events, hurtful interactions with attachment figures, and
traumatic experiences in our minds and bodies.
Finding Resources
It might seem counterintuitive, but no matter how sudden, devastating, or horrific
your past experiences have been, you undoubtedly called upon resources to get you
through those times that you can rediscover and reclaim now. Sometimes positive
things that occurred in the midst of the negative event can be recalled as well.
Consciously remembering your resources or any positive elements will help you
form new associations to the painful past memory that are not distressing. Adding
these new associations to what you already remember can not only alter your
relationship to the memory but also promote feelings of competence, capability, and
even pride in your resourcefulness.
Adanich accidentally fell through a glass door and nearly died from the injuries
when she was 5 years old. She suffered from intrusive images of blood and hospital
equipment for years following the event. As a young adult, her therapist encouraged
her to search for and remember the resources that had been available to her during
the time of her accident. First, Adanich tried to remember the “good things” that had
occurred prior to the accident, and she recalled the wonderful feeling of rough-and-
tumble play with her older brother in the living room. As Adanich remembered the
fun she’d had roughhousing, she experienced several building blocks of that
experience. She heard the sounds of their childish laughter, saw the image of herself
playing, and felt the joy and alive feeling in her body as she and her brother
wrestled together. Before the accident, Adanich had been a very physical child, but
this changed after the incident—she became timid and much less active. But by
consciously deciding to direct her mindful attention exclusively toward the memory
of her enjoyment of rough-and-tumble play, and taking the time to savor these
remembered good feelings, she began to reclaim the pleasurable, joyful, exuberant
emotions and vibrant body sensations she experienced at that time, but had long
forgotten.
With the help of her therapist, Adanich then turned her attention to the accident
itself, not to relive it, but to discover what had supported her and how she had
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coped during the accident. She remembered that immediately after she had fallen
through the glass window, her father had rushed to pick her up in his arms with a
frightened and worried expression on his face. This was a particularly important
recollection for Adanich because his expression told her how much she meant to
him. She had few memories of being held by her father and even fewer memories of
feeling his love for her. As she remembered seeing the love in her father’s eyes and
face in her mind’s eye, she felt warm inside. Capturing the feeling of being held and
loved by her father gave her a physical sense of security that she had rarely
experienced.
Anadich had been rushed to the emergency room and had remained hospitalized
for several days. Her family had brought her a giant teddy bear, which proved a
soothing resource for her while in the hospital, and she remembered touching the
soft “fur” and squishy body of her bear. Her feeling of being loved and secure
deepened as she remembered hugging her bear, appreciating that her family had
understood that she needed something soft to hold on to as she lay alone in her
hospital bed.
It is important to emphasize that Adanich had forgotten about these three
resources until her therapist suggested that she focus on the “positive” elements
surrounding her accident. In her mind she had gone over and over many of the
horrible images associated with it: the shattering of the glass, the blood on the
floor, the screeching sound of the siren, and the strange, scary hospital. But, after
remembering her three resources, Adanich felt that the memory would never be the
same. When she thought of the accident, she still remembered the horrible elements
but now she also remembered how much she loved playing with her brother, the
warmth in her heart as she felt her father’s love for her, and her big teddy bear and
how holding it soothed her at the hospital.
Sometimes the intense feelings of fear and helplessness overshadow our sense
of having had any resources at all at the time of traumatic events. However, if we
remember that survival in the moment of threat requires resources, and we stay
curious and keep asking ourselves how we survived what happened, we will
discover them.
For example, not only were Bob’s mother and alcoholic father both physically
abusive to each other, but they were also physically abusive to him when they were
drunk. Once Bob suffered extensive injuries from the abuse. At first Bob couldn’t
imagine having had any resources whatsoever at the time. But somehow he
survived, and as Bob went back to the memory of the moments just before and after
the violence, asking himself how he did survive, he realized that he had lain very,
very still afterwards. Somehow he instinctively knew that holding still would help
minimize his injuries and cause his parents to lose interest in beating him, even
though he couldn’t think clearly at the time. As he remembered staying so still, he
felt greater confidence in himself and his body. It was true that he couldn’t prevent
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the abuse, but he was able to help ensure that he survived it.
Our nontraumatic but nonetheless distressing memories also contain forgotten
resources that we can discover. George remembered his usually even-tempered
father being furious at him for accidentally scratching his brand new car. His
father’s anger surprised and confused George, who felt that he “never quite
recovered” from the impact of this event. Banished to his room, George cried for
what seemed like hours. Searching for resources in therapy, he remembered the
family dog scratching at his bedroom door to gain entrance. As he recalled Milo
licking his tears away, he remembered the comfort of the dog’s warm body and
doleful eyes, and he felt less distraught. He also remembered his mom putting her
arm around his shoulders in a wordless gesture of comfort when he was finally
allowed out of his room. These two resources, both of which communicated
empathy and understanding to George as a small boy, eased the negative impact of
the memory for him.
Although we can never change what happened, how we remember it can be
revised, edited, and modified no matter how long ago the events happened. You can
learn to orient toward and focus attention not only on the negative but also on the
positive aspects of painful experiences. Doing so will help you face the distressing,
painful parts of the memory in the work of the chapters to come. By discovering,
acknowledging, and embodying the resources you were able to use, as well as the
positive elements surrounding a painful memory, you are rewriting the story you
have remembered over and over in a particular way up until this point, and this can
change your brain’s memory of what happened. The worksheets that follow will
help you to remember internal and external resources alongside disturbing aspects
and upsetting emotions you felt during the distressing event. This brings balance to
a painful memory and supports our sense of confidence and mastery.
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Reconstructing Memory
P OSITIVE ELEMENTS OF A DISTRESSING EVENT, P ART 1
BEFORE THE EVENT
Purpose: To remember and embody a positive experience that occurred before a
painful event.
Directions: Under the guidance of your therapist, select a painful past event or
period of time to explore in this three-part worksheet. Recall how old you were
when this event occurred, how long it lasted (e.g., a moment, a day, a whole
summer, or a longer period of time), where you were, where it occurred, and what
you were doing at the time. Once the event is clear in your mind, direct your
mindfulness to a time before it happened and complete the prompts below.
1. Focus on any positive experiences that were occurring before the painful event
or during the time period leading up to the painful event. Perhaps you were learning
to read, paint, or dance. Maybe you were in the midst of developing a certain skill
—learning how to be independent, or discovering something interesting. Or
perhaps you enjoyed a special relationship with a friend, teacher, pet, or relative.
Stay focused on remembering the positive elements that occurred before the painful
event and choose one to describe in as much detail as you can in the box below.
Example: Adanich recalled the joy of rough-housing with her brother before her
accident. She remembered the sounds of laughter, the good physical feeling of
their wrestling, and the warm feeling of closeness.
2. Focus all your attention on remembering the positive experience that you
described above. See if you can re-experience the physical feeling of this positive
element right now.
•What movements or sensations do you notice now as you embody that positive
experience?
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4. Now, think of the memory of the event again, remembering the painful elements
while also focusing on the positive experience you described. What is different
when you remember both elements rather than only the negative?
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Reconstructing Memory
P OSITIVE ELEMENTS OF A DISTRESSING EVENT, P ART 2
DURING THE EVENT
Purpose: To remember and embody a positive experience that occurred or
resource that you used during a painful event.
Directions: Using the same memory of the distressing event that you used in the
previous worksheet, again gently tune into that time in your life, the age that you
were when the event occurred, and where it occurred. Direct your mindfulness to
the time when the event happened and complete the prompts below.
1. What happened during this painful event or difficult time in your life that felt
positive or empowering? Perhaps you used a survival resource or a somatic
resource such as breathing or being still. Perhaps someone came to help you, or you
turned to a beloved pet. Perhaps you could “leave” your body, or felt you could call
on an imaginary friend. Describe one resource you used or positive experience that
occurred right in the midst of the negative event in as much detail as you can in the
box below.
Example: Adanich recalled her father rushing to her side and the look of worry
and on his face. She remembered being held by her father and how loved she felt.
2. Take your time to focus on remembering the resource or positive experience that
you described above. See if you can re-experience the physical feeling of this
resource or positive element right now.
•What movements or sensations do you notice now as you embody the resource that
positive experience?
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negative?
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CHAPTER 22
Reconstructing Memory
P OSITIVE ELEMENTS OF A DISTRESSING EVENT, P ART 3
AFTER THE EVENT
Purpose: To remember and embody a positive experience that occurred or
resource that you used after a painful event.
Directions: Using the same memory of the distressing event that you used in the
previous two worksheets, again gently tune into the painful event or time in your
life, the age that you were when it occurred, and where it occurred. Direct your
mindfulness to the time after the painful event happened and complete the prompts
below.
1. What happened after this painful event or period in your life that felt positive?
What resources did you use to cope afterward? Did you call upon anyone for help?
Did you take steps to get help for yourself, such as going to physical therapy? Did
you read, draw, paint, or turn to nature? Were there people or pets that helped you
through this difficult time? Describe one resource you used or positive experience
that occurred after the negative event in as much detail as you can in the box below.
Example: Adanich recalled the huge teddy bear that her family gave to her in the
hospital for her, and it reminded her of their love and support. She recalled the
softness of the fur as she hugged the bear.
2. Take your time to focus on the resource that you used or positive experience that
occurred after the painful event. See if you can re-experience the physical feeling
related to the resource or positive experience right now.
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the event. What is different when you remember positive elements rather than only
the negative?
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Reconstructing Memory
F OCUSING ON YOUR RESOURCES
Purpose: To link positive elements of a distressing event to resources that you can
reclaim, develop, or call upon now when you need them in your current life.
Directions: Below, note the positive elements before, during, and after the event
that you discovered in the three previous worksheets entitled POSITIVE
ELEMENTS OF A DISTRESSING EVENT, and then complete the prompts.
1. In the rectangles below, write the resources or positive elements that you
discovered in the previous three worksheets, and determine the category or
categories of resource that fits each one. Write down whether each was an internal
or an external resource. For example, Adanich remembered rough-housing with her
brother before the trauma—an external, relational, and somatic resource. During
her trauma, her father holding her was an external, relational, and somatic resource.
And afterward, the teddy bear was an external, material, and somatic resource.
2. Do you use any resources now that are the same or similar to the ones you
described above? Explain below.
3. Were any of these resources put aside or interrupted due to the distressing event
or repercussions of the event? Describe below.
4. Make a plan to mindfully call upon or develop the resources you noted and
describe below. How do you think using these resources will affect your body?
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dissociate when they try to connect to memory. On the other hand, clients who
complain of being detached from their memories and emotions will benefit from
learning dual awareness to more fully embody the state they were in when the
events occurred, and still remain grounded in the present moment.
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were in during the past event, you can ask them what emotions, thoughts,
movements, sensations, or images emerge. If clients lose dual awareness and
become dysregulated, they need to put the memory aside and practice their
resources until arousal returns to the window of tolerance.
As they learn dual awareness skills, many clients will be reassured that they do
not need to relive the past but simply be willing to notice the effect of remembering
on their present experience and employ resources whenever they need to regulate.
This approach helps them maintain control of remembering, and thus often
increases their willingness to approach memory work. Clients will learn to refrain
from becoming immersed in their reactions, which represent intrusions of implicit
memories, and use their mindfulness skills to identify the building blocks that
comprise these reactions. You can positively reinforce their ability for dual
awareness, saying something like, “You’re doing great telling me what happens
inside as you remember”—a statement that also supports social engagement,
reinforces time orientation to the present, and supports differentiation of past and
present.
Clients who are detached from their memories and emotions will need your
help to experience the effects of what happened, not just report the facts or discuss
the event. You can help them discover and then inhibit the physical elements that go
along with detachment, such as tension, held breath, or a particular body posture.
Encouraging them to slow their narrative pace to pause and describe the building
blocks evoked by the content can help clients embody the state-specific memory.
Your prompting to describe the sights, sounds, and smells of the memory more
clearly, to find the moments in the memory that are emotionally meaningful to them,
and to become aware of, and perhaps even exaggerate, those physical reactions that
deepen the emotions can help clients more fully experience the memory state. It may
be helpful to review this chapter’s example of Darius together with your client to
clarify some ways to support embodying the state specific memory.
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normal phenomenon for many survivors. Dysregulated clients can practice with less
intense state-specific memories, such as a neutral memory instead of a “good” one,
and a mildly disturbing recent event, instead of past abuse, for a “bad” one.
Noticing patterns of remembrance helps to keep the emphasis on dual awareness
and implicit memory. You can emphasize that it is not the events themselves, but
how the client’s mind and body encoded those events that are important to address.
The second worksheet, EMBODYING A STATE-SPECIFIC MEMORY &
BEING MINDFUL, asks client’s to embody a state-specific memory and then use
mindfulness to remain in the here and now and observe present moment experience
while continuing to embody the memory. For nearly all clients, especially
dysregulated ones, this worksheet is best completed with you in session where you
can provide interactive regulation and adjust the worksheets specifically to your
client.
The worksheet, DUAL AWARENESS OF RECENT INTERPERSONAL
CONFLICT, helps clients deconstruct the memory of a current relational
disagreement into its component building blocks. It also asks them to reflect on
whether the current situation reminds them of earlier ones, helping them understand
how past conflicts impact current relationships. The following worksheet, DUAL
AWARENESS OF AN UPSETTING CHILDHOOD MEMORY, can be copied and
used to practice mindful deconstruction of a graduated intensity of events. You can
first explore a mildly upsetting memory and then work with increasingly
challenging memories. The final worksheet, DEEPENING THE STATE-SPECIFIC
MEMORY, is intended for clients who are detached and need your help to deepen
into painful emotions sufficiently to experience the state-specific memory. Clients
will benefit from your guidance in session, step by step, to focus on their internal
experience. You can pace the exercise according to your client’s ability to balance
accessing the state-specific memory with being aware of the present moment. After
you guide your client through the steps delineated in the worksheet, the two of you
can fill it out together as a reflective exercise meant to further integrate the
experiential component.
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practice dual awareness. For example, dysregulation, switching of parts or
intrusions of sensations, images, thought, or emotions from dissociative parts, are
all moments when dual awareness could be invaluable. However, dual awareness
often requires greater integrative capacity than clients with dissociative disorders
might currently possess. Various parts may have full, partial, or no awareness of
other parts or of the building blocks. Thus, some parts may be able to hold dual
attention more effectively and fully than others. It is important for you to assess
with clients whether dual awareness is possible with most or all parts. If not,
further work to promote awareness of the building blocks corresponding with
different parts and acceptance between parts must occur first. Various parts of the
client may be able to support and help other parts to increase awareness of the
present, fostering more sustained capacities for dual awareness.
It can increase symptoms and exacerbate dissociation to proceed with memory
work before all parts of the client have at least some capacity for dual awareness.
Until then, clients need to practice using resources from their repertoire when
memories are triggered. Once parts are adept at using resources when memories
involuntarily emerge, you might then attempt dual awareness by seeing if the client
can embody a neutral memory while being mindful of the building blocks.
Eventually dual awareness of the present moment and of the effects of voluntarily
stimulating the states that are reminiscent of when the trauma occurred may become
possible.
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In Two Places at Once
Rob reported that his parents had insisted on obedience. He felt that they had
controlled his every move, which had made him angry as a child, although he was
unable to express it then. As an adult, he implicitly remembered his childhood by
being quick to anger and quick to feel controlled by his wife when she asked him to
do something or even suggested an activity they could do together. In therapy, he
worked with a memory of when his parents had refused to listen to what he wanted
to do and had insisted that he do what they wanted instead.
As he described this memory, mindful dual awareness enabled him to remember
what happened and simultaneously to notice the anger he felt in the present as he
remembered. Rob also noticed the other building blocks that were stimulated by the
memory: the tension in his jaw and shoulders, a sensation of heat, angry thoughts,
and impulses to yell back at his parents. With dual awareness, Rob was in two
places at once—experientially back “in” the memory, reexperiencing (to a degree)
the state he was in as a child, aware of how his building blocks changed as he
embodied that state, and also aware of his current surroundings: where he was,
whom he was with, and the sounds, sights, and smells of his immediate
environment. When we can activate a state-specific memory and also remain aware
of the here and now, we can transform the effects of what has happened to us.
However, it is essential that we experience a kind of control now that we did
not have then so that we are not simply reliving the past. Working on a painful
memory naturally evokes emotions and can be dysregulating, but the effects of the
memory cannot be integrated if dysregulation is excessive. In dual awareness, as
you are talking about a past event with your therapist and also noticing how you are
responding in the present moment, you may notice your arousal escalating or intense
emotions coming up. Then you can put aside the memory to become mindful of the
effects of remembering—your experience of your building blocks in the present
moment. And your resource repertoire is your safeguard that will bring your
arousal into the window if you become too dysregulated, or if you want to change
the state you are experiencing.
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window of tolerance. Amanda first needed to develop a repertoire of resources and
practice using them when implicit memories provoked an internal state similar to
what she had experienced during past trauma. Gradually, she increased her
confidence in her ability “stop” the implicit memories and regulate herself by using
her resources. Feeling more in control, Amanda found the courage to address her
memories directly, but in a different way.
Amanda and her therapist decided that the first memory to focus on would be a
date rape from her teenage years. Practicing dual awareness, Amanda began to
think about the memory and stay mindful of her present experience of her building
blocks. She immediately noticed feeling shaky inside. Her therapist asked her to
notice where she felt the shaky feeling and then to discover what other building
blocks went with it. Amanda noticed emotions of shame, a feeling of revulsion in
her stomach, and the thought, “This is all my fault.” Her breathing became shallow,
and she felt her heart pounding. Amanda’s arousal was at the upper edge of her
window of tolerance, and she did not want it to increase.
She and her therapist then decided to put aside the images, thoughts, and
emotions and direct her mindful attention exclusively to a grounding resource from
Amanda’s resource repertoire until her arousal settled down. Through using her
resource, her body calmed and she felt more centered. Then she returned to dual
awareness of remembering the memory of the rape and noticing her present moment
experience as she remembered. Whenever remembering caused her arousal to
approach the limits of her window of tolerance she learned to use her resources
and put aside other elements of the memory until her arousal settled. Amanda began
to overcome her fear of processing memories as she developed the new habits of
implementing resources when remembering triggered her.
Dual awareness is used to stimulate the effects of the memory in present time,
but when those effects are too intense to integrate, then resources are used. If you
are not becoming dysregulated as you recall the past, you can continue to use dual
awareness to remember even more painful moments of the memory and mindfully
focus simultaneously on how remembering affects your building blocks in present
time.
Darius was not afraid of reliving his memories—he was afraid he was too “in
his head” to “connect” to them emotionally. He could not get in touch with the
emotional pain he intellectually knew that he had felt as a child. Growing up with a
single dad who worked two jobs to make ends meet and was “not the most
nurturing,” Darius had developed a strategy of self-reliance. It was hard for him to
depend on others, receive support, or stay connected to his emotions. In therapy,
Darius could sense the lonely and sad child he had been for a moment or two,
which made him feel sad in the present moment, but then he quickly detached from
the feeling,
Unlike Amanda, Darius’s difficulty was not that he became dysregulated when
550
he remembered his past. His difficulty was that he wanted to be in touch with the
emotions and needs he had pushed away, but he could not stay with them long
enough to experience them. In therapy, Darius could see a fleeting image of himself
as a boy alone in a dark apartment, not knowing when his father would return. In
dual awareness, he noticed his impulse to tighten up and “shield my heart” when he
saw the image. With his therapist’s help, Darius deliberately softened his chest to
inhibit his usual pattern of detaching from his emotions. He then used dual
awareness to remember more painful moments—curling up on the sofa, hugging his
teddy bear for comfort, the hard look on his father’s face as he failed to recognize
Darius’s need—while also mindfully describing the building blocks that were
evoked.
His therapist helped Darius embody the state he had been in as a child by
guiding him to recall more specific details. She asked him to describe the colors
and furniture of the dark room, to see the boy’s expression and posture when his
father came home with that hard look on his face, ignoring Darius’s need, and how
that felt to this small boy. Darius reported that he felt sad, but quickly came the
thought, “I should not be sad, I should be strong”—and again the impulse to tighten
up, to protect his heart, which he inhibited. As he continued to focus on the memory
of himself in the darkness, he took a breath to open his chest and refrained from
tightening his muscles. By doing so, he was able to embody the painful state of the
child more fully in the present. He felt the sadness and hurt in his chest, a softening
in his usually rigid posture, the impulse to curl up into a ball, and the thought,
“There is no one here to help me.”
Darius wept as he reexperienced the emotional pain of the lonely, sad, and
forlorn child he had been, reconnecting with a part of himself that he had pushed
away because there had been no one to comfort him when he was small. Dual
awareness helped Darius challenge the patterns that contributed to his automatic
avoidance of his emotions. He could use dual awareness to inhibit the tension,
remember the pain of his childhood more fully and express emotions he could not
express before, while remaining connected to the present moment and to his
therapist, whose empathy provided what he had missed as a child.
For Amanda, dual awareness helped her notice the effect of remembering so
that she could be aware of the building blocks that signaled her dysregulation, and
then practice her resources so that she could maintain control and prevent herself
from reliving the memory. For Darius, dual awareness helped him contact the
painful elements of the memory so that the emotions could be processed with his
therapist. The worksheets that follow will help you learn to track the moment-by-
moment building blocks that are stimulated as you remember painful past events
and develop the confidence that recalling the past is manageable. They will also
help you practice dual awareness as you remember current interpersonal conflicts.
Even though you reexperience, to a degree, the state you were in when the event or
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the conflict happened, you remain mindfully aware that the past is not happening
now. Being aware of the building blocks as they unfold in the present moment while
recalling the past takes some practice in the face of the intensity that a painful
memory can evoke. Being able to embody the state of the past can also take
practice, especially when habits of feeling detached from the felt sense of the
memory come into play. But the reward is that we can successfully process and
integrate the effects of our memories when we use dual awareness to keep one foot
in the present and one in the past.
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1. Recall a good memory and describe it in the box below. Practice embodying
that memory and being mindful of your experience. Check the box next to each
building block that you notice as you recall the memory, and describe the
building blocks you remember.
Five-sense perceptions:
Emotions:
Words/thoughts:
Five-sense perceptions:
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Body sensations and movements:
Emotions:
Words/thoughts:
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NOTE:
If you start to become dysregulated, what resource can you use?
OR
If you have trouble embodying the state-specific memory, which building blocks
can you focus on that might help you embody it more? It might be helpful to refer
to #5 on YOUR UNIQUE STYLE OF REMEMBERING worksheet.
2. Become mindful
Pause and use mindfulness to notice how embodying this memory affects your
present moment experience of each building block.
3. Describe the building blocks you experience right now as you continue to be
mindful and embody the state-specific memory.
Sensations
Movements and Impulses
Five-sense Perceptions
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Emotions
Thoughts
4. Describe how embodying the state-specific memory in #1 compared to being
mindful of your building blocks as you embody the memory in #2 and #3.
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Note: If you become dysregulated, call upon a resource to bring your arousal into
your window of tolerance.
1. Focus on the recent conflict until you experience a significant change in your
building blocks in the here and now. Write down the building blocks you
experience in the boxes below when you both embody the state specific memory
and are mindful.
2. Did you feel dysregulated or upset when you embodied the state-specific
memory and were mindful? Do you feel dysregulated or upset now? If so, identify a
resource from your resource repertoire that you can use right now and describe the
effects of using it. If you do not feel dysregulated or upset, move on to # 3.
3. Describe your experience of dual awareness of both embodying the state-
specific memory of the conflict and being mindful of the building blocks that
emerged in the present moment as you do so. What did you learn?
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4. Reread your descriptions of the building blocks above, and notice if they remind
you of any past relationships. Describe one or more earlier interpersonal conflicts
that are similar to this current conflict.
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1. Describe the piece of the memory that causes you to become upset. (e.g., My
mother being mad at me when I brought home a poor report card.)
2. Recall enough of the memory so that you can embody the state you were in then
in this present moment, but not so much that you become too dysregulated. As you
experience the effects of embodying the memory, describe what happens.
Example
I start to feel really bad about
myself, and my breathing
changes.
My body starts to feel heavy.
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and she looked happy and
proud of him.
3. Be mindful of the building blocks you experience as you embody the memory and
complete #2. Draw a line from each internal experience on the left to the
corresponding building block below as you maintain mindfulness. Then, write
anything else you notice from being mindful under the appropriate building block.
Five-Sense Perceptions: I see this little kid that I was, trying to be tough and
not cry.
4. Last, take a few minutes to look around your environment and orient to your
surroundings. Then describe how using mindfulness as you embodied the memory
changes your experience of it. (e.g., I realized that as I became more mindful, I
experienced the hurt that was under the anger.)
5. Discuss with your therapist any situations in your life today that you experience
similarly to this childhood memory or that remind you of this memory.
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1. Focus on the memory and describe ways you might avoid experiencing the
emotions of that memory (e.g., tighten, distract yourself, hold your breath,
minimize the emotional pain, self-talk, such as “what good would it do?”).
2. Do the opposite of the impulses you recorded in #1 (e.g., Relax your muscles,
focus on your body when you get distracted, breathe deeply, acknowledge the
emotional pain). Describe your experience.
3. Focus on the sensory elements of the memory that are the most painful to you—
describe the colors and surroundings, the people, the sounds of voices, facial
expressions and eyes, and movements of the other person or people that upset
you.
5. Continue to focus on the painful element and exaggerate slightly what you
notice physically to explore if doing so helps you more fully sense the emotions
connected to this memory. (e.g., If you feel an urge to curl up or turn away, do it
physically.) Describe your experience.
6. Take your time to notice the effects of this exercise, and describe the changes in
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your building blocks below.
Note: If you feel dysregulated after completing this exercise, discuss with your
therapist what resources you can use.
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CHAPTER 24
Sliver of Memory
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Another group that often shares the same fears is comprised of those clients
who function well in daily life but who are afraid that addressing painful memories
will lead to a loss of functioning, too-intense emotions, or an exacerbation of
symptoms. Their avoidance of memory can be addressed by the emphasis on
titration and by ensuring that exposure to memory is always accompanied by access
to resources and use of dual awareness. When they are encouraged to select a
sliver of a memory that is not too arousing and integrate the skills taught in the
previous two chapters, these clients can build confidence in how these approaches
work. Thus, their conviction that they have only the two choices of avoidance or
flooding can be challenged.
Clients who are not traumatized or prone to dysregulation but are still troubled
by upsetting memories with attachment figures can benefit from this chapter in a
different way. Finding the sliver that shaped negative core beliefs and has the most
meaning and emotional “charge” for them can add precision to the processing of the
memory. The attachment-related emotions that come up can be expressed and
empathically regulated within the therapeutic relationship. Clients who are not
dysregulated but who are detached from a painful past or who want to be able to
feel more emotionally connected to themselves and others can also benefit from
being able to focus on a potent sliver of past memory that will help them experience
their emotions more fully.
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For clients with anxiety, fears, or phobias of memory based on hyperarousal-
related flooding, exposure to just the smallest slivers of memory (the date of the
accident, the moment before an event, a single, more neutral, image) can help
develop confidence and desensitize them to memory exposure. If clients tend to
become hypoaroused or numb, it will probably be most effective to first work with
movement resources so that these are readily available when needed. Then you can
experiment with eliciting slightly evocative slivers of the event to activate a state-
specific memory, staying aware that if doing so exacerbates dysregulation,
resources will be needed. For other clients who have more integrative capacity and
a wider window, a more disturbing sliver can and should be stimulated at the
outset.
For clients who are not prone to dysregulation, you can stimulate and stay with
a sliver that evokes more emotional pain. Selecting a sliver of an original
attachment injury that has the most intensity for the client provides an opportunity
for the client to experience the unresolved emotions with you there for support and
regulation (cf. Chapter 30, “Making Sense of Emotions”). Finding a potent sliver
can also elucidate the meaning the client made at that time about him- or herself,
others, and the world (cf. Chapter 29, “Beliefs and the Body”).
Some clients may have no explicit memory of an event but may have been told
what happened, or may just know that something happened. This knowledge itself
can stimulate a similar state to the one experience during the event. Implicit
memories emerging in present time also evoke these states. In such cases, the
current implicit memory, remembering being told, or simply the knowledge about
what happened can replace the sliver.
After you help clients select an appropriate sliver of memory, remember to
facilitate dual awareness of being here in the moment with you and encourage them
to describe the impact of remembering the sliver on their building blocks. Some
clients’ internal state will shift the moment they turn their attention to the sliver.
Others will need your help to focus on and describe the sliver in more detail before
they are able to notice an internal shift. As always, the directed mindfulness
questions you ask once you select a sliver of memory should be appropriate to your
client’s integrative capacity. Clients whose arousal threatens to exceed the window
will need questions that guide them to be aware of the building blocks that will not
cause arousal to escalate further. Those whose arousal does not reach the edges of
the window, who easily detach from a felt sense of the effects of the memory, or
who tend to remain cognitive rather than access their emotions may need questions
that guide them to be aware of the more painful building blocks associated with the
memory.
It is important to keep in mind that for this intervention of working with a sliver
of memory to be successful, previously learned skills must be integrated. Dual
awareness of the internal state similar to the one experienced during the original
570
event, and simultaneously tracking the sensations, movement, perceptions,
emotions, and thoughts evoked by it, and resourcing when needed, will assure
mastery.
571
access a sliver of memory that will not exacerbate dysregulation. Any access to
memory may prematurely break down dissociative barriers and result in flooding.
When clients are exposed to memory, dysregulation, attempts to avoid memory,
dissociative switching, or shutdown are often triggered. Dissociative clients should
learn how to contain their memories and work toward communication and
cooperation among parts first. Only then, if there is a wide enough window of
tolerance for all parts, should the “sliver of memory” approach be used for the
more painful elements of the past. Until then, it might be possible to explore
choosing a neutral or positive sliver that all parts can tolerate, and practicing dual
awareness, using resources as needed.
For those clients with sufficient tolerance, working with a sliver of painful
memory can be a helpful way to decrease the impact of memory intrusion. If a
dissociative client has some capacities and resources, and a flashback occurs, you
should use resources from the client’s repertoire to return to the here and now and
ask him or her to connect with you. Then, you might ask the client to put aside the
memory for the moment, and just focus on what’s happening in the body. If the client
is able, you can look at the sliver in a different way that is more manageable. For
example, you might ask: “Can you connect with me and just notice that one little
piece of the memory from a distance, as though you are watching it on a small TV
screen all the way across the room?”; “Can you let yourself feel just a little tiny bit
of what happens inside from that—maybe 1% or just a teaspoon full?”; “Can you
let yourself feel what happens in your body for just 15 seconds?”; “Can parts share
together just a tiny bit of that feeling or image?” Often, your narrowing clients focus
with specific directions to notice just one building block or to notice a sliver or
building block connected to the memory for just a few moments helps them regulate
arousal so that the memory exposure can be tolerated.
It is important to remember that clients with dissociative disorders not only
have difficulties with dysregulation but also struggle with internal conflicts among
parts that exacerbate the tendency to either avoid or overexpose themselves to
memory. A vicious circle can ensue. Avoidance of memory can result in stuckness,
whereas overexposure threatens stability, ultimately resulting in stuckness as well.
Because of the risk of sudden flooding, these clients should be discouraged from
completing worksheets on their own. And even in therapy sessions, this client
group might do best focusing on the worksheet entitled IDENTIFY RESOURCES
FOR ADDRESSING A SLIVER OF MEMORY. By stressing resources for
regulating activation and emotion triggered by slivers of memory, we can better
ensure that our more dissociative clients continue to expand the window of
tolerance rather than become increasingly dysregulated.
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Sliver of Memory
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A Sliver of Traumatic Memory
Jennifer had suffered severe abuse growing up. Talking about what had happened
made things worse. She alternated between agitated hyperarousal states
accompanied by anxiety attacks to hypoarousal states in which she just wanted to
sleep. When Jennifer came to therapy, she was eager to learn the somatic resources
necessary to regulate herself, and she worked hard to develop a resource
repertoire. But she became frightened when her therapist suggested that she might
be ready to address her memories. She could understand the value of working with
memory intellectually, but she still had trepidation because talking about what had
happened had only increased her dysregulation in the past.
However, after practicing her resources when she “thought about” memory
work, Jennifer felt willing to try to work with a sliver from the past. She and her
therapist decided the first sliver would be an image of herself as a 6-year-old,
trying to “not be noticed” before an abusive incident. As Jennifer remembered that
sliver, tears started to burn in her eyes, and she could feel the fear and freezing and
an impulse to sink into a ball with her arms over her head. The sliver of the image
proved to be too frightening for Jennifer, so her therapist asked her to “pause and
just put the memory aside for a moment.” The therapist then helped Jennifer to turn
her mindful awareness toward her favorite resources: lengthening her spine and
putting her hands over her heart. Once Jennifer’s arousal returned to the window of
tolerance, they decided to work with the same sliver again, this time with Jennifer
maintaining the resources of an aligned spine and her hands over her heart.
Jennifer was able to stay with the sliver for a few more minutes before she felt
dysregulated. She returned to focusing exclusively on her resources for another few
minutes. When Jennifer again accessed the sliver, this time her therapist helped
direct her mindfulness to just her physical state—shaking and rapid beating of her
heart. At first, Jennifer was frightened of these sensations, but with her therapist’s
help, she was able to maintain dual awareness and notice that when she used
directed mindfulness to focus only on her body, and not the image or the emotions,
the shaking subsided, and her heart rate slowed down.
Several minutes later, Jennifer again brought to mind the image of herself as a
child, and this time, although she felt tearful and sad for the child she had been, she
was able to stay in the here and now while also embodying just a small amount of
the painful emotional state she had experienced as a child. This first session on
working with a sliver along with her resources gave Jennifer the confidence to
begin to address her memories without flooding and becoming overwhelmed. As
long as they could address just one little piece at a time, and then work with the
effects of remembering just that sliver, using her resources as needed, Jennifer felt
that her memories were not too big for her to tackle.
To resolve events that were dysregulating, arousal must be stimulated so the
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effects of the past on our bodies and physiology can be processed. But to ensure the
success of memory work, it is essential to use titration techniques: that is, to begin
by carefully and slowly calling to mind only a small sliver of the memory, always
followed by tracking the building blocks evoked by the sliver and deliberately
maintaining dual awareness. When dysregulation exceeds our capacity for
integration, embodying a resource from our resource repertoire or practicing
mindful awareness of only the body, putting images, emotions, and thoughts aside,
can helps us regulate. Each time we access a sliver of memory we once always
pause to notice how our building blocks change. Going at a slow pace and working
with a manageable sliver enables our arousal to approach the edges of the window
of tolerance without remaining in the hyper- or hypoaroused zones. This “just right”
level of arousal allows us to describe the experience without becoming immersed
in the memory, and facilitates integration of the effects of the past.
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reexperienced the hurt he had pushed aside as a child and recognized that the
meaning he had made from this experience was that he would always be a
disappointment to those who loved him. This meaning and the emotional charge
were superimposed on the more recent memory of his wife asking him to wash the
car, which implicitly reminded him of the original hurt. In therapy, Jonathan cried
hard as he sensed that small child who felt like such a disappointment, but he was
able to maintain his awareness of the here and now and receive the support of his
therapist. He felt that such empathic support for his feelings had been absent when
he was a child. This experience helped Jonathan integrate the emotions of the past
for so that he could relate to his wife’s requests differently. He realized that he was
not a disappointment to his wife, that her intention was not to nag him, and that his
reactions to her had to do with the old feeling of disappointing his mother.
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Sliver of Memory
CHOOSING SLIVERS OF A DIFFICULT MEMORY
Purpose: To identify several slivers—moments, images or sounds—of a difficult
memory and assess the effect of each sliver on your arousal.
Directions: Think about the memory you want to explore and choose five different
slivers of the memory. Write down each sliver in a segment of the circle below.
Use the “Key to Intensity of Sliver” scale to mark the intensity of each sliver. Then
determine which slivers activate just enough arousal that is high enough to reach the
outer edge of the window of tolerance but does not escalate to an unmanageable
level.
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Sliver of Memory
IDENTIFYING RESOURCES FOR ADDRESSING A SLIVER OF
MEMORY
Purpose: To identify and practice three resources from your resource repertoire
that you could use when a distressing or dysregulating sliver of memory is
activated.
Directions: Select a sliver of memory from the previous worksheet, CHOOSING
SLIVERS OF A DIFFICULT MEMORY, that causes your arousal to approach the
upper or lower edges of your window. Focus on remembering that sliver for a
moment, and notice your reactions, especially the emotions and sensations that let
you know your arousal is approaching the one of the edges of your window. Select
three resources from your resource repertoire that would be useful to regulate your
emotions and arousal when this sliver is activated. Try each one out and describe
how it helps.
Whole Memory
1. Identify the first resource, try it out, and describe the effect on your body and
arousal.
2. Identify the second resource, try it out, and describe the effect on your body and
arousal.
3. Identify the third resource, try it out, and describe the effect on your body and
arousal.
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Sliver of Memory
A SOMATIC RESOURCE FOR A SLIVER OF MEMORY
Purpose: To select a dysregulating sliver of memory, embody the state you were in
at the time it occurred, and find a somatic resource that helps you regulate your
arousal.
Directions: With your therapist, select one sliver of a disturbing memory—an
image, a smell, a sound, a person—that increases your arousal but not so much that
you become too dysregulated. You can use a sliver from the worksheet CHOOSING
SLIVERS OF A DIFFICULT MEMORY or you can choose a sliver from a different
memory. Then follow the prompts below.
2. Practice dual awareness: remember and embody the state you were in at the
time the event occurred, Describe how your building blocks change when you
embody that sliver.
Thoughts Emotions Five-Sense Perceptions Sensations Movements
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Sliver of Memory
OSCILLATING BETWEEN SLIVERS OF MEMORY AND RESOURCES
Purpose: To practice oscillating between awareness of a distressing sliver and
awareness of a resource from the same memory.
Directions: Select a painful memory you want to explore. Identify a distressing
sliver and a resource from the same memory. Then follow the prompts below.
Describe your cognitive, emotional and physical response to the sliver of positive
stimulus.
(e.g., I take a deep breath, my chin lifts a little, and I still feel sad but don’t feel
so ashamed. I have the thought that my doctor must know what she is talking
about, when she told me this could happen to anyone.)
First focus on the positive sliver, sensing your body, and then on the negative sliver,
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sensing your body. Oscillate back and forth several times and then describe what
you experience emotionally and physically.
(e.g., The whole thing starts to lose some of its charge. My body is a bit more
relaxed, and I have the thoughts, “These things do happen to everyone,”
“Everyone makes mistakes,” “I don’t need to be so ashamed,” and “I was young
and didn’t understand how slippery ice could be, and the person did fully
recover.” I start to feel better. I feel sort of tender toward myself that I had to go
through this.)
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Sliver of Memory
REMEMBERING A P AINFUL ATTACHMENT EXPERIENCE
Purpose: To explore a sliver of memory with an attachment figure that is
emotionally painful and to express these emotions with your therapist.
Directions: Under the guidance of your therapist, choose a sliver of memory with
an attachment figure that causes you significant emotional distress (e.g., you might
feel hurt, angry, sad, disappointed, or another painful emotion). Your therapist can
guide you through the steps below. Afterward you can complete the prompts
together.
2. Take your time to embody the emotional state you were in at the time the event
occurred. Immerse yourself in enough of the state so that your emotional arousal
reaches the upper edge of your window of tolerance. Describe what happens as
you immerse yourself in this emotional state.
3. What changes in your body when you focus on this sliver and re-experience the
emotions? What impulses do you have?
5. What thoughts about yourself, others, or the world take you deeper into the
experience of painful emotions?
6. Repeat any steps as you wish, and take all the time you want to be with and
share this experience with your therapist. Then describe how you feel afterwards.
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current situations. This group includes agoraphobic clients whose sense of the
world as a dangerous place precludes engagement in activities of normal life,
clients with anger management issues, chronically passive or repeatedly victimized
clients, and clients with overactive “flight” responses who tend to flee
precipitously. Any client whose habitual faulty neuroception of danger contributes
to relational strife or to symptoms such as night terrors and inability to sleep will
find this chapter useful. Clients whose symptoms of panic and anxiety are trauma-
based, or who use addictive substances to self-medicate and regulate arousal, may
also benefit. For all these clients, such difficulties may reflect dysregulated animal
defenses.
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fully understand the didactic material in the chapter and are curious about how it
applies to their circumstances. Curiosity and the hope that this way of working will
help free them of stuck patterns (e.g., long-term depression or shame, anger and
reactivity, fear and freezing or emotional volitility in relationships) are the best
motivators for encouraging clients to experiment with action. From there, you can
help them discover the sliver of memory in which an empowering defensive action
might have been available so that they can experience the impulse physically, as
described in the chapter.
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helpful to remind them to just sense how the action feels in the body in the present
moment, and to not think about the past. REGULATING DYSREGULATING
MOBILIZING DEFENSES will help clients regulate hyperaroused, hyperactive
fight-and-flight responses that lead to aggression or disconnection in relationships
by executing these actions slowly and mindfully.
By now, clients should be familiar with somatic resources from their resource
repertoire, and they can use those if they become dysregulated during these
exercises. If clients freeze or shut down, you can ask them to stand up or help them
embody somatic resources that they have found useful in the past (e.g., alignment or
grounding) that mitigate immobilizing responses. You can also help them orient to
their current environment by saying, for example, “Let’s take a moment to orient . . .
. Slowly look around the room. What do you notice?” Often, as clients orient to the
external environment, they can neurocept safety again. Reestablishing social
engagement with you might free clients to explore what their bodies want to do
rather than focus on what their bodies are afraid to do.
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of executing each action and which parts might be afraid or ashamed to perform that
action. If there are parts that would like to execute an action, then they could
participate in the exercises while other parts are asked to watch from a safe
distance. If there are parts that want to participate but are afraid to try out any of
these actions, you might find out which resources they would need to be less afraid
and whether other parts could be of assistance.
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We learned in “The Wisdom of the Body, Lost and Found” (Chapter 4) how
instinctual physical responses designed to protect us from harm are stimulated
when we feel threatened. These responses fall into two general types: mobilizing
actions, such as crying for help, fighting, and fleeing, and immobilizing actions that
keep us from moving when the mobilizing ones are ineffective, such as freezing and
shutting down or feigning death. These instincts are called animal defenses because
they are innate capacities in most animals.
Though no single animal defense is “better” than another, in the face of a
particular situation, one defense is usually more adaptive and effective. Freezing or
feigning death would be more successful than crying for help, fighting, or fleeing in
situations when the abuser could easily overpower us if we tried to fight, catch us if
we tried to run, or when there was no one to aid us if we called for help. If an
older, wiser, or stronger person is available to protect us, crying for help would be
effective. Running would work if we could run faster than an attacker. Fighting back
might be the best choice if we were stronger and had a good chance of winning the
fight. In the moment of threat, we do not have time to reflect on the best choice of
animal defense, and so the brain inhibits activity in the prefrontal cortex and
increases activity in the subcortical (mammalian and reptilian) brain (see Chapter
9, “The Triune Brain and Information Processing”). These subcortical structures
are responsible for implementing instinctive survival responses very quickly.
Ideally, the subcortical areas of the brain instinctively select the defense that
works the best for each situation. But when we have repeatedly been subjected to
threat, the same defense(s) is usually activated over and over. Although all of the
animal defenses are instinctive in nature, the one that we use the most is encoded in
procedural memory and becomes our default defense. We then may lose our ability
to use the other animal defenses. For example, when Jay was mugged and beaten,
he froze, and his body continued freezing in later situations, even when fighting
back or leaving a situation would have been more effective. Mateo grew up in a
family that expected him to be tough and stand up for himself. Because of this, he
developed a propensity to fight that was reinforced when his fight defense was
activated over and over during his military service. When he came back from the
war, the slightest traumatic reminder would stimulate his fight response, and he
would instinctively lash out. Fighting had become his default defense when he was
threatened, which sabotaged his relationships.
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The pathways in our brains that relate to the animal defenses used most
frequently become well traveled and sensitized to threat-related stimuli. It takes
conscious intention to develop new pathways. When the effects of memories that
turned certain animal defenses into habits have not yet been resolved, the same
defense is triggered over and over. This chapter describes the various animal
defenses and explores how to find the sliver of memory that will help you
rediscover actions you may have instinctively abandoned in the past. With these
new actions now rediscovered, you will be able to use a greater array of instinctive
animal defenses more appropriately. By reviving and engaging empowering
defensive actions, you will create a new experience for yourself and facilitate the
growth of new neural pathways necessary for neuroplastic brain change.
Mobilizing Defenses
The cry for help, flight, and fight defenses are called mobilizing defenses because,
powered by high arousal, they propel us to take action. The cry for help is an
attempt to get help from someone stronger, older, or wiser. Infants and children cry
for their attachment figures when distressed, but the cry for help also is used in
adulthood when we seek out others in times of stress and threat.
Flight is a common response to threat when escape is likely to be successful.
Flight can include both running away from danger and running toward a person or
place that can provide safety. Flight responses include other forms of “getting
away” as well, such as twisting or turning away or backing away. We use the fight
response when fighting back is expected (as in combat or street gangs) or when it
might be successful, such as when we seem to be stronger than the attacker. It goes
without saying that if the perpetrator has a weapon, such as a gun, the wisest
defensive choice for survival is usually to comply with his or her wishes.
During nonrelational trauma, such as falls or car accidents, we also use
procedurally learned mobilizing actions that have become instinctive from repeated
use, like slamming on the brakes or turning the steering wheel to avoid an accident,
engaging the righting reflexes during a near fall, raising an arm for protection from
a falling object, avoiding a rock in a downhill ski run, and so on. All these
illustrations highlight the reflexive body movements that take place when versions
of mobilizing defenses are stimulated by a threatening situation.
Immobilizing Defenses
The mobilizing defenses instinctively give way to immobilizing ones when the
former would be ineffective. When action would make things worse—for instance,
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if an abuser is bigger and stronger, has a gun, or can run faster, if we cannot escape,
or if no one is around to help—then not moving is the best strategy. There are two
types of immobilizing defenses: the freeze response and the shutdown (feigned
death) response.
The freeze response is characterized by high sympathetic nervous system
arousal and hyper attentiveness, combined with a feeling of being unable to move.
Tense muscles accompany this “alert immobility,” and we might feel anxious,
paralyzed, terrified, or agitated. In contrast, a shutdown defense, or “feigned
death,” is powered by the dorsal vagal branch of the parasympathetic system that
renders us immobile in a different way. Instead of being hyperaroused, we are
hypoaroused; instead of muscles becoming tense, they become flaccid or “floppy”;
instead of heart rate increase, heart rate decreases. Sometimes this can even lead to
fainting, or feeling like we will faint. This shutdown defense is an instinct that
occurs as a “last resort” when the other defenses are not effective.
599
anger, and he easily got into physical fights. Trish’s flight response led to feeling
restless and closed in, and she would “flee” from apartment to apartment, never
staying in one place. Meg’s desperate wish for others to rescue her was evidence of
a cry for help left over from a childhood in which her need for protection was not
met. Betty experienced the chronic shutdown/feigned death response, and she often
found herself “spacing out.” Jay, who had frozen when he was mugged, had trouble
mobilizing himself to be active and often felt “stuck.”
An adaptive flexibility in our animal defensive responses is necessary so that
we can instinctively call upon any of them as needed, rather than be stuck using
only one type. Mateo and Trish needed to address their overactive mobilizing
defenses and modulate their impulses to fight or flee. Meg needed to integrate her
desperate need for help from others so that it was appropriate to her current adult
relationships. Betty and Jay needed to find their long-lost mobilizing defenses.
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As he recalled the sliver of memory in therapy, the mobilizing defenses that Jay
could not act upon at the time of the mugging arose spontaneously as physical
impulses, allowing him to finally feel the power and strength of taking action to
defend himself. It is important to note that the instinctive impulse to push away
emerged from Jay’s awareness of his body as he focused on the image of the
mugger coming toward him, and not as an idea, concept, or thought that he “should”
defend himself. Jay’s therapist encouraged him to execute both the fight and flight
actions. First, Jay mindfully used his arms to push out against a cushion held by his
therapist, following the impulse of the tension in his arms to fight back. Second, Jay
followed the impulse in his legs to run by standing up and running in place. As he
performed these actions of fight and flight, Jay felt a new sense of strength and
competence. He felt empowered by the physical experience of having discovered
and executed the physical actions that had been stimulated when the mugging
occurred, but could not be acted upon at that time.
Betty had been severely abused throughout childhood by multiple perpetrators.
Her best option then was to shut down until it was over, and this became her default
defense. She often found herself “not there,” unable to focus or will herself to
move. With her therapist, Betty learned to become aware of how her building
blocks began to change when she started to shut down—a slight numbing and
heaviness in her body, feeling helpless, and thinking “It’s no use.” As she
recognized these antecedents, her therapist asked her to stand up and take a few
steps, putting aside any memories. Her therapist encouraged her to keep walking
around the ofiice so she could sense how her legs could now “run away.” Betty
realized that through mindful awareness, she could recognize when she was
beginning to shut down and could interrupt it before she became completely
immobile by standing up and walking around, sensing that her legs could now move
(the action of a flight defense). Like Jay, she also found many slivers of memory in
which she experienced a fleeting tension in her muscles that indicated she had
wanted to fight back. With her therapist, Betty explored putting her hands in front of
her body to protect herself, and finding the words “No” and “Stop.” Gradually,
practicing these mobilizing defenses over time, her shut down defense lessened and
she was able to be more present in her life.
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Resources”), his arousal would decrease. He practiced this resource over and over
at home until he began to feel mastery over his escalating arousal.
Next, in therapy, as he mindfully experienced tension in his arms and hands
right before he felt the urge to lash out, he tried making slow-motion actions of
hitting out against a pillow held by his therapist, while reporting to his therapist
exactly what he felt in his body sensation. Since mindfulness has been shown to be
effective in activating parts of the cortex that regulate instincts and emotions, being
mindful helped Mateo regulate the fight defense and the rage he felt. Mateo felt
empowered and “in control” as he executed the usually explosive aggressive action
in a mindful, controlled manner rather than chaotically in a fit of rage. Eventually,
Mateo felt that his fight response was no longer so easily triggered in his life,
presumably because executing it mindfully had prevented his subcortical instincts
from overriding his thinking brain, the neocortex, and helped his three brains work
better together.
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no allies. In therapy, her first sliver was remembering driving with her father to the
school when she was 8 years old. She focused on the image of her small self crying
uncontrollably, clinging to her father and begging him not to leave her. But he only
told her she was a big girl and would be fine. Embodying this sliver, Meg
reexperienced the frantic feeling and the belief that she could not survive without
someone to protect her. She realized that, in her current life, she similarly clung to
her friends because she still felt she could not survive alone.
Through the work with her therapist, Meg realized that her frenetic desire to be
with another person reflected the cry for help, a desperate need for protection that
had not been met in her childhood. Her empowering actions were to reach out to the
part of herself that felt so desperate. She learned to soothe and reassure herself by
using a somatic resource of wrapping her arms gently around her body and
communicating to that terrified child she once had been that she was no longer in
the same situation, that she was safe now with contact and comfort available from
trusted friends to whom she did not need to cling.
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Fight
Flight
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Freeze
Cry for Help: make noise, yell, Fight: push away, shove, Flight: flee,
scream or call out for help, attack, hit, kick, yell “stop” run away,
cling to or seek close proximity or “no”, verbally attack, back away,
to others strike out leave, escape
Other: Other: Other:
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move, hide, stiffen up, feel collapse, play dead, “not be there”, fall
paralyzed silent
Other: Other:
4. Reflect on which animal defenses you use more frequently and which ones you
don’t use as often. Why do you think that is? Discuss with your therapist.
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Cry for Help: What happens Try mindfully for help, saying to your
scream, yell, call when you imagine therapist, “I need help,” or clinging to a
out, cling to making noise, pillow or something else as if for safety.
others, or seek yelling or Stay focused on your body and describe
close proximity screaming or how this defensive action feels physically.
for safety crying/asking for
help?
Fight: shove, What happens Try mindfully and slowly pushing against
push away when you imagine the wall, a pillow, or a big therapy ball
shoving or pushing held by your therapist. Stay focused on
someone or your body and describe how this
something away? defensive action feels physically.
Fight: hit, kick, What happens Try mindfully and slowly kicking or
strike out when you imagine hitting a pillow or a big therapy ball held
striking out, by your therapist. Stay focused on your
hitting, or kicking? body and describe how this defensive
action feels physically.
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Flight: run What happens when Try backing away or running in place. Or
away, back you imagine backing just walk and sense your legs carrying you
away, leave away or running away. Stay focused on your body and
away from describe how this defensive action feels
something, or leaving physically.
a situation?
Freeze: What happens when Try slowly and mindfully tightening your
hyperalert but you imagine feeling muscles and be very alert, but do not
can’t move, hyperalert but not move, as if you are paralyzed or hiding.
hide, stiffen able to move, or Stay focused on your body and describe
up, feel when you imagine how this defensive action feels physically.
paralyzed freezing, or hiding?
Feign What happens when Try slowly shutting down just a little in a
Death/Shut you imagine shutting mindful and voluntary way. What do you
Down: go down, collapsing, do inside yourself to begin to go numb or
limp, numb, playing dead or not “not be there?” Stay focused on your body
collapse, play being there? and describe how this defensive action
dead, “not be feels physically.
there”
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Describe the event in which you felt threatened and became immobilized.
Describe which immobilizing defense you used and how it felt physically (i.e.,
Did you freeze and stiffen up or shut down, feel limp, and go numb?) stiffen up
or shut down, feel limp, and go numb?) Describe your sensation and arousal
level.
2. Take your time to search for a sliver of the memory before you became
immobile in which you wanted to take action (e.g., run, fight back, leave, scream,
or get help).
Describe the point in the memory when you wanted to take action. (e.g., Right
when I saw the look in my brother’s eyes as he was coming towards me, before
he started beating me up, I wanted to run but I didn’t move.)
3. Because muscles tense right before taking action, any tension can be a sign of
an mobilizing defense. Take your time to focus on the sliver you described in #2
and notice any tension or impulses you experience (e.g., tension in your shoulders
and arms and impulses to push away or hit, tension in your chest or throat and
impulses to yell for help or scream, tension in your legs and impulses to run or
kick).
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Describe any tension you experience and impulses to action you want to make.
(e.g., I felt my legs start to tense up and an impulse to turn to the left and
run.)
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2. Take your time to focus on the sliver of your memory just before you lashed out
or ran away and see if you can sense those impulses in your body. Be sensitive to
any slight tension you might experience as you remember. Describe how you
physically experience the impulses in the arrow to the right.
• (e.g., I can feel my chest expanding, a really deep breath starting, and a tingly
feeling—my arousal is shooting up. My fist clenches and my right arm starts
to move back to wind up to hit him. It feels hard to slow it down. My eyes get
wide and I grimace in anger.)
•
•
•
3. In slow motion, with mindful attention, begin to execute those actions. Let the
impulse come from your body rather than from your thoughts.
• Find a way that feels “good” or “right” to very slowly and mindfully execute the
action.
• While you slowly execute the action, describe to your therapist what you
experience in your body.
4. Repeat #2 and #3 until the action feels complete to you.
5. Sense your experience after executing the action. Describe what you
experience in your body, emotions, and thoughts.
Body Emotions Thoughts
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Note: If you feel unsettled or dysregulated after this exercise, practice a somatic
resource from your resource repertoire.
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Sensorimotor sequencing is an intervention for trauma-related hyperarousal. It is
not a technique to use with attachment-related emotions that need to be experienced.
Recalibrating the nervous system through sensorimotor sequencing can be valuable
for all traumatized individuals who are prone to hyperarousal. However, in order
for sensorimotor sequencing to be successful, clients need to have confidence in
their body’s intelligence and in bottom-up interventions because the technique
requires the ability to tolerate involuntary movements and sensations, such as
trembling. Provided that clients have developed such confidence in the body from
the work of previous chapters, especially Chapter 1, “The Wisdom of the Body,”
Chapter 10, “Exploring Body Sensation,” and all the chapters on somatic resources
in the previous section, those who will benefit the most are those whose emotions
or quality of life are limited by hyperarousal. You might recognize these clients by
the manifestations of their undischarged energies: for example, a tendency for
arousal to escalate quickly, and to experience tingling sensations, shaking, and
trembling under stress, when implicit memories emerge, or during explicit recall.
Clients who chronically struggle with hyperarousal symptoms such as anxiety,
panic, nightmares, flashbacks, feelings of being “driven” (e.g., “I can’t stop
moving”), restlessness, or involuntary movements (e.g., startling, trembling, tics,
jerks) might also benefit if undischarged or uncompleted energies of hyperarousal
contribute to these symptoms.
Another group of clients that also stands to gain from this chapter comprises
individuals with biphasic reactions; that is, those who are constantly triggered back
and forth from hyperarousal states to hypoarousal states and then back to
hyperarousal again. These clients stand to benefit from learning sensorimotor
sequencing, provided they have developed confidence in working with the body
and are comfortable with involuntary sensations and movements that go along with
hyperarousal.
619
to tremble, then gradually quiet and soften, and the accelerated heart rate might also
returns to baseline.
It is best to begin by teaching clients to notice their body sensations and
movement as distinguished from other building blocks. You might mindfully direct
their attention to a sliver of memory and then ask them to notice the effect on their
body, building on previous chapters. You will want to refer back to the sensation
vocabulary list that was studied in Chapter 10, “Exploring Body Sensation,” to
refresh clients’ memory of words to describe physical sensations. It is critical that
clients describe their sensations as they experience them because doing so
stimulates areas of the neocortex which can shut down during trauma or when
trauma is reactivated (cf., Chapter 9, “The Triune Brain and Information
Processing.”) With your help, clients can discover that for each significant thought,
emotion, image, sound, smell, or taste related to the memory, they will experience a
physical sensation.
Directed mindfulness questions like the following will facilitate their
awareness of this correlation: “When you see that image, what happens in your
body?”; “How does your sensation change when you think of the combat?”; “When
you sense that anger, what happens in your body sensation?”; “Can you just feel the
panic as body sensation?”; “What happens in your body when you have the thought,
‘It’s not safe here’?; “See that image in your mind’s eye, and notice what happens in
your body.” It is important to understand and convey to clients that for sensorimotor
sequencing, stimuli (such as images, emotions, or thoughts) are used to evoke body
sensations and involuntary movements. Then the stimuli are put aside, and
mindfulness is directed exclusively toward the body.
LeDoux (2003) reminds us: “In order for the amygdala to respond to fear
reactions, the prefrontal region has to be shut down . . . . [Treatment] of pathologic
fear may require that the patient learn to increase activity in the prefrontal region so
that the amygdala is less free to express fear” (p. 217). Sensorimotor sequencing is
used when arousal approaches the upper edge of the window of tolerance. This can
either occur spontaneously or by selecting a specific sliver of memory. For
sensorimotor sequencing to be successful, arousal can be neither too high nor too
low. The key is to stimulate enough arousal that strong sensations are experienced
but also to ensure that clients’ prefrontal cortex remains engaged through focused
attention, and verbal description of, the physical sensations and movements as they
progress through the body.
When clients who have unresolved trauma experience a clear sensation of their
arousal approaching the upper limits of the window of tolerance, sensorimotor
sequencing can be used. The thoughts, emotions, images, and other elements of the
content of the memory must be uncoupled from the body sensation. Clients are
taught to direct mindful attention exclusively to tracking the sensation as it
“sequences” through the body. Your job is to support clients in sustaining directed
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mindfulness solely on the sensations, such as tingling, vibration, involuntary tics,
trembling, and changes in temperature that emerge when focusing on a sliver of
traumatic memory or traumatic reminder. Instructions like, “Just put the fear aside;
don’t think about what happened. Just focus all your attention on your body,” can
help clients direct mindfulness exclusively to the body. Verbal encouragement, as
reflected in your tone of voice, attitude of curiosity, and confidence in sensorimotor
sequencing and the ability of the nervous system to recalibrate itself, will tend to
keep the client more focused and therefore more regulated. You can prompt clients
by drawing their attention to the details of their physical experience and to the
moment-by-moment progression of the sensations through the body. For example,
you might say something like “Yes, there’s a lot of tingling in your right arm, isn’t
there? Where does it begin and end? Does it include your shoulder, or spine, or
your hand? OK, so it seems to be moving down from your shoulders through your
arms into your fingers. Great—just sense it moving into your fingers. What happens
next in the tingling? Does it start to settle or get stronger?”
Helping your clients track their sensation by asking the important question
“What happens next?” both reassures them that there will be a “next,” and the
sensation will not stay the same, and also cues them to focus more on the movement
of the energies and sensations than on the content. If the tiny movements, jerks,
shakes, and energies cease, we might restart the sequencing by saying, “Notice
what is happening now in your body—and then notice what happens next.” If the
sequencing stalls, a somatic resource, such as pressing the feet into the ground,
aligning the spine, or self-touch can sometimes help the sequencing continue and
complete. Or you can return to the original sliver that caused hyperarousal and start
again. It is essential that, in spite of experiencing somewhat involuntary sensations,
clients know that they are always in control. It is helpful to say, “As long as you are
comfortable, just allow that sensation” or “You can stop any time if this doesn’t feel
right to you.”
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difference in how they feel afterward. This step is important because it emphasizes
that clients can always change their sensation if they wish by using resources.
SENSATIONS SEQUENCING THROUGH THE BODY helps clients trace
how sensations travel from one area of the body to another until they settle. For
clients who struggle with triggering, involuntary movements, activation, or
flashbacks on a daily basis, this worksheet may prove to be a good way to get
through these occurrences. You can help your client learn to sustain mindful focus
when tracing their sensations on the drawing of the body on the worksheet until
arousal settles. Your guidance especially with the question, “What happens next?”
will be essential in helping clients notice how their sensations travel sequentially
through the body. The slowness of this microprocessing, along with the physical
action of drawing the sequence of sensation on the paper, encourages dual
awareness and along, with maintaining social engagement between you and your
client, helps to keep the experience safe and manageable.
SENSORIMOTOR SEQUENCING & THE WINDOW OF TOLERANCE may
be especially helpful to clients who have trouble maintaining arousal within the
window and need the structure of the worksheet and your direction to help them
stay focused. The experience of successfully tracking how sensations change as
they approach the upper edge of the window, and then continue to change until they
settle, helps clients gain control over their dysregulation and feel present. You
should use this worksheet in session, guiding clients through the sequence of
sensations until they settle, and writing down their descriptions of the sensations on
the worksheet, then fill out the last question together.
The final worksheet, SEQUENCING ONE AROUSAL CYCLE AT A TIME,
provides the opportunity for you to guide clients in sequencing one sliver of a
memory three times. By processing one arousal cycle at a time, you can help clients
learn experientially that if they repeatedly use sensorimotor sequencing with one
sliver, they may no longer become triggered by that sliver or by the memory. Their
nervous system has recalibrated itself. Most clients will benefit from sequencing
the same sliver three times, and each time the arousal stimulated by the sliver
should be a little less, until the sliver no longer provokes arousal. However,
occasionally, after sequencing only one cycle, the sliver may no longer stimulate
arousal. After the first cycle, you can assess whether the same sliver still stimulates
arousal or not. If it does, you can sequence that sliver again; if not, you can
sequence another sliver of the same memory. Other clients may need to sequence
the same sliver more than three times, and if that is the case, you can continue until
the sliver no longer triggers arousal. As always, the worksheets should be adapted
specifically to the client.
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Chapter 26
We have learned that, in the face of trauma, animal defenses are instinctively
mobilized to assure our survival. Under threat, the sympathetic nervous system
prompts the adrenal glands to release adrenaline that gives us the burst of energy
we need to be fully prepared to fight or flee or get help. Traumatic reminders and
slivers of traumatic memory can both stimulate the same surges of energy, usually
experienced as uncomfortable body sensations such as sweating and trembling. As
we have pointed out, since these sensations result from autonomic nervous system
arousal, they are often impervious to resolution by talking about them or working
with their emotional components. These energies need to be addressed and
processed on a bodily level.
In much the same way that people with unresolved grief can identify and
experience the grief, we can identify and experience these instinctual energies
physically. In order to do so, it is necessary to distinguish body sensations and
movements from emotions and thoughts, as you learned to do in Chapter 10,
“Exploring Body Sensation.” This chapter will further the work of that chapter by
teaching you how to put emotions, thoughts, images, and memory content aside
when you are working with a memory in which your arousal begins to exceed the
upper edges of the window of tolerance into the hyperaroused zone. You will learn
sensorimotor sequencing, a technique of mindfully and exclusively attending to the
physical sensations of hyperarousal until the sensations settle down by themselves.
Through sensorimotor sequencing, you can work with the strong energies connected
to hyperarousal and defensive responses on a physical level and resolve the
sensations they cause when the past is activated deliberately in therapy or triggered
by reminders.
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action might be needed to survive. We experience the rush of adrenaline as an
increase in energy, focus, and muscle tension, and often as trembling, shaking,
tingling (often in hands and feet—the areas of the body involved in fight or flight
defenses), sweating, nausea, increased heart rate, dizziness, hyperventilation, or
shortness of breath. If you have ever seen a dog tremble after being frightened by a
clap of thunder, you have witnessed one of the effects of adrenaline.
When adrenaline is stimulated and we start to become hyperaroused, we can
learn to put aside any images, emotions, or thoughts and direct mindful attention
exclusively to the body—to the sensations of tingling, buzzing, trembling,
temperature changes, and so forth. We can then follow or track the sequence of
these sensations as they progress through the body. This is what we call
sensorimotor sequencing.
Over many years of therapy, Cate had worked with the memories of a terrible
traumatic event, but her symptoms of panic and hyperarousal, alternating with
depression, had not resolved. When Cate was 17 years old, her sister had lost her
life in an act of murder–suicide by her sister’s husband. Cate had been sent by her
parents to the morgue to identify her sister’s body. For nearly 40 years afterwards,
Cate felt she relived the event whenever she tried to address the memory. Even the
thought of what had happened caused panic, trembling, pounding heart, and thoughts
of “what if” and ”I wish I had died instead.” In a session, as she and her therapist
began to focus on the first sliver—“thinking about thinking about” what happened
the day her sister had died—Cate learned to put her panic and thoughts aside to
focus all her attention exclusively on her sensations. She noted the tingling in her
body that occurred along with the shaking and the slight acceleration in her heart
rate before it started pounding. With the help of her therapist, Cate learned to
mindfully follow the sequence of these sensations as they progressed through her
body, until the shaking stilled and her heart rate returned to normal. For the first
time since this terrible event, she had a way to remember a tolerable sliver of
memory, rather than relive what had happened, and to quiet her arousal through
sensorimotor sequencing. Cate repeated sensorimotor sequencing with several
slivers of this memory until the event felt “finished” and thinking about it no longer
provoked hyperarousal.
When we choose a sliver that stimulates arousal to the upper edge of the
window of tolerance we can use the technique of sensorimotor sequencing to direct
mindfulness exclusively to spontaneous body sensations and movement that emerge
instead of focusing on the images, emotions, and thoughts associated with the sliver.
Sensations can vary in intensity from tingling to a slight tremble and even progress
to strong tremors. We must allow the energies of unresolved trauma to slowly and
steadily dissipate in a controlled way. Think of a pressure cooker whose buildup of
pressure has to go somewhere or it remains energized and unstable, just as our
bodies sometimes do after trauma or stress. If we open the pressure cooker too
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quickly, there will be a burst of unregulated energy and the pressure cooker might
blow its lid, so we have to let a little bit out at a time. When we begin to
experience these powerful energies as they approach the upper edge of the window,
but just before they escalate to dysregulated hyperarousal, we can mindfully follow
the progression of the spontaneous sensations and movements that accompany very
high arousal. Cate noticed trembling in her spine and even her mouth as soon as she
thought of what had happened, but she stayed with these sensations and observed
them just as a feeling in her body, putting aside the memory contents. Since she was
attending only to body sensation, excluding emotions, cognitions, images, and
content, the amount and intensity of what she had to pay attention to in the moment
was tolerable for her. The sensations began to move or “sequence,” and the
trembling gradually subsided.
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tolerable. See Figure 26.1 for an illustration of sequencing one arousal cycle at a
time.
By processing one arousal cycle at a time, Martin began to trust that if he put his
mindful attention exclusively on the moment-to-moment changes in his body
sensation, his arousal would not escalate beyond control as it had before. By
putting aside emotions of panic and terror, images of the combat, and repetitive
thoughts that he was going to die, he was able to prevent the escalation of his
arousal. Instead, he found that his arousal returned to the window.
For those who wonder how we could process trauma without making meaning
of what happened, it is important to understand that we cannot make accurate
meaning of trauma until our bodies experience the physical sense that the danger is
over. After his arousal returned to a tolerable level and stayed there, Martin could
then look at the emotions and meaning of his war experience and process them
without undue dysregulation. Prior to that, the feelings he experienced (terror and
rage) or meanings he could attribute (“You can’t trust anyone,” “I’m going to die,”
and “I was stupid to enlist”) were biased by his dysregulated arousal. After
sensorimotor sequencing, Martin no longer felt the terror and rage as his nervous
system recalibrated and became regulated. He could then make a different meaning.
He recalled joining the army because he was young and idealistic. He realized that
not everyone was untrustworthy; some people in the world could be trusted. Even
more importantly, he could feel compassion for himself as a teenager exposed to so
much violence at such a young age.
FIGURE 26.1
Note that through sensorimotor sequencing, the mind is harnessed to support the
sequencing of the sensations associated with arousal rather than to manage or
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control them. Martin and Cate both experienced their sensations and movements as
if they were happening by themselves, without their intention or control. At first,
not being in control of the sensations was a bit disturbing and uncomfortable. But as
they learned to allow these sensations rather than try to control or suppress them,
and to find the words to describe their qualities such as shaky, jerky, and quivery,
they noticed that the sensations began to change and resolve without effort.
However, it is important to know that you are always in charge of your body
and of sensorimotor sequencing. If, at any point, you were to find that the sensations
were not settling the way you would like, or if you want to stop the process of
sequencing, you can simply focus on a voluntary somatic resource from your
repertoire—grounding, lengthening your spine, standing and walking, or pushing
away. You can choose resources to either facilitate the sequencing to progress or
help it cease, whichever you prefer. If you decide to stop the sequencing, you can
return to it later if you wish.
Working with beliefs and emotions (see Chapters 29, “Beliefs and the Body”
and 30, “Making Sense of Emotions”), although indispensable in healing certain
aspects of memory, does not directly address the resolution of the instinctual
physical and physiological effects of trauma and stress in the same way that
working directly with the body does. Through sensorimotor sequencing, many
people find that they experience more regulated arousal and a sense of mastery.
Cate reported that for the first time ever she was able to talk with her adult son
about her sister’s murder without getting dysregulated. After learning sensorimotor
sequencing to process his memories, Martin said, “I feel really easy in my body—
that’s new these days although I’ve done lots of [therapy]. I’m able to go back and
think about [combat] and not really get activated.”
Sensorimotor sequencing takes intention and practice, but with experience, you
can develop confidence that your hyperarousal will settle if you just follow the
sensations that you experience. With the help of your therapist and the worksheets
that follow, you can explore mindfully tracking the sequence of physical sensations
and movements as they progress through your body and to temporarily disregard the
emotions, images, and thoughts that arise. These sensations and movements will
then have the chance to resolve naturally, without your trying to control them. Over
time, with repeated iterations of sequencing, your nervous system can recalibrate,
as Cate’s and Martin’s did, so that you are no longer so triggered into hyperarousal
by your memories.
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4. After you have found the words to describe the sensation of your arousal rising,
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select a resource from your repertoire that you enjoy and that helps your arousal
return to an optimal level—breathing, grounding, moving around, or something else.
After you have practiced your resource, put a check next to any sensations you
notice in the chart above. If the sensation is not on the list, add it on the bottom line.
5. Describe your experience below. How do you feel after allowing your arousal to
increase to the upper edge of your window and then using a resource to bring it
down again?
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Note: If at any time you feel uncomfortable or want to stop, you can practice a
resource from your resource repertoire to help your arousal settle.
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Window of Tolerance
1. What are the first sensations that tell you your arousal is increasing?
2. What happens next in your body? What sensations tell you your arousal is
getting higher?
3. What happens next? What sensations tell you your arousal is a little over your
window?
A. If your arousal is returning to your window, describe the sensations that tell
you so in #5.
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5. Describe the sensations that tell you your arousal is settling.
6. Describe the sensations you feel as your arousal returns to an optimal level and
you complete the sequence.
How could you use this skill of sequencing in other situations in which you get
triggered?
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MOVING DOWN THE MOVING DOWN THE MOVING DOWN THE
CURVE CURVE CURVE
Reflect how your arousal changed with each arousal cycle, and whether your
sensations lessened and became more tolerable. If your arousal did not return to
within your window, use a resource from your repertoire to regulate.
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Clients Who Might Benefit
For traumatized clients who suffer from the consequences of dysregulated emotions
that do not resolve, this chapter will be invaluable. It speaks particularly to those
whose emotions feel out of control or wreak havoc on professional and personal
relationships, as well as to those who cannot access emotion, disconnect, or
automatically become numb in response to emotions of any kind. Other clients for
whom this chapter will be beneficial are those who have trouble with specific
emotions such as: fear of their own rage, chronic shame responses, prolonged
terror or despair, paralyzing anxiety. For these clients, too, the chapter can help to
normalize their difficulties and make sense of them. Clients who experience sudden
surges of intense “unreasonable” emotions that are out of proportion to the context
will find a possible explanation for this. Clients who have repeatedly been
encouraged to express intense emotions but who find no relief, and sometimes find
that their dysregulated emotions only increase, will benefit by learning why
emotional expression has not been effective. Those who think abreaction and
catharsis are the only way to resolve emotions will understand the use of bottom-up
approaches to work with animal defense-related emotions effectively.
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of Tolerance” to refresh their memory about the signs of dysregulation.
Traumatized clients often present with narratives describing whatever has been
most stressful or problematic for them since their last appointment. In talking about
these stories, clients may either have strong emotions (related to animal defenses of
cry-for-help, fight, flight, or freeze) or they may become numb and shut down
(related to the animal defense of feigned death). This pattern provides ample
opportunity for you to apply the information from this chapter and to integrate it into
treatment. You might verbalize what you notice using psychoeducation from the
chapter. Often, when you reframe an emotion as a survival response, it elicits
clients’ curiosity (e.g., “This anger you feel isn’t just anger—it goes with a fight
response”). Your own understanding and ability to convey to your clients why
expressing these emotions would not be a good therapeutic strategy without their
feeling that you are not empathic or that you refuse to or are unable to handle their
strong emotions is essential. You might ask them if expressing their emotions has
helped them in the past. Usually the answer is to the contrary, or that any relief has
only been temporary.
You can use directed mindfulness to guide clients to notice what happens
physically as they become aware of dysregulated emotions. They might report a
tightening in the jaw as they talk about their anger, impulses to flee after a negative
experience at work, wanting to curl up into a ball accompanied by a desperate
sadness or terror and impulses to defend coupled with feeling unable to move.
Dysregulated hyperaroused emotions such as rage and terror are often experienced
either as impulses to action or as strong sensations. If clients experience sensations
of tingling, trembling, vibrating, or buzzing, you can use sensorimotor sequencing,
as described in the previous chapter. Otherwise you can help them track their
physical impulses to discover the movements that want to happen.
You or your clients may notice “preparatory movements,” such as a lifting of the
fingers in preparation to push away, which are dependent upon the planned or
voluntary movement for the form they take (Bouisset, 1991). Physical tension is
often indicative of a preparatory movement and can be a precursor to a larger
action, such as tension in the legs as preparatory to the impulse to flee, or tension in
the arms as preparatory to fighting back. You can ask questions that evoke
preparatory moments, such as, “When you feel that sense of terror, what happens in
your body?”; “When you sense that rage coming up, what impulses do you have?”;
“When you feel so tight and frozen, what action would your body want to make if
you could move?” Often, impulses begin to manifest through a tightening or
clenching in the jaw, neck, shoulders, arms or hands, back, legs and feet, as well as
through small movements such as twisting of the spine or pulling back with an arm.
As clients notice these preparatory movements, you can encourage them to
mindfully follow their impulses to execute the action.
If clients feel hypoaroused, physically weak or limp, “flat” or detached from
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emotion, they might be experiencing a shutdown defense. They may not experience
any impulses to move and may not be able to feel the body. In such cases, voluntary
movement such as standing up together, pushing against a pillow, or moving the
head and neck to orient to various items in the room are probably the best options.
Voluntary defensive action is usually an antidote to this version of immobility, and
often other movements will then emerge spontaneously. In these cases, it also might
be useful to spend more time with the embodiment of animal defenses, especially
the mobilizing ones in Chapter 25, “Restoring Empowering Actions,” to establish a
physically felt sense of these defenses. Another option is to carefully choose a
sliver of memory in which an active defense might have been stimulated, as
described in Chapter 24, “Sliver of Memory,” and then direct clients’ mindful
attention to body sensations and movements.
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defenses, and resources—will consolidate this chapter’s teachings.
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bottom up with dysregulated emotions by helping them track their body to discover
the preparatory actions of animal defensives (e.g., pushing or getting away) fueled
by these emotions. You will need to adjust your pacing so that it is slow enough to
invite different parts to voice their reactions to making the action, so that parts and
conflicts are not overridden. If parts become threatened or frightened by the action,
you can pause to gather information from these parts about what is needed to make
the action acceptable or what they are worried might happen if the action is
completed. You can also help dysregulated parts by encouraging the support of
other, more stable parts when working with these emotions and actions.
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emotions, or feel powerless to manage them. Some of us may “feel nothing” even
when we are in dangerous situations, despite our rational mind telling us that we
should be afraid.
Other people might tell us that our emotions or reactions are “unreasonable” or
“out of proportion.” We ourselves may feel critical of, embarrassed by, ashamed of,
or disgusted by our strong emotions, not understanding that they make sense in terms
of animal defenses. Sometimes we may try to cope with them in ways that are not
helpful in the long run, such as hurting ourselves or others; erupting in
uncontrollable emotional outbursts; avoiding the feelings or trying to talk ourselves
out of them; attempting to regulate them with food, alcohol, or drugs; or by
withdrawing from situations and people that stimulate extreme emotions. We may
also feel detached from emotions.
Marcy told her therapist that she did things that would seem dangerous to most
people, such as driving too fast on her motorcycle, having unprotected sex with
strangers, venturing into dangerous areas of town alone, and even going to a bar that
was notorious for violence and criminal activity. The absence of fear when she
knew intellectually that she should be afraid left her wondering why that was. In
addition, Marcy was bothered by out-of-control emotional reactions. She was
triggered when others rejected her or did not give her the attention she felt she
needed. In such situations, she experienced uncontrollable fury or panic-driven
outbursts. Afterwards, she felt embarrassed at her “tantrum” and promised herself
not to overreact the next time—only to find that she continued to have the same
reactions to the same triggers. Though she was not aware of it, Marcy was reliving
the emotions related to the animal defenses she had needed during childhood
trauma. The numbing and detachment (related to a “feigned death” response that
was the last resort for Marcy during abuse) was triggered through the high-risk
activities. The rage she felt was related to a “fight” defense, and the panic had to do
with a desperate need for others to help her (cry for help defense).
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When we do not have adults to regulate or soothe us when we are small, we
may vacillate, like Marcy did, between hyperarousal (feeling too much) and
hypoarousal (feeling too little). As adults later on, we may still suffer from rapid,
dramatic, exhausting, and confusing shifts of the intense emotions that go along with
animal defenses. We may experience emotions as urgent calls to explosive,
dysregulated action, or complain of depression, inaction, and lack of motivation, or
alternate between bouts of impulsive action and feeling unable to act.
FIGURE 27.1
Some people report that they live in a chronic state of arousal and fear. The
desperate need for another person that is ordinarily a characteristic of a young
child’s cry for help from their caregivers may persist into adulthood. We may not be
able to feel safe unless someone who can protect us is nearby, and we may feel
distressed and frantic when we are alone. Fear and terror that fuel a flight defense
may become chronic, repeatedly triggered by traumatic reminders. We may have
recurring impulses to leave social situations, flee when someone approaches, or
even run out of the room during meetings when something triggers us. The anger and
rage associated with a fight defense could become chronic or out of control, and we
may find that triggers evoke uncontrollable bouts of rage, destructive behavior, or
impulses of violence against our own body or toward others.
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Both immobilizing defenses of freezing and feigned death/shut down are
characterized by a feeling of helplessness. Agitation and extreme anxiety or panic
combined with feeling paralyzed are the hallmarks of freeze. When no other
defense is effective, the last resort is a version of feigned death/shutdown,
accompanied by feeling detached from emotion. Sometimes it can be a relief not
having to feel the feelings, but often those who experience detachment and numbing
have a sense of defectiveness or become angry at themselves for not feeling normal
feelings like most people do, which only aggravates their feelings of inadequacy
and despair. They do not understand that a lack of emotion is most likely the result
of a shutdown, or feigned-death, animal defense.
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To do this, we must differentiate emotional processing from sensorimotor, or
body, processing and become familiar with the language of each as described in
Chapter 10, “Exploring Body Sensation.” Effective emotional processing involves
experiencing, articulating, expressing, and integrating emotions at the edges of the
window of tolerance (see Chapter 30, “Making Sense of Emotions”). The problem
with the emotions related to animal defenses is that they exceed the edges of the
window and cannot be integrated by expressing them. But they can be worked with
bottom-up through the body. Sensorimotor processing, in contrast to emotional
processing, refers to experiencing, describing, and integrating body sensation,
physiological arousal, and movement impulses. A direct, exclusive, or even
primary focus on emotional processing is of little benefit when we are experiencing
an overwhelming flood of emotions, a lack of emotion, or the same emotion over
and over. Expressing emotions in these cases can even make things worse. Instead
we can address them through bottom-up physical interventions.
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movements meant or what her father might have done, she found that it did feel
good to push against a pillow held by her therapist. She felt strong, determined, and
self-protective. Marcy realized that her anger was originally meant to fuel a “fight
back” defensive response that she could not act upon during the abuse by her
parent. When she mindfully made the fighting back motion of pushing, Marcy found
that her rage had a good, empowering (but not dysregulated) action to go with it
instead of being stuck or exploding.
Marcy had told her therapist that she often felt numb and detached from
emotions especially when she engaged in high-risk behavior. As she focused on a
sliver of seeing herself walking into the dangerous bar, she noticed that she could
barely feel her body. Another sliver of memory then emerged of being very small,
and she remembered that as a child, she felt helpless. Then Marcy began to lose
connection with her body as she had during the abuse. She said that she felt
“nothing,” no emotion whatsoever, and no sensation. The absence of emotion is
common with a feigned death/shutdown, defense. It was hard for Marcy to stay
present because her arousal had plummeted to outside of the lower edge of the
window of tolerance. She remembered “being a robot” and doing exactly what her
father wanted. Marcy was reexperiencing the state she had been in when the abuse
happened, the shut down and compliant behavior that helped her survive the abuse.
As an adult, she had relived that state of robotic compliance and numbness when
she engaged in high-risk behavior. Her therapist asked Marcy to stand up and walk
together through the room, and, with the movement and social engagement, Marcy
began to feel her body again. She learned to recognize the first signals of this
shutdown defense, which she described as a glazing over of her eyes and feeling
like a block of wood. When she began to sense this signal, she knew her best
resource was to move around, before the numb detachment got stronger.
Still later in her therapy, when Marcy recalled a particularly triggering sliver of
memory, she experienced panic and began to tremble. Her therapist asked her to put
the panic aside and just focus on the trembling sensations in her body and describe
them in detail. Marcy reported that the sensations felt like a vibration in her spine,
but that as long as she disregarded the panic and focused on her body, the vibration
itself was not unpleasant. Marcy was surprised to find that as she became mindfully
aware of the trembling and just directed her attention to it, it slowly began to
change. Through sensorimotor sequencing, the trembling settled eventually, by
itself. Marcy was able to use sensorimotor sequencing with several triggering
slivers to recalibrate her nervous system.
In each of these sessions, Marcy capitalized on bottom-up processing: first
using her anger to find an empowering physical fight action (the pushing), using
movement to mitigate the absence of emotion and robotic behavior that
accompanied the immobilizing defense, and eventually working with the panic by
putting the emotions and thoughts of the panic aside and using sensorimotor
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sequencing to follow the vibrations in her body until they settled. These somatic
interventions can help to resolve the intense emotions related to animal defenses
that occur too far out of the window of tolerance to integrate and pave the way for
future efficacious processing of emotions (see Chapter 30, “Making Sense of
Emotions”). The worksheets provided in this chapter can help you recognize,
understand, and find resources for the emotions that relate to animal defenses. They
will also give you and your therapist insight into your experience of any of these
emotions so that you can determine physical ways to work with them.
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What resources would help you regulate these emotions so that you could take the
action of your choice rather than behave in a way you might later regret? (e.g.,
Use my breath and grounding resources to calm down and ask my partner to sit
and hold hands with me and discuss the difficulty between us.)
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––––––––––
––––––––––
What resources would help you regulate these emotions so that you could take the
action of your choice rather than behave in a way you might later regret?
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What resources would help you regulate these emotions so that you could take the
action of your choice rather than react in a way you might later regret?
661
––––––––––
What resources would help you regulate these emotions so that you could take the
action of your choice rather than behave in a way you might later regret?
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What resources would help you regulate these emotions so that you could take the
action of your choice rather than react in a way you might later regret?
Discuss with your therapist various physical actions that would address these
emotions.
1. List the three emotions related to animal defenses that you would like to regulate.
2. Describe future situations in which each of these emotions might emerge and
identify the resources, especially somatic resources, you could use in each of those
situations to regulate.
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Hyperarousal
High Arousal
2. Think of different times when you experienced the emotions below, accompanied
by high arousal. Write any other relevant emotions on the last line. Describe how
your body feels when you experience each emotion.
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Discuss with your therapist which physical action (e.g., pushing, running, or another
action) or if sensorimotor sequencing would be useful to work with hyperaroused
emotions related to animal defenses.
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1. Think of different times when you experienced the emotions below, accompanied
by low arousal. Write any other relevant emotions on the last line. Describe how
your body feels when you experience each emotion.
Disappointment______________________________________________________
Sadness_____________________________________________________________
Boredom_____________________________________________________________
Other_______________________________________________________________
Low Arousal
Hypoarousal
2. Think of different times when you experienced the emotions below, accompanied
by hypoarousal related to the animal defense of feigned death/shut down. Write any
other relevant emotions on the last line. Describe how your body feels when you
experience each emotion.
Shame_____________________________________________________________
Despair___________________________________________________________
Absence of feeling________________________________________________
Other_____________________________________________________________
3. Identify two resources that might help you tolerate emotions accompanied by low
arousal, and prevent them from dropping into the hypoarousal zone.
4. Identify two resources that would help you regulate emotions accompanied by
hypoarousal.
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Discuss with your therapist what physical action or actions (e.g., standing, pushing,
running, or another action) would be most useful to work with these emotions.
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2. Select three emotions you circled in # 1 that you feel you expressed in a negative
or unsatisfying way and list them below. Describe what each feels like in your body
(e.g., Tense, jittery, held breath, rigid posture, collapsed posture, fast heart rate,
slow heart rate, or numb).
1.
2.
3.
3. How did you react to each emotions? (e.g., I got critical, angry, disgusted,
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ashamed, embarrassed, self-blaming, confused.)
1.
2.
3.
4. How did you express or manage these emotions? (e.g., I withdrew, lashed out,
apologized, hurt myself, went to bed, smoked marijuana, drank alcohol, watched
mindless TV.)
1.
2.
3.
5. List three alternative behaviors in the chart below and describe how you think
you would feel if you engaged in these behaviors.
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1. List your triggers for emotions that are accompanied by hyperarousal and draw
a line to connect each trigger with one or more of the emotions in the column in
#2.
2. Draw a line to connect each emotion on the left with one or more of the animal
defenses on the right that you experience when the emotion is triggered.
Fear/Terror Fight: hit, kick, strike out, push away, verbally attack
Anger/Rage Cry for help: scream, make noise, cling to or seek close proximity
to others
Panic Flight: run, back away
Other: Freeze: hyper alert but can’t move, feel paralyzed, crouch down,
hide
Other:
Hyperarousal
Window of Tolerance
Hypoarousal
4. List your triggers for emotions that are accompanied by hypoarousal and draw
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a line to connect each trigger with one or more of the emotions in the column in
#5.
5. Draw a line to connect each emotion on the left with one or more of the animal
defenses on the right that you experience when the emotion is triggered.
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SECTION FIVE
PHASE 3
Moving Forward
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stages and then become increasingly problematic (or vice versa) may glean insight
into the role their attachment histories play.
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Because relationships are such a sensitive topic for so many clients, the
didactic material in this chapter can provide a less triggering context for a
discussion of how the legacy of attachment affects them. Conveying that all of us
learned ways of relating that no longer serve us will help clients be receptive to
this material. Emphasizing that this chapter has something to offer that will support
their goals may also help to offset any reluctance, shame, or defensiveness that
might arise. The emphasis on collaboration is especially important because clients
so easily feel ridiculed or ashamed with regard to the topic of their relationships.
Communicating that everyone is affected by some degree of inadequate caregiving,
even in the best of families, and perhaps providing some examples, can help to
normalize their relational difficulties.
Since attachment histories shape transference and countertransference, this
chapter can shed light on how therapists inadvertently trigger clients, and vice-
versa, or how both are caught up in a more prolonged or complex enactment. As we
view clients’ transferences and our own countertransferences as legacies of
attachment in the form of implicit relational knowing, we may find ourselves
becoming curious about, rather than interpreting, the relational challenges between
us as a problem. For example, a therapist’s relational knowing that “It’s important
not to keep secrets” might lead her to pressure a client into disclosing more than is
therapeutic, or to have a strong reaction to the client’s fear that disclosing his
thoughts, feelings, and opinions could lead to humiliation or punishment. When your
clients respond to a steadily deepening therapeutic relationship with abandonment
fears, criticism of your skill, or with reactive fight or flight responses, you will
have a context for showing curiosity about these patterns as early attachment
imprints, reflecting clients’ “knowing,” such as, “It isn’t OK to be close—to depend
on—to trust—anyone because I will be abandoned, criticized, or betrayed.” If you
yourself react to your clients by feeling rejected or incompetent, you can become
aware of your own relational patterns as well, and how they interact with those of
your client. Holding in mind that transference, countertransference, and therapeutic
enactments stem from implicit relational knowing rather than conscious intention is
essential to remaining curious about the impact of your own attachment history, as
well as that of your client, on the therapeutic relationship.
At these moments, safety in the relationship may be threatened or even lost. But
this is not cause for undue concern for the therapist who is interested in learning
about his or her own participation in what takes place beneath the words. In fact,
the real magic and healing power of clinical practice often comes from negotiating
the implicit impact of therapist and client upon one another, a process which can
temporarily compromise social engagement, but in the end yield great reward
(Ogden, 2013). As Bromberg (2006) states:
The [therapist’s] ability to provide a safe environment is not in itself the source of therapeutic action.
While the [therapist] must indeed try not to go beyond the patient’s capacity to feel safe in the room, it is
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inevitably impossible for him to succeed, and it is because of this impossibility that therapeutic change
can take place. (p. 24)
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connected to early relational knowing—to enrich their current relationships. If your
client has difficulty remembering any positive relationships from childhood, an
alternative use of this and other worksheets would be for the client to examine the
relational knowing connected to the therapeutic relationship. In fact, with some
clients, many of the worksheets for this chapter may be best adapted to explore
their relationship with you.
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Our most joyful and pleasurable relationships are usually with those to whom we
are attached—in other words, those closest to us, our families and friends. These
same relationships are generally the source of the most distress and emotional pain
as well. Attachment reflects a biologically driven need for affiliation with other
humans that begins in infancy and continues throughout our lifespan. Forming and
sustaining attachment relationships is essential to our survival. We would perish
without someone to care for us and protect us when we are small, and we
instinctively call upon the “cry for help” animal defense to bring another person to
our aid when we are frightened. However, along with the need for safety and
protection, all of us have fundamental human needs for emotional connection,
physical contact, companionship, support, and a sense of belonging. We will not
thrive and may not survive unless our intangible emotional and relational needs are
met by our family and friends, our attachment figures.
We all have varying capacities to form and maintain attachment relationships.
This chapter focuses on how our capacity for attachment—for developing enduring
emotional bonds—is developed, distinguishes relational defenses from animal
defenses, and explores how we learn how to be in relationships. We hope that this
chapter will give you a better understanding of and compassion for the patterns you
have developed in relating to those close to you and also spark some ideas about
how you might improve your capacity for attachment.
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our caregivers tend to these needs physically with their touch, movement, and tone
of voice is our introduction to the nature of human relationships. If this genetically
driven dance between infant and parents goes well, the parents will experience a
desire to touch, rock, and hold their baby and tend to his or her needs. The baby
will snuggle, smile, and coo in response, internalizing the experience that the world
is a safe, loving place. Thus, our sense of ourselves in relationship to others is first
and foremost a body sense, experienced through the sensations and movements of
our own bodies in interaction with others when we are small. The dance of
reciprocal attachment behavior between a parent and infant, including
misattunements and reconnection, is meant to occur again and again. These
experiences foster an internalized template of safe relatedness that prepares us to
encounter frustration, disappointment, and hurt feelings and then to recover without
lasting ruptures in our relationships.
However, if our caregivers abuse or neglect us, our natural instinct to seek out
others for care, protection, and emotional connection is damaged. When people,
especially those to whom we are attached, frighten or ignore us, we may learn to
mistrust others and avoid depending upon their support, suspicious of their
intentions. Or we may start to feel that other people are the only hope of rescue or
protection even though they are also dangerous and scary. As a result of this legacy
of traumatic attachment, we are likely to become easily dysregulated in
relationships, which no longer feel like the sources of support and enjoyment they
could be. We become vulnerable to being repeatedly triggered by interactions with
others, especially those people closest to us.
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Jillian would try to please her mom when she “flew off the handle,” in an attempt to
keep herself safe and maintain the attachment bond. She pushed aside her own
angry reactions to her mother’s rage because she intuitively knew that expressing
her anger would only make things worse. Though she had inhibited her impulses to
rage back at her mother, she implicitly remembered this inhibited rage years later in
conflict with her husband. Jillian learned in therapy to recognize that the tension in
her jaw was the first signal that she was about to erupt in rage, and she learned to
pause, take some deep breaths, relax her jaw, and wait until her arousal calmed
before continuing to talk with her husband. In this way, Jillian used resources to
quiet her defensive “fight” response and restimulate her social engagement system.
If you have suffered attachment trauma like Jillian, becoming sensitive to the
first physical signs of the emergence of animal defenses in your attachment
relationships, and then inhibiting that response and practicing a resource instead,
can help quiet them when they are not needed. You might also work with your
therapist to find the actions your body wants to make when you experience intense
emotions. Pushing motions and words like “stop” gave Jillian’s rage empowering
actions that replaced the outbursts. Using sensorimotor sequencing to address the
sensations of hyperarousal can also be effective. Using sensorimotor sequencing
helped to reset Jillian’s nervous system and over time she found that she rarely
experienced dysregulated rage.
Relational Knowing
As we have seen, how and to what degree our relational needs were actually
fulfilled and how misattunements were resolved in childhood affects our future
relationships. Through both positive and negative interactions with our early
attachment figures, we acquire knowledge about how to interact with others—what
kinds of sounds, facial expressions, or actions will be welcomed or rejected by
them, and what we can expect in our relationships. Once we have acquired this
“relational knowing,” the sounds, expressions, and behaviors that produce the most
desirable response from the people close to us become automatic, and, conversely,
we inhibit behavior that provokes adverse or unwanted reactions. We no longer
think about what we are doing or how we are interacting with those close to us. Our
postures, facial expressions, gestures, and even emotional responses have become
procedurally learned habits.
If our parents respond to our distress with kindness and sensitivity, we learn
that we can count on others to support us when we need it. Our innate need to
connect then remains strong and becomes more sophisticated over time as we grow
up. If our parents put aside their activities to respond to our needs, we learn that we
matter and deserve attention. If our parents encourage us to try new things and are
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generous in their praise when we attempt difficult tasks, then we will probably be
excited and curious when faced with challenging new activities and move forward
to engage with the world and with others. If they help us deactivate our defenses
when they are unnecessary, then we learn to meet challenges with courage. For
example, parents can support a child who is afraid of dogs to slowly approach and
pet a friendly dog and teach the child to read the cues that tell whether a dog is
friendly or not. These positive exchanges teach us to expect satisfying, enjoyable
interactions with others and help our brains to develop in such a way as to increase
our capacity to form healthy attachment bonds that can last a lifetime.
No Parent Is Perfect
It is important to understand that no parent is perfect. All have deficits in their
parenting as a result of their own blind spots, childhood experiences, current stress,
and life circumstances. Even if we have not been neglected or traumatized, we have
all had childhood experiences with attachment figures that caused us some degree
of emotional distress. Our parents might have been good parents in general but still
did not give us quite enough attention or the kind of attention we most needed. They
might have been inconsistent or critical in how they treated us. Perhaps they were
just unaware of our needs or too focused on work demands or other stressors to
tend to us satisfactorily. All parents welcome, confirm and respond positively to
some aspects of their children, as well as deny, disconfirm and respond negatively
to other aspects.
Whatever less than optimal attachment experiences we had, it is likely that we
adapted by maximizing ways of relating that helped us to get the best possible
connection with our parents while avoiding their rejection and disapproval. If our
parents were critical, we might have learned to make an extra effort to do things
right and try to avoid mistakes in order to win their approval. These efforts might
result in bodies that are tense and anxious. If our parents responded positively to
our achievements, welcoming the parts of us that were competent, we might have
developed patterns of high-energy, goal-focused behavior designed to excel. If our
parents were threatened by or put down our achievements, we might have learned
to hold back our enthusiasm and competitive impulses. If our parents were stressed,
we might have put aside our own needs to try to comfort or help them. If they were
too busy to pay attention to us, we might have become self-reliant and given up on
needing their attention.
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LaVonne grew up in a loving, close-knit family and had many happy memories of
cozy evenings watching TV, going for walks together, and playing with her siblings.
But LaVonne’s parents did not always support her interests. LaVonne wanted to play
sports; her parents insisted on ballet classes instead. When she wanted to be a
vegetarian, her parents required that she eat meat. Through repeated situations in
which her wishes were thwarted, LaVonne began to sense that her interests were
not acceptable to them, and she started to put aside her own impulses in order to do
what her parents wanted. Instead of sticking up for her own wishes and convictions,
she responded by acquiescing to their wishes to keep the peace and fit in with her
family. Her body reflected this acquiescence in a slightly sunken chest, limp arms,
low energy, and somewhat shallow breathing. It eventually became difficult for
LaVonne to mobilize enough energy and confidence to voice her own opinions or
assert herself in her marriage.
LaVonne’s husband, David, had been a “latchkey kid,” often left to fend for
himself as a child. He remembered the lonely, boring hours waiting for his single
mother to come home from work, hoping she would not be too tired from her long
day to do something fun. David’s most precious memories of his childhood were
the exciting, joyful times he spent with his mom, from going to amusement parks to
making up stories, but these times were few and far between. Much as he had
longed for more fun times with his mother, David longed for more engagement from
LaVonne. He suggested they try couples therapy because he wanted an “equal
partner” who would come up with ideas for vacations and dates and spark
interesting conversations at mealtime. At the same time, he did not know how to
invite LaVonne to engage with him but rather waited for her to take the initiative
just as he had waited for his mother to come home and attend to him. He became
critical and aggressive, saying that LaVonne refused to “meet” him. Neither
LaVonne or David reported that they had suffered from trauma—in fact, both
remembered their childhoods as generally positive—but they both were
recapitulating early negative relational dynamics in their marriage.
It was important for LaVonne and David to understand that both their
procedurally learned patterns reflected implicit relational knowing acquired in
their original families. Once they understood that their relational difficulties would
not change through criticism or self-judgment, but through challenging their implicit
relational knowing, they could better work on their difficulties. LaVonne
discovered that she collapsed and “tuned out” when David asked her what she
wanted to do on their weekly date, a response originally designed to avoid the
disappointment she had felt when her interests were unsupported by her parents.
David tightened up and aggressively insisted that she come up with some ideas,
which only made her anxious.
In therapy, David learned to soften his body and lower his voice, express
curiosity about what LaVonne might be interested in, and refrain from pressuring
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her. LaVonne learned to take a deep breath, lengthen her spine, and reclaim some of
the interests with David she had foregone as a child, such as playing tennis together.
When they discussed their date options, they practiced social engagement by
making eye contact, sitting side-by-side on the sofa, and holding hands. They
supported each other and themselves to change how their histories “lived” in their
bodies, and were gradually able to move beyond their early attachment
conditioning and enjoy more intimacy in their marriage.
Our early attachment relationships leave us with both positive and negative
legacies. The relational knowing and procedural patterns learned from our positive
relational experiences can be harnessed and deepened into resources to support our
current relationships. Discovering the relational knowing and procedural patterns
learned from our negative attachment experiences can help us understand our
current interpersonal difficulties. The worksheets that follow will help you get in
touch with your own implicit relational knowing and how the effects of early
attachment relationships have shaped your beliefs, emotions, and body. You can
learn how to reclaim and deepen your positive attachment legacy as well as
discover and transform the attachment imprints you want to change.
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Legacy of Attachment
A P OSITIVE RELATIONAL EXPERIENCE
Purpose: To explore the positive, adaptive “relational knowing” that you acquired
from your early attachment relationships that contributes to the satisfaction you
experience in your relationships today.
Directions: Think about positive experiences with a childhood attachment figure
(parent, aunt, uncle, grandparent, sibling, teacher, family friend, or peer) and select
one to explore. You may also have had unpleasant or negative experiences with the
person, but just focus on a positive one for this exercise.
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1. Describe your positive relational experience.
2. Imagine that person is in the room with you right now just as he or she was
during the positive experience. Take your time to envision that he or she is with
you, maybe sitting beside you or across the room. Reflect on the triune brain model
and about how each of your three brains might respond to the positive experience.
Describe the thoughts, emotions, and body sensations and movements that come up
when you imagine this person in the room with you.
Thoughts/Beliefs:
Emotions:
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Legacy of Attachment
HARNESSING A SOMATIC RESOURCE FROM A P OSITIVE
RELATIONAL EXPERIENCE
Purpose: To draw on a positive relational experience to develop somatic
resources that can help you regulate your arousal, mood, and emotions in current
dysregulating or challenging relationships.
Directions: Explore one of your body responses from the last worksheet, LEGACY
OF A POSITIVE RELATIONAL EXPERIENCE and determine how you can turn
that response into a resource.
When my grandmother took care of me when I was sick, I felt that I deserved
love and that people could depend on one another.
3. How can you turn this relational knowing into a somatic resource that you can
use today?
4. How can you use your somatic resource to regulate the negative effects of
remembering upsetting experiences with an attachment figure?
“When I feel dysregulated when thinking about how my father left us when I
was a child, I can remember that my grandmother cared for me, and breathe
slowly.”
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Legacy of Attachment
A NEGATIVE RELATIONAL EXPERIENCE
Purpose: To explore a negative experience with an early attachment figure that has
influenced your relational knowing in a way that limits your fulfillment in your
current relationships.
Directions: Think about negative experiences with early attachment figures
(parents, aunts, uncles, grandparents, siblings, teachers, family friends, or peers)
and select one to explore. You may also have had pleasant or positive experiences
with the person, but just focus on a negative one for this exercise. Note: If you think
this exercise could be especially dysregulating, be sure to complete it under the
guidance of your therapist, or save it for later.
2. Imagine that person is in the room with you right now as he or she was when
the negative experience occurred. Take your time to envision that he or she is with
you, maybe sitting near you or across the room. Reflect on the triune brain model
and consider how each of your three brains might respond to this negative
experience. Write down thoughts that you have, the emotions that come up, and
how your body reacts.
Thoughts/Beliefs:
Emotions:
Body Reactions:
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4. Describe the relational knowing you received from this individual. What did he
or she teach you about relationships?
5. How do you think the relational knowing you learned from this person affects
your relationships today?
6. Identify any people in your life today who remind you of this relationship.
7. What body reactions and emotions do you experience with the people you
identified in #6 that are similar to those you experienced as a child?
8. What resources can you use to regulate arousal or lessen the effect of this
negative relational knowing?
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Legacy of Attachment
THE LEGACY OF ATTACHMENT IN DIFFICULT RELATIONSHIPS
Purpose: To identify a current difficult relationship dynamic that evokes implicit
memories (i.e., mental, emotional, and physical states) that are similar to those you
experienced in an previous attachment relationship.
Directions: Think of a difficulty you are having in a current relationship and
complete the prompts below.
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Legacy of Attachment
THE LEGACY OF ATTACHMENT IN P OSITIVE RELATIONSHIPS
Purpose: To identify two enjoyable and supportive current relationships and
explore how they pertain to relationships with early attachment figures.
Directions: Think of two current relationships that are enjoyable most of the time
in which you experience positive emotions. In the two charts below, describe the
ways in which the relationships are positive and how being with each person
affects your thoughts/beliefs, emotions, and body responses.
Thoughts/Beliefs
Emotions
Body Responses
Thoughts/Beliefs
Emotions
Body Responses
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related beliefs from trauma-related beliefs and explore a few ways to address each
kind of belief in therapy.
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occur. Many clients have identified themselves by their limiting beliefs, which feel
like truths rather than beliefs, and might feel apprehensive about having them
challenged. The work of this chapter does not require that clients give up their
beliefs or redefine them based on current reality. Instead, you can focus on
increasing their curiosity by asking questions such as these: “How might the belief
that feels ‘absolutely true’ have helped you survive?” or “What would it have been
like in your family if you hadn’t believed it?” By stimulating their curiosity about
the inception of beliefs that seem true to our clients, we challenge these schemas
while also validating their origins as adaptive.
You will find it useful to integrate this material on beliefs with the client’s
moment-to-moment experience. If, for example, a client has trouble making eye
contact, you can bring this difficulty into the open by saying, “Yes, you learned at an
early age that it wasn’t good to look other people straight in the eye . . . and it’s
happening here right this minute—it’s still with you.” Often, when you make the
connection to how a belief helped clients cope with early relational dynamics, it is
easier for clients to address the memories that formed the belief, experience the
emotions associated with them, and be able to upgrade the belief to fit with current
reality.
You can help clients discover the physical patterns that correspond with beliefs
by drawing attention to them, perhaps saying, “When you speak of others criticizing
you, your chin seems to lift.” Or “Your head seems to pull into your shoulders as
you talk about never being able to follow your dream.” Often memories emerge as
you address these limiting beliefs, and Chapter 24, “Sliver of Memory” on finding
a sliver of memory for attachment can be useful in these instances. The most
emotionally painful slivers of childhood memories usually have to do with the
formation of a limiting belief. A boy who thinks he is stupid may grow into an adult
client whose sliver of memory is the look in his father’s eyes when he made a
mistake or could not understand a math problem. These slivers in which beliefs
were formed or confirmed are fraught with strong emotions that need to be
accessed and experienced with your acceptance and regulation before the beliefs
can be upgraded (cf. Chapter 30, “Making Sense of Emotions”).
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Participating in this exercise with clients gives you the chance to emphasize how
the body both reflects and sustains beliefs. Once your client and you have identified
a core belief you can experiment with the opposite posture to illustrate how a
different posture makes it difficult to maintain the belief. DISCOVERING A CORE
BELIEF FROM YOUR BODY instructs clients to identify a tension pattern in their
body, and then, through mindful awareness, translate the language of the tension to
discover what belief it might reflect. Your guiding clients through this exercise,
refining the mindfulness questions, and contacting their response will help them
discover a belief. If clients discover a painful, formative memory, they will need
your empathy to process the emotions that are likely to come up. UPSETTING
SITUATIONS & CORE BELIEFS asks clients to select a particular sliver of a
recent upsetting incident. You can help them identify the particular sliver that is the
most upsetting to them. The worksheet then asks clients to make connections
between distressing or triggering experiences; core beliefs that might have been
formed about self, others, and the world; thoughts, emotions, and physical
reactions; and past experience. Clients reflect on how these beliefs are kept
“alive”: how the body and emotions make the beliefs feel true, even though they are
more relevant to the past than the present.
UPSETTING SITUATIONS & CORE BELIEFS is designed to identify the
beliefs about self, others, and the world that might have influenced a recent
upsetting situation. It helps clients think about whether these beliefs have their roots
in childhood, and whether they are accurate perceptions of the current upsetting
situation. The worksheet entitled NEGATIVE THOUGHTS & CORE BELIEFS
helps clients become more sensitive to the negative chatter in their minds about a
particular situation, identify the various thoughts that reflect beliefs about the self,
others, and the world, and describe the effects of these on their body and emotions.
It concludes with exploring how to interrupt one of these beliefs and support a new
one.
COMPASSION FOR YOURSELF reminds clients that core beliefs were not
formed by the person they are today, but by a younger version of themselves who
had to deal with difficult circumstances. The goal of this worksheet is for clients to
develop compassion instead of judgment for themselves as children who formed
certain beliefs that served an adaptive purpose in that family at that time—a goal
that will be supported as you demonstrate compassion for the pain they experienced
in the original circumstances and still experience today. From an attitude of self-
acceptance, new beliefs more appropriate to present-day circumstances can be
considered. EXPLORING BELIEFS THAT HOLD YOU BACK helps clients
discover a belief that inhibits achieving something they currently desire, whether it
is to get a new job, to be married, or to have more friends, and then identify and
practice a small movement or posture that challenges that belief and encourages a
new one that will support them in achieving their goals. As always, your reminders
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to practice the new movement will help them reap the most benefit from the
worksheet.
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accompany those beliefs. Eventually parts that have developed more adaptive
beliefs can be helpful to those whose beliefs are fixated in the trauma.
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Human beings are meaning makers. We make meaning every moment not only with
words, but through a range of automatic, nonverbal capacities. As we observe,
infer, and compile data from environmental stimuli and from our internal reactions
to stimuli (i.e., changes in our building blocks), we make meaning. Our brains
promptly assimilate the effects of external stimuli on our sensations, movements,
perceptions, emotions and thoughts, and, in a millisecond, compare all this data to
our past experience. By comparing the present to the past, we make sense of what is
occurring almost instantly, and from this usually implicit meaning, we forecast the
future and respond based on that forecast.
If a certain kind of experience is repeated often enough over time, the meaning
we make of it might also be repeated and eventually become a somewhat inflexible
core belief. Picture a child who seeks her father when she is frightened of new
experiences, such going on a playdate to a friend’s house, and the father repeatedly
comforts her and provides the support she needs to overcome her fear and engage
in the new activity. The child then learns to associate being frightened of something
new with the availability of someone to comfort and encourage her. This might
result in beliefs such as “When I’m scared, someone will be there to help me” or “I
can count on other people’s support.” or “It’s ok to try new things.” We all form
some positive beliefs like these, but trauma and painful attachment experiences also
lead us to form core beliefs that are negatively biased and erroneous. Beliefs such
as “I’m bad,” “It was my fault,” “No one will ever love me,” and “I’m never good
enough” remain powerful determinants of our behavior long after the experiences
that shaped these beliefs are over. And, as we have discussed, they are reflected
and sustained in the procedural patterns of the body.
In Phase 1, developing resources, we learned to be mindful of thoughts and
beliefs, as well as the emotions and physical elements, that went along with
resources. We learned resources to regulate arousal and increase our sense of
mastery and self-esteem. In Phase 2, working with memory, we practiced “bottom-
up” interventions for beliefs related to animal defenses by following the sensation
or movement of our bodies, and we put thoughts and beliefs aside if they interfered
with the movement our bodies wanted to make. A major goal in Phase 3 and in this
chapter is to directly address the core beliefs we formed through our interactions
with attachment figures. Learning to identify and understand core beliefs and how
they are formed, and discovering how they are reflected and sustained in your body
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are goals of this chapter. From there, you can challenge these limiting beliefs and
explore constructing more realistic or positive beliefs that can help you move
forward in your life today.
Types of Beliefs
Beliefs can be realistically positive (“Most people will treat me kindly”),
unrealistically positive (“All people will always treat me kindly”), or
unrealistically negative (“All people will always treat me unkindly”). Similarly,
beliefs about ourselves can be realistically positive (“I’m good enough just as I
am”), unrealistically positive (“I’m better than other people”), or unrealistically
negative (“I’m stupid and always mess up”). Following is a chart of examples of
realistic positive beliefs and unrealistic negative ones. Which ones resonate with
you?
Positive Negative
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“I deserve to be loved.” “I’m unlovable.”
“I can usually do what I want.” “I always have to do what others want.”
“I can get my needs met.” “My needs will never be met.”
“I can count on others.” “I can only count on myself.”
“I’m good enough.” “I’m not good enough.”
“Whatever I feel is OK.” “My feelings are not OK.”
“It’s OK to make mistakes.” “I always have to do everything right.”
Our negative or limiting beliefs usually involve global generalizations (no one, all
people, or everyone) and feel like facts or “absolutes.” Words such as always,
only, or never accompany these absolute beliefs; for example, “No one will ever
love me;” “I will never get what I want;” “This world is only full of heartache.”
These beliefs and the painful memories, emotions, and physical patterns that
accompany them all together form a repetitive, negative cycle.
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whatever I feel to myself,” and “My feelings are not OK.” However, as an adult,
his best friend, who came from a family that expressed emotions easily to one
another, often asked Nate how he felt. Through this friendship, Nate had an
opportunity to upgrade his old beliefs, and he began to challenge his limiting
beliefs with more realistically positive ones, such as, “My friends care about how I
feel.”
But, even though Nate’s limiting beliefs were challenged, he still had a difficult
time opening up to his friend. He implicitly remembered the early imprint of his
parents’ disinterest in his emotional life and how his attempts to communicate his
feelings had brought only indifference and disapproval—very hurtful to him as a
child. The possibility of testing out if his old belief was still accurate by opening
up to his friend felt frightening because Nate unconsciously associated the pain he
had experienced from his parents’ rejection of his emotions with opening up to
another person. He did not want to take the chance of reexperiencing the same hurt
he had experienced with his parents.
Keep in mind that such beliefs and related procedural learning are not
conscious. They are implicit strategies designed to minimize the recurrence of
painful relational experiences. Nate’s implicit learning told him that it was safer to
believe that no one would be interested in his emotions than to take the risk again of
hoping that they would be and then being profoundly disappointed if they were not.
When his friend would ask him how he was feeling, Nate’s body tightened and
his breath constricted automatically, implicitly signaling to him that he should keep
his feelings to himself. His core belief was not upgraded because it had become a
procedural habit. Instead, Nate overly oriented to any evidence of others being
disinterested in his emotions. If Nate’s friend looked away, was slightly distracted,
or furrowed his brow, Nate unconsciously interpreted these behaviors as proof that
his friend was not interested in his emotions and that his limiting belief was
correct. His body tightened and pulled back a little more at these moments.
In this way, our beliefs become inflexible, and, like Nate, we repeat actions that
were adaptive in the past, even though they are no longer needed or useful in
present time. Ideally, beliefs should be flexible, changing with new experiences and
geared to the needs of the present rather than to the past. Our actions and the way
we approach life should expand through development, maturation, and learning
gained from interactions with others so that we have increasingly satisfying lives
and relationships. But, when our core beliefs feel like the “truth,” it takes intention,
courage, and diligence to change them.
Nate took several steps to challenge his core belief. He became aware of his
procedural learning—the tension and constricted breath—and he made an effort to
relax his body and take deep breaths, especially when he was with his friend. This
helped him be receptive to a new experience. He also decided to talk with his
friend about his desire to change his pattern, and to ask his friend’s help, and the
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two friends set about challenging Nate’s belief. They decided together that when
Nate started to interpret his friend’s behavior as disinterest, Nate would ask openly
if that were true (which, according to his friend, it never was). They also decided
to have an evening once a month to discuss their feelings about their lives and
relationships, and Nate learned from his friend’s openness and receptivity at those
meetings that showing emotions was OK. In therapy, Nate revisited one especially
painful sliver of memory, tearfully remembering how he had cried as a young boy
after being bullied, only to be told by his father to grow up and be a man.
Reconnecting to the emotions he had pushed aside to fit into his family was critical
in changing Nate’s belief.
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can work with our trauma-related beliefs through bottom-up interventions,
developing resources and working with traumatic memory as described in previous
chapters. For example, Sue, who suffered ongoing sexual abuse in childhood from a
nonfamily member, had developed trauma-related belief, “I am a weak, incapable
person.” Since this belief was associated with the danger she experienced during
the abuse and with being too little to defend herself, she and her therapist addressed
it using somatic resources and reinstating empowering physical defenses. Sue
learned how her rounded shoulders, collapsed posture, and the lack of tone and
energy in her arms reinforced these beliefs. She began to practice alignment of her
spine, lifting her head, and strengthening the “pushing away” muscles of her arms
by lifting weights under the instruction of a trainer. As she worked with her
therapist to resolve her traumatic memories, she discovered the long-lost ability to
push away and defend herself. This changed her trauma-related belief to “I am
capable. I can protect myself.”
On the other hand, nontraumatic attachment beliefs are fraught with emotions
(see Chapter 30, “Making Sense of Emotion”) that need to be experienced and
expressed. John had formed the attachment belief, “I have to be a high achiever to
be loved,” which grew out of being raised in an extremely accomplished family that
insisted upon excellence in all endeavors. John’s body, mobilized for action,
reflected this belief through overall tension, high, shallow breathing, and quick,
incessant movements. Even when he was sitting, some part of his body was in
motion. His leg jiggled, and he squirmed in his chair. These physical patterns
contributed to his need to stay active and achieve at all costs, which prevented
relaxation and drove him to workaholism.
John began to develop the new belief, “I can be loved for who I am,” by
learning to slow down and relax his body, and to have compassion for the little boy
he used to be who kept performing for fear of losing the love and attention of his
parents. The painful emotions of feeling that he would not be loved for himself also
needed to be experienced and accepted by another person. With his therapist’s
compassionate support, John, like Nate, was able to express the deep sadness on
behalf of his young self and for all the years spent working so hard to win approval.
His agitated movements lessened and his breathing deepened as he cried softly.
Gradually, over time, John was able to exchange his limiting belief of only being
loved if he achieved for “I’m loveable as I am, not for what I achieve.”
It is important to know that when we are working with attachment-related
beliefs, we often re-experience the emotional pain of disapproval, rejection, or
lack of support from those who were most important to us growing up. The
compassion both you and your therapist can convey to the young child you once
were who needed to form these beliefs to cope with childhood circumstances will
help you experience the healing grief that can resolve the past and change your core
beliefs. The worksheets that follow can help you explore your core beliefs, how
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they relate to your body, and to begin to understand the circumstances that led you
to form them.
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#1
1. Imitate this posture, then describe your experience of the posture and alignment
of the body. (e.g., My chin and head are forward. My neck feels like it is
sticking out. My shoulders are rounded. My spine is collapsed and I can’t
breathe very well. My stomach is sticking out and my arms and legs feel weak.
2. What positive or negative beliefs do you think this person has about himself?
(e.g., “There is no use trying;” “It’s OK to be peaceful and non-aggressive;” “I
can be close with others;” “I don’t have enough support.”)
3. How do you think he feels about himself? (e.g., low self esteem,
disempowered)
What childhood experiences may have contributed to this belief? (e.g., Maybe
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his parents always put him down, or made him feel bad about himself. Maybe
he didn’t do well in school.)
#2
1. Imitate this posture, then describe your experience of the posture and alignment
of the body.
2. What positive or negative beliefs do you think this person has about himself?
3. How do you think he feels about himself?
#3
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1. Imitate this posture, then describe your experience of the posture and alignment
of the body.
2. What positive or negative beliefs do you think this person has about himself?
3. How do you think he feels about himself?
#4
1. Imitate this posture, then describe your experience of the posture and alignment
of the body.
2. What positive or negative beliefs do you think this person has about himself?
3. How do you think he feels about himself?
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1. Describe the Describe the qualities of the tension (e.g., tight, dense, achy,
tension. dull, sharp, congested, hard, blocked, rigid, painful, knobby).
Where exactly is
the tension?
Is it a big area or How is the tension pulling (e.g., if your shoulder is tense, does
a specific point? the tension pull up, in, forward, down, back, diagonally)?
Where does it
begin and end?
Tense
Thoughts
Emotions
Images/memories
Body Responses
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Relaxed
Thoughts
Emotions
Images/memories
Body Responses
• If this tension could say one sentence about you, what would it be? (e.g., “I’m a
loser.”)
5. Refine.
Say a belief you discovered about yourself out loud while you exaggerate the
tension—see if the words and the tension say the same thing. If not, find new
words to fit the tension.
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CHAPTER 29
1. Describe the upsetting experience and identify a sliver of that memory to focus
on.
2. Describe how your body responds when you focus on that sliver (e.g., changes
in movement, posture, tension, location of tension, how tension is pulling).
3. Describe your thoughts and emotions when you focus on that sliver.
4. Stay with your thoughts, emotions, and body responses that are activated by the
situation or person. Identify negative beliefs about yourself, others, and the world
that this experience seems to confirm:
• Yourself? (e.g., “I can never get it right.”)
• Others? (e.g., “Others are out to get me.”)
• The World? (e.g., “Things always turn out badly.”)
5. Reflect on the beliefs you discovered. 6. Think about how you want to
Can you connect them to memories from respond to this situation in the future
your childhood? Evaluate if the beliefs are and identify one somatic resource
accurate and fitting for this current that would support you in this
situation. Describe below. situation. Describe below.
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CHAPTER 29
727
don’t have anything interesting down. My body belong. I
to say. I won’t have any fun. I’ll tightens and don’t matter.
just feel awkward. I should stay pulls in. I feel There is
home and watch TV.” ashamed and something
afraid. wrong with
me.”
Identify beliefs about the world, others, and yourself that you would rather have and
describe how you could change your body to interrupt each old belief and support
the new belief. (e.g., The belief I would rather have is, “There is nothing wrong
with me.” I could relax my shoulders, lift my chin, make eye contact, breathe,
and engage my TV A muscle a little.)
The World
Others
Yourself
728
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Purpose: To explore how negative core beliefs helped you cope in the past, and
imagine conveying compassion to yourself, especially to the part of you that formed
these beliefs in order to cope with difficult experiences.
Directions: With your therapist, choose two negative core beliefs you want to
explore. You can choose a core belief that you discovered in one of the previous
worksheets for this chapter, or choose a different one. Reflect on the childhood
experiences that caused you to form them, and how they helped you cope with these
difficult experiences. Then fill out the boxes below.
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How the belief helped you cope
Take a moment to remember yourself as you were during the situations when you
formed one of these core beliefs.
Find a gesture (e.g., a hand over your heart, rocking, gentle self touch) that
expresses compassion for yourself and especially for the younger “you” who had to
deal with painful circumstances. Then try out the gesture with the intention of
conveying compassion toward yourself and describe your experience.
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1. Describe something you want in your life that eludes you. (e.g., I want to have
more friends.)
2. Identify a belief that holds you back from achieving what you identified in #1.
(e.g., I don’t matter.)
3. Describe the childhood situation(s) that led you to form that belief. (e.g.,
Parents divorced; lived with Mother and she was always off doing things with
other people. She never had time for me.)
4. How did the belief help you in that situation? (e.g., Believing, “I don’t
matter,” led me to stop wanting attention from her. I avoided disappointment
and learned to be on my own.)
5. How does your body reflect the belief now? (e.g., My shoulders tighten and
come up, I duck my head, and my knees lock. My stomach feels tight.)
6. Explore a small change you could make in the way your body holds the limiting
belief. (e.g., I lift my chin a bit and drop my shoulders a little.)
7. Identify what this small change might communicate to the part of you that had
formed the old belief. (e.g., You deserve attention.)
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8. Say those words that you discovered in #7 to yourself or aloud. Be aware if
there is any part of you that does not believe these words. If so, change the words
so that they are believable. What happens? (e.g., My stomach tightened when I
said the words, “You deserve attention.” The words that are more accurate and
believable are, “You deserve attention, but sometimes you will be disappointed.
But that does not mean you have to always be on your own.” Then my stomach
relaxes and my knees let go a bit. These words make it easier for my chin to lift
and my shoulders to relax.)
9. Continue with this movement and the new thought, and think about what you
want that you described in #1. Describe your experience.
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from there, to explore the underlying authentic or “core” emotions (Fosha, 2000)
that reflect a deep contact and comfort with the self and the self in relationship with
others. The ability to mindfully study these patterns and then to connect to and
experience painful emotions previously disowned or disconnected can help expand
clients’ affect array and foster a richer emotional life. This endeavor was started in
Chapter 23, “Dual Awareness of Past and Present,” and is further expanded in this
one.
736
safety-providing relationship” (Fosha, 2000, p. 42). For this work, a crucial
element is your own tolerance for emotions, which will determine the kinds,
strength, and variety of emotions that are expressed or denied within the alliance
between you and your clients (Schore, 2003b).
This chapter seeks to differentiate “core” emotions from “patterned” emotions.
Core emotions reflect a deep contact and comfort with the self and the self in
relationship, such as: the experience and expression of emotional pain unmasked by
defensive emotion, and the joy, pride, love, and deep resonance in the dyadic
context. Core emotions are supported by corresponding physical actions. For
example, adaptive anger is supported by increased alignment of the spine and a
degree of physical tension; joy by an uplifting of the spine and expansive
movement; empathy by a softening of the face and chest, and perhaps a gentle
reaching out.
Patterned emotions are “learned, dysfunctional responses that interrupt the
process of resolution. These patterns often serve to thwart or defend against a
primary emotional response” (Engel, Beutler, & Daldrup, 1991, p. 175). These
emotional biases serve to minimize affects that are either frightening or aversive
(Fosha, 2000; Frijda, 1986; Ogden, 2009). They can be thought of as relational
defenses (distinguished from animal defenses) that limit the negative impact of
painful emotions that evoked inadequate or inappropriate regulation and empathy
from attachment figures. However, they limit emotional competence:
Attachment related [patterned emotions] mask or suppress a deeper [core] emotion, recapitulate early
affect-laden interactions with caregivers, and limit affective experience, array and expression. These
emotions have a repetitive quality, and often disguise and defend against a deeper level of feeling, having
been formed as successful strategies for meeting needs where direct authentic emotional
communications proved unsuccessful. (Ogden, 2009, p. 228)
737
emotions unawares, clients are helped to discover their function and experience the
underlying core emotions.
Postures, facial expressions, and gestures outwardly express internal emotional
states, communicating these states to others. Damasio’s (1999) “dispositional
tendencies” appear similar to Bull’s (1945, 1962) “motor attitudes” that
communicate emotions. Through this chapter, we want to help clients become
aware of the sequences in interpersonal relationships that are propelled by their
emotional patterns and the related physical tendencies. Perhaps the client who
never gets angry is unable to share much with her husband or is cut off not only
from anger but from other emotions as well, reflected in a tight, unexpressive body
—the result of which is that her husband feels unimportant. Or the client who never
cries but suffers from performance anxiety accompanied by constrained upper chest
breathing and quick, anxious movements might have a difficult time relaxing enough
to enjoy playing with her children.
Often clients question their emotion, asking, “Am I right to feel this way? Would
other people feel this way?” By stimulating their curiosity and interest in emotional
biases and the physical patterns that support them, we can disrupt clients’
identification with them as “just how I am” and challenge evaluations of emotions
as “right” or “wrong,” “bad” or “good.”
As you encourage clients to be nonjudgmental and mindful of patterns of
emotional over- and underexpression that complicate their relationships, you will
spontaneously encounter opportunities to work with particular slivers of memory
that lend themselves to emotional processing. You might say, “Let’s go back to that
moment when you looked around the auditorium and saw that your mom wasn’t
there” or “Can you connect to that time you were crying and then saw your father’s
face harden? Do you see his face now?” When you ask clients to direct their
mindfulness back to a sliver of memory that is fraught with unexpressed painful
core emotion, whether it is the recent past or many decades ago, you evoke the
state-specific experience of that affect-laden moment. Clients can often connect to
the feelings that were available but not expressed at that time. Where there has been
an underuse of some emotions (due to disconfirmation of parents, and their
aversion, rejection, or punishment) and the overuse of others (due to confirmation
of parents), there might be a feeling of relief as well as grief when the client is
finally able to connect to and experience them.
Maroda (2002) advises that “helping our inhibited, cooperative, and well-
behaved patients to be more emotional should be as important as helping our over-
emotional patients to contain themselves” (p. 75). Clients need to experience their
core emotions fully and effectively in a way that expands their affect array, brings
closure to past encounters, and reclaims emotions that have been dissociated,
devalued, or suppressed. However, it is important to assess the nature or source of
a client’s emotional arousal e.g., whether it is a patterned, habitual emotion
738
stemming from attachment or trauma history, or an authentic emotional response to
the present moment or a past situation.
Sometimes therapists have learned that either containing and resourcing all
dysregulated emotions or expressing and abreacting all strong or dysregulated
emotions is the priority in therapy. It is important to recognize that these extremes
can equally prevent core emotions. Our own bias as therapists in regard to the role
of emotions in psychotherapy can contribute to therapeutic enactments, for example,
when we find ourselves pushing to help the client feel emotions or intervening
anxiously to regulate client distress.
739
EMOTIONS, BELIEFS & THE BODY helps clients to clarify a negative
feedback loop of emotions, thoughts, movements and sensations. A negative
emotion can catalyze a negative thought, which in turn leads to physical responses
that evoke more negative emotions, followed by more beliefs, followed by more
somatic responses, and so on. Clients are asked to identify a resource that might
help them interrupt this negative feedback loop. The final worksheet,
EMBODYING AN UNFAMILIAR EMOTION, leads clients to identify an
unfamiliar emotion they want to explore and embody. This worksheet’s material
will need your guidance so it should be completed in session. As a sliver of a
childhood memory with an attachment figure that induced an aversion to a
particular emotion is addressed, clients will need your empathy and regulation. The
intention of this worksheet is that clients will expand affect array by being able to
more fully embody an emotion they had learned to avoid.
740
is ready to work more directly with emotion as described in this chapter. Questions
to ask yourself in that regard include these: Are all parts of my client able to
tolerate emotion, at least to a degree?; Is there any remaining internal punishment or
shame for the experience or expression of emotion?; Can all parts of my client
work together, at least to a degree, on small steps forward?; Is my client able to
step back and reflect on emotions, rather than being embedded in them?
Some clients, or parts of clients, may insist on the temporary relief that
uncontained catharsis, that is, the expression of intense emotions might provide
even though doing so has no lasting benefit and can exacerbate dysregulation in the
long run. At the same time, clients with dissociative disorders may be masterful at
avoiding emotions, and will need sustained encouragement from you to
appropriately experience attachment-related emotions, including grief for what they
missed. Keep in mind that, as van der Hart (2006) notes, “Grief is experienced
after every therapeutic gain. Grief is the bridge between past, present, and future.”
It is helpful to ensure that clients have experienced positive emotions prior to grief
work, by completing worksheets in previous sections on positive emotions. A
reference point of positivity can support resolution and helps prevent a spiral into
despair, loss, or rage.
A purpose of the phases of therapy is to systematically build the capacity for
deeper emotional work, step by step. If clients with dissociative disorder are still
in crisis, are unable to maintain a relatively steady relationship with you, are still
losing time, self-harming or switching, have trouble keeping an adult part in charge,
or cannot remember some or all of your sessions, then the focus should remain on
Phase 1 stabilization. If clients are struggling with vehement emotions related to
animal defense, working with them via bottom-up interventions is probably your
best option. You also might be able to read and discuss this chapter together, even
noting what emotions are possible without further dysregulation, and which ones
are not, and how these relate to early attachment patterns. But it will be critical to
refrain from accessing painful emotions before clients have developed the capacity
to do so in a way that is integrative.
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Emotions add richness and complexity to our experience. Without them, our lives
would seem flat and impoverished because the fullness and depth of experience that
emotions make possible would be missing. Our emotional brain steers our attention
toward certain cues, people, and situations that have meaning and value for us on a
feeling level, and then the emotions we experience motivate our actions in response
to these stimuli. Fear motivates us to move away from a source of anxiety or
danger, enjoyment motivates us to continue whatever activity feels good, sadness or
grief motivate us to seek out comfort, and love motivates us to pursue the company
of those we care about.
Our emotions can be confusing. They are constantly changing in response to our
fluctuating internal and external landscape. We might experience emotions related
to animal defenses and those related to attachment relationships at the same time.
We can experience contradictory feelings toward the same person or stimulus.
Sometimes certain emotions are aroused by reminders of past relationships rather
than current ones. Emotions related to earlier attachment relationships usually need
to be expressed as long as they are not dysregulating. Resolving the emotions that
keep us stuck in repeating negative relationship dynamics of the past can help us
respond to people in our current lives in new and adaptive ways. On the other hand,
trauma-related emotions that fuel animal defenses are usually best addressed
through sensorimotor sequencing, physical action, and somatic resources. This
chapter will help you make sense of the difficult or painful emotional patterns and
biases you developed in the context of early attachment, explore how to navigate
them, and how to distinguish them from emotions connected to animal defenses.
Note that we will discuss the pleasurable emotions more thoroughly in Chapter 34,
“Play, Pleasure and Positive Emotions.”
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we are excited, a heavy feeling in the chest speaks of grief, tension in the jaw
informs us that we are angry, and an all-over tingling feeling or a tightness in the
chest indicates fear.
These internal emotional states are also reflected in our movements and facial
expressions, giving signals to others around us about how we feel. Sadness might
be visible in the downward turn of the mouth and head, moist eyes, and general
softening of the body. Disappointment may be communicated in hunched shoulders,
held breath, and a pleading look in the eyes; hurt in a bracing or moving away from
the person who hurt our feelings. Thus, the activation and deactivation of our
various emotional states are felt as internal body sensations, but postures, facial
expressions, and gestures outwardly express these emotions, visibly revealing them
to others.
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unconsciously keep all our emotions, positive and negative, under wraps. Even
when we know intellectually that emotions are neither good nor bad, these
automatic emotional and physical habits can persist.
Relational Defenses
Our emotions and their bodily sensations and stances can occur in response to a
current situation or to internal experience (e.g., thinking about someone who has
disappointed us). They also can become a chronic, pervasive habit related to our
history and beliefs rather than to the present. We can think of these habits as
relational defenses that serve to minimize or block emotions that were frightening
or aversive to our caregivers, and thus to us. These kinds of relational defenses and
their functions are to be distinguished from animal defenses. The emotions
associated with relational defenses are not focused on life-or-death survival.
Instead, they form to avoid negative responses from our attachment figures, such as
rejection, disapproval, or distancing. For example, if they disapprove of us when
we’re irritated, we will automatically try not to be irritated in order to avoid their
disapproval. We develop a relational defense against irritation, in favor of other
emotions that our attachment figures accept, such as sadness or disappointment. For
those of us with both trauma and painful attachment histories, relational defenses
can be complicated by autonomic dysregulation and bodily cues that signal danger.
For example, if expressing irritation led to abuse in the past, your belief might be
“It’s not safe to get irritated.” In contrast, if you were not traumatized but grew up
in a family that did not accept angry feelings, your belief might be, “I won’t be
accepted if I get angry” or “It’s better to be sad than angry.”
Relational defenses override, alter, or mask the core emotions in different
ways. When caregivers or other important people in our lives ignore or react
negatively to our emotions, we then might dismiss signals of internal distress inside
us and minimize our emotional needs. If we have implicitly lost hope that our
emotions will elicit comfort and empathy, we may fail to communicate emotions or
even to experience them. We might learn to “overregulate” our emotions, which
eventually reduces our capacity to experience both positive and negative emotion.
If we have learned to forfeit a rich, emotional inner life in favor of being accepted
in our families, we may as adults pay the price by feeling emotionally
impoverished and unable to connect with others on a deep core emotional level.
Having lost access to the richness of our emotions, as well as to a broad range of
different types of emotions, we may blame ourselves for feeling flat and
unemotional, without awareness that these are relational defenses, beyond our
conscious control.
In contrast, our attachment figures may have been undependable and
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unpredictable, their comfort obtained only intermittently when we showed distress
intense enough to capture their attention. When we can elicit needed attention and
comfort only through being upset, we might learn to underregulate our emotions. We
might experience uncontrollably strong emotional states that keep us at the mercy of
our emotional intensity. And we might be anxious about whether our feelings will
be attended to or not. Extreme emotional states come to feel normal.
Even if our attachment figures did not cause us to form habits of over- or
underregulation of our emotions, no parent is perfect. They may provide adequate
regulation and repair, but nevertheless particular emotional responses are
commonly favored over others even in the best of families. As a result, children
develop emotions in predictable ways that lead to emotional biases, inadvertently
limiting their access to a wide range of emotions. For example, having grown up in
a family that minimized vulnerable emotions of sadness, hurt, and disappointment,
but welcomed assertion and even anger, Jim habitually interpreted any painful
emotions as frustration and anger. He had learned to narrow his range of emotions
in order to “fit into” a family that “never showed weakness.” His core emotions of
sadness and grief remained unacknowledged and unresolved, expressed as
frustration and anger instead. In contrast, Jim’s partner Leslie had an affinity for
sadness, avoiding core emotions of anger or outrage—a tendency he developed in a
family that favored the more vulnerable feelings over more aggressive or assertive
ones. To maximize the availability of caregivers who paid attention to him when he
was sad, but chided him when he was assertive or angry, Leslie had suppressed
these feelings. When anger was called for, he became sad instead. As an adult, he
had trouble being assertive and would often acquiesce to the wishes of others.
746
In couple therapy, they could observe the patterns with curiosity and empathy
for each of them having done the best he could to fit into their families of origin.
Both Jim and Leslie were able to express the grief and hurt they had felt as children
whose emotions were not accepted. Having worked with a well-tested, often used
repertoire of resources upon which to draw, both felt ready to touch in to the
emotions they had avoided. Over time, Jim worked to change the physical patterns
that reinforced being “tough” by softening his jaw and his chest, especially the area
around his heart, to connect with the core feelings of tenderness and vulnerability
he had pushed away. In therapy Jim was able to reclaim the vulnerable part of
himself, which he saw as a small, sad boy alone in his room, listening to the loud,
aggressive voices of his siblings, feeling like he did not fit in with his family and
had nowhere to go. In one moving moment in therapy, Jim placed his hands gently
on his chest and imagined holding that small boy that he had been, a wordless
communication of his acceptance and understanding that symbolically gave the
vulnerable child the tenderness he needed.
Leslie worked with a specific sliver of memory. As a child, he had been given
a new pair of coveted Converse sneakers for his birthday. It was time for school,
and he didn’t want to wear his boots—he wanted to wear his brand-new sneakers.
His mother yelled irritably, “Don’t be silly. It’s just a pair of shoes. Just put your
boots on—we have to go.” As he mindfully noticed the effects of remembering this
sliver, Leslie could feel a wave of anger coming up through his body, and tension
his legs and arms and jaw. He wanted to yell back, “No!” As he felt the surge of
anger, Leslie could feel a stronger pull to tears, and as his body collapsed, the
anger diminished. Leslie started to cry, saying “I couldn’t say ‘no’, she would have
gotten really mad. It would have just made things worse.” His therapist understood
how painful this was for the 6-year-old Leslie who could not say ‘no’ and have his
mother’s love at the same time. Her emphatic understanding of how Leslie had to
sacrifice his own assertion for his mother’s love led to more sad tears mixed with
relief at being understood the sliver of memory in which Leslie heard his mother’s
words, “Don’t be silly,” and again he felt the tension in his body and the wave of
anger, a core emotion he had pushed aside to win his mother’s acceptance.
His therapist encouraged him to stay with the tension and the angry feelings. He
felt an impulse at the back of his throat, his shoulders, chest, and jaw tensed, and
the words that came up for him were: “I’m not silly! You can’t tell me what I
want!” The waves of emotion were strong as he connected to the frustration, anger,
and then the grief of being that little boy who had to trade expressing his anger for
connection to his mother. But this sadness felt different to Leslie. Instead of the
defeated sadness of giving up his authentic emotions, opinions, needs, and desires,
this crying felt like the grief of a boy who for so many years had kept his anger at
bay in exchange for affection. But it was an empowering feeling for Leslie to finally
express his anger and reclaim his self-assertion.
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To reclaim the variety of core emotions that have been previously inaccessible
because of our childhood relational defenses, we will need the support of a trusted
other person. We also need a wide-enough window of tolerance and a repertoire of
resources that keep our emotional feet on the ground. When we can access early
attachment experiences through the body, we can often express the intense distress
that we needed help with as children. Doing so helps us reclaim the core emotions
that we had pushed aside. Since our patterned emotions developed in our early
relationships, they can be transformed, rather than simply vented, in the context of
an empathic relationship.
This transformation is supported by dual awareness, when we experience
ourselves here in present time as resourced adults and ourselves in past time in the
state we were in as young children seeking emotional safety and acceptance. Within
an attuned relationship, within which both people can attend to the hurt, wounded
self, we can appropriately reexperience the old pain and emotions that we could
not express then. Through this process, we learn to embody the physical
expressions, postures, and movements that help us to feel and express a fuller range
and richness of emotions. The worksheets that follow will help you explore the
interface between your emotions and your body—and familiar and unfamiliar
emotions—and perhaps re-experience the old pain with your therapist, and
discover resources to interrupt cycles of negative, emotions, beliefs and procedural
tendencies.
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Disgust
Fear
Sadness
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Surprise
Shame
Anger
Describe the emotions and postures that felt the most familiar.
Describe the emotions and postures that felt the least familiar.
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1. List three emotions that are most 2. List three emotions that are most
familiar to you. unfamiliar to you.
3. How does your body reflect or express each familiar emotion? (e.g., Cheerful:
deep breath, open heart, aligned spine, smile; Dejected: rounded shoulders, head
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down, tight chest, lower lip protrudes, knees turn inward.)
4. How does your body hold back each unfamiliar emotion? Do negative beliefs
participate in suppressing them? (e.g., Hold back anger by not breathing,
tightening my jaw, purse my lips, pull back. Beliefs: “Anger is not OK. Keep it to
yourself.”)
5. Describe the relationship between the emotions you find familiar or unfamiliar
and your family dynamics when you were a child (e.g., note if these emotions were
accepted or common in your family, if and how a family member expressed them,
or if you were chided for some emotions).
6. Choose one of the unfamiliar emotions that you want to experience more and
imagine that it is acceptable to others. Describe what changes in your posture,
sensation, or movement. (e.g., If anger were acceptable, I could express it and I
wouldn’t have so much tension in my jaw, and I wouldn’t pull away from my
husband when I’m mad.)
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1. Circle those emotions that were familiar, common or accepted in your family
when you were a child.
2. Describe how the emotions you circled were expressed in your family. Were they
expressed openly, indirectly, in a dysregulated manner, or were they hidden or held
in?
3. Choose two high arousal emotions that you circled and describe how you
experience each one in your body and how you express them when they come up.
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Defeat Helplessness Shame
Depression Hopelessness
5. Describe how the emotions you circled were expressed in your family. Were they
expressed openly, indirectly, in a dysregulated manner, or were they hidden or held
in?
6. Choose two low arousal emotions that you circled and describe how you
experience each one in your body and how you express them when they come up.
7. How could you draw on your body to relate to any of your high arousal or low
arousal emotions differently? (e.g., Find an action to show compassion to the part
of myself that is depressed instead of beating myself up for being depressed; find
an action to resource it; reach out to someone I trust for support.)
Note: If you circled any of these emotions, indicating that they become
dysregulated for you, discuss with your therapist resources you might use to
regulate them.
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I feel:
Last, describe one resource you could implement to interrupt the negative feedback
loop you illustrated on the left.
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2. Describe what emotion(s) you tend to experience instead that is more familiar
to you (e.g., rather than allow myself to feel sad and vulnerable, I get angry).
3. Think back to your childhood and identify three situations with an attachment
figure in which the emotion you want to reclaim was not accepted.
1.
2.
3.
4. Choose a sliver from one of the memories in #3 to explore. Describe the sliver
here and what happened that told you that emotion was not accepted (e.g., the
look on my parent’s face, being ignored, what was said, the tone of voice, being
sent to my room or punished).
5. Take your time to embody the state you were in when this sliver of memory
occurred and describe:
Your emotions (e.g., I feel sad but try not to).
What happens in your body (e.g., lightness; shallow breathing; my heart feels
closed; an impulse to pull away from others that goes with sadness).
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6. Identify any physical patterns that prevent you from feeling the emotion (e.g.,
tension in my shoulders, my heart feels hard, do not exhale fully) and explore
inhibiting them to embody that unfamiliar emotion. Describe your experience.
8. Discuss with your therapist how you might challenge any beliefs that keep the
unfamiliar emotion at bay and determine a somatic resource you could use to help
you reclaim that emotion.
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emotions. Traumatized clients may notice that their dysregulated arousal or animal
defensive responses automatically affects their way of walking. They might benefit
first from exploring gait in a way that brings arousal into the window of tolerance
and quiets the defenses and then for its correlation to beliefs.
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Personal styles of walking have developed over many years of repetitive
movement, sometimes for hours a day. They usually feel “normal” to the client.
Experimenting with changing the pattern can feel awkward, strange, uncomfortable,
“wrong,” and even frightening. As Franklin (1996) points out, “Unless you ‘evolve’
into new movements very slowly, change sends an alarm through the body” (p. 43).
It is best to proceed gradually, with one slight intervention at a time. Even
experimenting with small modifications of the normal walking pattern, such as
pushing off with the toes of the feet, or lifting the chin slightly instead of looking at
the ground, can make a profound difference for your clients. To slowly help them
learn new ways of walking, you might decide to explore gait as an ongoing part of
therapy, rather than in only a few sessions.
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client wishes, he or she can practice chosen elements from the previous worksheet,
staying aware of their body’s movements and sensations and of their surroundings.
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exercises, so that they also can sense this capacity. When the client says, “I want to
get up and go,” you can respond “Maybe you can check to see if all parts are
listening and watching? Then let’s see what happens if you slow the impulse but
keep following it—slowly rising, getting on your feet, taking a step or two forward.
Notice how that feels . . . and how does the part that wants to run experience it?
How about the part of you that is shut down?” It is essential, as always, for you to
do the movement with your clients rather than only observe their movement, and to
have as many parts of the client as possible participating actively or by
“observing.”
Because movement patterns tend to be evoked by triggers, it may be difficult to
collaborate with clients to mindfully notice their walking patterns and experiment
with new ones. But you can begin by simply walking together, helping all parts
sense their capacity to walk away and walk toward, and over time discover how to
intervene with walking in a way that supports the integration of parts.
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The way we walk speaks volumes about who we are and how we feel. Whether we
shuffle, stride, saunter, glide, traipse, or trudge with heavy footsteps, we are telling
the world how we feel today, how we feel about ourselves and what we expect
from others. We may plod along, dragging our feet behind us as if we have very
little energy, giving the impression that we are tired or depressed. We may walk
with a hurried, rushed gait, leaning forward, eyes focused straight ahead, giving the
impression that we are preoccupied, busy, harried, and have no time to spare. If we
feel afraid to be seen, we may walk cautiously and hesitantly; if we feel uncertain,
we may slouch and shuffle with our eyes cast downward. We may stomp our feet
with every step if we feel angry or bounce with a spring in our step if we feel
joyful. Our gait changes with our mood, but our characteristic style of walking, like
all our physical habits, is formed over time from a variety of influences. This
chapter explores walking habits and styles, how we learned them, and what
different ways of walking convey. It will also help you learn about the various
components of your own gait and explore changing one or two of them to support
new, less limiting beliefs and attitudes.
Walking Habits
Walking is influenced by the strength and flexibility of the spine and surrounding
muscles, which provide an axis around which we literally move through the world
(cf. Chapter 17, “Core Alignment: Working with Posture”). When we are small, our
legs develop through crawling, standing, and eventually walking and running. Our
core, the spine, supports the movement of our legs through space and absorbing the
shock of each footstep. We form patterns of walking as we imitate how our parents
move, so if they walked proudly with heads up and shoulders down and back, with
a gentle sway in the hips, we might follow suit, most likely giving an impression of
someone who is confident, happy, and at peace with him- or herself. If our parents
walked tentatively, as if on eggshells, we are likely to have imitated that way of
walking, perhaps conveying the impression that we are unsure, timid, or lack
confidence.
Our emotional and psychological experience also shapes the way we walk. If
we have limiting beliefs such as “I don’t deserve to be treated well,” “I have no
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value,” or “I am incompetent,” our shoulders might slump in a posture of defeat,
sadness, or fear. We may take small hesitant steps, heads down, with little swing in
our arms. If we grew up without sufficient nourishment, whether it be food,
affection, or attention, the way we walk—perhaps with arms hanging limply, spine
collapsed, gait slow, with little energy—might go along with a belief that there’s no
use in trying to get what we need. If our families expected us to be strong, avoid
vulnerability, and be prepared for confrontation and fight back, we might walk with
chests out, shoulders back, and a tough-guy, challenging swagger to our gait. If we
grew up in a family where the members were supportive of one another and
generally happy, we may bop along with a spring in our step, making eye contact
with those passing, giving the impression that we trust that good things will come
our way and that others will treat us well.
Past trauma and dysregulated arousal can also affect the way we walk.
Hyperarousal can result in gait patterns that are jerky, rigid, agitated, or too rapid to
allow focus. Hypoarousal affects gait in almost the opposite way, usually resulting
in slow, mechanical, numb, and disconnected movements. Lisa, a survivor of child
abuse from a series of foster parents, had been unable to escape from danger and
often felt trapped and incapable of leaving situations that were triggering or
abusive. She walked stiffly and robotically, with little movement through her spine
or arms. She reported that she often felt spacey and foggy and could not feel her
legs.
In therapy Lisa learned to walk with mindful attention to the sensations of
movement through her feet, legs, pelvis, and spine, relaxing her neck and allowing a
little swing to her arms. As she noticed her feet coming into contact with the ground
and how with each step, her legs propelled her forward, she experienced the felt
sense that she could walk away from situations and people when she wanted to.
Lisa felt less spacey, more empowered and present in the here and now. The
experience of her ability to move through space was something that Lisa returned to
again and again because it mitigated the physical feeling of being frozen and
trapped and helped her sense an effective “flight” defense.
The way we walk not only reflects past trauma, chronic beliefs, and
characteristic emotional biases but also our mood moment to moment. Our gait
changes depending on how we feel, the environment, and who we are with. If we
are with someone with whom we feel good and who treats us well, our gait may
become more confident, arms swinging, posture more aligned, and head lifted. If
we are walking with someone with whom we feel inferior or who treats us badly,
we may walk with heavier footsteps, tense shoulders that prevent a free swing in
the arms, head down to avoid orienting to the person. If we want to attract the
attention of our husband or wife, or of a potential sexual partner, we may walk with
more movement in our bodies and swing to our hips, increasing eye contact and
sending a flirtatious “look at me” message.
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Attuning to Your Walk
We rarely notice how we walk, but when we do, we may be surprised. Alejandro
often felt stuck and a little depressed, in spite of having realized his dream of
earning U.S. citizenship along with many other accomplishments. With his
therapist’s help, Alejandro was surprised to discover that his walking style
reinforced the beliefs of his childhood. He walked slowly, with long strides, his
arms hanging lifelessly by his sides. The back edges of his heels struck the ground
hard with each step.
As his therapist encouraged him to be mindful, he noticed a reverberating wave
of force moving through his legs, pelvis, and into his spine every time his heel hit
the ground. Each heavy step seemed to compress his spine, causing a slightly
painful sensation in his lower back that, to Alejandro, went along with a feeling of
hopelessness. Alejandro’s walking pattern accompanied the “all work and no
play,” “life is hard” attitudes that he had embodied as a boy in his struggling, hard-
working immigrant family that often suffered discrimination and, being
undocumented, lived in fear of being sent back to Mexico. Alejandro’s life had
changed, but his walk did not reflect the job he loved or the relaxed, happy home
life full of the laughter of his two young children and jovial wife who always
looked on the bright side.
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unwilling to engage with others. We may focus several feet in front of us, or look
around to take in our surroundings as we walk. Our feet may be turned out or in,
rather than pointed forward. Our arms may be stiff and straight, hang limply at our
sides, or swing vigorously side to side instead of forward and back in rhythm with
each step. We can mindfully explore any of these elements of walking to discover
their meaning.
Since walking is a repetitive activity—the average person takes several
thousand steps per day—one seemingly minor walking error can have a strong
effect because it is repeated thousands of times per day. This can cause wear and
tear on the muscles and joints, and eventually even pain, along with reinforcing the
attitudes and self-concepts our style of walking might reflect.
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lightness and joy.
Robert had come to therapy because he felt isolated, wanted to make more
friends, and find a girlfriend. With his therapist walking alongside him, they noticed
together the ways in which Robert’s walk reflected and sustained what he has
learned growing up—mainly, to keep to himself, not get involved in other people’s
business, and stay focused on the task in front of him. His shoulders hiked up, and
he walked very quickly with his head forward of his body, looking down at the
ground in front of him, with his arms slightly swinging but only from the elbows
down.
Realizing that his hurried, tense, walk did not support his goals for himself,
Robert decided he wanted to practice a new way of walking. First he lengthened
his spine and relaxed his shoulders, which allowed his arms to gently swing from
his shoulders, bent slightly at the elbow. He paid attention to slowing down his
speed, striking the ground gently and squarely with his heel, then sensing the
pressure on the sole of his front foot as he rolled toward the ball, pushing off with
his toes. He immediately noticed that he felt grounded but lighter, physically and
emotionally. With his head lifted up and his chin parallel to the ground, he was
more aware of his environment and the people in it. These changes, practiced over
several months, challenged the old beliefs that were embodied in his walking style.
With mindful attention Robert was gradually able to alter the way he walked so that
his ability to orient to his surroundings and engage with others was enhanced as he
moved through the world.
When we walk, many parts of our body work together to produce our particular
style—the arm swing, head carriage, movement in the shoulder girdle, pelvis, and
through the joints; how we place our feet, how we push off with the balls of our
feet, the resiliency of our spine. Together these body parts interact to create a
distinctive pattern that might be recognized from a distance as a personal signature
long before our features are visible. Unless there is an organic cause, our unique
walking patterns reflect our histories, beliefs, and emotional biases. Because we
take a few thousand steps per foot per day, we have many opportunities to either
strengthen that pattern or to become aware of it and change it to support new ways
of being.
Like Lisa, Alejandro, and Robert, you can try out new ways of walking to help
you change outdated psychological patterns that are reflected and sustained by your
old way of moving through the world. The worksheets that follow will help you
explore different styles of walking, discover your own style, and experiment with
ways of modifying your sway of walking so that you can move through the world in
a manner that supports your goals.
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How does this walk feel How does this walk feel How does this walk feel
in your body? in your body? in your body?
What does this walk feel What does this walk feel What does this walk feel
like emotionally? like emotionally? like emotionally?
How do you feel about How do you feel about How do you feel about
yourself when walking yourself when walking yourself when walking
this way? this way? this way?
What belief might this What belief might this What belief might this
walk convey about you? walk convey about you? walk convey about you?
How might other people How might other people How might other people
respond to you? respond to you? respond to you?
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with your head in front down, arms hanging limp, strides, swinging your
of your body. looking at the ground. shoulders and arms.
How does this walk feel How does this walk feel How does this walk feel
in your body? in your body? in your body?
What does this walk feel What does this walk feel What does this walk feel
like emotionally? like emotionally? like emotionally?
How do you feel about How do you feel about How do you feel about
yourself when walking yourself when walking yourself when walking
this way? this way? this way?
What belief might this What belief might this What belief might this
walk convey about you? walk convey about you? walk convey about you?
How might other people How might other people How might other people
respond to you? respond to you? respond to you?
7. Was your initial assessment accurate of which way or ways of walking were
familiar? Which walk was most familiar?
8. Identify one physical element of the walking style that was most familiar to you
that you would like to change (e.g., walking with my head down felt familiar, and I
want to practice walking with my head up, looking around).
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How do your feet come into contact with the ground? Do you come down hard on
your heels? Or on the flat of your heel? Is your weight more on the inside or
outside of your feet?
Notice joints in your feet, ankles, knees, hips, spine, shoulders, elbows and
hands. Are your joints tight, or do they feel relaxed and loose?
Do you roll from your heel to your toe with each step, pushing off with your toes?
Do you swing your arms a little, a lot, or not at all? Do you swing them from your
shoulders or your elbows? Are your elbows bent of straight? Does one arm swing
more than the other?
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Is your body slumped over, rigid, leaning forward, or leaning backward?
What is the rhythm of your walk? Fast, slow, staccato, flowing, disjointed?
Can you tell which part of your body you lead with-your head, feet, chest, or
pelvis?
What is the position of your head—are you looking down at the ground, or
several feet in front of you? Are you leading with your head? Are you looking
around?
What emotions are expressed by your walking style? What might your walking
style convey about you? (e.g., My style expresses depression and grief about my
past. It tells people that I am not a happy person.)
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1. Select one of the people above and describe your relationship with him or her.
2. Imagine that the person you selected will join you for a walk. Review the
prompts below, then go for a walk. Fill out the prompts after your walk. If you are
unsure of the answer to a prompt, take another short walk to discover the answer.
3. As you begin your walk, take note of how you are walking. Then visualize this
important person joining you. Take your time to imagine that her or she is walking
beside you, on your right side or left.
4. Describe the first thing you notice about how your walk changes when you
imagine that this person is walking beside you.
5. Circle below what else changes in your walk when you imagine the person
beside you, writing down any additional changes you notice in the blank spaces.
Walk faster Walk slower Spine slumps Spine lengthens Chest puffs up
Head tilts Spine is rigid Look down Swing arms less Eyes look up
Longer stride Shorter stride Shoulders sag Head lifts up Chin lifts up
Head down Walk heavier Walk lighter Look at ground
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6. How do your emotions change when you imagine this person walking beside
you? Do you feel more joyful and happy, or disappointed, inadequate, on edge or
nervous? How are your emotions reflected in your walk?
7. What thoughts or beliefs do you seem to have about yourself when you imagine
this person walking with you?
8. What do the changes in your walk seem to tell you about this relationship and
how this person has influenced you?
9. Think about how this person walking beside you affected your walk. How might
what you learned influence the way you walk? (e.g., When I imagined my son
walking with me, my walk became freer, my arms were swinging, and I walked
lighter, and I want to practice these elements; When I imagined walking with my
critical father, my head came down, and my body pulled inward. I want to try to
do the opposite—lift my head, and relax!)
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• Speed up slow
walking by taking
more strides, not
longer strides.
Posture • Relax shoulders
back and down.
• Align neck with
shoulders (not
reaching forward or
retracted).
• Raise or lower your
chin so that it is
parallel with the
ground.
• Look ahead and
around you rather
than down.
• Lengthen your spine
and walk tall.
• Hug your naval to
your spine, engaging
your TVA muscle.
• Gently push up with
your head and down
with your feet as you
walk.
Tension • Slowly scan your
patterns body from your feet
to your head,
noticing any tense
areas, and relax
them.
• Relax the joints in
your feet, ankles,
knees, hips, spine,
shoulders, arms and
hands
• Let your head gently
lengthen upward.
• Pay attention to your
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breath and relax
with each exhale.
Arm • Swing your arms
swing freely from your
shoulders.
• Let your hands be
loose.
• Let the arm opposite
your forward foot
swing forward in
rhythm with your
walk.
• Allow your arms to
swing directly
forward and back
rather than cross the
center line of your
body when they
swing.
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• As you walk, focus first on your body sensation and movement: how your feet
land on the ground, the sensation and movement through your joints, the swing of
your arms, or your breath.
• Stay mindful of your body, but also orient toward and take note of your
surrounding—the sights, smells and sounds, the feel of the air and the
temperature on your body.
• Notice any internal experiences that distract you, especially thoughts and
emotions. Name them to yourself (e.g., “I’m having the thought right now that I
should be working”), and return your focus to both your body and your
surroundings.
• Identify any external distractions that draw your attention away from your body,
name them, and return your focus to both your body and your surroundings.
1. After mindful walking, describe what you sense in your body and how you feel.
2. During your walk, what sights, sounds, smells did you notice? Did you notice the
wind, or the temperature?
3. During your walk, what did you notice about your movement and sensation?
4. Were you able to stay aware of both your body and your surroundings at the same
time?
6. How and when might you use mindful walking as a resource in the future?
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Their complaints are often indicative of an underbounded style that leads to giving
too much, an inability to defend or protect themselves, difficulty screening what to
take in and what to keep out or trouble buffering disappointment, rejection, or hurt
feelings. Clients who experience alternating approach–avoidance tendencies
(opens up too much, gets disappointed or let down, and then puts up walls and
pushes others away; experiences alternating feelings of connection and loneliness),
may also find this material enlightening.
Clients who tend to set too rigid boundaries, experience chronic distrust, tense
musculature, or tend to be distant and withhold personal information will benefit
from this material. Clients whose distrust and guardedness are triggered by close
relationships often feel challenged by friends and partners wanting “more”
emotional connection. They have much to gain from seeing these issues as evidence
of procedurally learned rigid relational boundary styles rather than as negative
reflections of themselves or their significant others.
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They might look away, unable to sustain eye contact. Others will say the word “no”
definitively and even aggressively, often accompanied by a forward movement and
tension in the jaw, arms, or shoulders.
Similarly, for overbounded clients who are unreasonable inflexible around
limits or cannot say “yes,” having a felt sense of appropriate containment,
differentiation, and protection can allow some relaxation of their guardedness.
Often, guarded clients are asked to relax their vigilance or tension prematurely,
before they have developed adaptive boundaries. Such clients can benefit from
making the physical boundary actions that engender a direct bodily sense of
empowerment that naturally allow a counterbalancing relaxation of the tension that
sustains a rigid boundary. Prematurely relaxing boundaries can elicit fear and
vulnerability that, in turn, exacerbates rigid boundaries.
Having established their boundary style or the mixture of styles found in
pendulum or incomplete boundaries, the next step might be to ask your clients to
observe these indicators in their relationships to see if a boundary style might
contribute to a problem that they may have identified as “my fault” or “his/her
fault.” In each case, the chapter material and exercises will be richer if the client’s
expressed current relational difficulties, including those with you, are the context
for this exploration.
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The worksheet on SETTING BOUNDARIES WITH ANOTHER PERSON
(Marjorie Rand, 1981. personal communication). provides an especially effective
interactive exercise for use in a therapy session. For some clients, it could also be
assigned to use with a partner or friend. Its goal is to help clients increase their
awareness of the responses dictated by their boundary styles when a boundary is
breached, and then practice reestablishing their boundary. Exploring this exercise
together in session will elucidate boundary issues within the relationship. For
example, you and your client may discover that your client has difficulty saying
“no” to you directly. Helping clients practice new adaptive ways of setting
boundaries with you supports a greater sense of safety, trust, and collaboration in
the therapeutic relationship.
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to, and enmeshment with, others. They usually are extremely sensitive to rejection,
withdrawal, or disappointment. It can be helpful for dissociative clients to notice
and identify the different boundary style of each part, validate the function of that
style, and discuss how that style serves them, or fails to serve them, in their current
relationships.
Observing the stimuli that trigger a protector part’s tight boundaries or a shut
down submissive part’s lack of boundaries is, in and of itself, a step toward
differentiation and eventual integration. Reflecting on how a particular boundary
style operates in their current life, and evaluating when it might be needed and
when it might be overactive can pave the way for clients to develop more adaptive
boundaries.
If the boundary exercises are couched as protective in nature yet also as
allowing safer relationships, all parts of the client are more likely to be willing to
try them, rather than refuse or become triggered. You can explore inviting different
parts to fill out a worksheet, and perhaps discover a boundary action that is
acceptable to several parts. Working successfully with dissociative clients requires
titrating and carefully integrating the material to ensure that any experience with
boundary exercises reassures all parts of the client that it is safe to try out new
ways of setting boundaries in relationships.
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mindful awareness of the behaviors and body cues of each style, you will begin to
identify when you use these styles in present-day interactions with others.
UNDERBOUNDED STYLE
This boundary style is particularly well adapted to a family environment in which
members tend to merge with each other, where what is “me” and what is “you” is
blurred. In such situations, it is usually not acceptable or safe to set one’s own
individual boundaries. Perhaps the family defines individuality as “disloyal,” or
maybe setting boundaries is considered “disrespectful” and even punished.
Sometimes it is safer to be merged so that we can better sense what is needed or
wanted by our parents, moment by moment. Individuals who have developed an
underbounded style understandably have difficulty setting limits or saying “no” and
have trouble differentiating their feelings, opinions, needs, and preferences from
those of others.
If you grew up in a family in which an underbounded boundary style was
adaptive, you may experience some of the following:
• You may have difficulty saying “no” and find yourself frequently acquiescing
or saying “yes” even when you don’t want to.
• You may fear that others will reject, abandon, mistreat you, be angry with or
disappointed in you if you say “no.”
• You may feel you must please others by giving in to their needs, preferences,
and desires; you may often end up feeling used and taken advantage of.
• You may have difficulty identifying your own feelings, preferences, and needs
and distinguishing yours from those of others.
• You may tend to turn to others for advice, help, and direction instead of
having confidence in your own sense of what you want, need, or prefer. You
may allow others to tell you what to do, think and feel.
• You may have a desire to merge in relationships, have difficulty
differentiating yourself from others, or feel hurt or rejected if they have
different feelings or opinions than you do.
• In relationships, you are apt to “give too much” and share too much too soon.
You also may have difficulty keeping the confidences of others.
• If you have trouble saying “no,” you may be susceptible to emotional,
physical, or sexual abuse and might find yourself in a constant state of trying
to recover from your boundaries being violated.
• You may lack awareness of social space; that is, unconsciously get too close,
physically or emotionally, to others. You might get hurtful feedback that
others experience you as intrusive, needy, or as violating their boundaries.
You may not understand why they react that way.
• You may find it so easy to empathize with others’ emotions that their side of
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the story feels more compelling than your own emotions or point of view.
Your body might reflect having learned diffuse or lax boundaries by being either
collapsed, unguarded, or both. The tendency to merge with others may literally
show up in a loss of muscular definition and tone in your body. Your body language
might give the message that you cannot protect or defend yourself or that your sense
of self is weak and easily manipulated to do the bidding of others. A few examples
of this are going to the movie others want to see instead of stating your preference,
agreeing to help them when you do not want to, and perhaps even violating your
own sexual or physical preferences to meet the desires of someone else.
It is important to note that certain strengths or survival resources characterize
this boundary style as well. A person with an underbounded style, because of the
permeable nature of his or her boundaries, often has a sensitivity or awareness of
others and the ability for empathy and attunement to the feelings of others.
OVERBOUNDED STYLE
This boundary style tends to be rigid, impenetrable, inflexible, and dense instead of
permeable. It is easier and more familiar for someone with this style to say “no”
than to say “yes.” The overbounded style is adaptive in family environments in
which parents avoid physical or emotional contact with the child, such that the
child must meet his or her own needs, or those contexts in which it isn’t safe to be
vulnerable or to let down your guard. The caregivers may be abusive emotionally
or physically, inducing fear and avoidance of close relationships in the child. In
such a family, it is safer to be alone, self-reliant, guarded. Mistrust might be more
adaptive than trust.
If you have grown up in a family in which an overbounded boundary style was
most adaptive, you may experience some of the following:
• Your automatic response to others may be to say “no” rather than to say
“yes.” Or you may find it difficult to say “yes” to others’ requests; it may feel
like “giving in” or being too vulnerable.
• You may believe that the “wall” you put up is a healthy boundary, but in fact it
keeps everything out. When you have a wall, you cannot let much of anything
in, not even good things.
• You may be hypervigilantly protective of your “space” and prefer more
distance in relationships. Contact with others can feel invasive, rather than
nourishing.
• You may be uncomfortable revealing personal information and do not solicit
personal information from others.
• You rarely ask for the opinions, feelings, or thoughts of others, and avoid
asking for help. You probably tend to be self-reliant and independent.
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• You may perceive others as a potential threat and have difficulty with trust,
intimacy, and vulnerability. It may be hard for you to let down your guard.
• You may find yourself isolated from others; find it difficult to let others get
close, and you may spend much of your time alone. Or perhaps when you
spend time with other people, you notice that there is an emotional distance
between you and others, but you do not understand how you “keep people
out.”
• Empathy and attuning to others are hindered by an overbounded style. You
may avoid being vulnerable or getting involved emotionally with other
people. This may result in others’ view of you as emotionally unavailable,
closed, insensitive, inconsiderate, or abrasive. And you may or may not
understand why they say such things.
The tendency for rigid boundaries with others may literally show up in an increased
muscular tonicity in your body. Your body might reflect these rigid and strong
boundaries by being tense and guarded. Your body language might give the message
that you do not want anyone near you and that you want to be left alone.
Individuals with an overbounded style also have certain strengths or survival
resources. This boundary style protects a sense of self and reduces the influence
and impact of other people’s feelings and opinions. People with this style can be
helpful in times of stress, since they are self-sufficient, able to take charge, and give
off an aura of confidence and self-assurance.
801
romantic partners, authority figures, parents, or children. We may have trouble
saying “no” to a lover or spouse but can easily say “no” to strangers, friends, or
coworkers. A loss of healthy boundary may also occur when we are in certain
emotional, mental, or physical states: for example, being tired, sick, needy, angry,
or distressed. In these cases, our healthy boundaries may become weak or rigid.
However, a person with this style has a generally healthy and adaptive boundary,
and is able to say “yes” or “no” effectively in most situations.
802
explore the tightening in his chest, which to him meant that his heart was protected.
Voluntarily tightening the muscles of his chest was followed by the impulse to relax
them. Then he could feel more open toward his wife and that felt good to him.
Continuing to practice these exercises was also much easier for him than “trying to
let my guard down.” Once Dan learned that his rigid boundary style is something he
can control, rather than something that only happens automatically, his boundary
became increasingly voluntary rather than automatic. He learned the difference
between “Don’t come in” versus “I choose not to let you in.” With choice, he felt he
then had the option to learn to say “yes” to his wife and to other people and things
that had meaning for him.
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2. Describe what you experience in your body when you are underbounded.
3. Situation(s) in which you tend to be overbounded (e.g., those in which you feel
unnecessarily guarded, mistrustful, secretive, emotionally distant, automatically say
“no”):
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4. Describe what you experience in your body when you are overbounded.
5. Situation(s) in which you tend to have a pendulum style (e.g., those in which
you are too quick to say “yes” and open up, then feel overwhelmed or too open so
you withdraw or close down):
805
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
6. Describe what you experience in your body when you use a pendulum style
boundary.
8. Describe what you experience in your body when you use a healthy boundary.
9. Identify a physical element from #8 that you can use as a somatic resource in
situations in which you use an overbounded, underbounded or a pendulum boundary
(e.g., My posture is aligned, but not tense, and my breathing is full). Practice
embodying this resource in those situations.
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Shake your Furrow your brow, Move away or Change your voice tone
head frown or scowl lean back
Purse your Clench your jaw or Look down or Display aggressive
lips thrust it forward away posture
Crinkle Make a “stop sign” or Narrow, roll, or Square your shoulders
your nose gesture with your hand close your eyes or hunch them forward
Laugh or Make physical contact Cross your arms
snicker (e.g., hit, push) or legs
Tighten Make a stern or firm Turn your body
your body facial expression away
Move your Sigh with exasperation Raise one or
head back or disgust both eyebrows
2. Describe any memories of saying “no” with your body that stand out to you.
3. Throughout the week, pay attention to your interactions with others. At the end
of each day, make a tally mark next any ways you noticed that you say “no” with
your body. Add any other ways of saying no that you used that are not on the list.
At the end of the week, answer the remaining prompts.
4. Describe a situation in which the way you set or conveyed a boundary was
808
ineffective, dysregulated, or otherwise unsatisfactory to you.
5. How do you want to convey your boundary with your body in similar situations
in the future?
How do you want to convey your boundary verbally in similar situations in the
future?
Take your time to mindfully say the words out loud while you convey your
boundary with your body simultaneously. Describe your experience.
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1. First, circle any of the ways of saying “yes” that you remember using in the
past. In the empty boxes, write down any other ways of saying “yes” nonverbally
that you have used that are not on the list.
2. Describe any memories of saying “yes” with your body that stand out to you.
2. Throughout the week, pay attention to your interactions with others, noting
when you say “yes” with any of these actions. At the end of each day, make a tally
mark next to any ways you noticed you say yes with your body. In the empty boxes
in the chart, write down any other ways of saying “yes” with your body that are
not on the list. Take special notice of any situations in which you wanted to say
“yes” but did not, or wanted to say “no” but said “yes” anyway.
811
3. Do you recall any moments in which you wanted to say “yes”, but did not? If
so, how did your body refrain from saying “yes (e.g., tighten up, pull back, look
away, collapse, or something else)?
6. Do you recall any moments in the past week in which you wanted to say “no”
but said “yes” instead? If so, describe the moment and how it felt in your body.
7. Describe any changes you would like to make in the nonverbal ways you say
“yes” and “no” to others. (e.g., I would like to move forward and touch my kids
more; I would like to keep my body relaxed and maintain eye contact when I
say no”.)
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2. A Breach of Boundary
Notice what happens if your therapist slowly crosses your tangible boundary
physically without invitation (e.g, for the purpose of the exercise, you do not
want your therapist to cross your boundary). Mindfully notice your automatic
response.
814
Emotions: (e.g., Unhappy, mad, helpless, anxious.)
Memories: (e.g., My mom kept hugging me when I didn’t want her to; of being
abused.)
3. Respect of a Boundary
Now, have your therapist move out of your tangible boundary. Mindfully notice
your response, especially in your body, when your therapist is no longer in your
boundary.
Thoughts:
Emotions:
Body response:
Memories:
Thoughts:
Emotions:
Body response:
Memories:
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indirectly about these actions, may say things along these lines: “I want a
relationship, but I can’t approach people. I can’t even look them in the eye, much
less carry on a conversation.” Or “I don’t reach out to others. I just holed up in my
apartment all weekend and didn’t even answer the phone.” Or “Why doesn’t he
reach out to me? I call him all the time, but he never calls me.” These clients will
find this material especially useful. Those with current relational difficulties can
benefit enormously from understanding both the origins of proximity-seeking
actions in early attachment and by discovering ways to change those that they want
to change through the practice of new actions. Both those who have not been able to
reach out and have ended up alone and isolated and those who frantically seek
proximity and often drive others away can make use of this material. Clients with
unresolved trauma who experience the sequential or simultaneous stimulation of
defensive and proximity-seeking impulses can also benefit from this chapter.
Parents who are triggered by their children’s proximity seeking or who have
difficulty separating from their children might discover that this material can affect
not only their well-being but that of their children as well.
817
Eyes can be intent, as the absorbed gaze of a baby with his mother, or blank and
unseeing, like the vacant stare of a person in shock. Eye contact can be frightening
for some clients who may be “beset by shame and anxiety and terrified by being
judged and ‘seen’ by the therapist” (Courtois, 1999, p. 190). You might experiment
with this proximity-seeking action by making eye contact with your client, having
one or the other of you look away or close the eyes, and then help the client be
mindful of what happens internally and what changes relationally.
Healthy relationships require both connection and distance. “Too much” or “too
little” distance between people can be equally negative (Hall, Harrigan, &
Rosenthal, 1995, p. 21). Clients need to understand that proximity-seeking actions
and relational boundaries go hand in hand, and using both as needed, contributes to
increased connection and intimacy. Weaving the material in this chapter together
with material in the previous chapter, “Boundary Styles in Relationships,” will
help clients understand this concept.
Because exploring both distance and closeness are usually evocative for
clients, strong transference responses can be stimulated when we experiment with
proximity seeking, boundary setting, or increasing distance. We may also notice our
own countertransference to clients’ needs for either proximity or distance: It might
be difficult to tolerate the client who sits as far as possible from us and cannot
sustain eye contact. Or we may become uncomfortable with the client who wants
greater proximity or sustained eye contact. We may find ourselves interpreting
clients’ proximity-seeking behavior, or lack of it, toward us in habitual ways. It can
be revealing to notice what happens in our own bodies when clients seek or
withdraw from proximity with us?
When a client complains, “I can’t get out of my shell,” you have an opportunity
to help him observe how the shell protects him from proximity-seeking actions and
to notice with him how necessary that shell once was in his family of origin. Or if a
client is inconsolable because her boyfriend hasn’t called in the last 24 hours, you
might say something like, “It makes sense that staying close and connected is
important for you—that’s how you kept your mother’s attention during her
depressions. That might be why you get upset when your boyfriend doesn’t call.”
It’s important to acknowledge currently ineffective proximity seeking actions as
having been adaptive in the past. After you do so, you can start helping clients
notice these patterns and then ask them to mindfully experiment with the proximity-
seeking actions that are most familiar and natural and assess their efficacy in their
current lives. From there, clients can explore more adaptive proximity-seeking
actions that challenge their implicit relational knowing.
818
Since these worksheets directly pertain to seeking proximity in relationship, they
lend themselves to exploration together in session. Clients who are less avoidant
than others might appreciate the opportunity to explore many of these exercises
together with you. However, it may be especially helpful for more avoidant,
dismissing clients for whom these issues may be uncomfortable to discuss and
write about to initially complete the worksheets in the privacy of their own home
before exploring them together with you.
The first worksheet, YOUR PROXIMITY-SEEKING ACTIONS, asks clients to
reflect on and observe how they, and others in their lives, seek proximity. They will
assess how they respond to the proximity-seeking actions of others, as well as
which actions they use the most and can perform easily, which are more difficult,
and which ones they do not use. It often comes as a surprise to clients that there are
so many everyday proximity-seeking actions, and that they are comfortable with
some, and uncomfortable with others. You can explore this worksheet in terms of
what proximity seeking actions clients use with you, discuss if they are effective,
and whether other ones could be more effective.
The two worksheets on REACHING OUT instruct clients to practice different
ways of reaching out to discover their internal reactions, which styles are more
comfortable or familiar, and which are uncomfortable or unfamiliar. With clients
for whom reaching out feels threatening, you can explore these worksheets together
in therapy sessions and break down each step into smaller pieces, slowly
experimenting together with each one. For some clients, identifying habitual
patterns will spontaneously encourage experimenting with new proximity-seeking
actions; for others, these worksheets may require overcoming fears of proximity or
proximity-seeking actions.
EXECUTING PROXIMITY-SEEKING ACTIONS is designed for use with
another person, and can be most beneficial to explore together in session. Clients
experiment with being on both the giving and receiving end of three proximity-
seeking actions—reaching out, eye contact, and leaning toward—bringing mindful
attention to the building blocks that emerge. Lastly, the worksheet PROXIMITY &
DISTANCE combines an action of proximity seeking with one of setting
boundaries. It can be effective as an in-session exploration and will help clients
decipher the somatic indicators that inform them that they need more physical
distance or more proximity to another person. The worksheet instructs clients to
make beckoning and boundary motion, but you might also make these motions
yourself and explore your client’s response to them. This can be particularly helpful
for clients who have trouble accurately interpreting the intentions of others who
seek proximity to or distance from them.
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proximity when the child is not distressed, too, by cuddling, holding, snuggling, and
playing with the child. Even when the child does not seek contact, a parent may
watch him with a loving expression, smile or gaze fondly at him, or reach out to pat
his cheek or tousle his hair. These actions all convey an implicit message to
children that close relationships are rewarding, that others want to be near to them,
and that their own proximity-seeking actions are welcomed and will be responded
to favorably most of the time.
If we have experienced an abundance of these kinds of interactions, then
initiating and sustaining friendships and intimate adult relationships are smoother
and easier for us. We know how to ask others to come nearer and how to express
our needs and desires for contact. We can engage appropriately in physical
behaviors that maximize closeness, such as making eye contact, hugging those with
whom we feel safe and comfortable, holding hands, offering physical comfort, and
engaging sexually with an intimate partner. Trusting that we will be responded to
with sensitivity, we have little or no avoidance, anger, or fear of seeking proximity
when we wish or need to do so. We also are better able to tolerate frustrations and
disappointments in relationships when proximity is not possible or not satisfying.
Due to early experiences of being regulated and cared for by those we trust, we are
able to seek and receive, with no ambivalence, the soothing and calming we need
from people close to us. We are also able to regulate ourselves when we are alone
or when others are unavailable.
824
eye contact with their attachment figures. A sudden tightening or narrowing of the
eyes can convey pain, aversion, disagreement, suspicion, or threat, while a
widening of the eyes might signal excitement, surprise, or shock. Other ways of
communicating with the eyes (i.e., glancing, pupil dilation or constriction, blinking
eyes, wide or shrouded, eyes angled downward or upward, frequency, length and
intensity of eye contact) all convey implicit messages. Some parents have an
excessive need for eye contact with their children, while others do not seek it or
may even avoid eye contact. If as children we are looked at in a negative way, we
might become afraid of what we will see in another person’s eyes. Even as adults,
we may expect to see similar criticism, disappointment, withdrawal, or rejection if
that was what we perceived in the eyes of the people close to us growing up. We
may also be anxious about making eye contact if we fear being seen ourselves, if
we have beliefs like “I’m bad,” or “If people see who I am, they will not like me,”
or if being seen has provoked negative responses in the past.
Proximity-seeking actions can be abandoned or distorted, if we received
repeated negative responses to them in childhood. As we get older, we may be
unable to reach out to others in a relaxed, confident manner—with palms up, our
arms fully extended in a way that conveys openness and an expectation that our
reaching will be met. We may instead withdraw from relationships, shun physical
contact, and have a hard time making eye contact, reaching out, or even being near
others. If we do reach out, we may do so in a way that reflects and sustains implicit
meanings about the pain of seeking proximity with our attachment figures. We may
reach out with a stiff arm, palm down, tense shoulders, or a rigid spine, bracing
ourselves for a negative response. Or we may reach out weakly, shoulders rounded,
holding the elbow close to the waist rather than fully extending the arm because we
don’t expect anyone to respond. Or we may reach out in a demanding, eager way,
driven by intense need, leaning forward, both arms fully extended. All of these
styles of reaching out, learned in the context of early attachment relationships,
impact the quality of our current relationships.
825
one had ever responded in a way that felt good to her.
Max said that relationships were “for other people,” not for him. When he
explored reaching out in therapy, his body drooped and his reaching was partial
and weak, with his bent elbow remaining close to his side. His gaze turned
downward and he failed to extend his arm fully. The gesture lacked energy and
conviction. He said, “What is the point? No one will reach back.” The lack of
muscle tone, energy, and vitality in his arms as he reached echoed his words. Both
reflected a paucity of empathic parental attention and care.
Like Max and Marilyn, Boris had experienced a lack of attention and care as a
child, and he grew up distrusting that he could count on anyone but himself. He
reported to his therapist that his girlfriend had complained that he always seemed
suspicious of her. His therapist noticed that Boris frequently narrowed his eyes.
When she asked him to explore doing it mindfully, he realized that he felt wary of
everyone, even his therapist, although he had never verbalized that even to himself.
Boris eventually traced this pattern back to emotionally charged memories of a
childhood with an unpredictable and withdrawn mother, which left him feeling on
guard, insecure, and suspicious in relationships. Becoming aware of this pattern,
working through the difficulties of his childhood, and inhibiting the narrowing of
his eyes enabled him to be more trusting and convey his desire to connection
instead of suspicion to his girlfriend.
Instead of being distant and unresponsive, like Max’s, Marilyn’s and Boris’s
parents, Carmen’s parents were inconsistent in their availability, sometimes
allowing and encouraging proximity and sometimes not. Unsure if her parents
would respond to her need for contact, Carmen engaged in increased and
sometimes frantic proximity-seeking behavior. Yet, being unsure about whether she
could count on them, she was unable to relax into feeling connected and comforted
even when they responded positively to her. In therapy, Carmen experimented with
reaching out to her therapist. She leaned forward eagerly, reaching out with a full
extension of her arms, taking a step forward as she did so, and her wide eyes held
unflinching contact with her therapist. She asked if she could come even closer and
became agitated and irritated when her therapist instead suggested she might
explore reaching out from an increased distance. Carmen was preoccupied with the
emotional and physical availability of others and interpreted her therapist’s
suggestions to mean that he wasn’t available to her. This interpretation was an
artifact left over from having had to fight for the attention she needed as a child and
to struggle to maintain it when she got it. Given her attachment history, it made
perfect sense that her proximity-seeking actions were exaggerated rather than
curtailed as in Max’s case.
If our caregivers were frightening to us as children, our proximity-seeking
actions become more complicated. When parents are loud, intrusive, loom over us,
or are unpredictably reactive, invasive, threatening, abusive, or frightened and
826
unable to respond when we seek proximity, nearness to them become associated
with danger and threat. Two conflicting systems have been stimulated in us when
we experience relational trauma like this—animal defense (with the goal of
protection) and attachment (with the goal of proximity). As adults, we might seek
proximity but, once we achieve closeness, we may freeze, find it hard to speak,
withdraw, or collapse and shut down. We may want to get away, and find ourselves
tightening up and pulling away, or ending a relationship. Or we may find ourselves
being aggressive and even picking fights with those with whom we had been
longing to connect.
Nora had experienced relational trauma as a child and came to therapy because
she was confused by her current relationships. She complained that she had very
little support in her life. She wanted to sit closer to her therapist and to hold her
hand when she felt lonely or sad. When her therapist asked Nora to try reaching out,
however, her body pulled back at the same time, and she turned her gaze away.
Nora felt suddenly distrustful, and her body tightened as if expecting an attack.
Instead of helping her to feel close and safer, reaching triggered animal defenses.
She held back from reaching out, became hypervigilant, and avoided eye contact.
Her therapist helped Nora feel safe reaching out by exploring both proximity-
seeking and defensive actions at the same time. She directed Nora to reach out with
one hand while putting her other hand up, as if making a “stop” sign. With this
gesture, Nora took a deep breath, saying, “I was always going back and forth from
one to the other—either reaching or pushing. But I need both—I need contact, but I
need to know I can have a boundary and protect myself too.” Over time, she learned
to integrate proximity seeking with boundaries and found she began to feel safer
and more regulated in her relationships with others. She had discovered that
boundaries and proximity seeking go hand in hand, and that confidence in her
ability to set a boundary, when needed, increases her openness to proximity.
Cooper also needed to be able to set boundaries in order to comfortably seek
proximity. He was apprehensive about physical nearness, even with his family. He
and his therapist decided to stand across the room from each other and explore
decreasing the distance between them. As Cooper made a beckoning motion to
signal his therapist to walk toward him, he felt an immediate desire to back up. As
he explored that impulse, memories of his seductive, unbounded mother came up.
She had insisted on cuddling, hugging, and being physically close to Cooper even
when he was a teenager. Cooper had made an unconscious decision to just stay
away from proximity lest it turn into something he did not want. As he explored
asking his therapist to move back, with words and gesture, and then asking her to
move closer, he began to experience a felt sense of control he had not experienced
with his mother. Developing trust that his boundary would be respected gave him
what he needed to feel comfortable seeking proximity
Exploring our unconscious proximity-seeking actions in therapy can be
827
revealing. The habits we have formed that impact how we make eye contact, reach
out, and seek or avoid nearness to others by moving toward or leaning toward them
all reflect past experiences. Exploring proximity seeking actions in the worksheets
that follow can help us learn about our unconscious habits of proximity seeking in
attachment relationships and how to develop new, more satisfying patterns.
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1. Put a tally mark next to the proximity seeking actions you make in relationships
with others over the next few days. Also notice which ones others make.
2. Describe three significant experiences when you used any of the proximity-
seeking actions above.
3. Put a tally mark next to the proximity seeking actions you make in relationships
with others over the next few days. Also notice the ones others make towards you.
4. Describe what you learned about the proximity seeking actions you made over
the past few days (e.g., I learned that I try to coerce my partner, make full eye
contact and move closer even when she doesn’t want me to.)
5. Choose a proximity-seeking action another made toward you that stands out and
describe your reaction to it.
6. What one proximity-seeking action might you explore in order to attract more of
the kind of contact you want?
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Reaching out with stiff arms, hunched shoulders, & tight chest
Describe your thoughts, emotions, and body responses when you reach in this
way.
833
Reaching out by leaning forward, with head and neck in front of shoulders, &
arms overextended
Describe your thoughts, emotions, and body responses when you reach in this
way.
Describe your thoughts, emotions, and body responses when you reach in this
way.
834
Is this way of reaching familiar or unfamiliar? Do you, or does someone you
know, reach out like this?
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Reaching out with palm sideways, eyes averted, & head down & to the side
Describe your thoughts, emotions, and body responses when you reach in this
way.
837
Reaching out with palm down, stiff arm, & upper body pulling back
Describe your thoughts, emotions, and body responses when you reach in this
way.
Reaching out with palm up, eye contact, chin level, & spine aligned
Describe your thoughts, emotions, and body responses when you reach in this
way.
838
Is this way of reaching familiar or unfamiliar? Do you, or does someone you
know, reach out like this?
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Reach Out
Thoughts:
Emotions:
Images/Memories:
841
Lean Toward
Thoughts:
Emotions:
Images/Memories:
Eye Contact
Thoughts:
Emotions:
Images/Memories:
842
difficult?
843
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4. Experiment with beckoning and stop motions again until you can physically sense
the degree of proximity that feels just “right” to you. It may be indicated by a
change in breath, a relaxation, the ability to easily make eye contact, an opening in
your body. Describe the body signals of the “right” proximity in the box to the right.
5. Track the body signals you identified as too close, too far, and “just right”
throughout the week and identify the situation in which you experience the body
signals for each degree of proximity below.
845
Discuss what you discovered with your therapist at the end of the week.
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847
Because play and positive emotions depend upon secure attachment for their
full elaboration, and defensive responses require inhibition of spontaneous or
playful behavior, it is not surprising that positive emotions can be challenging for
our clients. Play and pleasure are not compatible with hypervigilance, bodily
tension, constricted movements, or hyper- and hypoarousal, or with fear of
criticism, judgment, humiliation, or rejection. Integral to the third phase of
treatment, this chapter’s goals are to help clients expand their capacity for positive
emotions, pleasure, and play by working with the patterns that inhibit the ability to
experience increased joie de vivre and exploring new possibilities to foster these
capacities. Cannon (2013) even goes so far as to say that it may be that learning to
live more in the “spirit of play” than in the “spirit of seriousness” is the end goal of
all therapy. A playful life stance allows us to embrace life and each other with
lightness, humor, and openness.
848
Suggestions for Clinical Use
By this stage of this book, much work has already been done with regard to clients’
fears, dysregulation, painful emotions, limiting beliefs, and corresponding physical
tendencies. As they are increasingly able to neurocept safety, clients may
spontaneously smile and laugh more often, increasingly enjoy eye contact with you,
and more easily execute proximity-seeking actions. Their voices may be lighter and
less tense and their bodies may move more freely. In the context of your attunement
and collaboration, clients can learn to become more curious and mindful of internal
experience in response to these pleasurable expressions, of thoughts or memories
of play and positive affect and the movements that express them, or of spontaneous
moments of playful interaction and positive affect with you in session.
Capitalizing on every in-the-moment experience of humor, lightness,
spontaneity, relaxation, playfulness, or mutuality as it occurs in the therapy session
will promote clients’ capacity for positive states. When you see clients smile and
relax the shoulders a bit, for example, you can enhance the moment by naming and
mirroring their actions or sharing your own experience. You might say something
like “A smile comes when you talk about your kids, and your shoulders seem to
relax” or “It feels good to smile, doesn’t it? Let’s stay with that good feeling for a
few minutes. What else happens in your body or with your thoughts, images, or
emotions?” Another way to explore body movements that go along with positive
emotions is to discover with your clients what kind of posture and movements they
would want to make in a context of enjoyment, fun and play, such as, opening,
expressive movements; jumping, dancing movements with legs and arms; bouncy
steps; tilting the head; a more upright, open posture or a different kind of walk or
facial expression. You might playfully model these movements yourself and invite
them to join you. This may test your own ability to engage in or demonstrate
carefree, silly, playful actions and possibly refine them at your client’s instruction.
Some clients may be unable to experience positive emotions with you, with
others, or generally in life, and might report that they do not know what activities or
interactions would bring them pleasure, satisfaction, joy, or other feelings of well-
being. They will need your help to discover which people and activities induce,
even slightly, positive emotions or awaken their impulse to play. You also might
capitalize on the connection, pleasure, and playfulness some clients have found
with their pets, but may not experience in human interactions. For example, one
client brought her dog to therapy and explored positive emotion with her therapist
as they played together with her dog.
You might also use the material to encourage clients’ curiosity about how they
“hold themselves back,” keep a poker face, stay serious, or guard against play or
positive emotions. Some clients may recall a family expectation to appear happy
even in the midst of fear or emotional pain, whereas others recall the importance of
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never appearing joyful or excited no matter how much fun they were having. These
slivers of memory may help clients address survival resources or coping behaviors
that inculcated limiting beliefs related to positive emotions.
Keep in mind that challenging clients capacities for pleasure may catalyze
apprehension or increase procedurally learned physical patterns that still constrict
their enjoyment of life. For many clients at this stage, remaining focused on
increasing the capacity for play and pleasure will be more useful than exploring
negative patterns associated with positive emotions that have already been
addressed. You can help clients sense the safety of the here and now, remind them
of their ability to set boundaries and say “no,” but still continue to encourage their
exploration of the spontaneous, relaxed, more expressive movements characteristic
of positive emotion.
Some clients may find positive feelings even harder to tolerate than distressing
emotions. When positive emotions feel more out of control or more foreign, or
clients associate pleasurable feelings with trauma, punishment, abandonment,
criticism, or rejection, the material in previous chapters can help you process and
shift limiting beliefs and emotions that prohibit play and positive emotions.
Afterwards, to the extent possible, given each individual client’s capacity, you can
notice, and help clients notice, how their procedural tendencies interfere with
enjoyable interactions. For example, having a tense face and body, pulling back, or
furrowing the brow might put off playful overtures from a significant other or
potential partner. They can then practice inhibiting such tendencies.
Keep in mind that exploring any type of positive emotion will support the goals
of this chapter. As Panksepp (2000) states, “In addition to laughter, we may need to
focus on issues such as hope, love and confidence as natural, health-promoting
features of the brain–mind in humans” (p. 186). Although some of your clients may
welcome only high-arousal pleasurable states, and others only low-arousal ones,
positive emotions at both extremes of the window of tolerance are valuable to
explore and deepen in therapy. Additionally, you can encourage your clients to
experiment with embedding play and fun into their ordinary lives by “do[ing] many
purposeful, productive things playfully, mixing seriousness and frivolity together
into the same activity” (Caldwell, 2003, p. 304).
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smiles? Did people ever interact playfully or seem to enjoy each others’ company?
What things did you do for fun with anyone in your family? Did anyone ever enjoy
your enjoyment of something?” This worksheet can be helpful for clients whose
constricted movements, hypo- and hyperarousal, avoidance behavior, or tension in
the face and body is observed in session. On the LOOKOUT FOR FUN & PLAY
encourages clients to heighten their awareness of the playfulness already available
or spontaneously occurring in themselves and in others. Even if they insist that they
never feel pleasure, the concrete categories and examples here may help them
become aware of the little acts of play that often go unrecognized. Clients will
benefit from your validation of even the smallest moments of playfulness.
For some clients, positive feelings were met with humiliation and scorn or
punished emotionally or physically, leading to somatic patterns that inhibit
playfulness. POSTURES & MOVEMENTS TO SUPPORT PLAYFULNESS &
FUN brings to light the body responses that dampen or constrict the capacity to feel
pleasure or to “flow” spontaneously moment to moment, and contrast these with
body responses that communicate a readiness to play. The two of you might
playfully experiment together with movements that prevent or invite play. You can
become aware of the sometimes subtle changes in the body that participate in each
of these states. HIGH AND LOW AROUSAL POSITIVE EMOTIONS helps clients
identify pleasurable emotions at both extremes of the window of tolerance, assess
the ones that are familiar to them and the ones that are not, and explore some ways
to develop one emotion that is unfamiliar. BELIEFS THAT LIMIT POSITIVE
EMOTIONS is designed to elicit the cognitive schemas that underlie difficulties
feeling the full range of pleasurable emotions and to begin experimenting with
alternative beliefs that allow a more relaxed, deeply pleasurable experience of life.
The activities in PRACTICING PLAYFULNESS can be used to encourage clients
to step outside their comfort zone and to identify and intentionally engage in playful
activities of their choosing and then mindfully notice their responses. With
observation and practice of what feels good, clients can discover how their
experience changes when they can enjoy playfulness. Your ongoing encouragement
to follow through with the activities of the final steps of these worksheets will be
essential for lasting change.
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child. Yet other parts may be persistently playful or silly in order to avoid painful
emotions and memories. Certain parts may feel betrayed by experiencing pleasure
during sexual abuse. It is especially important to validate each part’s reactions to
positive emotion as consistent with that part’s role in helping the client survive so
that you do not inadvertently increase the internal conflicts between parts holding
different survival strategies.
If you use one or more of the worksheets with your dissociative clients, they
might experiment with different parts filling them out and then sharing the results
internally at home or in session with you, if they find that helpful. It will be
important to discover what each part needs in order to foster positive emotions in a
way that is tolerable and feels good, emphasizing that no part has to try something
that feels dangerous or overwhelming. Even if your clients are too dysregulated to
increase play and positive emotions at this time, there is still a therapeutic benefit
in helping them notice the internal struggles between parts in regard to this topic.
By observing how some parts long to feel good and how others fight all positive
feelings, holding both in awareness simultaneously, you can foster a small but
significant piece of integration. Helping parts communicated with one another can
sometimes promote discovery of common ground or common longings for
pleasurable emotions. Perhaps parts can agree on one playful action to explore, or
one positive emotion to cultivate. Or, if some parts cannot agree at this time,
perhaps they can observe from a safe distance.
If the material in this chapter exceeds the integrative capacity of dissociative
clients with a narrow window of tolerance or abuse histories that cause them to
associate pleasure with danger or pain, you can also use the chapter for
psychoeducation about positive affect intolerance, break down the material into
small steps, or save it for a later time in therapy when the client can make better use
of it.
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Despite the growth you have accomplished as you have gone through this book, you
might still feel that life could be more enjoyable. Maybe you don’t remember the
last time you laughed out loud or thoroughly enjoyed yourself. Maybe you long to
put your stress and worries aside and just have some fun. In the hectic pace of
modern life, it’s easy to be so consumed with work and commitments that we don’t
find the time to just kick back, relax, and play. Or, when we do manage to carve out
some time for ourselves, we don’t want to do anything except surf the internet or
zone out in front of the TV. Some of us may find that we don’t have the energy or
motivation to engage in playful activities or just don’t know how to have fun.
Perhaps you have a tendency to be “all work and no play,”or to have difficulty
“letting go,” to be good in a crisis but tongue-tied in social situations calling for
laughter and small talk. Maybe you feel envious of parents who easily giggle and
play with their children, or of the fun-loving friend whose laughter is contagious
and whose big, openhearted smile lights up a room. Maybe you find yourself
focusing on the negative aspects of life. Positive emotions of all kinds—joy, hope,
excitement, contentment, or tenderness—might be few and far between.
Some of us grew up in environments that were not conducive to positive
emotions such as the joy, delight, exuberance, laughter, and fun that go along with
being playful and lighthearted. The capacity for play and other positive emotions
cannot develop under the scrutiny of a strict, disapproving, overly serious, or
performance-oriented parents, nor in the shadow of threat and danger. If safety and
well-being are at risk, or if children are concerned about being criticized or
rejected, their pleasurable feelings and playful activities are instantly terminated,
and the body tenses, constricts, and pulls back. Spontaneous movements cease,
voices quiet, and actions tend to become small, wary, frozen or constrained.
If these conditions are prolonged, the ability to play and experience positive
emotions can be greatly diminished, creating far-ranging consequences for our
capacity to revel in the enjoyment of positive emotions and playful spontaneity. We
may miss out on the advantages of the deeply serene, exuberant, or uplifting
emotional states that foster resilience, safeguard us in difficult times and contribute
to our enjoyment of life. This chapter explains how childhood environments nurture
or limit positive emotions, explores the physical characteristics of playfulness, and
provides some ideas for how to reclaim and further develop our capacity for play,
pleasure, and positive emotions.
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How Play and Positive Emotions Develop
Joan complained that her life was tedious and she never had any fun. Spontaneity,
laughter, and the confidence and flexibility to engage in open-ended, unstructured
playful activities were unfamiliar to her. The contraction and hunching of her
shoulders, a lack of free movement in her upper body, and a plodding, heavy quality
to her gait all went along with being “too serious.” Her tense body and constricted
way of moving were the opposite of the relaxed, open body posture that invites
playfulness, pleasure, and positive emotions.
Though Joan wished she could “lighten up” and enjoy herself, she felt
uncomfortable when she attempted to be more spontaneous and playful. She found
that movements typical of a playful attitude—tilting of the head, an unexpected
gesture, sudden laughter, a whimsical expression or grin, a bounce to one’s gait—
were foreign to her and often made her nervous when she saw them in others. And,
when she observed others relaxing and enjoying themselves, she thought they were
“wasting time.” Joan had come to associate play, pleasure, and positive emotions
with laziness, being unproductive, and being vulnerable to ridicule or threat. She
had little experience with the joyful spontaneity and elation characteristic of play,
and rarely felt happy, delighted, or even contented. She failed to see the humor in
things, and habitually viewed herself and others from a negative perspective.
Simply put, she did not know how to “feel good.”
We are all born with an innate impulse to play and enjoy ourselves, a need that
is met when our caregivers play with us. We’ve all heard the shrieks of laughter
and joy when a mother or father takes a child’s excitement to the upper edges of the
window of tolerance by chasing her in the park, tossing him into the air, or playing
a stimulating game of peek-a-boo. During these high-energy interactions, each
person responds to the other with laughter and rapid changes in movements, heart
rate, and breathing as arousal states fluctuate. Through these activities, the child
learns to enjoy sympathetic high-arousal states coupled with joyful exuberance and
a measure of unpredictability through these activities. If these high-arousal states
alternate with calming, soothing interactions, the child also learns to enjoy quiet
parasympathetic low-arousal states of serenity, tenderness, deep relaxation and
contentment.
In these interactions, extreme states of high- and low-arousal have been paired
with pleasurable emotions instead of with the fear that accompanies hyper- and
hypoarousal. The association of high- and low-arousal states with positive
experiences supports a flexible nervous system that can adapt quickly to all kinds
of stimulation and a wide range of life events. The window of tolerance can expand
to include both calm (peaceful, serene, contented, tender, relaxed, or restful) and
intense (exhilarated, excited, delighted, ecstatic, hilarious, elated) emotions.
Play activities change over a lifetime. In childhood, they range from the social
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play of peek-a-boo, to hide-and-seek, to uncontrollable silliness and rough-and-
tumble play with peers or adults. As we mature, play activities become more
elaborated include imaginative play, creative activities and spontaneous group play
activities. Later in childhood, less physical and more cognitive varieties of play
often emerge in the form of jokes, puns, word games, and other kinds of verbal
repartee, mental humor, comedy, and entertainment. Although “contest” activities—
organized sports, music, or art competitions, video games, and other competitive
pursuits—can be a lot of fun and are often described as play, they do not qualify as
playful if they are anxiety-driven or excessively focused on “winning.” True play is
anxiety free, without pressure, and engaged for its own sake rather than to achieve a
goal, such as to win or out-do someone else.
The spontaneous nature of playful activities strengthens attachment and social
bonds in a different way from being comforted when distressed or generally cared
for. Play helps us develop a capacity for mutuality and an appreciation of shared
enjoyment unadulterated by pressures to win approval or avoid losing or fear of
performing poorly. Elevated excitement, joy, and elation are paired with high-
energy play activities such as tag or sports or energetic, fun verbal banter with
others, and often followed by relaxing, enjoyable, more restful, quiet pleasure, such
as hanging out or enjoying a beer together.
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playful routine of storytelling or fantasy that interweaves fun with the
disappointment of ending something pleasurable. When the child falls and bruises a
knee, good interactive repair from a caregiver provides both comfort and
reorienting of attention to something enjoyable. When parents return after
separation from their child, they communicate pleasure and excitement, upon
reunion even when the child has been upset at their absence. This transitioning from
positive to negative and back to positive emotions helps children develop
resiliency and flexible, adaptive capabilities in all their social relationships.
Learning to Play
Reclaiming or enhancing the capacity for play, pleasure and positive emotions can
foster resilience and buoyancy. There are many ways to do this. Joan’s first step
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was to be on the lookout for fleeting moments of playfulness and enjoyment in her
daily life. With her therapist’s encouragement she began to orient toward even the
briefest of giggles, laughter, smiles, and other expressions of fun in others. As she
noticed moments with others that felt good, she also noticed her response—a brief
smile, a slight lift of her posture, a warm or tingly sensation. With practice, she
began to identify situations, people, and activities that elicited pleasurable feelings.
Gradually, she changed her orienting habits from only paying attention to serious
cues to also paying attention to positive and playful cues.
With her therapist, Joan explored different postures and movements to counter
her stiffness and constriction. She practiced exchanging her plodding gait for a
bouncy, head-up walk, her hunched shoulders and rounded spine for an upright
posture that encouraged eye contact and engagement with others and supported
positive feelings. She practiced looking around to see what colors, people, or
scenery she found pleasing, and then tuning in to savor her internal experience of
enjoyment.
During one therapy session, Joan and her therapist decided to explore playing
together through a game of catch, playfully throwing a soft ball back and forth. At
first, Joan felt uneasy and awkward, saying, “This is dumb.” Catching it, though,
she began to feel a sense of lightness, and a giggle rising up into her with the
satisfying feeling of catching the ball. She remembered how humiliated she had felt
as a child when the others kids had teased her mercilessly for being clumsy and shy.
Eventually, she had refused to join in neighborhood games, but she had felt lonely
and jealous when she saw the other kids playing catch outside her window. Joan
tearfully told her therapist that she had felt so miserable as a child that she had
wished she had never been born. For Joan, an important step was to grieve for the
friendless sad child she had been who had grown up without the laughter,
playfulness, and fun that every child deserves.
Over many sessions, Joan and her therapist continued to experiment with
playful games of catch until gradually, Joan’s discomfort gave way to laughter and
enjoyment of the fun and mutuality of this simple activity. After one particularly
fast-paced, fun game of catch filled with spontaneous laughter, Joan found the
words to describe the pleasure and enjoyment she felt in that moment: “I feel the
joy connected to an energized feeling in my chest that has warm, tingly feeling
around my heart. There’s a feeling of radiating energy that seems to go from the
core of my body out my arms and legs. My eyes widen, and I feel the slight
tightening of muscles in my cheeks and mouth that go with a smile. And I feel the
good feeling of happy tears behind my eyes.” As Joan practiced finding other
activities that stimulated these pleasurable sensations and joyful feelings in her
daily life, her capacity for positive emotions slowly grew.
Bill complained of feeling socially awkward, perpetually scattered and unable
to focus, reflected in his quick, uncontained, impetuous movements, and in his eyes
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that darted around the room. He always had several projects going at once, many of
which remained incomplete, and he told his therapist he could never rest. He
always felt that there was too much to do. With his hands in constant motion, Bill
spoke rapidly and hardly seemed to pause for breath. He was distracted and
uncomfortable in social interactions and his strained smile communicated that he
did not enjoy himself. In therapy, Bill learned to pause and notice his rapid heart
rate, anxiety, all-over tension, and apprehension when he thought about not moving
so fast or doing so much. He began to realize that “slowing down” made him
uneasy. In his work with his therapist, Bill realized that his apprehension was left
over from a family who prized “doing” over “being.” Always staying so busy
interfered with his enjoyment of life, and especially quiet, tender, or relaxing
moments that had “no purpose.” Every night at dinner, his parents would ask, “What
do you have to show for yourself today?” The more projects he reported to his
parents, the more they praised him. Bill had learned at a young age to turn his
attention to goal-oriented, “productive” activities and tried to meet their
expectations by doing more.
Bill’s therapist encouraged him to experiment with doing nothing. He stretched
out on the sofa and tried to let his body sink into the comfy cushions, but he couldn’t
relax. Mindfully, Bill noticed his impulses to move, uneasy emotions (nervousness,
anxiety) and thoughts of “Stop being so lazy! You should be doing something.
You’re just wasting time.” Bill’s first step was to reexperience the emotional pain
he had felt at dinnertime when his parents demanded proof of his achievements for
the day. He also remembered vividly a time when he was 7 years old lying on his
back in the summer sun watching the clouds float by and daydreaming. His reverie
was suddenly interrupted by his father sarcastic voice saying that Bill was a “lazy
slug” and that he would never amount to anything. Ashamed and hurt, Bill had
pushed away a tender, quiet, dreamy part of himself. Eventually, after processing
this sliver of memory filled with anger at his father and grief for the part of himself
he had lost, Bill inhibited his impulses to move and challenged his self-critical
thoughts with, “I have a right to relax. I don’t have to produce all the time. It’s OK
to be lazy sometime. I can just enjoy myself.”
Bill gradually began to relax and enjoy the sensations of his muscles letting go
and his breathing deepening and he slowly felt more connection and peace within
himself. Later, Bill reported that as he practiced low-arousal pleasurable states, he
discovered a newfound tenderness in activities with his 4-year-old son—quietly
cuddling at bedtime, lying together on the grass watching clouds and making up
stories, and sometimes just tenderly snuggling with no talking at all.
Whether in therapy or with friends and family, all of us have experienced
moments of pleasure, fun, playfulness, and other positive emotions that included
spontaneous movements, relaxation, pleasurable eye contact, deep calm,
contentment, smiling or laughter. The worksheets that follow will help you watch
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for incipient spontaneous actions and emotions—the beginning of a smile,
meaningful eye contact, a gentle and kind moment with another person, the trust of a
child or pet, a more expansive or playful movement, a bounce in your walk—you
can learn to capitalize on those moments by participating more consciously in them,
enabling the moment to linger. The worksheets will encourage you to explore all
kinds of positive emotions from excitement, joy, humor, and lightheartedness to
tranquility, deep satisfaction, or quiet tenderness. The ability to enjoy a wide range
of positive emotions can counter the often arduous work of therapy and help us
expand the boundaries of our windows of tolerance.
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Select two times in your life when you had the most fun. They could be childhood
memories or more recent memories. They could be activities from the chart above.
Describe your memories in the first boxes and then, follow the arrows.
Remember and describe your physical expressions or actions of this fun moment.
Remember how each of those actions felt in your body, and describe what you
felt.
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What thoughts did you have about yourself, others, or the world?
Remember and describe your physical expression or actions of this fun moment
Remember how each of those actions in your body, and describe what you felt.
What thoughts did you have about yourself, others, or the world?
How could you incorporate these or similar playful actions and activities more
fully into your life today?
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Spontaneous actions
e.g., I imitated my boss with my coworkers and we all laughed out loud.
Laughter, smiling
Other:
Spontaneous actions
e.g., When I took my kids to the park, they met some new kids and they laughed
and shrieked at the treasure hunt game they made up.
Laughter, smiling
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e.g., My husband laughed when our two-year-old son offered to share the cookie
he had slobbered on.
Other:
Did you notice any fun or playfulness in your life that you had not acknowledged
until now? If so, make a commitment to remember to recognize those overlooked
moments in your life and enjoy them.
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Describe your posture, How does it What emotions and What memories
movement, or feel in your thoughts go along go along with
expression. body? with it? it?
2. Now find a posture, movement, or expression that says “Let’s play!” or “Let’s
have fun.” Try thinking of a mischievous child ready for fun, teenagers joking
around with their friends, or a dog dropping a ball in front of you and giving your
that playful look. Take a few moments to embody the expression you found and then
describe your experience in the chart below.
Describe your posture, How does it What emotions and What memories
movement, or feel in your thoughts go along go along with
expression. body? with it? it?
4. Identify three situations in which you want to embody a playful attitude with
others (e.g., When my family comes to visit; weekend mornings when the kids
climb into bed with us; with my too-serious friend).
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2. List three of the high arousal emotions that you circled. Describe a situation or
person that evokes each one and how you experience each of them physically.
a.
b.
c.
Window of Tolerance
3. Circle pleasurable low arousal emotions that you experience frequently. Add any
that are not on the list in the empty space at the bottom.
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Caring Grateful Satisfied
Compassionate Kindhearted Tender
Composed Loving Tranquil
4. List three of the low arousal emotions that you circled. Then describe a situation
or person that evokes each one and how you experience each of them physically.
a.
b.
c.
5. Choose one high arousal emotion and one low arousal emotion that you do not
experience very often and describe how you might cultivate each one.
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2. Describe the belief you formed and how it affects your body.
3. Describe how the belief affects your ability for positive emotions today.
4. How could you challenge the veracity of the limiting belief? (e.g., My parents
taught me that I should be serious and never be silly, but being with my friend
Joe challenges the belief because he is silly all the time and I can be silly with
him.)
5. How could you change your body to support the new belief? (e.g., I could
remember to relax, smile, and giggle more.)
6. What activities could you try out? (e.g., I could hang out with Joe and my
friend’s children who are good at being silly and be silly with them.)
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• Do things with a friend that make you laugh (e.g., sing in a silly voice, skip
down the street).
• Play with a child, puppy, or pet.
• Think of funny things that have happened to you and tell your friends or family.
• Watch a funny TV show.
• Do something fun you used to do, but stopped doing.
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their windows of tolerance and increases their capacity for full living and relating.
This final chapter of the book can be the beginning of increased vitality for your
clients, as you and they use this material to develop their confidence to seek out and
enjoy new adventures and endeavors.
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confident. As clients consciously inhibit old patterns by working and “playing” at
the edges of the window, neuroplasticity is harnessed that allows both the alteration
of already-existing connections in the brain and the formation of brand-new
connections (Siegel, 2010a).
Some clients who take impulsive risks but fail to assess the consequences of
their actions will need your assistance to predict and evaluate potential outcomes
of risk-taking activities and select appropriate risks that will help them lead more
grounded yet vibrant lives. Many clients will recognize that their already expanded
windows of tolerance can support their braving more emotional, physical, or
intellectual risks. Old procedural learning may still bias others to react negatively
to healthy challenge, risk, and change. It is valuable information to many clients to
know that their avoidance of risk-taking is procedurally learned and related to the
past, and also that their overavoidance of novelty works against them in achieving
their goals. To expand their tolerance for arousal and live a fuller life, they will
have to allow and accept uneasy feelings outside of their comfort zone. They will
need your support to dare to take on challenges that, until now, they have
neurocepted as dangerous or uncomfortable (most likely because the outcome was
either unknown or predicted to be negative). If you can encourage clients to take
little risks, particularly in the direction of what they have always wanted, and help
them develop their confidence that they now have the resources to handle whatever
the outcome might be, their windows of tolerance and their enjoyment in life will
gradually expand.
Some clients will need your explicit encouragement and psychoeducation to
take on needed challenges and push beyond the limits of their comfort zones for the
longer-term reward of a more vital life. To challenge such beliefs as “There’s no
use trying,” “I’ll just fail,” or “I don’t deserve it,” it may be more important to jump
into the tasks of this chapter rather than to continue to explore the pain of these
beliefs. Clients might then realize discrepancies between what they expect to
happen and what does happen. For clients who are triggered by optimal arousal
states, engaging in some activities that promote optimal arousal, rather than
challenging their windows excessively, is also a form of healthy risk-taking for
them.
At this stage, every time clients are triggered by another step forward or are
disappointed in the outcome of the risk they took, an opportunity is provided for
further integration of the work of this chapter. As you and your clients reframe any
dysregulation or disappointment as natural parts of risk taking that provide
occasions for tolerating frustration and using resources, their confidence will
continue to grow and their best selves will emerge.
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humiliation. With orienting biased toward threat cues, they may have difficulty
challenging the regulatory boundaries of their windows. Both high and low arousal
might be coupled with excessive fear or shame rather than with excitement or
relaxation. Thus, experiencing the bodily feelings related to low arousal and
pleasurable states of calm, quiet, and contentment, or to high arousal excitement,
joy, and elation may be triggering.
Clients with dissociative disorders may have several different reactions to this
chapter. They might long to feel happy, but happy feelings might evoke shame in a
humiliated part, and fear in a child part connected to being punished for smiling,
who heard words like, “I’ll wipe that smile off your face.” Yet another part might
equate the bodily sensations of excitement (increased heart rate, butterflies in the
stomach) with fear or rage and thus neurocept danger. Similarly low arousal
challenges may evoke pleasurable states such as tranquility or contentment that may
be coupled with anxiety.
Dissociative clients and each of their parts generally want to stay within their
comfort zone of what is familiar and so will need your consistent encouragement to
brave appropriate small challenges that will expand the window. Facilitating
collaboration among parts to agree on healthy risks that are appropriate for clients
as a whole is optimal. You can help clients elicit the support of stronger, more
confident qualities or parts of themselves to support the frightened, shutdown, or
withdrawn parts so that they can successfully undertake challenges.
Because optimal arousal itself is so challenging for this group of clients, it is
important to proceed extremely slowly with an experimental attitude if you choose
to explore risk-taking. You and your clients need to be prepared that doing so might
take their arousal to the edges of the window of tolerance. The excitement of risk
can easily catalyze hyper- or hypoarousal in these clients. You might experiment by
simply asking clients to notice what happens when they (or parts of them) imagine
taking the smallest risk, and be curious together about the reactions of different
parts. You can help clients identify an appropriate risk for each part, and then
explore how to modify that risk so that it is tolerable or acceptable for the other
parts. If that is too dysregulating, you and your clients can titrate even more,
perhaps just by discussing the psychoeducational content of the chapter, and
discover the reaction of different parts to the discussion.
For clients with dissociative disorders, risks and challenges might include
work on decreasing switching and tolerating the resulting sensations and affects;
increasing the ability to mindfully track and accept the voices, thoughts, emotions,
and body responses of different parts; staying aware of the emergence of internal
parts; or working with the fears of parts that are phobic of change and risk-taking.
For those clients who can gradually build up a capacity for taking healthy risks, this
chapter will ultimately prove useful when adapted to their specific needs. For
others, it can be postponed, and the work can return to resourcing and regulating if
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exposure to “too much” risk increases dysregulation or threatens stability.
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Human beings have innate drives for both novelty and safety. We need a certain
degree of safety to venture out of our comfort zones and explore new endeavors that
challenge our capacities. Through the previous chapters and worksheets, you have
developed resources, addressed painful memories, and explored the effects of
trauma and attachment wounds. All this hard work has helped the grip of the past on
your current life to relax a little, or a lot, so that you can experience more security
and ease within yourself and with others.
You are now ready to turn more attention to moving forward instead of focusing
on regulating arousal or resolving the influence of a painful past. You are better
prepared to challenge yourself to undertake appropriate risks, seek novel activities
and pursue new adventures. Risk and novelty bring a sense of vitality, vibrancy and
the joy of learning to our lives. Think of the wonder, excitement, and curiosity of a
small child who discovers something new every day. We can recapture that feeling
by pursuing new activities that are a little out of our comfort zones and take our
arousal to the limits of our windows of tolerance.
You have already begun to directly expand your window of tolerance through
the previous chapters, especially the last chapter’s task of exploring play and
positive emotions. This chapter is meant to continue to challenge you to widen your
window through deliberate healthy risk-taking that expands your personal and
professional horizons. By seeking appropriate novelty and new challenges and
pursuing a greater variety of activities and stimulation, you can develop areas of
your life that you may have neglected, such as intimate relationships, occupational
and professional desires, recreational activities, special talents, or spiritual
interests.
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remain too long in an uncomfortably high or low zone, then we likely developed
wide windows as children. The immature brain structures that regulate emotions
are supported to mature when caregivers offer soothing when our arousal is too
high and provide stimulating activities (e.g., a game of peek-a-boo, an interesting
toy) when arousal is too low this supports a wider window of tolerance. When
caregivers can relax with us in pleasurable low-arousal states, or join with us in
the excitement or joy of high arousal states, a wider window is also encouraged.
It is never too late to widen your window. With each resource you have
developed, and with every step you have taken to resolve the past, you have been
increasing the width of your window. As you regulate unpleasant high arousal states
(e.g., fear, distress, frustration, or disappointment) and low arousal ones (e.g.,
hopelessness, shame, helplessness, or boredom), your window expands. As you
allow and enjoy the high arousal positive emotions at the upper edge (e.g.,
excitement, passion, joy, playfulness) or lower end (e.g., relaxation, tenderness,
peace, contentment), your window also expands. An internal confidence in your
ability to regulate arousal provides you with a safe base inside yourself that you
can rely on as you begin to focus directly on seeking out the challenges and risks
that will not only expand your window even more but also expand your world.
Remember that research in neuroplasticity suggests that no matter how old we
are, our brains are always capable of changing. Typically, though, we fall into
habits that reinforce well-established neural pathways that bias our patterns of
thoughts, emotions, and behaviors to familiar ones connected to the past. To change
the brain and expand our windows of tolerance, we must interrupt and inhibit old
habits and try new things that challenge our comfort zones. The exciting part of this
is that we can become conscious and intentional participants in changing our brains
and widening our windows by purposefully seeking out novel endeavors.
When we take healthy, appropriate risks that are challenging or new, we
stimulate neuronal firing in areas of the brain not stimulated by familiar, routine
activities. To capitalize on neuroplasticity and expand our windows, we can
consciously choose to brave a variety of novel challenges, we might develop our
creative abilities through art, dance, music, writing, or theater; learn something
new, such as a foreign language; take up a physical discipline; explore uncharted
territory in relationships with others; challenge our avoidance of previously feared
situations; or engage in any activity that pushes our boundaries.
As Aniah considered what she could pursue that would expand her window, she
thought of a passion she had given up in her youth that she wanted to reclaim. As a
small child, Aniah had loved to sing, but was ridiculed and mocked for her poor
pitch at home and at school. Aniah had loved the music at her church, but her fear of
performing in front of others and being criticized and teased prevented her from
joining the choir, and eventually she stopped singing altogether. She wanted to take
up singing again to expand her window but her fear held her back. Reminded by her
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therapist that if she were not a bit scared, she could not test her courage, Aniah
challenged her window by enrolling in a singing class. She found that with
coaching from her teacher, her pitch improved, and she was able to reclaim a lost
passion of childhood with gusto by joining her church choir.
Appropriate Risk-taking
Determining appropriate risks to take can be challenging in and of itself. Paying
attention to our bodies can help. We can learn to assess when old patterns of
procedural learning interfere with our ability to navigate challenges and explore
new possibilities. For example, Jerome wanted to leave a job he did not enjoy even
though it paid well. He decided to pick up the phone to schedule an interview for a
job he really wanted—it was his dream job—but his arm tightened by his side. He
asked himself what was the meaning of his arm tightening? Is it: “I will open myself
to danger? Failure? Loss? Shame? Criticism?” Staying mindful for a few moments,
Jerome realized that his tension stemmed from growing up in a family where his
parents both had dead-end jobs that they described as monotonous and boring, the
“daily grind.” “Another day, another dollar,” was their favorite expression, always
uttered in a hopeless tone. He was taught that he should not expect happiness or
success in the workplace. He learned to work to pay the bills, not for enjoyment or
satisfaction. Scheduling that job interview was anxiety-producing for Jerome
because it challenged his family’s beliefs. Jerome remembered his father’s advice:
“Life is hard and you should not expect much out of it. Don’t set yourself up for
disappointment. Just get through the day and be glad you’ve got food on the table.”
Once he recognized the message he had received, he understood his own reluctance
and the meaning of the tension in his arm. With these new insights, Jerome
overcame his hesitation and made the call, which turned out to be well worth the
effort because his new job allowed him to use the skills he possessed and also
challenged him to develop new ones.
Often, the risks that are most challenging involve relationships—to open up,
start dating, assert ourselves, explore sexual intimacy, change entrenched patterns,
or participate in a challenging group activity, like Aniah did by joining the choir.
Expanding the window of tolerance by deliberately challenging relational habits
can support intimacy. Sometimes the first step is to recognize and inhibit our usual
behaviors. Jennifer and Steven’s constant fighting resulted from faulty neuroception
that repeatedly activated hyperarousal for both of them, even when both wished to
be close. Their therapist encouraged them to inhibit their usual impulsive reactions
of blaming the other person when they started to get in a fight. This was a risk for
both that challenged their regulatory capacities; they were accustomed to “blowing
off steam” by fighting, and both shied away from admitting their underlying feelings
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of inadequacy and vulnerability. Inhibiting their usual behavior in order to “hang
out” in the intense vulnerable feelings, noticing them as body and emotional
experiences, was challenging. They both felt “safer” fighting and blaming the other
person than feeling their vulnerable emotions.
Jennifer recalled tearfully how she’d had to fight to be seen in a family that
showed little interest in her, which she interpreted as meaning that she did not
matter to them. She realized that when Steven was preoccupied with work, her old
pattern emerged. Steven had avoided vulnerability for as long as he could
remember, having grown up with an overwhelmed single mother who needed him to
be calm and strong. He had put aside his own needs to take care of her. Steven
began to realize that he implicitly interpreted Jennifer’s demands for attention as
the same message of his childhood—that his needs were not important—and his
interpretation resulted in his angrily “fleeing” from the relationship into his work.
Each needed to challenge their childhood patterns in order to risk vulnerability in
the presence of the other.
Instead of reactively fighting or withdrawing, Jennifer learned to recognize the
tension in her chest that precipitated a fight, to take a breath, and to say, “I feel like
blaming you, but I don’t want to do that. It’s hard for me to be vulnerable and be
able to say I need to feel that I matter to you right now.” Stephen learned to
recognize the tension in his jaw and legs when he just wanted to get away, and,
instead of leaving, to say, “I think my old patterns are coming up. Let’s sit and hold
hands and really listen to each other, and I will try not to pull away.” Learning to
notice their tendencies to fight, choosing to inhibit habitual behaviors, and being
open with their needs and vulnerable feelings instead of fighting was immensely
challenging for each of them, and they practiced in fits and starts. But their
commitment to seek proximity instead of fight and to risk being vulnerable by
asking for what they needed from one another widened each of their windows and
brought them closer.
To identify suitable risks that would help you stretch beyond your current
capacities and challenge your comfort zone, you might ask yourself if you could
become your best self, the person you would want to be, what capacities or skills
would you have that you do not have now? How would you be different in your
close relationships? Would you behave differently in your life than you do now? Is
there a risk you might take with someone you are close to that could deepen your
connection? Is there some activity you have always wanted to do that you have been
afraid to undertake, such as dance, climb a mountain, play the clarinet, or paint? Do
you wish to spend more time with friends or to create a beautiful garden? What
would it be like to just be, to do nothing instead of being busy all the time?
Imagining alternative ways of being or visualizing yourself as becoming more of the
person you would like to be can generate meaningful and expand your window.
When Lauren thought about what would happen if she could wave a magic
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wand and be whoever she wanted, she realized she had missed the dancing she had
so loved as a child, but had given up because she had gained weight. She imagined
herself as a dancer who was graceful and confident. John realized that, if he were
his best self, he would feel strong enough to take an aikido class to develop his
internal strength and the assertion he needed to achieve his goal. For Sam,
becoming his best self was a more internal process. At first, he was confused by the
language: “Best self?” he asked. “What in the world does that mean?” But with his
therapist’s help, he recognized his wish to become a more relaxed, less judgmental
person, less apt to react angrily or impatiently. As he practiced slowing himself
down, deliberately relaxing, consciously inhibiting critical thoughts and orienting to
positive ones instead of negative ones, he learned to feel more content and less
frustrated.
As you work toward widening your own window of tolerance, keep in mind
that neuroplastic change requires novelty. Although there is security and
predictability in doing what is familiar, it usually doesn’t lead to progress. By
turning your mindful attention to inhibiting the procedural learning that holds you
back and then intentionally trying something new that challenges those patterns
without overwhelming your capacities, you create new experiences for yourself.
Remember, any novel endeavor should and will feel at least slightly scary and
nerve-wracking. It is natural to be a bit apprehensive about what might happen if
you take a risk because the outcome is not entirely certain. Something could go
wrong, it won’t be perfect, you might give up, fail, or make mistakes. But when you
make mistakes and recover from them, you are able to grow. If we’re not a tiny bit
scared when we embark on something new, it’s not much of a risk. The worksheets
that follow will guide you to determine appropriate risks that will expand your
window of tolerance. The risks you decide to take should not cause your arousal to
be too dysregulated but they should be unnerving enough to take your arousal to the
limits of your window so your capacities, and your window, can expand.
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CHAPTER 35
1. How does your body look and feel if you imagine embodying your best self?
What is different—your posture, arousal, breathing, tension, facial expression?
What physical actions might be easier: reaching out, letting go, pushing away,
taking in, setting boundaries?
2. In what activities do you see yourself participating that you are not engaged in
currently?
3. What beliefs would you have about yourself, others, or the world if you were
your best self?
4. How would you be different in your interactions with the people in your life?
How might others respond to you differently?
6. Describe three steps you could take on the road to becoming your best self.
7. What somatic resources could you practice to support the three steps you
identified in #6?
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891
CHAPTER 35
Take your time to remember each one and then describe your body responses and
emotions for each of those situations below.
Body Sensations
Movements
Emotions
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893
CHAPTER 35
Take your time to remember each one and then describe your body responses and
emotions for each of those situations below.
Body Sensations
Movements
Emotions
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895
CHAPTER 35
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program.
Your Body’s Response:
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898
CHAPTER 35
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E.g., plan a nature adventure, such as visiting a natural wonder or hiking the
Grand Canyon; go white water rafting; camping in the wilderness; fishing on the
ocean; climb a mountain; start a blog about your experiences in nature; volunteer
to clean up a natural area; grow your own vegetables or houseplants, join a bird-
watching group.
Your Body’s Response:
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CHAPTER 35
2. Describe the situation and people’s responses to you during this high arousal
challenge.
3. Describe below how you experienced the high arousal challenge in your body,
emotions, and thoughts.
Window of Tolerance
4. In the circle to the left, describe one way you can challenge yourself this week at
the lower edge of your window (e.g., take time off work to take a nap in the
afternoon, go to a meditation group, get a massage, do nothing at a time when you
would normally be busy, snuggle with your kid, turn off your phone and computer
for a day to relax, let someone else take care of you).
5. Describe the situation and people’s responses to you during this low arousal
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challenge.
6. Describe to the right how you experienced the low arousal challenge in your
body, emotions, and thoughts.
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Afterword
By the time you have reached the end of this book, it should be self-evident that
who we are, what we feel, and what we believe are intrinsically connected to our
bodies. The overarching ambition throughout this work has been to experientially
expose the inherent wisdom of this connection, unveiling an innate knowledge that
goes beyond cognitive understanding.
We have learned that the way we move, stand, sit, and so forth, is the result of
personal history interacting with immediate circumstance. If we understand this, we
also understand that the intelligence of our bodies is not static. Our posture,
movement and sensation fluctuate moment-to-moment depending on the present
situation and the people we are with as well as our internal state, predictions, and
expectations. These bodily fluctuations are not only obvious and on a large scale,
like a conspicuous change in posture, but also subtle and slight, but no less
profound, like an inward tensing that is not outwardly apparent. Because the body
itself is a living, complex system constantly in flux, we can think of the intelligence
of the body as an emergent property that arises out of our ever-changing experience
with others, the world, and our self.
The body’s actions and their meanings are shaped by our surroundings,
developing anew in moment-to-moment interactions with others and the
environment. It is the response of others that gives our actions meaning and
significance and thus it is also this response that shapes the form of each of our
actions in the here and now. Without someone or something to reach for, we would
not reach at all; without another person to reach back, we would not reach out for
contact. As we have learned, over time repeated responses from others lead to
repeated actions in ourselves, eventually shaping our posture and the way we
move. However, new relationships, and new developments in long-term
relationships, bring forth new actions and new ways of being. Therefore, our
actions cannot be entirely predetermined, but emerge anew as they adapt and adjust
to context and relationships. Thus, the study of our actions demands an interest in
these adaptations and a certain comfort with unpredictability that in turn generate
new insight and understanding.
The inception of knowledge lies in wonderment and questioning. Young
children naturally possess these qualities, and spontaneously seek adventure and
novelty. They have an innate curiosity and desire to learn and grow. Picture a little
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girl’s expression of awe as she discovers a flower or butterfly with her father close
by sharing the wonder of her experience, or the beaming face of a toddler taking his
first steps towards the welcoming arms of his proud mom. These moments
epitomize our innate thirst for challenge, exploration, and knowledge and the shared
relational experiences that encourage it. We catch a glimpse of the delight in the
process and its reward.
We can capitalize on this innate capacity to learn and grow in many ways,
including remaining curious about the body’s emerging intelligence. In doing so, we
are likely to find ourselves inquiring into our internal world, how it changes in
relationship with others, and being open to the discoveries, whatever they might be.
We may pay more attention to what happens internally when we meet a stranger or
an old friend, how our bodies change when we are angry or joyful, how we seek to
know and become known through actions such as eye contact and proximity seeking
movements as well as how we seek to conceal who we are or set boundaries
through tension, gaze aversion or distance-seeking actions.
Unpredictability is an inherent quality of emergence, and thus mindful study of
our own bodies carries with it a certain degree of psychological risk. Unforeseen
discoveries abound, some of which may be welcome and pleasant, some
unwelcome and unpleasant. We may like and appreciate what we discover about
ourselves and who we are in relationship with others. We may also dislike or be
disturbed by what we find, or notice that our view of ourselves is challenged by
our discoveries. All adventures, including the adventure of mindful awareness,
hold a measure of risk and require courage and flexibility, along with the
willingness to accept unpredictability. We might be intimidated by the prospect, but
realize intuitively that there is sometimes more at stake by not taking a risk to try
something new or to cultivate awareness.
You may have originally picked up this volume with the hope that exploring
your sensation, posture, and movement would catalyze the change you desired.
Hopefully, as you’ve delved into the somewhat unpredictable landscape of your
internal somatic experience in relationship to others, you have been rewarded by
the joy of new discoveries and a deeper respect for your body’s wisdom. Since this
wisdom is emergent—always in transition—learning from it can continue
throughout the lifespan. Your body has different things to teach you at different
times of your life, through different relationships, and as you go through various life
processes and challenges. The structure of the book is intended to provide tools for
continuing to draw upon the emerging intelligence of your body in a practical and
progressive way—not only as a guide to help heal from the wounds of the past but
also as a roadmap for discovery and growth in the future. You can revisit the
chapters and worksheets of this volume as often as you like throughout your life to
continue to discover and draw upon the ever-changing intelligence of your body.
Keep in mind that what makes the body intelligent is not its fixity but its
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emergence. We run the risk of boxing in new discoveries before they have fully
revealed themselves if we are intently driven to find answers. Thus, we must resist
hastily defining the body’s wisdom, lest a deeper knowing be curtailed. Seeking to
understand its ever-changing intelligence with a gentle curiosity, while refraining
from focusing on it too precisely or too intently, can allow its wisdom to unfold
organically. The dance of discovery then stays alive and meanings gradually
become more transparent. It is not always comfortable or easy to refrain from
grasping for an external goal in favor of resting in the faith that the process itself is
of maximum value. Reaching beyond what we know into what we don’t know, for
what we want instead of what we might have had to settle for, means we find the
courage to relinquish our fixation on the outcome and trust the process even in the
face of discomfort and unpredictability. The sensation and movement of the body is
a laboratory that is always available to teach us more about the hidden recesses of
the self, expanding our understanding so that we can try out new ways of living and
relating. Resisting the impulse to “know” too soon, remaining in a creative place of
unfamiliarity, and opening to the mystery of the body’s intelligence will yield
treasures throughout the lifespan that we never knew were there.
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Glossary
Animal defenses the instinctive survival responses common to most animals in the face of danger or threat,
including cry-for-help, fight, flight, freeze, feigned death/shut down.
Align, alignment to bring the segments of the body into a vertical line in which the shoulders are relaxed and
drawn downward, the head reaches toward the sky and sits centered over the shoulders, the chest rests over
the lower half of the body, the torso is stacked above the pelvis, and the legs and feet are directly under the
body.
Arousal the degree of activation of the autonomic nervous system (note, arousal does not refer to sexual
arousal in the context of this book).
Arousal cycle the cycle created when arousal diverts from a starting point, or baseline, either by increasing or
decreasing, and then returns to baseline.
Attachment a biologically driven need for affiliation with other humans that begins in infancy and continues
throughout the lifespan.
Attachment cry an instinctive response used to secure the nearness of the attachment figure; usually used in
reference to when infants cry upon separation with their attachment figures, or when they are frightened or
uncomfortable. See also cry for help.
Attachment figure the people who take care of us as children, to whom we form enduring emotional bonds;
as adults, our attachment figures also include the people to whom we form emotional bonds that endure over
time (i.e., partners, spouses, close friends, our children and other relatives).
Attachment history the history of our experience with attachment figures, usually referring to childhood
attachment figures, but also include attachment formed in adulthood.
Autonomic arousal the activation of the autonomic nervous system; see also arousal.
Autonomic nervous system the regulatory system of the body that is responsible for body functions, such as
heartbeat, digestion, and breathing, that are not consiously directed; it consista of the sympathetic nervous
system and the parasympathetic nervous system.
Bottom-up processing a term used in this volume to indicate how autonomic arousal, postures, movements,
expressions, gestures and sensations of the body affects emotional and cognitive processing.
Boundary the emotional and physical sense of the need for protection or physical distance from others and
the sense of our right to our personal preferences, emotions, thoughts and opinions.
Building blocks the five elements (cognitions or thoughts, emotions, five-sense perceptions, movements, and
body sensations) that comprise our present moment internal experience; the building blocks are the focus of
mindful attention in Sensorimotor Psychotherapy.
Caregiver a term used in this volume to refer to a childhood “attachment figure.” See also attachment
figure.
Centering resource a somatic resource of being aware of the core of the body in order to regulate arousal
and regain a sense of being connected with ourselves when we are distressed or “off center.”
Containment resource a somatic resource that helps us sense the actual physical container of our bodies—
the skin and superficial muscles.
Core (of the body) refers to the spine and surrounding muscles.
Creative resource a personal strength or competency that nurtures our spiritual, physical, emotional, and
mental development.
Cry-for-help a mobilizing animal defense used by humans and other animals when they feel threatened and
want to summon help; also called the “separation cry” or attachment cry. See also animal defenses.
Directed mindfulness deliberately choosing particular elements of present-moment internal experience on
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which to focus.
Dissociate/Dissociated/Dissociation to involuntarily compartmentalize, interrupt, detach from usually
associated processes such that we experience a disruption of continuity of awareness, identity, history,
memory, and so forth.
Dual awareness to experience a state specific memory, to a degree, while remaining rooted in the here and
now by being mindful of one’s internal reactions (building blocks) and aware of the surroundings.
Dysregulated arousal autonomic arousal that greatly exceeds the window of tolerance so that it is either
intolerably high (hyperarousal) or intolerably low (hypoarousal).
Dysregulated emotions emotions that are accompanied by hyper or hyporaousal, often related to animal
defenses.
Embody to understand or “know” something through experience—emotions and the physically felt sense—
rather than through reflection, analysis, thoughts or objectivity.
External resources sources of support that reside outside oneself, such as organizations, people, and things.
Faulty neuroception the inability to distinguish whether the environment and other people are safe, such as
detecting danger when there is no real threat. Also see neuroception.
Feigned death an immobilizing animal defense in which the body becomes limp, collapsed, hypoaroused, and
may appear dead. Also called “shutdown.”
Fight mobilizing animal defense involving movement toward the source of threat with aggression.
Flight mobilizing animal defense involving movement away from the source of threat.
Freeze an immobilizing animal defense that includes an inability to move coupled with hyperarousal; the
body is tense and the senses are hyper-alert.
Gait a person’s manner of walking.
Grounding a foundational somatic resource; the felt sense of a somatic base of support and connection to the
ground. See also undergrounded and overgrounded.
High arousal arousal that approaches, or is slightly over, the upper edge of the window of tolerance.
Hyperarousal arousal that is excessively over the upper edge of the window of tolerance associated with
intense sensations as agitation, trembling, rapid heart rate, or overwhelming emotions such as rage, terror or
panic.
Hypoarousal arousal that is excessively under the lower edge of the window of tolerance associated with
inability to move, heaviness, numbness or remotions like despair or hoplessness or an an absence of feelings.
Immobilizing defenses instinctive animal defenses that keep us from moving in order to protect us; see
freeze and feign death/shutdown.
Implicit memory non-verbal memories; somatic and emotional memory states similar to those experienced in
past events, but not accompanied by an internal sense that something from the past is being remembered.
Integrate/integration the adaptive process of assimilating our experiences through linking cognitive,
emotional and physical processes that helps foster a consistent sense of self over time and contexts; also
used to describe when present moment connections – cognitive, emotional, and somatic – are made and
experienced among dissociative parts.
Interactive repair the effort made in a relationship to mend a breach in connection, misattunement, or
boundary violation; often used in reference to attachment figures providing interactive repair to soothe an
upset infant or child.
Internal experience the sum effect of the moment-to-moment fluctuation of the building blocks of present
experience (sensations, movements, five-sense-perceptions, emotions and thoughts. See also internal state
and building blocks.
Internal resources capacities that reside within us that help us regulate arousal and enhance feelings of
competency or mastery.
Interrupted resource a resource whose development was truncated due to trauma, stress, relational strife or
other events.
Low arousal autonomic arousal that approaches or is slightly under to lower edge of the window of tolerance.
Mammalian brain the area of the brain that is concerned with our emotional and relational experience, so
called because it developed with the first mammals. Also called limbic brain.
Mobilizing defenses animal defenses that propel us to take protective action, such as the cry for help, flight,
and fight defenses.
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Neocortex the last part of the brain to develop in evolution, sometimes called the “thinking” brain because it is
responsible for our reasoning, self- awareness, and abstraction abilities.
Neural networks bundles of neurons that connect one region of the brain or nervous system with another for
a common purpose.
Neuroception a neural process that occurs outside of awareness that automatically detects and assesses
features in the environment and cues from others that indicate degrees of safety, danger, and threat.
Neuroplasticity the brain’s plastic or maleable quality that enables it to grow new neural networks and make
old ones obsolete, through experience, including the way we orient.
Orienting the process of paying attention to, or orienting toward, select environmental cues to the exclusion of
others.
Orienting reflex the instinctive, involuntary movement of focusing our attention toward a novel stimuli,
automatically turning our eyes or even the entire head and body toward it. See also orienting.
Overgrounded a state in which our energy sinks downward in our bodies, as if the feet are pushing strongly
downward without the counterbalance of lengthening the spine and lifting toward the sky; the opposite of
ungrounded.
Parts (of self) a term used to describe repeatedly activated states of mind or aspects of the personality.
Different “parts” may hold different core beliefs, emotional biases, procedural tendencies that are not
integrated. In dissociatve disorders, parts of the self are more highly compartmentalized, such that each
might function outside of one’s control or awareness some of the time.
Procedural learning habits of movement, behavior, actions or skills that are automatic; learned as adaptations
to specific environments (like slumping to avoid being seen) or to perform certain actions efficiently (like
tying our shoes); implicit memory for physical behaviors.
Regulate, regulated, regulation the ability to monitor and modify internal processes; to soothe or intensify
our emotions, arousal, and sensations until they do not feel uncomfortably low or high, to bring arousal within
a window of tolerance.
Relational knowing the knowledge about how to interact with others—what kinds of sounds, facial
expressions, or actions will be welcomed or rejected and what to expect in relationships—acquired through
our negative and positive experiences with those who care for us in childhood.
Relational trauma interactions with with other people, including those with attachment figures, that are
experienced as threatening and stimulate dysregulated arousal and animal defense.
Reptilian brain a lower brain structure that is the oldest of the three areas of the triune brain that operates
on instinct and is responsible for the survival-related functions of the body. Also called the brainstem.
Resources anything that enhances the quality of our lives or provides what we need to meet life’s challenges.
See also internal resource, external resource, creative resources, somatic resources, survival
resources, & interrupted resource.
Sense of self an emergent, associative process, rather than a fixed “thing,” that develops from an inborn need
and disposition to relate to others; an internal sense of identity in a particular moment.
Sensorimotor includes both motor and sensory functions, movments and pathways; 5-sense perception,
sensation, and movement of all kinds; the “body” level of information processing.
Sensorimotor Psychotherapy A body-oriented talking psychotherapy that specifically addresses trauma and
attachment wounds, emphasizing the body as an avenue for exploration and vehicle for change.
Sliver (of memory) a small but important moment in a memory that can be focused on to process its effects
in therapy, rather than attending to the entire memory at once.
Social engagement system a set of circuits including the ventral vagal nerve that stimulates engagement
with the environment and other human beings through our facial expressions, eye movements, voicebox, and
turning and tilting of the head; the social engagement system is accessible when when we feel safe.
Somatic having to do with the body.
Somatic resources resources that reside within the body; the physical functions, actions, and capacities that
provide a sense of well-being and competency on a physical level and in turn positively affect how we feel.
Stabilize (arousal) to modify or regulate autonomic arousal, impulses and behavior, and emotional distress
so that arousal remains within or returns to the window of tolerance.
State (Internal state) the subjective experience of our building blocks (sensation, movement, five-sense
perception, emotions and cognition) in the present moment; a temporary activation of neural firing patterns.
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State-specific memory the reexperience (in therapy, to a manageable degree) of an internal state similar to
the one we were in when the past event actually occurred.
Survival resources resources that help us endure and cope with adverse experiences.
Top down processing a term used in this volume to indicate how thought processes (insight, beliefs,
reasoning, reflection, and so forth) affect the body and emotional processing.
Trauma overwhelming experiences that cannot be integrated that elicit instinctive survival mechanisms of
hyper- or hypoarousal and subcortical animal defenses.
Trigger those things, situations, people, or internal experiences that we reflexively neurocept as threatening
when they are not, causing arousal to exceed the window of tolerance.
Triune brain an evolutionary model of the brain (MacLean 1988) that divides it into three defined but
integrated regions, the reptialian brain, the mammalian brain, and the neocortex.
Ungrounded a state in which our energy rises upward in our bodies, causing us to lose a solid feeling of
connection to the support of the ground.
Window of tolerance a zone of optimal arousal, not too high and not too low, within which we can adaptively
and flexibly process stimuli, including thoughts, emotions and physical reactions, without becoming
overwhelmed or numb (Siegel, 1999).
910
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918
Acknowledgments
This book has been decades in the making, endured countless revisions, and
benefitted from contributions from a variety of sources. First and foremost, I’d like
to thank my students and clients from the 1970s to the present day who taught me
how to be a psychotherapist, motivated me to come up with new ways to treat their
troubles, and inspired the initial worksheets that evolved into the ones created for
this book. They have been my best teachers.
For over a decade it has been an enormous privilege to work closely with
Janina Fisher. I am deeply grateful to her for consistently supporting this book’s
concept, graciously enduring all the revisions I put it through, and diligently
laboring over its contents. Janina’s clinical expertise shines throughout this volume,
especially in the practical suggestions in the therapist’s guides and in many of the
clinical examples woven through the chapters. Since the early 2000s, she has been
essential to Sensorimotor Psychotherapy Institute’s growth and development,
serving as the institute’s Assistant Educational Director, Director of Trainer
Development, Director of Research, and Senior Trainer. With her original voice,
boundless energy, astute business sense, exceptional talent as a trainer, and
comprehensive understanding of the field of trauma and its treatment. Janina is an
irreplaceable asset to the work of Sensorimotor Psychotherapy.
I want to extend a special thank you to everyone else who offered their moral
support and contributed their time and expertise to improve this book: Kekuni
Minton, who for two and a half decades has been my primary collaborator in
developing Sensorimotor Psychotherapy, for troubleshooting some of the more
complex worksheets; Kathy Steele, for all the enlivening and enlightening
discussions on dissociation and attachment, and for reworking the sections in the
therapist’s guides on how to adapt each chapter’s contents for use with dissociative
clients; Steve Porges, whose Polyvagal Theory changed the way I think of
psychotherapy, for promptly answering all my questions about neuroception;
Bonnie Goldstein, for staying up with me for half the night on more than one
occasion to review the worksheets in their entirety and for suggesting the concept
for the very first worksheet; Betty Cannon for revising some of the more
problematic chapters during the final weeks of writing and even providing a few
case examples; Susan Aposhyan and Christine Caldwell for reviewing the chapter
on breath; Ame Cutler, Brigitta Karelis, Susan Miller, Marion Solomon, Judy
919
Schore, and Anne Suokas-Cunliffe for their encouragement and feedback on the
worksheets.
I am so grateful to many other esteemed colleagues who have generously
offered their friendship and knowledge over the years: Bessel van der Kolk, who
has provided so many opportunities, helped me understand neuroscience, always
believed in this work, and supported me during one the most difficult life
challenges; Onno van der Hart, who, along with Kathy Steele, has strongly
influenced how I think about dissociation, for his willingness to brainstorm with me
and offer a helping hand when I needed it; Allan Schore, whose work has changed
how I think about my own work, for taking me under his wing to nurture my
professional growth and challenge me to explore unchartered territory; Philip
Bromberg, who has inspired me with his own beautiful writing, encouraged me to
find my voice, and patiently taught me that therapeutic enactments are anything but
“mistakes;” Beatrice Beebe, who provided just the right advice when I needed it
most and taught me the significance of video micro-analysis; Jaak Panksepp, whose
emphasis on play and novelty, and so much more, has influenced my thinking;
Marion Solomon, for her zest for learning and commitment to strengthening
relationships; Dan Siegel for his big picture view and for helping me clarify how
we use mindfulness in Sensorimotor Psychotherapy; and Ed Tronick for exposing
the complexity of meaning-making and embracing the messiness of relationships. I
am grateful to Marilyn Devalier, Ruth Lanius, Clare Pain, Judy Schore, and Martha
Stark whose support and ideas over the years have contributed directly or
indirectly to this book.
SPI’s outstanding group of trainers deserve a special, heartfelt thank you for
their commitment to teach Sensorimotor Psychotherapy throughout the world and
for their unique contributions to and skillful applications of this body of work, both
of which further its impact and efficacy so much more than I could take it alone:
Kekuni Minton, Christina Dickinson, Janina Fisher, Brigitta Karelis, Lana Epstein,
Ame Cutler, Andrew Harkin, Anne Westcott, Esther Perez, Rebeca Farca, Tony
Buckley, Bonnie Goldstien, Linda Cooke, Rochelle Sharpe Lohrasbe, Amy
Gladstone, and Mason Sommers. It is an honor to work with such a gifted group of
trainers.
Deb Del Hierro, my assistant, has my sincere appreciation and admiration for
her diligent work on the manuscript. She worked with me nearly full time for over a
year to bring this book to fruition, editing it countless times, formatting all the
worksheets and designing many of them, and troubleshooting difficult sections to
make them more understandable. Deb, along with Anthony Del Heirro, illustrated
this volume with precise, hand drawn figures and technical drawings that clearly
communicate the concepts. Deb’s superb artistic talent and editing skills,
impeccable grammar, fresh eyes, eagerness to learn about Sensorimotor
Psychotherapy, and willingness to go the extra mile right down to the last hour have
920
been indispensable.
My deepest, heartfelt gratitude goes to my son and CEO of the Sensorimotor
Psychotherapy Institute, Brennan Arnold, whose generous support, both personal
and professional, means the world to me. As my son, he is the source of
immeasurable joy, pride, and comfort. As the institute’s CEO, his business acumen,
skilled leadership, and systemic approach ensure that the school runs well, grows
responsibly, and is sustainable. Without Brennan, I would not have had the support,
time or peace of mind I needed to write this book. I am grateful to him, Nate
Mariotti (SPI’s exceptional Director of Training Operations), Sheldon Romer (our
consultant), Deb Del Hierro, Elizabeth Haupt, Kristi Horward, Lauren Sands,
Laurie Bukovinsky, and the rest of the staff of the Sensorimotor Psychotherapy
Institute for taking on extra work during the past several years so that I could focus
on the manuscript. But beyond making it possible to devote myself to writing, this
capable and talented group is essential to the work of Sensorimotor Psychotherapy.
Without their skillful attention to the enormous complexities of this Institute, it
would be impossible to carry out our training programs throughout the world. I am
immensely proud and appreciative of the collaboration between trainers and office
staff, and what we are able to accomplish together.
It is always a pleasure to work with the staff at Norton. Deborah Malmud goes
out of her way to patiently and promptly respond to my many concerns, no matter
how trivial. Her faith in my writing and in this volume has carried this book through
from beginning to end. I also want to thank Margaret Ryan, whose expert editing
and suggestions made this work much clearer, more user-friendly, and
grammatically correct. Katie Moyer has been extremely patient and helpful in the
last months of production.
A huge thank you goes to my dear friends and family for their unwavering
personal support and tolerance of my unavailability during the writing of this book;
my mother, who always insisted that I reach beyond what I thought I could do; Paul
Joel, whose incomparable talent for improvisation made life an adventure for
nearly three decades; and the children of all ages in my life: my son, Brennan
Arnold; stepchildren, Ally and Quinsen Joel; goddaughters, Jovanna Stepan, and
Shira Goldstein; nephews, Redmond and Matthew Ogden; niece, Shante Ogden; and
grandniece, Mia Ogden. You kids keep me young at heart and never fail to inspire
me to play, laugh, and learn.
And, finally, thanks to you, the reader, for considering these ideas and
interventions and for your efforts to integrate them into your therapeutic work. I
hope you will forgive any inadequacies or inaccuracies that may still remain, which
are entirely my own responsibility. This book was written especially for you, and I
am eager to hear what you discover!
Pat Ogden
921
Founder and Educational Director,
Sensorimotor Psychotherapy Institute
First and foremost, I want to thank Pat Ogden from the bottom of my heart for the
opportunity to assist her in writing this book directly to clients and their therapists.
Not only am I grateful to her for having been an incredibly generous teacher and
mentor, but I also feel privileged to practice and teach her work every day of my
professional life. What drew me to it ten years ago was its theoretical strength,
exquisite relationality, and ability to reach and resolve traumatic memories and
emotional pain without re-living them over and over again. Having the chance to
assist Pat on this very important book was a welcome opportunity to support her
and reach the therapists and trauma survivors all over the world who struggle to
successfully address the legacy of trauma and attachment failure in therapy.
Had it not been for my longtime friend and mentor, Bessel van der Kolk, I
would never have met Pat and changed the course of my clinical work after twenty
years of traditional psychodynamic practice. I am eternally grateful for my years at
the Trauma Center, the opportunity to learn from him, his encouragement of my
teaching and writing, and the privilege of being part of the revolution in the trauma
world over the last twenty years reflected in this book.
Last but surely not least, I want to thank my family and my family of friends for
their support and patience. No one can appreciate the sacrifice of loved ones
without having written a book: the weekends, evenings, vacations, even phone calls
they give up so that we can write, edit or perfect what we’ve already written.
Special thanks to Stephanie Ross and Deborah Spragg for their persistent
encouragement of my writing; Lisa Ferentz and Linda Graham, important members
of my writing support system; dear friends Frank and Michael Anderson; my
wonderful Sensorimotor Psychotherapy community of students and colleagues in the
Bay Area, New York, Seattle, Phoenix, Oslo and London; and my oldest friend and
colleague Lana Epstein. To my family (Camille, Jason and Kelli, Jadu, Julia, Ruby,
and Nika), I owe you! I owe you not only my heartfelt love and thanks but also the
many makeup dinners, weekends, and family events in your future!
Janina Fisher
Assistant Educational Director,
Sensorimotor Psychotherapy Institute;
Instructor, The Trauma Center
922
Index
Page numbers listed correspond to the print edition of this book. You can use your device’s search function
to locate particular terms in the text.
923
conditions for effective integration in, 441
with dissociative client, 438–39, 458
goals for, 248, 435, 441, 479
maintaining awareness of present moment in, 473
as phase of therapy process, 17, 19–20, 243, 244, 245, 247
by promoting awareness and processing of implicit memories, 435, 436–38, 443–44
resource repertoire for, 435–36, 437, 438, 444–46, 447–53, 480–81
resources for reconstructing memory in, 455
social engagement with therapist in, 503
strategies and techniques for, 248
strategies and technques for, 19–20
worksheets for implicit memory interventions, 438, 447–53
see also dual awareness of past and present in memory work; reconstructing memory; sliver of memory
ADHD, 72
Adjusting Sensory Stimulation worksheet, 304, 323
adrenaline, 32, 82, 543–44
affect communication cure, 47
affective competence, 31, 632
agency, mindfulness to promote sense of, 131
age of client, 54, 55
aggression
in boundary-setting, 392, 400
brain’s regulation of, 180
regulating overactive defenses leading to, 517–18, 523–24
agoraphobia, 111, 229, 516
alcoholic father, overactive flight defense in client with, 524
alert immobility, 32
alignment
defined, 769
see also core alignment
amnesia, 38, 80
amygdala
activated by distressing reminder, 174
fear response in, 539
function of, 179–80
sensitized to danger cues, 181
anger
arousal of, in support of threat response, 557
hyperarousal and, 228
orienting habits in clients with problems of, 111–12
reflected and sustained by body, 633
reframing, as resource, 258
in response to distressing events, 161
anger management issues
breath work and, 370, 378
restoring empowering action to address, 516
animal defenses
activated by implicit neuroception in therapy, 43
defined, 769
in dissociation, 36–37, 222
effects of repetitive activation of, 519, 521
elicited in trauma, 29, 515
emotional response and, 557
enduring emotions related to, 563–64
executing, in empowering manner, 517
924
extremes of emotional dysregulation related to, 564–66
functions of, 37, 515, 519
goals of daily life system versus, 37
goals of restoring empowering actions, 519–20
identifying dysregulated emotions associated with, 558–59, 563, 569–73
identifying emergence of attachment legacy in, 592–93
inflexible, 521–22
instinctive mobilization of, 519
integrating, 522–25
need for adaptive flexibility in, 521–22
neurophysiology of, 516
proximity-seeking actions and, 708–9
recognizing, 517, 527
relational issues related to dysregulation of, 516
survival role of emotions in, 557
therapeutic goals for work with, 19–20, 515, 525
therapeutic intervention with emotional dysregulation related to, 566–68
therapists’ guide to emotions and, 557–61
in threat response, 32–33, 515
types of, 519
worksheets, 517, 527–31
worksheets on emotional dysregulation associated with, 560, 569–81
see also cry for help defense; fright-freeze-flight response; shutdown defense
Animal Defensive Responses & the Body worksheets, 517, 518, 529, 531
anterior cingulate, 41
anxiety
adapting therapy process for client with, 73
benefits of mindful attention to, 161–62
breathing patterns associated with, 369, 378
hyperarousal and, 228
restoring empowering action to clients with, 516
somatic resources for soothing, 308
approach–avoidance tendencies, 680
approach behaviors, 699
arousal
biphasic, 538
breathing techniques to regulate, 18, 389
challenges in widening window of tolerance, 747, 748
of daily life systems, 37
defined, 769
developing resources to regulate, 247–48
in emotional processing of trauma-related core beliefs, 617
exploration of neuroception for dysregulated, 219, 220–21
exploring body sensations to relieve, 206
faulty neuroception in dysregulation of, 228–29
goals of sliver of memory work, 494–95, 499–500, 501–2
grounding resources for regulating, 325, 327–28, 345
identifying triggers to regulate, 228–30
manifestations of attachment history in, 31–32
manifestations of trauma experience in, 32
neuroception correlated with level of, 227
normal daily fluctuations of, 225, 239
orientation for clients about regulating, in therapy process, 68–70
recognizing optimal, 222, 241
recognizing signs of dysregulated, 220–21, 231
925
regulating, in exploration of traumatic memory, 248
in sensorimotor sequencing, 539
social engagement system in regulation of, 30
therapeutic relationship in regulation of, 46–47
transgenerational transmission of patterns of, 228
working at edge of client’s regulatory boundaries of, 48–49
worksheets for recognizing signs and patterns of, 221–22
see also hyperarousal; hypoarousal; window of tolerance
arousal cycle, 541, 545–47, 555, 769
artistics resources, 277, 278t, 279
asthma, 370, 378
attachment
adaptation to caregiving deficits, 594
animal defenses and, 592–93
brain activity in, 180
brain development and, 181
child’s response to parental expectations in, 31, 262–63, 332
clients who might benefit from exploration of relational capacities related to, 585–86
complexity and contradiction in, 34
defined, 769
developmental significance of, 20
in development of beliefs, 20, 614, 617–18
in development of boundary styles, 21, 399–400
in development of emotional biases, 20
in development of proximity-seeking behaviors, 31–32, 699, 705–7
disconfirmation of self-states in, 35–36
formation of working models from, 33–34
healthy formation of, 591–92, 593
influence on emotions, 631, 640
intervention with painful emotions related to, 245, 632–35, 642–44
intervention with relational capacities influenced by, 586–88, 594–95
learning to recover from negative emotions in, 729
neurocepted safety and, 226
nonverbal expression of, 25
organization of proximity-seeking behaviors and, 699
orientation for clients about, 66
orienting response and, 16, 116
posture as expression of, 31, 81–82, 95, 254–55, 262–63
problems in. see attachment inadequacies or failure
procedural learning and, 99–102
relational capacities influenced by, 585, 591–92, 593, 685
resources from positive relational experience in, 588–89, 597, 599
secure, 28
selection of worksheets based on client’s, 56
social engagement system and, 29–30
therapists’ guide to emotions and, 585–89
therapists’ guide to legacy of, 585–89
unsatisfactory, 30–31
walking style as expression of, 661–62
working with dissociative clients on emotions related to, 636–37
working with dissociative clients on relational patterns as legacy of, 589
worksheets on emotions related to, 635–36, 645–53
worksheets on relational patterns as legacy of, 588–89, 597–605
see also attachment figures
attachment cry, 32
926
defined, 769
attachment figures
animal defenses aroused by, 521
boundary setting and, 399–400
breathing patterns developed as adaptation to, 378
child’s response to expectations of, 31, 78, 81–82, 262–63, 332
child’s working models of, 35
defined, 66, 769
development of relational habits with, 66
disapproval from, neurocepted as danger, 31, 226
eye contact with, 706–7
in formation of core beliefs, 613
in formation of emotional habits, 640
loss of grounding in relationship with, 332
mindful attention toward, 134
orienting habits learned from, 113
procedural learning in relationship with, 96
proximity-seeking behavior with, 699
resource development and, 419
see also acceptance and approval from attachment figures
attachment-focused therapy, 14, 51
attachment inadequacies or failure
behavioral manifestations of, 31–32
benefits of directed mindfulness for clients with, 157–58
benefits of grounding for clients with, 325–26
boundary development and, 399–400
breathing patterns and, 375
client’s troubled by memory work with, 494
development of inflexible animal defenses in response to, 521
development of survival resources in response to, 262–63, 419–20
difficulties with proximity-seeking behaviors related to, 699–700
directed mindfulness in examination of, 42–43
disconnect from body in response to, 83–84
dissociation related to, 37
fear of memory of, 435–36
feelings toward body influenced by, 82–83
feeling ungrounded as result of, 332
hypoarousal patterns related to, 228
impaired capacity for play and pleasure related to, 721–22, 727, 730
implicit memories of, 442–43
influence on building blocks of present experience, 140
influence on gait, 655–56
intergenerational transmission of arousal patterns through, 228
neuroception of danger in, 226
nonverbal indicators reflecting, 40
orientation for clients about, 65–67
persistence of adaptive responses to, 82
postural adaptations to, 347, 354–55
reconstructing memory of, 456
relational patterns as legacy of, 592, 685
as result of trauma experience, 33
sliver of memory, 502–3, 513
strengths recognition impeded by, 255, 261–62
trauma versus, 29
treatment model for intervention with, 243
927
types of, 30
Attitudes and Actions worksheet, 79, 91
autonomic arousal, 15, 17, 30, 31–32, 69, 225, 537, 769
autonomic functions
brain control of, 180
exploring body sensations to relieve arousal of, 206
normal fluctuations of arousal, 225
trauma-related arousal of, 537, 543
autonomic nervous system, 17, 69, 769
autoregulation
developmental influences on capacity for, 30, 700
manifestations of attachment history in, 31–32
auxiliary cortex, 46
avoidance behavior
breathing patterns associated with, 369
client’s understanding of, 158
inhibiting, to challenge window of tolerance, 746, 747
Awareness of Physical Boundaries worksheet, 393–94, 405
928
worksheets, 609–10, 619–29
Beliefs, Emotions, and the Body worksheet, 200, 217
Beliefs That Limit Positive Emotions worksheet, 725, 741
best self, 754–55, 757
bike riding, 311
biphasic arousal, 538
bipolar disorder, client with, 73
Biven, L., 721
body
alienation from, in clients with dissociative disorder, 80
awareness, therepeutic experiments with, 44
client’s dislike or phobia of, 57–58, 78
client’s resistance to working with, 77
clinical significance of, 14–15, 22, 25, 28, 53, 102
directed mindfulness to identify effects of thoughts on, 159, 169
disconnecting from, 83–84
effects of trauma on attitudes towards, 82–83
emotional states reflected and sustained by, 631, 633–34, 635, 639–40, 642–44, 645
homeostatic regulation of, 81
influence of early experience on structure of, 27
intelligence of, 13, 775, 776, 777
introducing client to attending to, 60–61
language of, 16, 25, 27, 95, 99
manifestations of attachment experience in, 81–82
manifestations of early implicit memory in, 436
manifestations of trauma exposure in, 82
in meaning-making, 27–28, 607
reconnecting with, 84
substitute language for, 58
therapist’s guides to wisdom of, 77–80
therapist’s use of own, to demonstrate or model actions, 59–60
translating language of, 97
wisdom of, 16, 77–78, 81, 776–77
worksheets for exploring client’s attitudes toward and connection to, 79–80, 85–93
see also body sensation(s); movement(s); nonverbal expression; posture
body-oriented talking therapy, 14
Body Reading for Core Beliefs worksheet, 609–10, 619
Body Reading worksheet, 97, 103
body sensation(s)
beliefs reflected and sustained by, 201, 609–10, 619, 621
brain activity in, 180
as building block of present experience, 140
clinical use of, 198–99
defined, 201
exploration of, in sensorimotor sequencing, 539, 549, 551
exploration of, with dissociative client, 200
exploring connections of emotions and beliefs and, 198–200, 204–7, 217
feedback loop of beliefs and emotions and, 651
indications for therapeutic focus on, 197–98
internal states influenced by, 201
introduction to exploration of, 201–2
mindful awareness of, 197
sources of, 201
therapeutic significance of, 197
therapists’ guide to, 197–200
929
therapuetic goals in work with, 17
in triune brain model, 174
using movement and touch to increase, 211
vocabulary for describing, 198, 199, 202–4, 206, 207, 213
worksheets, 199–200, 209–17
Body’s Signals worksheet, 79–80, 93
bottom-up approach, 64
to address dysregulated animal defenses, 516, 566–67
to address dysregulated emotions, 558
defined, 769
to regulate hyperarousal, 537
triune brain model to explain, 175
bottom-up hijacking of neocortex, 181
bottom-up information processing, 182–83
boundaries
aggressive setting of, 392
communication of, 19, 391, 397, 400–402, 403, 409
defined, 769
development of, 399–400
function of, 397
maladaptive, 391
physical and internal, 18–19, 391, 397–98, 405, 407
in relationships, 21
respect for client’s, 393
signs of failure to set, 392–93
somatic sense of, 18–19
therapeutic goals in work with, 21, 391
therapeutic relationship and, 392
therapeutic work at edge of regulatory, 48–49
touch, 398
unhealthy, signs of, 391
validating client’s, 58
verbal and nonverbal setting, 392, 394
see also relational boundaries; somatic sense of boundaries
Boundaries: Respected and Breached worksheet, 394, 413
Bowlby, J., 34, 39, 46, 632, 699
brain
development of, 178–79, 180–82
hemispheres, 178–79
homeostatic regulation of body by, 81
regulation of social engagement system in, 29–30
structure and functions of, 177
triune model of, 17
brain-injured client, 54
brain stem, 29, 180
breathing
arousal triggered by experiments in, 372, 378, 379
biological functions of, 375, 377–78
cautions in therapeutic intervention with, 370, 372, 378
clients who might benefit from work with, 369–70
conscious control of, 377
implementing interventions with, 370–71, 378–80
increasing awareness of, 370, 371, 379, 381, 385
intervention goals, 369
interventions with dissociative clients, 372–73
930
maladaptive patterns of, 375, 378
mechanics of, 375–77
as personal resource, 18
posture and, 371, 378, 383
to regulate arousal, 389
as resource for processing implicit memories, 444
suboptimal patterns of, 369
therapists’ guide to, 369–73
therapist’s modeling of interventions with, 371
worksheets, 371–72, 381–89
Bromberg, P., 27, 35, 36, 45, 48, 49, 437, 587–88, 746
bronchi, 376, 543
Building Blocks of a Good Experience worksheet, 134, 145
building blocks of present experience
awareness of boundaries and, 394, 413
awareness of resources and, 285, 305, 307, 437
benefits of mindful curiosity about, 162
body sensation as, 138f, 140
cognitions as, 138, 138f
defined, 138f, 770
directed mindfulness to change focus on, 161–62
directed mindfulness to focus on, with dissociative client, 159–60
dual awareness and, 475, 477, 480, 481, 482, 485, 487
effects of distressing events on, 161
emotions as, 138–39, 138f
five, 137, 138f. see also specific building block
five-sense perception as, 138f, 139
focus on, in directed mindfulness, 132–33, 134, 137, 157, 158, 165, 167
mindful awareness of, to explore information processing, 182, 183
movement as, 138f, 139
to notice faulty neuroception, 222
proximity-seeking and, 702
sliver of memory and, 495, 499, 502
therapeutic goals in work with, 131
therapeutic significance of, 162
use of triune brain model to explain, 174, 178, 178t
Bull, N., 348, 634
bullying, 66, 350, 524
butterflies in stomach, 140, 162, 178, 201, 397, 639, 749
931
dissociative client’s perception of, 305
to process implicit memory, 445
as somatic resource, 309
worksheet, 304, 317
Centering: Hand on Heart/Hand on Belly worksheet, 304, 317
center of gravity, 309
cerebellum, 180
change
bottom up approach to, 64
client orientation about, 73
in exploration of orienting habits, 112
imagining or visualizing, 754–55
implicit and explicit processes in therapeutic process of, 51–52
importance of therapeutic relationship in, 21–22, 45–46
lifelong process of, 776–77
limitations of talking cure for, 25
of orienting habits, 118–19
reconnecting with body in, 84
safety in therapeutic relationship and, 587–88
in Sensorimotor Psychotherapy, 14–15
therapeutic journey to, 247
Changing Negative Beliefs worksheet, 159, 165
Changing Orienting Habits worksheet, 113, 129
Choosing Slivers of a Difficult Memory worksheet, 496, 505
Choosing What to Orient To worksheet, 113, 125
clinical examples of therapeutic situations or problems, 55, 68
closed postures, 354
cognitive functioning
benefits of directed mindfulness, 162–63
benefits of grounding, 325
building blocks of present awareness, 137, 138, 138f
difficulty in concentrating, 325, 332
effects of being ungrounded, 325, 332
erroneous or negative beliefs in, 138
manifestation of personal history in, 20
neurophysiology of, 17
procedural learning versus, 97–98, 109
reliance on, in disconnect from somatic intelligence, 83–84
top-down processing, 179
in triune brain model, 174–75, 177, 178, 179
cognitive schemas, 607, 608, 609, 611, 725
cognitive therapy, mindfulness-based, 41
cold compress, 372
collapsed posture, 349, 351, 355, 371, 392
compartmentalization, dissociative, 37, 62, 63, 64, 80
Compassion for Yourself worksheet, 610, 627
competencies and abilities, 247, 249, 256, 261, 264. see also resources; strengths recognition
competitive behavior, 180
compliance with abusive treatment, 100, 262–63
postural adaptations to, 347
confidence
exploration of, as missing resource, 416
loss of, as resource, 419
reinforcing client’s, 60–61, 78–79
for sensorimotor sequencing, 538
932
to start therapy, 247
Connecting with the Back of the Body worksheet, 304, 319
contacting present experience, 61, 62
containment, 18
dissociative client’s perception of, 305
as resource, 309, 770
worksheet, 304, 321
Containment Resources worksheet, 304, 321
contest activities, 729
Contradictions Between Mind and Body worksheet, 97–98, 109
control, client’s sense of
affirming, 59
core alignment and, 356–57
orienting to new stimuli to improve, 112
in processing implicit memories, 438
core alignment
assessment, 349
characteristics of good posture, 355–57
clients who might benefit from work with, 347
clinical use of, 348–49
exercises, 365
grounding and, 355–56
mindfulness in therapeutic work with, 350
psychological benefits of, 355
risk of triggering clients in work with, 350, 351
therapeutic significance of, 18, 347
therapist’s comfort in working with, 349
therapists’ guide to, 347–51
use of muscles in, 356
working with dissociative clients on, 350–51
worksheets, 349–50, 359–67
Core Alignment and Posture worksheets, 349, 359, 361
core emotions, 632, 633, 634, 640, 641, 642, 643
corpus callosum, 179
cortisol, 33
Cozolino, L., 417
Creating New Patterns worksheet, 159, 167
creative resources, 18
benefits of, 262
defined, 770
developing, with dissociative client, 258–59
embodying, 258, 273, 297
to expand window of tolerance, 763, 765
goals of therapy, 255, 256
healthy function of, 264
helping clients recognize and acknowledge, 256–57, 264–65
replacing survival resources with, 258, 264–65, 275
therapists’ guide to, 255–59
worksheets, 258, 271–75, 287–91
Creative Resources to Expand Your Window of Tolerance worksheet, 748
Creative Resource to Expand Your Window worksheets, 763, 765
cry for help defense
in adulthood, 520
brain control of, 180
defined, 770
933
emotional dysregulation in, 563, 565
overactivation of, physical and behavioral manifestations of, 521
overactive, 394–95
purpose of, 32, 37, 519, 520
regulating, 524–25
see also animal defenses
cuddling, 311
culturally-sensitive practice, 680, 685
curiosity, 42–43, 162
934
as phase of therapy process, 17, 18–19, 243, 247–48
promoting client’s understanding of, 278
by reclaiming lost resources, 278
taking inventory, 277–85
taking inventory worksheets, 279, 287–99
therapist’s stance for, 256
see also creative resources; somatic resources; survival resources
development, childhood
of body structure, 27
boundary setting in, 399–400
of brain, 178–79, 180–82
effects of repeated activation of threat response in, 181–82
failure to develop resources in, 419–20
formation of core beliefs in, 614
formation of predictions and expectancies in, 26–27
healthy attachment experience in, 591–92
influence of infant–caregiver interactions on, 26–27
innate curiosity in, 776
integration of self-states in, 34–35
internal working models in, 33–34
interruption of resource development in, 421, 423
learning of procedural patterns and habits in, 99
learning to recover from negative emotions, 729
meaning-making in, 607, 614
organization of proximity-seeking behaviors in, 699
play behaviors in, 728–29
proximity-seeking actions in, 21, 705–7
resource acquisition in, 419
social engagement system in, 29–30, 225–26
somatic sense of boundaries in, 19
of spine, 353
use of somatic resources in, 308
of walking style, 661
developmental delay, 54
diabetes, 370, 378
dialectical behavior therapy, 41
diaphragm, 376, 378
diet, 83
Different Ways of Breathing worksheet, 371, 385
Different Ways of Walking worksheet, 657, 669
digestion, 180
Dijkstra, K., 96
directed mindfulness
client’s potential misunderstanding of, 158
clinical examples of, 163–64
clinical use of, 42, 62, 158–59, 161–62
defined, 157, 161, 770
with dissociative clients, 159–60
focus of attention in, 62, 157
focus on physical elements associated with negative beliefs, 159, 165
in grounding exercises, 326, 327
to identify animal defense-associated emotional dysregulation, 559
to identify effects of thoughts on body, 159, 165
neuroplasticity and, 17, 157, 161, 162–64
to notice faulty neuroception, 222
935
in promoting dual awareness in memory work, 474–75, 476
in sensorimotor sequencing, 539–40, 544
tasks of, 162–64
therapeutic value of, 157–58
worksheets, 159, 165–71
Directed Mindfulness worksheet, 159, 171
disconfirmation, 35–36, 38, 50, 634
disconnect from body
in anticipation of emotional pain, 83
as healthy response to distressing circumstances, 83
potential harm from, 83–84
in response to emotional pain, 83, 201–2
therapeutic intervention with, 198, 201–2
disconnect from internal experience, 133
Discovering a Core Belief from Your Body worksheet, 610, 621
Discovering Your Current Posture worksheet, 363
Discovering Your Current Posturing worksheet, 349–50
disorganized-disoriented attachment
action sequences and, 30, 37
dissociation and, 682, 702–3
formation of, 33
play behavior and, 721–22
trauma-related dissociation and, 38
dissociative client(s), 15
adapting therapy material for, 71–73, 80
breathing interventions with, 372–73
conflict between systems of defense and daily life in, 36–37, 63–64, 71–72
continuum of integrative failure in, 34–35, 38
core alignment work with, 350–51
developing missing resources with, 418
developing resources with, 258–59, 279–80
developing somatic resources with, 305
diagnostic signs and symptoms of, 38–39, 98
directed mindfulness work with, 159–60
dual awareness work with, 476–77
examining triune brain model with, 176
exploration of procedural learning with, 98
exploring body sensations with, 200
exploring boundaries with, 394–95
exploring mindfulness with, 135
exploring neuroception with, 222–23
exploring orienting habits with, 113–14
failure to integrate self-states in, 35–37, 38, 39
with fear of integration, 246
focus on walking with, 658–59
grounding exercises for, 328–29
implicit memory work with, 438–39
interaction of action systems in, 38
legacy of attachment in relational patterns of, 589
psychoeducation for, 63
reactions to optimal arousal by, 749
reconstructing memory with, 458
resistance to therapy by, 63
restoring empowering actions with, 518
risks and challenges in widening window of tolerance with, 748-749
936
sensorimotor sequencing with, 541–42
slowing sympathetic arousal in, 372
therapeutic goals for, 63–64
therapist orientation for work with, 62–64
therapy planning and implementation with, 245–46
treatment model for intervention with, 243
use of therapeutic experiments with, 44–45
working on attachment-related emotion with, 636–37
working on core beliefs with, 611
working on play and positive emotions with, 725–26
working on proximity-seeking actions with, 702–3
working with animal defense-associated dysregulated emotion, 560–61
working with sliver of memory with, 496–97
see also parts of self in dissociation
dissociative identity disorder, 62, 64
distrust, 348
dogs, fear of, 118–19
dorsal vagal system, 33, 227, 370, 372, 521, 745
dual awareness
defined, 770
in processing attachment-related emotions, 643–44
to restore empowering action, 516–17
therapeutic significance of, 19
see also dual awareness of past and present in memory work
Dual Awareness of an Upsetting Childhood Memory worksheet, 476, 489
dual awareness of past and present in memory work
clients who might benefit from focus on, 473–74
with dissociative client, 476–77
experience of, 479–80
managing client’s dysregulation in, 474–76, 480–81
practicing, 480–82
selection of sliver of memory and, 495
therapeutic rationale for, 479
therapeutic significance of, 473, 479
therapists’ guide to, 473–77
working with client on, 474–75
worksheets, 475–76, 483–91
Dual Awareness of Recent Interpersonal Conflict worksheet, 476, 487
dyslexia, 57, 72
dysregulated arousal
defined, 770
identifying triggers and signs of, 221, 228–30
instinctive activation of, 17
mindful attention to, 206
somatic resources for, 302–3
therapeutic goals for, 219, 220–21, 224
see also hyperarousal; hypoarousal
Dysregulated Emotions & the Body worksheet, 560, 579
937
Embodying a State-Specific Memory & Being Mindful worksheet, 476, 485
emotional attunement, 47
emotional biases
attachment experience in development of, 20, 641–42
manifestation of personal history in, 20
reflected and sustained in body, 635, 642–44
as relational defenses, 633
therapeutic goals in work with, 20
emotional pain, 83
emotional resources, 277, 283t
Emotions, Beliefs & The Body worksheet, 635, 651
Emotions, Defenses, and Behavior worksheet, 560
Emotions, Defenses, and Behavior worksheets, 561, 569–73
Emotions, Expressions, & the Body worksheet, 635, 645
Emotions, High Arousal, and Hyperarousal worksheet, 560, 575
Emotions, Low Arousal, and Hyperarousal worksheet, 560, 577
Emotions and Early Attachment worksheet, 649
emotions and emotional processes
addressing attachment-related, in therapy, 245, 631–32
affective competence in, 31, 632
attachment-related development of, 631, 640
attachment-related problems in, 639
attachment trauma manifestations in, 33
benefits of directed mindfulness for, 162–63
bottom-up approach for addressing problems of, 558
as building block of present experience, 138–39, 138f, 161
clients who might benefit from work with, 632
client–therapist attunement in work with, 47
clinical significance of, 631, 634–35
containment exercises for, 304
core versus patterned, 633
directed mindfulness to deepen experience of, 158
disconnect from, 558, 565–66, 567–68
effects of implicit memory on, 442
enduring animal defense-related dysregulation of, 563–64
exploration of neuroception in, 219–20
exploring connections of beliefs and body sensations and, 198–200, 201–2, 204–7, 217
extremes of arousal in, related to animal defenses, 564–66
feedback loop of beliefs and physical sensations and, 635, 651
healthy, 639
identifying animal defense-associated dysregulation of, 558–59, 563, 569–73
influence of past experiences on present, 138–39
influence of posture on, 347, 348, 355, 359, 361
internal working models of, 34
intervention with breathing and, 379
lack of control over, 558
manifestations of insecure attachment patterns in, 30–31
mindful attention to internal experience, 132–34
negative effects of intense arousal of, 557
neurophysiology of, 17
outcomes of imperfect but secure attachment, 30–31
positive affect intolerance in, 722, 724
preparatory movements indicating dysregulation of, 559
problems in traumatized clients, 558
procedural learning and, 97, 633
938
recovering from negative emotions, 729
reflected and sustained by body, 631, 633–34, 635, 639–40, 645
relational defenses in, 640–42
resources for dysregulated, 581
role of boundaries in, 398
sensorimotor processing versus emotional processing, 566–67
sudden surges in, 558
survival function of, in threat response, 557
therapeutic intervention for dysregulated and vehement, 558–60, 563
therapeutic intervention for trauma-related dysregulation of, 566–68
therapeutic intervention with painful attachment-related, 632–35, 639, 642–44
therapeutic processing of attachment-related, 639
therapeutic use of triune brain model to examine, 174
therapists’ guide to attachment, 631–37
threat-related, animal defenses and, 557
trauma-related beliefs and, 617
triune brain model of, 173, 174, 175, 177, 178, 179–80, 191
vocabulary for describing, 213
walking as expression of, 661
withdrawal as survival resource, 263
working with dissociative client on animal defense-associated dysregulation of, 560–61
working with dissociative client on attachment-related, 636–37
worksheets on animal defense-associated dysregulation of, 560, 569–81
worksheets on attachment-related, 635–36, 645–53
worksheet to become aware of and name, 134, 147
see also positive emotions
Emotions & Early Attachment worksheet, 649
empathy, 688
empowering action(s)
for addressing dysregulated emotions, 558
client’s fear of, 517
client who might benefit from work with, 515–16
to identify animal defense-associated emotional dysregulation, 560
integrating animal defenses to restore, 522–25
for intervention with trauma-related core beliefs, 617
therapeutic goals in restoration of, 19–20, 515, 525
therapeutic interventions to restore, 516–17, 517
therapists’ guide to, 515–18
triggering dysregulation in work with, 517
working with dissociative clients on, 518
worksheets, 517–18, 527–35
enactments, therapeutic, 16
emotional processing and, 634–35
in exploration of core beliefs, 608
legacy of attachment history in, 587–88
navigating, 51, 437–38
source of, 49, 50, 51
encoding, 46, 47
Engaging Your TVA Muscle worksheet, 350, 367
enmeshment, 32, 392, 685
Executing Proximity-Seeking Actions worksheet, 702, 717
executive functioning, 179
exercise and physical activity, 83, 302
mechanics of breathing in, 376–77
as somatic resources, 311
939
Exercises for Posture & Alignment worksheet, 350, 365
Existing & Missing Resources worksheet, 417, 425
Expanding Your Window: High Arousal Challenges worksheet, 748, 761
Expanding Your Window: Low Arousal Challenges worksheet, 748, 759
Exploring Beliefs That Hold You Back worksheet, 610, 629
Exploring Your Relationship To The Body worksheet, 79, 85
external resources
clinical use of, 281
defined, 770
identifying, 279, 285, 287–91, 456
missing, identifying and developing, 417–18, 431
purpose of, 281
in reconstructing memory, 456, 463
somatic, 301, 310–11
types of, 281, 283–84t
working with dissociative client on, 279–80
worksheets, 279, 285, 287–91, 417–18, 431
External Somatic Resources worksheet, 303–4, 315
eye contact, 706–7
in attachment formation, 30, 31, 32, 180
avoidance of, 95–96, 100, 101, 400–401, 586, 615, 703
awareness of, 59, 60, 609, 700, 709
in boundary setting, 402
cultural differences in, 685
influence of attachment experience on style of, 43–44, 82, 662, 706
negative response to, 28
as proximity-seeking behavior, 700–701, 702, 705, 706–7, 709
therapeutic relationship and, 503, 701
eye gaze, 13, 29
940
of body sensations, 200
breathing patterns in, 378
of disappointing attachment figures, 332
faulty neuroception as source of, 220
hyperarousal and, 228
of memory of adverse experience, 435
neurophysiology of, 539
of reconnecting with body, 84
wisdom of body and, 79, 87
Fears and Hopes worksheet, 79, 87
feet, nerve endings of, 334
feigned death. see shutdown defense
felt sense
of boundaries, 18–19, 391, 397
of competency and well-being, 301
in grounding, 18
of resolving past trauma, 537
of self, 689–90
in therapeutic relationship, 21–22
five-sense perception, 138f, 139, 174, 178, 499
flashbacks, 66, 327, 455–56, 458, 497, 538, 540–41
flight defense. see fright-freeze-flight response
flooding, emotional, 174
Focusing on Your Resources worksheet, 457–58, 471
Focusing Your Sense of Hearing worksheet, 134, 149
Focusing Your Sense of Sight worksheet, 134, 151
Focusing Your Sense of Taste and Smell worksheet, 134, 155
Focusing Your Sense of Touch worksheet, 134, 153
form and function, 27
framing, mindful attention and, 62
Franklin, E., 657
Frederick, A., 538
free association, 158
freeze defense. see fright-freeze-flight response
fright-freeze-flight response
attachment trauma manifestations in, 33
brain activity in, 180
defined, 770
developmental significance of early activation of, 181–82
discovering, in therapy, 522–23
emotional dysregulation in, 563, 565
empowering actions to replace, 517–18, 519–20
exploration of orienting response in clients with problems of, 112
exploring physical feel of, 529, 531
initiation of, 519, 520–21
mobilizing and immobilizing actions in, 519, 520–21
neurophysiology of, 516, 543
overactive, physical and behavioral manifestations of, 521
overactive flight response, 516, 521, 524
regulating fight defense in, 523–24
stimulation of, 225
survival function of, 37
to trauma, 32–33, 82, 520
see also animal defenses
future
941
adverse experiences promoting focus on, 101
language indicating focus on, 133
rehearsing response to challenges in, to develop new resources, 422, 425
unconscious presumptions about, in procedural learning, 101
habits, 15
of attention, 158, 162
beliefs and, 20
of orienting, 111
physical manifestations of trauma and attachment problems in, 25, 95
procedural learning of, 99
survival behavior, brain control of, 173
therapeutic focus on, 53
therepeutic experiments with, 43–44
see also procedural patterns and habits
Harnessing a Resources from a Positive Relational Experience worksheet, 588
Harnessing a Somatic Resource from a Positive Relational Experience worksheet, 599
Harnessing Neuroplasticity for Positive Change worksheet, 159, 169
hate crimes, 66
Having a Bad Day? worksheet, 279, 299
health resources, 281
hearing, 139, 304
focusing sense of, 134, 149
here and now, 15
adverse experiences interfering with being present in, 137
building blocks of present experience, 130, 131, 134, 137–40, 138f
942
dual awareness of past and, 19
mindfulness to become aware of internal experience in, 131, 133
processing adverse memories in, 436
processing client–therapist enactments in, 51
shared awareness of client’s experience in, 61
teaching mindfulness in, 61–62
therapy process as taking place in, 45
in work with sliver of memory, 499
see also dual awareness of past and present in memory work
hide-and-seek, 728
High and Low Arousal Positive Emotions worksheet, 725
High Arousal Emotions and Attachment worksheet, 635
hijacking of neocortex, 175–76, 181, 195
Hijacking of Your Neocortex worksheet, 175–76, 195
hippocampus, 180
hoarding, 180
Hobson, J., 557
holding environment, 304
homeostasis, 81
hopelessness, 161, 228, 326, 370, 379
How Our Different Brains Remember worksheet, 175, 187
Hughes, D., 255
hunger, 83, 93
hyperarousal
as animal defense-related dysregulation, 564
as attachment trauma outcome, 33
biphasic reactions, 538
boundary work with clients in, 394
breathing interventions for, 369, 379
breathing patterns in, 370
client’s understanding of, as faulty neuroception, 219–20, 223, 229
defined, 770
disengagement from body sensations in, 201–2
elicited in trauma, 29
empowering actions to regulate, 517–18
grounding to regulate, 42, 158, 325, 327–28, 345
identifying animal defense-associated dysregulation of, 575
long-term effects of, 228
neurocepted danger as source of, 225, 226, 227
neurophysiology of, 537
play and pleasure incompatible with, 722
of pleasurable emotions, 728, 739
recognizing triggers worksheet, 221–22, 233
related to unresolved trauma, 32, 40, 82
sensorimotor sequencing to treat trauma-related, 20, 538, 543. see also sensorimotor sequencing
signs and symptoms of, 40, 221, 228, 538
therapeutic processing of, 20
as threat response, 225
tracking to regulate, with dissociative client, 223
triggered by memory work, 480–81, 494–95
walking patterns related to, 662
in zones of arousal in window of tolerance, 69–70
hypervigilance, 33, 114, 348, 722
hypoarousal
as animal defense-related dysregulation, 564
943
as attachment trauma outcome, 33, 228
biphasic reactions, 538
boundary work with clients in, 394
breathing interventions for, 369, 379
breathing patterns in, 370
client’s understanding of, as faulty neuroception, 219, 225
defined, 771
disengagement from body sensations in, 201–2
elicited in trauma, 29
exploring body sensations to relieve, 206
grounding skills to regulate, 325, 327–28, 345
identifying animal defense-associated dysregulation of, 577
long-term effects of, 228
neurocepted danger as source of, 225, 227
play and pleasure incompatible with, 722
recognizing triggers worksheet, 221–22, 235
reframed as survival resource, 262–63
replacing, with empowering defense, 517
signs and symptoms of, 40, 221
tracking to regulate, with dissociative client, 223
triggered by memory work, 494–95
walking patterns related to, 662
in zones of arousal in window of tolerance, 69–70
944
hyperarousal and, 228
inadequacy, feelings of, 65, 164, 202, 255, 261
incomplete boundary style, 689
Increasing Sensation worksheet, 199, 211
indicators, nonverbal, 39–41
unconscious encoding and decoding of, in therapy, 47
infant–caregiver interactions
brain activity in, 180
brain development and, 180–81
in development of social engagement system, 225–26
formation of beliefs through, 614
in formation of predictions and expectations, 26–27, 28–29
implicit memory formation in, 442
role of infant social engagement system in, 29
see also attachment
information processing, 17
bottom-up and top-down forms of, 182–83
feeling of safety necessary for, 416
in triune brain model, 174, 175, 177–80, 182–83
worksheet on three levels of, 175, 183, 185
insecure-ambivalent attachment, 30, 32
capacity for play and, 721–22
insecure-avoidant attachment, 30, 31–32
instinctual behaviors, 173
brain control of, 180
insula, 41
integration
defined, 771
of implicit memories, 443
therapeutic goals and strategies for, 17, 19–20
intellectual resources, 277, 283t
intelligence of body, 13, 775, 776, 777
interactive repair, 729, 771
Internal Boundaries worksheet, 394, 407
internal experience
building blocks of present experience comprising reaction to, 131, 132–33, 134
client’s detachment from, 133
contradictory communications about, 39–40
defined, 771
mindfulness skills for exploring, 131–34
physical manifestations of, 61
teaching mindful awareness of, 17, 42–43, 46, 61–62
of traumatized individuals, 37
Internal & External Creative Resources worksheet, 287–91
Internal & External Resources worksheet, 279
Internal Somatic Resources worksheet, 303, 313
internal working models, 33–34
interoception. see body sensations
interpersonal interactions and relationships
boundary-related problems in, 392
boundary styles in, 21
clients who might benefit from exploration of attachment legacy in, 585–86
clients who might benefit from exploration of boundary styles in, 679–80
cultural differences in, 680, 685
daily life systems for, 37
945
differentiation of self and other, 686–87
dual awareness of recent conflict in, 476, 487
dysregulated arousal as obstacle to, 228
effects of early implicit relational memory on, 436, 442, 443
expanding window of tolerance by challenging habits of, 753–54
exploration of orienting habits in clients with problems of, 111, 112
fear of being alone interfering with, 524–25
goals of therapeutic process for, 248–49
influence of attachment-related emotional patterns on, 634
internal working models of, 34
interventions with attachment-related problems in, 586–88, 594–95
legacy of attachment experience in, 20, 31, 32, 95–96, 585, 591–92, 593
neural activity in, 180
proximity-seeking actions in, 21
role of boundaries in, 397, 398–99, 401, 407
signs of overbounded relational style in, 687–88
signs of underbounded relational style in, 686–87
somatic resources for regulating, 302
survival resources interfering with, 263
trauma effects on, 32
working with dissociative clients on legacy of attachment in, 589
worksheets on legacy of attachment in, 588–89, 597–605
see also proximity-seeking actions; relational boundaries
interpersonal neurobiology, 14
interrupted resource, 417, 421–22, 771
Interrupted Resource worksheet, 417, 423
Kaschak, M. P., 96
Kurtz, R., 39, 46, 47, 61
Laird, J. D., 96
language
of body, 16, 25, 27, 95, 99
body sensation vocabulary, 198, 202–4, 206, 207
clients with learning disabilities of, 57
indicating past or future focus, 133
play with, 728–29
translating body’s, 97, 105
translating nonverbal, into words, 99
use of simple, in therapy, 47
vocabulary for beliefs and meaning, 215
Lapides, F., 47
laughter, 721
learned helplessness, 255
learning disabilities, 54, 57, 72
LeDoux, J. E., 539
Legacy of a Positive Relational Experience worksheet, 588
Legacy of Attachment in Difficult Relationships worksheet, 603
Legacy of Attachment in Positive Relationships worksheet, 588–89, 605
Legacy of Early Attachment in Difficult Relationships worksheet, 588
lethargy, 228
Letter To Your Body, 79, 89
946
Levine, P., 372, 538
limbic brain, 179, 516
Llinas, R., 608
locus of control, 356–57
Lookout for Fun & Play worksheet, 725, 735
Low Arousal Emotions and Attachment worksheet, 635
947
curiosity and, 42–43
defined, 41, 137
in exploration of emotions, 631–32
in framing of therapeutic exploration, 62
to promote grounding, 334
to regulate fight defense, 523–24
as resource for processing implicit memories, 444–45
to restore empowering action, 516–17, 525
in Sensorimotor Psychotherapy, 41–43
Sensorimotor Psychotherapy approach to, 17
as somatic resource, 307
teaching, 61–62
in therapeutic experiments, 43–45
in therapeutic relationship, 132
therapeutic value of, 41, 131–32, 137, 141–43
therapists’ guide to, 157–60
walking with, 657, 677
worksheets to learn, 134, 145–55
see also directed mindfulness
mirror neuron system, 60, 303, 371
missing resources, 278
causes of, 415, 416, 419–22, 421
clients who might benefit from work on, 415–16
identifying, 417–18, 425
manifestations of, 416
neuroplastic change and development of, 416–17
obstacles to development of, 416
as obstacle to therapeutic progress, 415
therapeutic interventions to develop, 278, 416–17, 419
therapists’ guide to developing, 415–18
working with dissociative client on, 418
worksheets on development of, 417–18, 423–31
mistrust, 392
mobilizing defenses, 37, 517–18, 519, 520, 521–22, 771
Modifying Your Walk worksheet, 657, 675
Montgomery, A., 47
motor cortex, 174
movement(s), 13
associated with positive emotions, 723, 725, 728
as building block of present experience, 139, 161
changes caused by distressing events, 161
development of procedural habits of, 99
emotional expression and, 639–40, 651
identifying somatic resources in, 308
increasing awareness of, in moving forward phase of therapy, 21
internal experience manifested by, 61
manifestations of past experience in, 95
as somatic resource, 18, 310
to support playfulness and fun, 737
therapeutic goals in exploration of habits of, 95–96
therepeutic experiments with habits of, 44
triune brain activity in habits of, 193
triune brain model of, 174
unconscious adaptation in, 28
moving forward phase of therapy
948
techniques and goals in, 20–21
therapeutic goals of, 613, 722
in therapy process, 17, 20–21, 243, 248–49
walking as focus of, 655. see also walking
mugging, defenses mobilized in response to, 522–23
musculature
abdominal, 350, 376, 664
body sensation of, 201
for breathing, 375, 376
in core alignment, 18, 353, 356, 367
in grounded state, 334
in immobilizing defenses, 520–21
relational styles associated with, 687, 688
sense of containment in, 309
social engagement system regulation of, 29–30
threat response, 543
in ungrounded state, 333
My Body Brain worksheet, 175, 193
My Emotional Brain worksheet, 175, 191
My Thinking Brain worksheet, 175, 189
949
indications for therapeutic focus on, 219–20
physiology of, in threat response, 543–44
recognizing triggers of, to regulate arousal, 228–30
restoring empowering action to counter faulty, 515–16
as source of dysregulated arousal, 225
stimulation of threat response by, 225, 226–27
therapists’ guide to, 219–23
window of tolerance and, 225
worksheet for understanding, 237
worksheets on window of tolerance and, 221–22, 231–41
see also neuroception of safety
neuroception of safety
activation of arousal in, 225
for daily life systems, 37
in development of social engagement system, 30, 37
in dissociative client, 222–23
in early development, 30, 31
effects of dysregulation of, 516
as goal of therapy, 230
recognizing optimal arousal in, 222, 241
trauma effects on, 32
use of mindfulness to increase client’s, 43
see also neuroception
neurophysiology
of animal defenses, 516, 543
of attention, 157
of breathing, 376–77
of fear, 539
of hyperarousal, 537
of mirror neuron system, 60
of neuroception of danger, 226–27
of social engagement system, 29–30
of threat response, 32–33, 543–44
of trauma-related dissociation, 36–37
see also brain; neuroplasticity
neuroplasticity
in brain development, 180–81
in challenging window of tolerance, 746–47, 752, 755
defined, 771
for developing missing resources, 416–17
directed mindfulness and, 17, 161, 162–64
mindful attention and, 157, 158–59
process of change in, 163–64
in reconstructing memory, 455
therapeutic significance of, 161
therapists’ guide to, 157–60
worksheets on, 57, 159, 165–71
nightmares, 66, 538
night terrors, 516
Nonverbal Boundary Setting worksheet, 393
nonverbal expression
of boundaries and boundary setting problems, 392–93, 394, 397–98, 400–402, 403, 409
clinical significance of, 39, 51–52
to communicate safety in therapy, 46
contradicted by verbal expression, 39–40, 400–401
950
development of social engagement system and, 30
indications for opportunity to explore somatic resources, 302–3
manifestations of trauma and attachment problems through, 25, 133
messages conveyed by posture, 44, 353, 359, 361, 363
of somatic narrative, 13
between therapist and client, 46–47
translated into words, 99
nonverbal indicators, 39–41
Noticing Body Sensations for Sensorimotor Sequencing worksheet, 540
Noticing Body Sensations of High Arousal worksheet, 549
Noticing Your Breath worksheet, 371, 381
novelty-seeking, 745, 755
numbness
in animal defense-related emotional dysregulation, 565–66
in dissociative client, 200, 222
hyperarousal and, 228
mindful exploration of, 133, 198, 436, 567–68
related to past adverse experience, 66, 161, 563
as trauma response, 82
951
therapists’ guide to, 111–14
working with dissociative clients on, 113–14
worksheets for exploring, 113, 121–29
Oscillating Between Sliver of Memory and Resources worksheet, 496, 511
out-of-body experiences, 328
overbounded relational style, 681, 687–88, 689–90
overgrounded, 326, 327, 333, 348, 356, 771
oxygen, 376–77
952
phobias and phobic reactions, 37
about body, 54, 57–58, 78, 80, 305
about emotion, 636
about memory, 246, 435, 473, 494–95
about parts of self, 63
about positive emotions, 256, 258
about risks and challenges, 749
physical activity. see exercise and physical activity
physical disabilities or handicaps, 72
play
attachment experience as source of impaired capacity for, 721–22, 727, 730
clients who might benefit from therapeutic focus on, 722
contest activities versus, 729
development of capacity for, 728–29
impaired capacity for, 721
movements and postures associated with, 725
rationale for increasing or amplifying, 727
socialization benefits of, 729
therapeutic goals in work with, 722
therapeutic interventions to increase capacity for, 723–24, 730–32
therapists’ guide to, 721–26
working with dissociative clients on, 725–26
worksheets, 724–25, 733–43
playing dead, 227
Porges, S. W., 29, 516
Positive Elements of a Distressing Event worksheets, 457, 465–69
positive emotion(s)
attachment experience as source of impaired capacity for, 721–22, 727, 730
body sensations associated with, 199
client’s aversion or resistance to, 303, 727–28
clients who might benefit from therapeutic focus on, 722
development of capacity for, 728–29
grief work and, 637
high and low arousal of, 728, 739
impaired capacity for experiencing, 721, 727–28
limiting beliefs, 725, 741
movements and postures associated with, 725, 728
rationale for increasing or amplifying, 21, 721, 727
recovering from negative emotions to experience, 729
slivers of memory of, 723–24
therapeutic goals in work with, 722
therapeutic interventions to promote, 723–24, 730–32
therapists’ guide to, 721–26
vocabulary for describing, 202
working with dissociative clients on, 725–26
worksheets, 725, 733–43
Positive Relational Experience worksheet, 597
posttraumatic stress disorder, 55, 243
difficulties in accepting positive feedback in, 257
posture, 13
associated with positive emotions, 723, 725, 728
beliefs reflected and sustained by, 609–10, 617, 618, 619
breathing and, 371, 378, 383
client’s discomfort with therapeutic interventions with, 348
communication of meaning through, 44, 353, 359, 361, 363
953
core as determinant of, 353
development of procedural habits of, 99
effects of trauma experience on, 347, 354
framing of therapeutic exploration of, 62
good qualities of, 355–57
identifying somatic resources in, 308
infant development, 353
influence of, on emotions, 347, 348
internal experience manifested by, 61
manifestation of attachment experience in, 31, 81–82, 95, 262–63, 354–55
manifestation of emotional biases in, 635
psychological effects of poor, 355
resources for processing implicit memory, 445
rigid, 347, 348, 353, 354, 355, 356, 371
signs and symptoms of dissociative disorder in, 98
slumped, 347, 348, 353, 354, 356, 378, 420
to support playfulness and fun, 737
therapeutic goals in exploration of habits of, 95–96
therepeutic experiments with habits of, 44
triune brain activity in habits of, 193
unconscious adaptation in, 28
walking and, 663
see also core alignment
Posture, Tension, and Breath worksheet, 371, 383
Postures & Movements to Support Playfulness & Fun worksheet, 725, 737
Practice Taking Risks worksheet, 748
Practice Walking Mindfully worksheet, 657, 677
Practicing Playfulness worksheet, 725, 742
Practicing Taking Risks worksheet, 767
predictions and expectations
clinical significance of, 27
healthy attachment experience and, 28
influence of infant experiences in formation of, 26–27
meaning-making and, 607
in procedural learning, 101
in processing of sensory stimuli, 26
trauma effects on, 28, 29
prefrontal cortex, 41, 133, 176
fear response in, 539
premotor cortex, 174
preparatory movements, 559
problem solving, 179
procedural memory, 99
legacy of attachment encoded in, 585
working models encoded in, 34
procedural patterns and habits
ability to navigate challenges impeded by, 753
attachment experience and, 20
beliefs and, 607–8, 613, 616
development of, 99
effects of dissociative disorder on therapeutic work with, 98
effects of trauma and attachment on, 99–102
in emotional functioning, 633
introducing clients to concept of, 96–97
manifestation of personal history in, 20, 95, 99
954
mental knowing versus, 97–98, 109
in mobilization of animal defenses, 519–20
as obstacles to setting boundaries, 391
as reflection of early implicit relational memory, 436
relational boundary setting as, 685
relational defenses as, 640–42
therapeutic exploration of, 95–96, 101–2
therapists’ guide to, 95–98
unconscious presumptions about future in, 101
worksheets for exploring, 97–98, 103–9
prosody, 13, 25, 40, 47, 474
Proximity & Distance worksheet, 702, 719
proximity-seeking action(s), 245
attachment experience in development of, 31–32, 699, 705–7
clients who might benefit from exploration of, 699–700
defensive actions and, 708–9
eye contact as, 28, 31, 700–701, 706–7, 708
healthy, 706
identification of, 702, 711
infant response in Still Face experiments, 26–27
making meaning and predictions influenced by early experience of, 28–29
malformation of, 706–7
physical nearness as, 708–9, 719
purpose of, 699, 705
reaching out as, 28, 31, 700, 702, 707, 713, 715
relational boundaries and, 700, 701, 709
therapeutic goals in work with, 21, 709
therapeutic interventions with, 700–701, 707–9
therapists’ guide to, 699–703
transference -countertransference reactions in work with, 701
working with dissociative client on, 702–3
worksheets, 701–2, 711–19
psychoeducation, 58–59, 63, 223
about relational boundaries, 680
about therapy process, 244–45
psychological resources, 277, 284t
psychotherapy
as affect communicating cure, 47
limitations of talking cure in, 25
pushing away, 30, 31, 32, 397, 398, 517, 547, 567, 617
rape, 66
reaching out, 28, 30, 31, 59, 700, 707–8, 713, 715
Reaching Out worksheets, 702, 713, 715
reading the body, 97, 103
reality testing, 113–14
Recognizing Animal Defenses worksheet, 517, 518, 527
Recognizing Optimal Arousal worksheet, 222, 241
Recognizing Triggers & Regulating Hyperarousal worksheet, 221–22, 233
Recognizing Triggers & Regulating Hypoarousal worksheet, 221–22
Recognizing Your Survival Resources worksheet, 257, 267
reconnecting with body, 84
reconstructing memory, 19
clients who might benefit from, 455–56
with dissociative client, 458
955
goals for, 455
identifying resources for, 455, 456–58, 460–63, 467, 469, 471
process of, 460
therapeutic rationale for, 459–61, 463
therapists’ guide to, 455–58
working with clients on, 456–57
worksheets, 457–58, 465–71
reflexive behavior, 117, 180
reframing, 18
emotional dysregulation as survival response, 559
inadequacies as missing resources, 416
of maladaptive behaviors as survival resources, 255–58, 262–63, 269
Reframing a Survival Resource worksheet, 257–58, 269
Regulating Arousal with Grounding Resources worksheet, 327–28, 345
Regulating Dysregulated Mobilizing Defenses worksheet, 517–18, 535
Regulating Your Arousal or Mood with Your Breath worksheet, 371–72, 389
regulation of emotions, sensations, and impulses, 18
containment resources for, 309
defined, 772
developing resources for, 247–48
grounding for, 325, 327–28, 345
missing resources for, 416
orientation for clients about, 68–70
rationale for therapeutic focus on body sensation for, 197
somatic resources for, 301, 304, 310
therapist’s role in, 46
working at edges of client’s boundaries of, 48–49
in work with sliver of memory, 495
reinforcement of client’s body awareness, 60–61
relational boundaries
anticipating and recognizing violations of, 690, 697
as attachment legacy, 679, 685, 686, 687
attachment trauma as violation of, 679
clients who might benefit from focus on, 679–80
cultural differences in, 680, 685
of dissociative clients, 682–83
formation of, 685
incomplete style, 689
overbounded style, 687–88, 689–90
pendulum style, 688
proximity-seeking actions and, 700, 701, 709
purpose of, 680
saying “yes” and “no” and, 680–81, 686, 687, 689, 693, 695
style assessment, 680–81, 686–89, 691
therapeutic intervention with, 689–90
therapeutic significance of, 679
therapists’ guide to, 679–83
underbounded style, 686–87, 689
working with dissociative client on, 682–83
worksheets, 681–82, 691–97
relational defenses, 633, 640–42
relational knowing, 593, 597, 772
relational resources, 277, 283t
relational trauma, 29
defined, 772
956
orientation for clients about, 66
relaxation techniques, 370
religious institutions, 281
Remembering a Painful Attachment Experience worksheet, 513
Remembering Fun Times worksheet, 724–25, 733
Replacing Immobilizing Defense with a Mobilizing Defense worksheet, 533
Replacing Immobilizing Defensive Responses with Empowering Actions worksheet, 517
Replacing Survival Resources with Creative Resources worksheet, 258, 275
reptilian brain, 17, 173, 174, 176, 177, 178, 180, 516
defined, 772
see also triune brain
resilience, learning, 729
Resource and Reaction Balance worksheet, 438, 453
resources
categories of, 18–19, 277, 279, 283–84t, 293, 295
for challenging window of tolerance, 746, 748
defined, 772
development of, 419
for dysregulated emotions, 581
embodying, 279
external, 303–4, 310–11, 315, 417–18, 431, 770
as facts and capacities versus opinions, 256
function of, 261
identifying weak or missing, 19
internal capacities, 261, 277, 279, 281–85, 303, 313, 417–18, 429, 771
interrupted development of, 421–22, 423, 771
for memory work, 19, 245, 435–36, 437, 438, 441, 444–46, 447–53, 455, 456–58, 460–63, 467, 469, 471
from positive relational attachment experience, 588–89, 597, 599
recognizing, 18
scope of, 261
for sensorimotor sequencing, 540, 546–47
therapists’ guide to categories of, 277–80
use of future templates to develop new, 422, 425
for work with sliver of memory, 496, 507–11
see also developing resources in therapy; somatic resources
Resources for Dysregulated Emotions worksheet, 560, 581
respiratory system, 378
problems of, breathing techniques and, 370
threat response, 543
right-brain to right-brain communication, 22
in therapeutic relationship, 47
right hemisphere of brain, implicit processing in, 25
rigid posture, 347, 348, 353, 354, 355, 356, 371
risk-taking, healthy and appropriate, 745, 747, 752, 753–55, 767, 776
running, 311
safety
body-to-body affective communication to create, 46
child’s meeting of parental expectations to feel, 31, 221, 332
compliance with abusive treatment to attain, 100
need for feeling of, to orient to new information, 416
need for novelty and, 745
orientation for clients about, in therapy process, 68–70
in therapeutic environment, 43, 45–46, 48, 587–88, 746
therapist’s window of tolerance to establish, 48
957
see danger; neuroception of safety
Saying “No” in a Relationship worksheet, 681, 693
saying “yes” and “no,” 680–81, 686, 687, 689, 693, 695
Saying “Yes” in a Relationship worksheet, 681, 695
Schnall, S., 96
Schore, A. N., 25, 45, 51
secure attachment, 30–31
self-esteem, 18, 243, 247
goals of developing resources phase of therapy, 255, 256, 262
identifying resources in clients with low, 277–78
self-harm behavior
disconnect from body leading to, 83
exploration of orienting response in clients with, 112
reframed as survival resource, 255, 256, 258, 263–64
self-judgment, 161
self-loathing, exploration of orienting habits in clients with, 111
self-perception, 18
imagining or visualizing best self, 754–55
in underbounded relational style, 686–87
self-regulation
developmental influences on capacity for, 30
mindfulness to improve, 131
selection of worksheets based on client’s capacity for, 56
self-representation(s), 14–15
self-soothing, 179, 301, 305, 308
self-states
disconfirmation of, in development, 35–36
integration of, in development, 34–35
nonverbal indicators revealing conflict between, 39–40
therapeutic experiments in processing of, 44–45
trauma-related dissociation and, 35, 36–37, 38, 39
Sensations Sequencing through the Body worksheet, 540–41, 551
sensorimotor processing
defined, 772
directed mindfulness in, 539–40
emotional processing versus, 566–67
neurophysiology of, 17
in triune brain model, 174, 178
Sensorimotor Psychotherapy
approach to memory treatment, 435
client psychoeducation about, 58–59
clinical significance of nonverbal behaviors in, 39
collaborative implementation of, 53–54
conceptual basis of, 14–15
contraindications to, 54
defined, 772
examples of clinical situations and problems, 55
mindfulness applications in, 41–43
orientation for clients in implementation of, 54
preparation and training of therapists for, 13–14, 53, 54–55
Sensorimotor Psychotherapy Institute, 14
sensorimotor sequencing, 20
for addressing dysregulated emotions, 558, 568
benefits of, 547
clients who might benefit from, 538
958
clinical use of, 538–40, 544–45
defined, 537, 544
with dissociative client, 541–42
level of arousal in, 539, 541, 544–45
meaning-making and, 545–46
one arousal cycle at a time, 541, 545–47, 555
requirements for successful intervention with, 538, 542
selecting resource for, 540, 546–47
stalled, 540
therapeutic rationale for, 537, 543
therapists’ guide to, 537–42
therapist’s stance in, 539–40
worksheets, 540–41, 549–55
Sensorimotor Sequencing & The Window of Tolerance worksheet, 541, 553
sensory stimuli
developing somatic resources for moderating responses to, 302, 304, 323
heightening awareness of, 134
orienting response to, 16, 115–16
processing of, 26
reexperiencing reminders of adverse events, 139
separation cry, 32
Sequencing One Arousal Cycle at a Time worksheet, 541, 555
Setting Boundaries with Another Person worksheet, 681–82, 697
sexual abuse, 227
core beliefs related to, 617
feelings about body from, 82
hypoarousal as response to, 227
as relational trauma, 66
resource development interrupted by, 421
shame, 161, 415–16
about body, 57–58
about body sensations, 200
benefits of memory reconstruction in clients with, 456
dysregulated animal defenses as cause of, 516
exploration of orienting habits in clients with, 111
reframed as survival resource, 255, 258
therapeutic use of triune brain model to examine, 174
toward body, attachment or trauma experience leading to, 83
shoulders
beliefs and, 617
boundary style and, 689
breathing and, 378–79
emotions and, 59, 61, 353, 633, 640
in good posture, 355
grounding and, 331, 332, 333
manifestations of early experiences in, 27, 31, 95, 98, 100–101, 262
mindful awareness of, 41, 61, 162, 203, 206, 221, 264–65, 540, 723
procedural learning expressed in, 101
relational style and, 707
in walking, 661, 662, 664–65
shutdown defense, 33, 520–21
emotional dysregulation in, 563, 565–66
overactive, physical and behavioral manifestations of, 521
signs of, 559–60
triggered in memory work, 496
959
unresolved trauma and, 43
see also animal defenses
Siegel, D., 157, 348, 455
sight, focusing sense of, 134, 139, 151
signaling behavior, 699
Signals of Autonomic Arousal worksheet, 231
skateboarding, 311
sleep, 58, 83, 311, 516
Sliver of Attachment Memory for Work with Emotions worksheet, 496
sliver of memory
of belief formation, 609, 610
clients who might benefit from focus on, 493–94
clinical use of, 493, 494–95, 499, 503
defined, 499, 772
for emotional processing, 634
to identify animal defense-associated emotional dysregulation, 560
of positive experience, 723–24
resources for work with, 496, 507, 509, 511
restoring empowering action and, 517, 520, 522–23
selecting, 493, 494–95, 496, 499–500, 505
in sensorimotor sequencing, 539, 540, 541, 544, 553
therapists’ guide to, 493–97
of trauma, 500–502
worksheets, 496, 505–13
work with attachment wounds, 502–3, 513
work with dissociative client, 496–97
smell, focusing sense of, 134, 155
social engagement system
attachment formation and, 30–31
defined, 772
development of, 225–26
disruption of, in therapeutic relationship, 503
neural regulation of, 29–30, 180
neurocepted safety in stimulation of, 225
in play activities, 729
in promoting dual awareness in memory work, 474
purpose of, 30
switching from defensive strategies to, 516
in therapeutic setting, 46
threat response in, 33
trauma effects on, 32
social resources, 281
somatic narrative
significance of, 13
therapeutic examination of verbal narrative and, 40–41
somatic psychology approaches, 14. see also Sensorimotor Psychotherapy
Somatic Psychotherapy
essential principles of, 15–16
practice settings for, 15
Somatic Resource for a Sliver of Memory worksheet, 496, 509
somatic resources, 18, 247–48
centering as, 308–9
clients who might benefit from development of, 301–2
clinical use of, 302–3, 307
containment as, 309–10
960
defined, 772
developmental causes of absence or distortion of, 301
development and use of, across lifespan, 308
discovering existing, 307308
dynamic nature of, 302
functions of, 307
individual differences in, 307
internal and external, 283t, 303–4, 310–11, 313–15
for intervention with trauma-related core beliefs, 617
for memory work, 438, 444–45, 451
movements as, 310
positive memories leading to, 310
from positive relational experiences, 599
practicing, 311, 327
range of, 283t, 307
in restoring empowering actions, 518
for sensorimotor sequencing, 546–47
therapeutic goals for developing, 301
therapists’ guide to, 301–5
therapist’s modeling of, 303
working with dissociative client to develop, 305
worksheets, 303–4, 313–23
for work with sliver of memory, 496, 509
see also grounding
somatic sense of boundaries
clients who might benefit from work with, 392
clinical use of, 392–93
as essential resource, 391
healthy functioning of, 397–99
missing resources for, 420
promoting awareness of, 394, 405, 411
reactions to violations of, 393–94
resources for processing implicit memory, 445
therapeutic goals in work with, 391, 397, 401–2
therapists’ guide to, 391–95
worksheets, 393–94, 403–13
work with dissociative client on, 394–95
see also boundaries; relational boundaries
speechless terror of trauma, 25
spine
alignment of, as resource, 18, 347
curves of, 353, 354f
infant development, 353
postural adaptation of, to adverse experience, 347
see also core alignment
spiritual resources, 277, 279, 284t
sports, 729
startle reflex, 180
state-specific memory, 19, 435, 442, 473, 476, 479, 485, 491
defined, 772
see also dual awareness of past and present in memory work
Steele, K., 37, 304
Stepper, ., 347
Stevens, D., 40
Still Face experiments, 26
961
Strack, F., 347
strengths recognition, 18, 247
creative resources, 264–65
therapeutic goals for, 249, 262
therapists’ guide to, 255–59
trauma experience and attachment difficulty as obstacles to, 255, 261–62
worksheets, 167–275
see also developing resources in therapy
subcortical processing
of animal defensive response, 519
development of, 179
dysregulated arousal governed by, 220–21
hijacking of neocortex, 175–76, 195
threat response in, 174–75
substance abuse and addiction, 73
restoring empowering action to clients with, 516
as survival resource, 264
suicidal behavior or ideation, 73
as survival resource, 263–64
survival behaviors, 27
brain control of, 173, 177, 180
dysregulated arousal as, 220–21
effects of repeated activation of, on brain development, 181
orienting habits as, 112
physical responses to trauma, 82
response to neurocepted danger, 225
threat response, 37
survival resources, 18
adaptive role of, 262, 263–64
to avoid disapproval of attachment figures, 262–63
boundary habits as, 400
defined, 773
developing, with dissociative client, 258–59
goals of therapy, 255, 256
helping clients recognize and acknowledge, 256–57, 262–63, 267
in overbounded relational style, 688
reframing maladaptive behaviors as, 255, 256, 262–63, 269
replaced with creative resources, 258, 264–65, 275
therapists’ guide to, 255–59
worksheets, 257–58, 267, 269
swimming, 311
sympathetic nervous system
in breathing, 376
effects of attachment trauma in, 33
effects of childhood neglect experience in, 33
threat response in, 32–33, 82, 226–27, 543
synaptic pruning, 181
962
breathing and, 371, 383
core beliefs and, 621
development of procedural habits of, 99
directed mindfulness to relax, 162
as expression of emotional bias, 642
in interpersonal relating, as attachment legacy, 586
as manifestation of early experience, 25, 99–100
play and pleasure incompatible with, 722
as precursor to action, 100
terror
as animal defense-associated dysregulation, 559
flight defense and, 563, 566
trauma beliefs and, 617
thalamus, 179
therapeutic experiments
elicitation of adversarial self-states or parts in, 44–45
purpose of, 43
spontaneous use of, 45
types of, 43–44
with walking, 664–65
therapeutic relationship
client’s efforts to meet therapist’s expectations in, 221
client’s neuroception of danger in, 221
clinical significance of, 13, 21–22, 45–46
disruption of social engagement in, 503
embedded relational mindfulness in, 41–43
emergence of boundary issues in, 392
emotional attunement in, 47
evocation of implicit memories in, 437–38
exploration of boundary styles in, 681–82
implicit and explicit journeys of client and therapist in, 49–52
legacy of attachment history in, 587–88
mindful awareness in, 132
navigating enactments in, 50–51
nonverbal communication in, 46–47
orienting client about misunderstanding and repair in, 70
in promoting dual awareness in memory work, 474
safety in, 43, 45–49, 48, 587–88
showing respect for client’s boundaries in, 393
therapist’s window of tolerance in establishing, 47–48
use of Sensorimotor Psychotherapy workbook in context of, 13–14
for work with painful attachment-related emotions, 632
see also enactments, therapeutic; transference–countertransference reactions
therapist education and training
for Sensorimotor Psychotherapy, 13–14, 53, 54–55
therapists’ guides
to beliefs, 607–11
to boundaries, 391–95
to boundary styles in relationships, 679–83
to categories of resources, 277–80
to challenging window of tolerance, 745–49
to core alignment, 347–51
to developing missing resources, 415–18
to directed mindfulness and neuroplasticity, 157–60
to dual awareness, 473–77
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to emotions and animal defenses, 557–61
to empowering actions, 515–18
to exploring body sensations, 197–200
to exploring breath, 369–73
to exploring walking, 655–59
to grounding, 325–29
to implicit memory, 435–39
to legacy of attachment, 585–89
to making sense of emotions, 631–37
to mindfulness, 131–35
to neuroception and window of tolerance, 219–23
to orienting response, 111–14
to phases of therapy, 243–46
to play and positive emotions, 721–26
to procedural learning, 95–98
to proximity-seeking, 699–703
to reconstructing memory, 455–58
to sensorimotor sequencing, 537–42
to slivery of memory, 493–97
to somatice resources, 301–5
to survival and creative resources, 255–59
to triune brain and information processing, 173–76
use of, 54–55, 67
to wisdom of body, 77–80
therapy process
challenges for therapists in, 49
client characteristics determining design and implementation of, 244, 250
client preparation for, 247
client’s understanding of goals and tasks of, 244–45
collaborative planning and implementation of, 243, 245
exploration of body sensations in, 201–7
exploration of orienting habits in, 112
flexibility of implementation of, 250
goals for exploration of procedural learning in, 95–96
implicit and explicit journeys of client and therapist in, 49–52
introducing procedural learning in, 96–97
as journey, 247
mindful awareness of building blocks of present experience in, 140–42
orientation for clients about safety and risk in, 68–70
phase 1 of treatment. see developing resources in therapy
phase 2 of treatment. see addressing memories in therapy
phase 3 of treatment. see moving forward phase of therapy
planning and implementation with dissociative client, 245–46
prioritizing client-appropriate challenges in, 55
spontaneous and open-ended nature of, 45
structure and sequencing, 244, 245, 249–50
therapists’ guide to, 243–46
three phases of, 17, 243, 244, 245, 247–50, 613
use of mindfulness in, 132–34
worksheets, 245, 250, 251
thirst, 83, 93
threat response
activation in unresolved trauma, 33, 36–37, 43, 82
animal defenses in, 32–33, 515
becoming ungrounded as, 331–32
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in dissociation, 71
effects of repetitive activation of, 33, 519, 521
faulty neuroception leading to, 219–20, 228–29
neurobiology of, 179–80, 226–27, 543–44
neurocepted danger as source of, 17, 225, 226
in relational trauma, 66
repeated activation of, brain development and, 181–82
see also danger
Three Levels of Information Processing worksheet, 175, 185
Todd, M. E., 27
top-down processing, 179, 182–83, 516
defined, 773
touch
boundaries, 398
focusing sense of, 134, 153
tracking, 61, 62, 64
in sensorimotor sequencing, 540
Tracking Your Arousal worksheet, 222, 239
Tracking Your Orienting Habits worksheet, 113, 123
transference–countertransference reactions, 49
in exploration of core beliefs, 608
as legacy of attachment, 587
windows of tolerance and, 48
in work with proximity-seeking, 701
transverse abdominal muscle, 356, 367
Trauma and the Body: A Sensorimotor Approach to Psychotherapy (Ogden, Minton & Pain), 13
trauma experience
attachment failure versus, 29
attachment outcomes from, 33
attention problems in sufferers of, 157
benefits of directed mindfulness for clients with, 157
breathing patterns and, 375
compliance of victim in, 100
conflict between systems of defense and daily life as result of, 37, 63–64
core beliefs related to, 617
in development of beliefs, 20
difficulties with proximity-seeking behaviors related to, 699–700
directed mindfulness in examination of, 42–43
disconnect from body in response to, 83–84
dislike or phobia of body after, 57–58
dissociative response to, 34–39
dual awareness in reexperience of, 19
effects on brain development, 181–82
effects on procedural learning, 99–102
emergence of implicit memories of, 443–44
emotional problems arising from, 558
failure to develop resources as result of, 416
failure to integrate action systems as result of, 37–38
fear of memory of, 435–36
feelings toward body influenced by, 82–83
goals for memory processing of, 248, 537
goals for therapeutic intervention with, 41
impaired capacity for play related to, 721–22
influence of, on making meaning and predictions, 28, 29
influence on building blocks of present experience, 140
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influence on gait, 655–56
innate physical responses to, 82
neuroception impairment in, 32, 43
nonverbal indicators reflecting, 40
nonverbal manifestations of, 25
orientation for clients about, 65–67
orienting response and, 16, 116
persistence of adaptive responses to, 82
physiological effects of reactivated, 537, 543
postural adaptations to, 347, 354
recalibrating nervous system as goal of treatment for, 537
reconstructing memory of, 455–56
sliver of memory of, 500–501
strengths recognition impeded by, 255, 261–62
types of, 66
ungrounding as effect of, 331–32
walking style as expression of, 662
triggers, arousal, 228–30, 233, 235
for animal defense-associated dysregulated emotion, 560
in breathing exercises, 372, 378, 379
defined, 773
grounding exercises as, for dissociative client, 328–29
in memory work, 480–81
triune brain, 17
conflict among parts of, 178
defined, 773
dominance of parts in, 174–75
effects of adverse experiences on functions of, 174–75
exploring, with dissociative clients, 176
information processing in, 175, 177–80, 182–83
memory processes in, 175, 179–80, 187
structure and function, 173, 177f
therapeutic use of concept of, 173–75
therapists’ guide to, 173–76
worksheets on, 175–76
Tronick, E. Z., 26, 51–52, 607
trust, 279, 392, 687, 688
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van der Hart, O., 304, 636–37
van der Kolk, B. A., 416, 721–22
vehement emotions, 557, 558
Verbal and Nonverbal Boundaries worksheet, 394, 409
visualization exercises, 444
Vocabulary for Beliefs and Meanings worksheet, 199–200, 215
Vocabulary for Emotions worksheet, 199, 213
Vocabulary for Sensations worksheet, 199, 209
vulnerability, feelings of, 304
walking, 311
clients who might benefit from therapeutic focus on, 655–56
clinical significance of, 655
determinants of, 655, 661–62, 665
experimenting with, 664–65, 669, 675
as expression of beliefs, 661–62
as expression of emotional state, 661
goals of therapeutic focus on, 655
habits, 661–62
increasing awareness of, in moving forward phase of therapy, 21
metaphors for feeling based on, 656
mindful, 657, 677
physical elements of, 663–64, 665
posture and, 663
therapeutic intervention with, 656–57, 662–63, 664–65
therapists’ guide to exploration of, 655–59
working with dissociative client on, 658–59
worksheets, 657, 667–77
Walking with Someone Significant worksheet, 657, 673
What a Walk Conveys worksheet, 657, 667
What Stands Out worksheet, 113, 121
When You Felt Ungrounded worksheet, 327, 343
Wilkinson, M., 35
window of tolerance, 17, 20
appropriate risk taking to widen, 753–55
arousal challenges in widening, 747, 748
benefits of challenging, 745–46
creative resources to expand, 763, 765
defined, 773
experience of positive emotions in, 728, 739
helping clients to challenge, 746–47
high arousal challenges for expanding, 761
identifying animal defense-associated emotional dysregulation in, 558, 564, 565f
in interpersonal relationships, 753–54
low arousal challenges for expanding, 759
neuroception and, 225
neuroplastic change in widening of, 752, 755
as optimal arousal zone, 227
orientation for clients about, 69
preparing clients to challenge, 746
rationale for challenging, 751
recognizing neuroceptions to return arousal to, 219, 220, 221, 222
resources for widening, 752
in sensorimotor sequencing, 539, 541, 553
strategies for increasing, 745
967
to sustain dual awareness, 516–17
therapeutic goals for widening, 21, 249
therapist’s, 47–48
therapists’ guide to, 219–23
therapists’ guide to challenging, 745–49
wide enough, 751–52
working at edge of client’s regulatory boundaries of, 48–49
working with dissociative client to challenge, 748–49
worksheets on challenging, 747–48, 757–67
worksheets on neuroception and, 221–22, 231–41
Winnicott, D., 304
wisdom of body, 16, 77, 81, 776–77
disconnect from, 83–84
therapeutic significance of, 84
therapists’ guide to, 77–80
word games, 728–29
workaholism, 115, 263, 302
worksheets
on animal defense-associated emotional dysregulation, 560, 569–81
for assessing client’s attitudes toward and connection to body, 79–80, 85–93
for assessing client’s fears and hopes about somatic therapy, 79, 87
on attachment-related emotions, 635–36, 645–53
beginning set of, 79–80
on beliefs and cognitive schemas, 609–10, 619–29
body sensation, 199–200, 209–17
on breathing interventions, 371–72, 381–89
on challenging window of tolerance, 747–48, 757–67
client’s resistance to completing, 57
client–therapist collaboration in use of, 56–57, 68
for completion between sessions, 56, 57, 68
core alignment, 349–50, 359–67
on creative and survival resources, 257–58, 267–75
on developing missing resources, 417–18, 423–31
on directed mindfulness, 159, 165–71
on dual awareness of past and present, 475–76, 483–91
to explore procedural learning, 97–98, 103–9
for exploring orienting habits, 113, 121–29
grounding, 327–28, 337–45
to identify building blocks of present experience with mindfulness, 134, 142–43, 145
for implicit memory work, 438, 447–53
on information processing, 183, 185–95
on legacy of attachment in relational patterns, 588–89, 597–605
matching client capacities and characteristics to, 56
neuroception and window of tolerance, 221–22, 231–41
orientation for clients about, 67–68
on play and positive emotions, 724–25, 733–43
proximity-seeking, 701–2, 711–19
purpose of, 15, 56
reconstructing memory, 457–58, 465–71
relational boundary, 681–82, 691–97
repeated use of, 57
restoring empowering action, 517–18, 527–35
sensorimotor sequencing, 540–41, 549–55
sliver of memory, 496, 505–13
somatic resource, 303–4, 313–23
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on somatic sense of boundaries, 393–94, 403–13
taking inventory of resources, 279, 287–99
therapist’s preparation for use of, 54–55
on treatment goals and tasks, 245, 250, 251
on triune brain, 175–76, 183, 185–95
on walking, 657, 667–77
Zwann, R. A., 96
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Also available from
Neurobiologically Informed Trauma Therapy with Children and Adolescents: Understanding Mechanisms
of Change
Linda Chapman
Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real
Richard A. Chefetz
The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice
Diana Fosha, Daniel J. Siegel, Marion Solomon
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Affect Regulation Theory: A Clinical Model
Daniel Hill
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Love and War in Intimate Relationships: Connection, Disconnection, and Mutual Regulation in Couple
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The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization
Onno Van Der Hart, Ellert R. S. Nijenhuis, Kathy Steele
For complete book details, and to order online, please visit the Series webpage at www.tiny.cc/1zrsfw
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Copyright © 2015 by Pat Ogden
ISBN: 978-0-393-70613-0
ISBN: 978-0-393-70850-9 (e-book)
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