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  • 11 Sep 2020 9:30 PM | Anonymous member (Administrator)

    By Sheila Rubin, LMFT, RDT/BCT

    (Adapted from my chapter "Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet" in the book Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients by Stephanie L. Brooke, editor.)


    PART ONE

    I begin this article about the internet with the fact that my clients think I’m a Luddite. I grew up with a wall phone telephone that, by definition, was attached to the wall. At most we could stand a few feet from the wall, with a few inches of cord linking us to the phone. This was in a time even before answering machines. I came of age and went to study radio and television in college during the time of the black-and-white Porta Pak video machine that was heavy, where we actually spliced tape using our fingers—just before electronic newsgathering. Response time to a letter was a couple of days to a couple of weeks. I’m fully aware that the words I’m writing here will likely be outdated due to technology changes before this book is out in the world. I have accepted the use of a smartphone into my private practice, along with doing therapy over the phone or Skype or Zoom if I have met the client at least once in person. I have come a long way.

     

    Therapy on the Phone or Internet

    Therapy, on both phone and internet, is with individuals or couples. When I am not physically with a client, I find that I check more often for feelings that I might be able to sense when working face-to-face. I slow things down and tend to do more somatic work, asking clients to ground and to sense somatically for part of the session. I always ask at the end, “What are you taking from this session? What was helpful?” I also give homework after each session. For example: Make a list of the coping skills from the session and put them on your calendar day by day. Or: Take the powerful objects from this session and put them out in your room at home with a note by each to remind you what we did in the session today. If the session helped them find a vision to support the marriage, we have that symbol, like a strong tree holding both of them as they deal with difficulties during the week.

     

    Concerns about Technology

    What about when technology fails? When a person just revealed something they’ve been hiding and the screen suddenly freezes? A while ago, I was in the middle of a Skype session where a husband was telling his wife why he had trouble when she touched him. Suddenly the screen froze and this tender moment was interrupted with my frantically trying to call them on Skype, which would not reconnect. I had to call them on my cell phone, and by the time I reached them, the tender moment had passed and they were fighting again. I had to slow things down and gently find the words to tell them about the negative cycle their communication was in and how to do a repair to get out of it.

     

    As Kaufman says, shame is the rupture of the interpersonal bridge (1974, 1992). Any disruption in connection with a significant other can disconnect the person from him- or herself, or the therapist, and activate the feeling of shame. And this couple was experiencing a disruption in connection. I was eventually able to use the symbol of disconnection because of the unpredictability of the internet as a way for each of them to have a role of explorer rather than blaming each other.

     

    What I realized was I have to let clients know ahead of time about the constraints and the benefits of using the phone or internet for therapy. It will save them time coming to my office when they are in a difficult place, but it may not be as contained as an in-person session.

     

    One couple was struggling with the husband having had an online affair and the wife needing to check his phone in order to be reassured that he wasn’t meeting the woman. I spoke slowly and carefully to them to get agreement before we began to talk:

    Because we are not face to face, I can’t just interrupt you if there is shouting. I am going to do the session slowly and have you repeat what you hear the other person saying, so that I can know you heard them and they can know that you heard them. We are going to take turns. Are you both in agreement? And because the phone is not a predictable medium, and each of us is on a cell phone, if one of us gets disconnected for any reason we need to have a plan. Are each of you near a home or office line? If someone’s line dies, we will momentarily stop the session and I will wait for the call of the person who was disconnected.  Call me back on your phone and I will use my phone to accept both calls.

     

     

    Shame During the Session

    In my chapter in The Self in Performance, I write that “Shame can be right there in the shadows. It is easy for misunderstanding.”

     

    When I can’t see the emotion on clients’ faces, because we are on the phone or they are looking away from the screen, I don’t know what they are experiencing and truly expressing. In the book Shame and Pride, Nathanson (1992) explained that throughout life we are balancing between pride, when we are seen in a good light, and shame, when we make a mistake or are seen in a less than favorable light. Diana Fosha (1992) later wrote that we call this our “self at best” and our “self at worst.” We strive to be seen as smart or clever or helpful, but when a mistake is made and something is unclear, suddenly the person is risking being exposed and seen as self at worst. This concept is helpful to remember when a client is sharing vulnerable revelations. I know from my own vulnerability how scary it can be to be exposed at the wrong time or without kindness and support.

     

    Listen for Subtle Signs of Shame

    In the chapter “Treating Family Systems with Shame and Addiction Problems,” Ron Potter-Efron wrote that:

    Clients do not always directly communicate their experience of shame with their counselors. Rather, they may hint at their shame through relatively subtle cues, downcast eyes, sudden speech stoppages, avoidance of an apparently innocuous topic, unusual phrases, and so forth. They may also speak at length about other emotions regarding a particular experience without adding that they also or even primarily feel shame about it (p. 230).

    He suggests the importance of the interactive process between the therapist and client can even be more important than the client actually disclosing the feelings of shame because the client expects that the therapist will dismiss them. He explains, “Shamed clients have a specific hope, not necessarily stated, within the counseling relationship. They desire to reveal everything within them that feels dirty, disgusting, and defective. They seldom reveal all this material immediately and may never be able to share some of it” (p. 229). He explained how the therapist needs to gently layer by layer work carefully and not reject the client as they reveal more levels of shame during the sessions.

     

    Internet Therapy

    The good news is that the internet can serve as a bridge between family members who do not live within driving distance of one another. It can also get in the way of having the direct eye contact family members long for. It proved very therapeutic for an elder client to see her grandchild over Skype, even though she believed it would not “do the trick.” She had been hurting and reported being filled with rage because her son didn’t call her as often after his baby came, and because the other grandparent was being invited over and she was not. We role-played her talking to her son, but nothing shifted. She still felt left out, like something was wrong with her for not being chosen to spend time with the new family. We unpacked all the feelings of anger toward her son for not insisting that his wife invite her at the same time as the other grandparents, and under that was the feeling of shame. She felt ashamed to not be invited and fought with him on the phone when they did talk. I asked her to role-play talking to her son in a way that invited a solution instead of blaming him for her frustration. I invited her to role play the visit with the grandchild. She rocked back and forth. Finally, I suggested that she use Skype as a way to visit her grandchild. She told me that I didn’t understand. She wanted to pick her up and rock her in her lap in the rocking chair. I invited her to try just one phone visit on Skype with her son and grandbaby. She sat in the rocking chair at her home and rocked. She was delighted to see her grandchild recognize Grammy over Skype. This experience fulfilled her longing to visit with her grandchild. There were many Skype visits thereafter. Her feelings of shame about being left out decreased and invitations to visit increased.

     

    Containment

    Please note that I only do sessions remotely if I have met with the client in my office and we have developed a solid therapeutic container first. When the client is in my office, I can observe a range of nonverbal cues and get a sense of his or her energy. Over the phone, there are subtle cues I may miss. There are ways I work with the absence of the visual modality. Because I am not seeing them, there are things I need to do to contain the energy of the session and the pace of the session. Because the client isn’t seeing me, there are ways I want to structure things to help them feel me where they are sitting.

     

    Case Example of Phone Session

    This client was feeling dark. Her boyfriend was spending time with his ex-lover again instead of going on the date they had planned.

    Client: “He’s still in the role of letting his ex-wife rely on him. I couldn’t stop crying for hours. My emotions got all wacky or something. I see his side when he’s helping his kids. But every act of his kindness is an act of affection toward his ex-wife. One day it’s good between us, and the next day I feel ignored, neglected.”

    Therapist: “How about if you choose something in your room to represent your feeling neglected and ignored.”

    Client: “OK, this plant.”

    Therapist: “Can you move it near you and look closer at it? And as you are looking at it, what does it say to you? What does it symbolize?”

    Client: “You have to pay attention to a flower. You have to water it or it dies!”

    Therapist: “So that’s a very powerful symbol of needing to be tended and cared for.”

    I wanted to pause and have her reflect on the importance of her attachment needs. She really wanted to just rush past them in the session. Choosing an object helped me direct the session to make space for that subject. The act of choosing something took her into another part of her brain where creativity was more open to her. Having a symbol can be very powerful metaphor. Having it in front of her helped her to focus on it during the whole session.

    Client: “Yes! I want to be cared for. But when I feel this way, I don’t feel like myself. It feels like I don’t exist. It’s too painful when he says he’s coming over and then he cancels because he’s with his ex-lover. Why am I punishing myself? I could go out and be in another relationship!”

    Therapist: “So there’s another part of you that doesn’t want to be punished any more, that wants to find another relationship, one where the guy is choosing you instead of choosing his ex. Can you look around the room and find an object that represents this part of you?”

    This is another place I want to pause the session and give her time to feel the power of what she just said. I want a symbol for that part so we can talk to that part as well, maybe have a conversation with both of them.

    Client: “This candle!”

    Therapist: “Can you put the candle in front of you and look at it. What does it represent?”

    Client: (Surprised) “There’s a light in it! I can attract things… People! But I’m not ready to move on.”

    Therapist: “Can you give each a voice? What does the flower say and what does the candle say to you?”

    The candle told her that she is bright inside when she’s not so depressed, worrying what is going on with this guy she’s dating. It gives her inspiration to grow herself and step out of the relationship to a real relationship where someone could really be available for her. As she was expressing this, another feeling showed up.

    Client: “I feel deep anxiety.”

    Therapist: “Where is the anxiety in your body?”

    Client: “My diaphragm.”

    Therapist: “Can you put some space around it and take some slow deep breaths?”

    Client: “I’m not being logical. I should just leave him. But I don’t want to leave him. He says kind things to me, offers to work it out. I really care about him. He’s clear about his intention that he wants to be with me!”

    Therapist: “There are a lot of conflicting feelings.”

    Because we are on the phone, I want to keep the connection and let her know that I am here and that I hear her.

    Client: “I’m scared. Lonely.”

    Therapist: “Yes, there’s a part that’s scared and lonely.”

    I want to support this part.

    Client: “It’s like a pouting child!”

    And it feels like she is putting down that part. It is like some part of her is shaming that part of her for wanting what she is wanting.

    Therapist: “I wonder… I’m curious if there is some shame around that part?”

    Client: “Yes.”

    Therapist: “Can you look around and find an object to represent the part that comes out and shames you when you talk about your attachment needs?”

    Client: (Apparently looking around her room for a few moments) “A hat.”

    Therapist: “How does a hat represent shame?”

    Client: “I put it on myself!!! I have a hard time asking him to meet my needs and I’m scared that they won’t get met again. That he’ll cancel plans with me again!”

    Therapist: “Maybe the shame comes out to put you down for feeling what you’re feeling?”

    Client: “Yes. If I’d recognize those things, logically, I would leave.”

    Therapist: “That inner conflict is so painful. So one part of you shames you for having normal wants and needs from him, and when you think he lies again or cancels plans, then that part shames you again for not leaving.”

    Client: “He told me he couldn’t have me over because he didn’t want his neighbors to think I was a homewrecker because his ex just moved out. So now I feel shame for wanting to come to his house. It’s been over six months we’ve been dating. So when is he going to tell people?”

    Therapist: “How did you feel when he said that?

    Client: “Insecure! Nerves all over my body. On edge!”

    Therapist: “What did the nerves say?”

    Client: “Run!”

    Therapist: “And what did you do when you felt that strong urge to run?”

    Client: “I’m feeling shame about my feelings. He’s good with his words, but his actions don’t match. Then I feel shame for wanting to leave.”

    Therapist: “I wonder if this current feeling of shame reminds you of anything that happened before in your life.”

    Client: “I feel so much shame in this relationship. It reminds me of my last relationship.”

    Therapist: “The one where the guy was hiding his porn addiction and hiding his other lovers?”

    Client: “Yes. That was terrible. But I want to give this guy more opportunity, more time to show me that he can make the life for us he is always promising. I want to give him the benefit of my doubts. I want this relationship to work.”

    Therapist: “Of course you want this relationship to work. Can you turn to the plant that represents your needs? What does the plant say?”

    Client: “The plant says, ‘You’re making yourself suffer!’”

    Therapist: “What does the hat say?”

    Client: “It says that I’m ashamed of my feelings. I’m embarrassed that I want him to visit me instead of his kids. That’s terrible.”

    Therapist: “What does the candle say?”

    Client: “It says that I don’t need to shame myself for my feelings. I have light inside me. I need to remember.”

    I’m wanting her to stop here and reflect and to work to understand if maybe there is something here for her to be shameful for. That would be a form of healthy shame.

    Therapist: “Sometimes shame can pull a person out of her deep knowing by cutting off the life force or the light. Sometimes there is healthy shame that tells a person that there is something he or she is doing or another person is doing that is actually shameful, that should be shameful. And there might be helpful information here if this is healthy shame. Healthy shame can help a person make new decisions or understand things in a different way. Here is some homework to do before our next session. Get out your journal at the end of the session and ask yourself, ‘What did I get from this session?’ Please write it down. And please write down some of these questions. Please do some journal writing to answer these questions.”

    • What does the plant say?
    • What does the candle say?
    • What does the hat say about how you shame yourself?
    • Listen to the shame and feel if there is something of value here or if it is just putting you down.
    • Is there part of it that is valid?
    • Is there something to listen to that is actually shaming for a reason in this situation?
    • Is there something here from a past relationship or a situation where you felt shamed?
    • Is there something you feel shy about?
    • Is there something for you to learn about shame here?

     

    In Dancing with Fire, A Mindful Way of Loving Relationships (2013) John Amadeo writes “Stumbling into adolescence and adulthood we may continue to hear the message that we are too selfish, needy, or flawed to be loved. The resulting isolation generates emotional suffering that is often unbearable. This begins an epic journey of scrambling to figure out who we need to be in order to win love and connection” (p.23). He writes that we lose the thread of connection with ourselves. “Shame prompts us to seek affirmation and approval rather than connection and intimacy. We look outside ourselves to sense whether we’re emotionally safe” (p 111). Many people end up looking outside themselves to find out how they feel or even what they should be doing.

    See part 2 for the continuation of this article.

  • 11 Sep 2020 8:05 PM | Anonymous member (Administrator)

    PART TWO

    Understanding Shame

    Shame is a primary emotion. The role of shame is to warn us and protect us. Our nervous system shuts down and we actually lose cognitive ability when we are feeling ashamed. Two indicators of shame are confusion and stuckness. Shame can freeze both mind and body. Shame is so difficult to see and cope with because it often hides behind other emotions. Shame is wired into our nervous system to protect us by lowering our emotional intensity and capacity to act. It is important to differentiate healthy shame, which can help us pause and rethink, from toxic shame, which can produce paralysis and leave a person so frozen that he or she is incapable of action and clear thinking. Healthy shame can lead a person to take responsibility for his or her actions, reassess, and make changes.

     

    Daniel Hughes, in Attachment Focused Family Therapy, writes that shame places a person in a fog that gets in the way of the intersubjective experience of being understood with empathy that can help a person gain understanding and acceptance. Also, shame itself can prevent a person from being able to reflect on their behavior or experience (p. 184). In the Eight Keys to Safe Trauma Recovery (2000), Babette Rothschild notes that “shame, quite simply, tells us that something is amiss” (p. 87) and that “Rather than discharge, as an example in yelling or crying, shame dissipates, when it is understood or acknowledged by a supportive other. More than any other feeling, I find that shame needs contact to diminish” (p. 92). Rothschild describes a process for deciding when to address shame, understanding the value of shame, apportioning shame fairly, and sharing shame (pp. 98–100).

     

    Shyness

    In the book The Authentic Heart, John Amadeo explains shyness can actually be a friend. “Shyness is an entrance into a tender fold within your authentic heart” (p. 110). But shame can cut both ways. “shame can be debilitating when you’re ashamed of your shame” (p.70). By replacing control with trust and by beginning to trust and express feelings, shyness can serve as a guide to use shame in a healthy way. One of my clients reported the comfort of shame like a blanket, like a burka, covering her grief after the sudden loss of her father and the shame of friends who expected her to just return to work after her three days of mourning period. Many clients let this feeling of extreme shyness, even social anxiety get in their way of making friends or living their life.

     

    Role Development

    In the chapter “Psychodrama” by Antonia Garcia and Dale Richard Buchanan in Current Approaches in Drama Therapy by David Read Johnson and Renée Emunah, editors (p. 396): “Moreno believed that the self emerges from the roles we play. He postulated that when people learn a new role, they follow a particular pattern of role development. The arc of the learning curve begins with role taking and proceeds to role playing and role creating.” The authors also say: “Dysfunction occurs when a person has a lack of either social roles or psychodramatic roles, and function is seen as having a balance of both.”

    First, a person can’t imagine a certain role, so I tell them a story about someone who had that experience. Then I may suggest a conversation that that person may have. Moreno wrote that “In order to develop functionally, each of us must first be doubled as newborns” (p. 43). So much of the work I do in the therapy session is about mirroring the client.

     

    This list is from my chapter “Almost Magic: Working with the Shame that Underlies Depression” in The Use of the Creative Therapies in Treating Depression, edited by Charles Meyers and Stephanie Brooke. I wrote a series of therapeutic processes to work with shame that can be used over the internet as well, as I describe in the case that follows (p. 236).

     

    Working with Shame

    • Counter-shaming: Help the client experience a series of successes. Focus on strengths.
    • Grounding
    • Contribute some personal sharing to join with the client and show humanity, join them in imperfection.
    • Provide psycho-education about shame.
    • Mindfulness or observing ego
    • Use objects or symbols to externalize shame and process current shame.
    • Separate shame from other emotions. Objects or scarves or pillows can be used as symbols.
    • Use projective or embodied processes to explore where the shame may have originally come from.
    • Introduce a protector.
    • Find aesthetic distance for the client to work with the shame.
    • Use projective or expressive processes to work with the shame.
    • Find the person’s true voice.
    • Give back the shame to where it came from.
    • Witness the powerful healing taking place.
    • Embody the new role, the new voice. Try a posture or movement.

     

    A teenaged client complained of feeling “a presence watching me sometimes.” As we worked, I wanted to understand about the presence she sometimes felt while undressing and also when she got home from school. I wondered if it was perhaps an externalized voice of her inner critic, so I asked general questions about how she felt at school, at home, and listened for something that said she might feel judged or criticized. I asked when she felt the presence most strongly. She said she felt it most strongly in school when, even though she knew the answer, she felt shy to raise her hand, worrying that the other person would be thinking that she would give the wrong answer and that maybe wasn’t smart. She had fears of letting herself down and letting down her family. Over time I normalized her concerns by telling her that some of the developmental jobs of this particular time in her life were about comparison and finding her way socially as well as academically. I shared briefly about my shyness in high school and ways that I overcame it. This helped to normalize what she was going through and model that it was possible to get through it.

     

    I helped her begin to feel inside her body by doing grounding exercises and stomping her feet. At some point she could feel inside her body and began to feel lighter and more hopeful. The next time she felt the presence was on a trip, and she was able to use coping skills to put her attention on other things. During one Skype session we used symbolic imagery to represent the part of her that was afraid that if she showed up as her real self in school, and people still didn’t like her, then she would feel destroyed.  Describing the imagery helped her to develop empathy for the part of her that needed protection.

     

    In one session I asked her to imagine a movie or play with similar characters to the situation the client is coping with in her life, like a waitress and a customer. I said, “Let’s say the waitress made a mistake with the order. And in the first scene, let’s say the customer is a mom who used to work as a waitress. How would the girl who was a waitress feel? Terrible, just terrible. And if the customer left a big tip then the waitress would realize that she had gone through the whole dinner remembering her mistake and thinking about it.” I asked, “Would you have compassion for the young waitress? You know how hard a job that is and she is just learning.” My client replied, “Yes, but you know, if the woman gave her a big tip it is because she probably thought she was a loser.”

     

    “Wow,” I said, “That’s pretty critical. Let’s change the scene. Same kind of scene, but a different movie. Let’s say it’s the same waitress and the customer is someone her same age. Let’s say he’s a guy this time, a cute guy. So how would the waitress feel if she made a mistake at his table?” “Even worse,” she said. “So much worse, because he’s someone she wants to impress. That would be horrible!!! She probably would just feel like she’s wrong for even thinking he was cute, if she made a mistake with his order.” “And what about the tip? What if he left a big tip?” “That would be the worst,” she said. “Why?” I asked. She sighed and said, “If it was someone her own age and she made a mistake, that would be horrible.” “Why?” I asked. “Because he would know how awful she really was.”

     

    As we discussed the imaginary scenes and went into detail exploring the different levels of imagining embarrassment, my listening to her rather than judging her allowed her to share the level of inner criticism she was coping with.

     

    “So is there something you could tell the waitress about each of those scenes?” I asked. “Given that it’s a new job with a high learning process, what would you tell the waitress, if you could, to reassure her?” I asked her to replay the scene one more time, then said, “If you could go back and change one thing after the mistake, what would it be?”

     

    For the first scene my client had the waitress tell the female customer how sorry she was, and that she was just learning this new waitress job. I asked her to imagine how the woman would respond. She said, “She might laugh in a kind way and say that she remembers what it’s like to learn something new.”

     

    I asked her how that felt. She paused and said, “Not so bad when we talk about it.” I had her go back into the second scene with the cute guy. She imagined telling him later that it was her first day, so of course the job was new. She imagined the waitress then joking with the guy and both of them laughing! I asked, “How does that feel?” “So much better,” she said. I asked, “So how does your body feel?” She replied, “Lighter… A little more space.” “Where is the space?” I asked. She pointed to her chest. We both breathe a sigh of relief together over Skype.

     

    As we unpacked the scene, she admitted surprise at how easy it was to imagine the waitress talking about her mistake and saying what was happening for her instead of keeping it all inside! I asked about the feelings of embarrassment. She said they were much less. And she couldn’t wait to practice this next week. I ask what she’s taking from the session, and she reports feeling lighter and less worried about the pressure she has been feeling.

     

    I explained that we were working on several levels. One level was giving her tools to cope with the experience of the presence and the shyness. On another level we were working with symbols to understand the role that the presence had for her and other ways to relate to it. On another level we were working developmentally about what it is to be female in high school and all the issues of dating, finding her place with the other kids socially and intellectually. She began to understand that the presence was something she could gain more control over, by shifting her focus away from it by talking to family, friends, and getting busy with schoolwork. Eventually she realized she had gained a different relationship to it and it bothered her less and less. As she became more comfortable with saying what was going on with her instead of hiding behind her shyness, friends started to reach out to her more and she didn’t feel as alone.

     

    The power of somatic imagery helped. Role plays that we did over Skype helped. The eye contact we had over Skype helped her feel normal and that this was part of her life journey. She reported learning to laugh at herself, something that had been very hard, in a way that was counter-shaming for herself and the other person. She reported that it took the pressure off of herself and the other person when in an uncomfortable moment. She said that sometimes she wasn’t worried what the other person was thinking.

     

    Along the way we found things she could say in her new role of power, taking her locus of control back: “I’m committed, I’m ready, I’m in control. In sessions she felt a calmness in her body and a relaxedness. That’s how I would track. I would track her aliveness returning in the sessions. She first felt like a cold fish. After each session she felt a little more hopeful and a little surer of herself. Her somatic awareness also increased. She became more hopeful and began taking a few risks by sharing more what was going on with her. We found a way for her to talk to herself in a kind counter-shaming voice inside.

     

    Imagination Activated via Drama Therapy and Expressive Arts Therapy

    From our workshops and from an unpublished paper on “Healing Shame in the Imaginal Realm,” Bret Lyon, Ph.D. and I present that:

    When a person gets stuck in shame, the most powerful way to get unstuck may be to activate his or her imagination. In the imaginal realm, logic and time are fluid and flexible. What actually happened can be explored and changed. What was stuck can be reexamined and shifted. Shaming situations from the past can be revisited, excavated through writing and expressive exercises, and thereby shifted. There are ways to give back the shame to where it belongs—through drawing, writing, and imagining past shaming experiences and saying now what you wish you had said then. Structured writing and expressive processes can symbolically give back the shame. This is where to find resilience.

     

    This work needs to be done with extra care when the session is over the internet, because the person can quietly slip into the shame vortex. I develop exercises to help them have something to hold on to during and after the session.

     

    Renée Emunah, in her book Acting For Real (1992), writes about “Drama Therapy as the intentional and systematic use of drama and theater processes to achieve psychological growth and change.” Psychodramatist and child psychiatrist Adam Blatner, expounded in “Foundations for Psychodrama” that psychodrama can offer a place for expressing unexpressed feelings and even replaying scenes of the past, expressing feelings now that have not been expressed, and for opening new possibilities for the future.” There is the idea of surplus reality in which a person can play with and change a conversation or an event that happened in the past where they felt shame and replay it to take a new role. The idea of act hunger that can be explored where unexpressed parts of a person can be invited into the psychodrama scene. Sometimes I use psychodrama just sitting with a client and ask them to imagine some things.

     

     

    Conclusion: Working with Counter-Shaming Metaphors

    There is much to be explored in this new world of online therapy. There is much to be explored. There is much to be created. I am excited about being able to reach people who don’t live near me and to do work online. I am excited about developing ways to work through shyness and awkwardness and shame using a combination of drama therapy, expressive arts and attachment work/psychotherapy. What I realize is that because they are home or at work when we do the session, they can actually have a power symbol or drawing or object on the shelf that we work with during the session and put on their desk or shelf behind them to help them keep ahold of the changes between sessions.

     

    References

    Amadeo, J. (2001). The Authentic Heart: An Eightfold Path to Midlife Love. New York, John Wiley and Sons.

    Amadeo.  J. (2013). Dancing with Fire, A Mindful Way to Loving Relationships. Weaten, Il, Quest Books.

    Blatner, A. (1988). Foundations of Psychodrama: History, Theory, and Practice. New York, NY: Springer Publishing.

    Emunah, R. (1994). Acting for Real: Drama Therapy Process, Technique, and Performance. New York, NY: Brunner/Mazel.

    Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. New York, NY: Basic Books.

    Graham, Linda.  (2013). Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-being.  Novato, Ca.: New World Library.

    Lyon, B. and Rubin, S “Through the Looking Glass, Using Imaginal Resources to Heal Shame; A Workshop for Therapists,” an unpublished paper, Berkeley, CA

    Hughes, D. A. (2007). Attachment-Focused Family Therapy. New York, NY: Norton & Company.

    Potter-Efron, R. (2011) “Therapy with Shame Prone Alcoholic and Drug Dependent Clients.” In Shame in the Therapy Hour by Dearing and Tangney, APP

    Johnson, S. (2005). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds, NY, NY. The Guilford Press.

    Kaufman, G. (1974). “On Shame, Identity and the Dynamic of Change.” Paper presented at the annual meeting of the American Psychological Association, New Orleans, LA. Retrieved from http://files.eric.ed.gov/fulltext/ED097605.pdf

    Kaufman, G. (1992). Shame: The Power of Caring (3rd ed.). Rochester, NY: Schenkman Books.

    Nathanson, D. L. (1992). Shame and Pride: Affect, Sex, and the Birth of the Self. New York, NY: W. W. Norton & Company.

    Rubin, S. ((2015) “Almost Magic, Working with the Shame That Underlies Depression; Using Drama Therapy in the Imaginal Realm,” in The Use of the Creative Therapies in Treating Depression, eds. Brooke S. and Meyers, Springfield Illinois, C. Charles Thomas.

    Rubin, S. (2007) “Self-Revelatory Performance” in Intercalative and Improvisational

    Drama: Varieties of Applied Theatre and Performance, ed. Blatner, A. Universe.

    Rubin, S. (2017). “Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet.” In S. L. Brooke (Ed.), Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients (pp.187-198). Springfield, IL: Charles C. Thomas.

    Schore, A. Affect Regulation and the Origin of the Self: the Neurobiology of Emotional Development. 1994 New Jersey, Lawrence Erlbaum Assoc. Publishers.


  • 1 Jul 2020 10:14 PM | Anonymous member (Administrator)

    This series was created to empower people in challenging times and everyday life. We are bringing to the public short resourcing exercises to regulate body and mind.

    In challenging times, when stress and anxiety run high, nurturing your body-brain and mind is more important than ever.

    Maintaining presence and equanimity depends on your capacity to mindfully align sensations, emotions, and thoughts. 

    These short somatic exercises, generously offered by our members, teach you how to use your energy, emotions, and awareness so that you can face challenges with confidence, and step into your life feeling connected and empowered. 

    Use them for yourself and with your clients.

    View this series in its entirety on Youtube. 

    Visit the Channel

    Episode 1:
    Simple Movement to Ease Your Anxiety - Dave Berger

    Watch


  • 20 Jun 2020 7:50 PM | Anonymous member (Administrator)

    Below you will find resources for addressing this topic. There are links and people that have been referenced in USABP circles. You can also reach out to our member organizations as well. Please email us with any of your suggestions. The list and site presence will build out over time. Thank you all for your contributions.

    USABP Training organizations

    Member Organizations often include webinars, workshops or specialize in training activity to address social justice, anti-racism, diversity, systemic racism, implicit bias, polarization and more.

    See a list of our organizations and the ways in which they assist in this issue through Somatic Psychology, Body Psychotherapy and other Somatic-based Therapy Practices

    VIEW ORGANIZATIONS


    Radical Aliveness Institute is a USABP Official Training School addressing somatic and systemic issues world wide from US to Central and South America to Africa and the Middle East.

    LEARN MORE


    A List of Member Organizations' Helpful Resources

    NARM & Cultural Misattunement Webinar: Addressing the Impact of Cultural Trauma from Systemic Oppression with NARM Therapist Claude Cayemitte, MSW, CCTP hosted by NARM Training Director and Senior Faculty Brad Kammer, LMFT, LPCC

    SIGN UP

    Two podcasts brought to you by the NARM® Training Institute

    Transforming Trauma, Episode 013:
    Addressing Systemic, Cultural, Racial, and Complex Trauma with Claude Cayemitte

    LISTEN

    Transforming Trauma Episode 015:
    Post-Traumatic Growth in Communities of Color and NARM in the Classroom with Giancarlo Simpson

    LISTEN


    USABP Continuing Education Training webinars: 

    > To view one has to be a member and logged in to there account. 

    Working with Polarization and Trauma in Groups:  how to work cross-culturally and cross-nationally

    Presented by Ann Bradney, CCEP, CPRA 
    Founder of the Radical Aliveness Institute 

    WATCH NOW

    Embodied Activism: Getting a Grip on Social Justice and Moral Courage in Somatic Psychotherapy
    Presented by Rae Johnson, PhD, RSW, RSMT, BCC 

    WATCH NOW

    A Thousand Paper Cuts - Grasping and Transforming the Trauma of Embodied Micro-aggressions
    Presented by Rae Johnson, PhD, RSW, RSMT, BCC 

    WATCH NOW


    USABP viewpoints ARTICLES

    Privileges and Perils of Power

    By Dr. Cedar Barstow, M.Ed., C.H.T., D.P.I.

    Power, simply the ability to have an effect or to have influence, is a magnetic, addictive, and corrupting force. Research shows that taking on higher role power or having higher rank power inevitably changes you. You are given gifts, actually privileges, from the outside world that change how you see yourself, how you see and relate to others, and how they see and relate to you. The greater the power difference the greater the effect. These privileges change you whether your intentions are for service or for selfish gain.

    READ ON


    FIND A SOMATIC THERAPIST BY TOPIC

    USABP Somatic Practitioners

    Search 

    Somatic Experiencing Practitioners specializing in matters related to the Criminal System

    Search


    USABP MEMBER ACTION RESOURCES
    Directory, Organizations, Books, Trainings, and more

    Dr. Rae Johnson
    Embodied Social Justice introduces a body-centered approach to working with oppression, designed for social workers, counselors, educators, and other human service professionals. Grounded in current research, this integrative approach to social justice works directly with the implicit knowledge of our bodies to address imbalances in social power.

    USABP Member Nola Butler-Byrd
    Nola Butler Byrd, Ph.D., LPCC is a Certified Radix Practitioner and a Licensed Professional Clinical Counselor. She is also an Associate Professor and Director of the Community-Based Block Multicultural Counseling and Social Justice Education Program

    USABP Member Zeshan Mustafa, CCEP, JD, RYT
    Specialties with Somatic Support:
    BIPOC, Anti-Racist Activists, and Codependents.

    Author of:
    "When Helping Is Not Helping: a Somatic Approach to Working with Clients of Color."

     Read More & Buy


    Additional Non-USABP RESOURCES

    Right Use of Power Institute

    White Supremacy and Me by Layla F Saad

    National Association of Social Workers Anti-Racism Resources

    Blindspot by Mahzarin Banaji and Anthony Greenwald

    Center for Partnership Studies, founded by Dr. Riane Eisler

    Take the Implicit Association Test (IAT) to Measure Your Bias:

    Test me

    The IAT

    At the heart of the book Blindspot: Hidden Biases of Good People is a method called the Implicit Association Test (IAT) which was designed by Tony Greenwald to detect the hidden contents of the mind. Its original application was to explore the group-based preferences, stereotype, and identities that may not be accessible to conscious awareness. Since then, it has been used widely to study preferences, beliefs, and identity, and found applications in domains of health, education, business, government, the law and law enforcement. The test is currently available at 39 country sites, in 25 languages.


    Free Racialized Trauma Course


    Google Drive link to comprehensive educational reading, tools, exercises and organizations to help explore this topic from many sources.

    Take me to these links


    Engaged Citizenry

    Andrew Goodman Foundation


    Research

    BU Center for Anti-racism Research


    Featured Body Psychotherapists, Speakers, Authors and Trainers

    Resmaa Menakem
    Coins the phrase White "Body" Supremacy and has exercises for one to work through to embodying trauma and work with issues around race and trauma.

    We can't help ourselves to heal racialized trauma if we don't acknowledge that it even exists 

    WE CAN’T HELP OURSELVES EVEN BEGIN TO HEAL RACIALIZED TRAUMA IF WE DON’T ACKNOWLEDGE THAT IT EVEN EXISTS.

    Resmaa Menakem, MSW, LICSW, SEP, has appeared on both The Oprah Winfrey Show and Dr. Phil as an expert on conflict and violence.

    He has served as director of counseling services for the Tubman Family Alliance; as behavioral health director for African American Family Services in Minneapolis; as a domestic violence counselor for Wilder Foundation; as a certified Military and Family Life Consultant for the U.S. Armed Forces; as a trauma consultant for the Minneapolis Public Schools; and as a Cultural Somatics consultant for the Minneapolis Police Department.


  • 15 Apr 2020 5:54 PM | Anonymous member (Administrator)

    Recently the USABP and Bodynamics Institute presented a webinar that included demonstrations on how to "Use one's body to contain anxiety under times of uncertainty." 

    Anne Isaacs went over that in her full webinar presentation,  Creating New Psychophysical Resources That Heal Developmental Disruptions:   Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns.

    Following that webinar attendee and USABP member Karen Kirsch stepped in to action to provide other USABP members and the larger community with some of the tools presented in the above webinar.

    These tools can be useful in Teletherapy.

    Use them for self care too. 


    This demo is also found on youtube too



  • 15 Apr 2020 4:04 PM | Anonymous member (Administrator)

    Instructional Guide to Somatic Resourcing Strategies for Containment and Orienting

    Prepared by Sarah Schlote
    An Excerpt from the Anne Isaacs', Bodynamic Institute presentation, Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns

    
The following selected illustrated practices derived from Bodynamics support resilience and self-regulation through containment and present-time orientation in times that are activating or unsettling.

    I have added in additional commentary drawing from Somatic Experiencing® and the polyvagal theory to elaborate and support integration of some of these ideas.

    A file with visual cues is available in two formats. Download to get them:

    Get the PDF Download 

    Get the A4 Download


    CONTAINMENT
    Iliotibial Tract Hold

    The iliotibial tract (also known as the IT band) is a thick band of connective tissue that extends from the pelvis and hip area to the tibia and knee, along the outside of the leg. It provides a sense of social balance, in terms of pulling oneself together and also letting go, and allows us to manage our emotional energy through self- containment. Bringing intentional attention to the outer edges of our physical container can provide a settling effect when we are feeling panic, have lost a sense of our own boundaries, or are hyperventilating. This particular practice shifts anxious energy from the head and upper body and provides an embodied felt sense of our body as a container, which helps us to feel centered in our core (the abdominal cavity is a much larger space and offers more “breathing room” to be with difficult emotions than when they are up in the head). It also allows the rest of the body, in particular the limbs, to become a conduit for stuck activation, allowing that energy to move down towards the feet.

    Version 1:

    • Place your hands on the outsides of your lower thighs or knees, and have your feet and knees shoulder-width apart. Lean forward on your legs as you are doing this.

    • Keeping your knees in place, press outwards into your hands, as your hands provide resistance against the pressure from your legs (while keeping the hands in place). This will create a sense of dynamic tension.

    • Hold this position for a little while.

    • The most important part of the practice: Relax slowly to a count of 10 (“one locomotive, two locomotive, three locomotive…”), gradually releasing the tension/resistance from your hands, arms and legs. If you like, lengthen your exhalations as well as you let go.

    • When finished, sit upright and notice what is different.

    Version 2:

    • Follow the same instructions as above, only without crossing your arms.

    Other Options:

    • Place your feet on the inside of each chair leg, and press out with your knees. The chair legs will provide the resistance that your hands did in the other versions. This frees up your hands for other things, and can be done more discreetly (like when in a meeting or another social setting).

    • When standing, with your feet flat on the floor, push outwards from your knees to your hips.

    • When lying down, cross your ankles and then push outwards from your knees to your hips.

    Lower Side Ribcage Expansion

    At times, when we feel a surge of emotion rising up, we might sense a knot in our chest and a tightening in our throat as our body contracts around our feelings. Emotions like anxiety feel like they “get stuck” in the upper chest, and there can be a sense that things are too painful or overwhelming. This can especially be the case if we tend to become submerged in or blend with our internal experience, and lose a sense of having a grounded adult witness or access to our core Self in the present moment. Unconsciously, we might forget that we now have a much larger, grown-up body that can hold our internal experience, and instinctually respond as though our physical container was much smaller when feelings  were much more overwhelming to our less developed nervous system. Our container contracts to hold things in, which gives the impression that the pain or discomfort will never end, or that we won’t be able to handle it: a somatic re-enactment of what we may have felt when we were younger. As a result, emotions and sensations become blocked and don’t move through our system as they were meant to. This exercise provides a felt sense of having a larger container, which can have a calming effect and provide a more spacious conduit for emotions to pass through and settle.

    Instructions:

    • Take a deep breath in, breathing into your lower side ribs so that they expand outward. Then, use your muscles to keep your ribcage open. You can continue to breathe if you like (or if you are able) while holding your ribcage in this wider position.

    • After a few moments of holding your ribcage open, slowly allow your ribcage to relax as you exhale. Take all the time you need to do this.

    • Allow your breath to come in normally and notice what shifts as you pay attention.

    • If you like, at the same time, isometrically activate the adductor muscles (inside the thighs), and then very slowly let those go as well.

    • Track what happens inside. What is different in terms of your sensations or feelings? Or, what is different about how you are experiencing them?

    Serratus Anterior Superior Hold

    The serratus anterior superior is a muscle located beneath the armpits on both sides of the body, starting under the shoulder blade and stretching forward along the sides of the ribcage. As babies and young children, this is the area where grownups place their hands as they pick us up in response to our need for social engagement, co- regulation, reassurance, and play. The serratus muscle is involved in connectedness, a sense of the heart opening and the physical action of reaching out towards others or nourishment.

    This muscle is also connected to our desire to be wanted and loved for who we are (including our curiosity and impulses), and provides us with a felt sense of our ability to contain our sensations and emotions while also getting our needs met. Finally, it is linked to having the space to enjoy ourselves, the freedom to explore the world, and the ability to express our emotions without losing contact with ourselves and others.

    From the standpoint of the polyvagal theory, early face-to-face interactions are the first step to experiencing co- regulation, since as infants we rely on the social engagement system of our caregivers to help us develop our own. The face-to-face moments we experience in the safety of our relationship with our caregivers supports the face-to- heart connection. In other words, these interactions stimulate the

    ventral branch of the vagus nerve, which links the musculature of the face, neck, larynx and pharynx with the heart and lungs. When we feel safe and held, the ventral vagus acts as a pacemaker on the heart, which modulates our arousal.

    This particular self-hold can help provide a sense of containment and settling when we are feeling anxious or lonely.

    Instructions:

    • Place your hands under your armpits and then allow your arms to come down over top of your hands.

    • Press in or squeeze into that muscle on both sides, holding yourself in that place.

    • If you like, lengthen your exhalations as you breathe.

    • What do you notice when you hold yourself there?


    ORIENTING

    Orienting is a deceptively simple practice, the purpose of which is to support us to become more present. As we become more present to ourselves and our current conditions, and if these conditions are perceived by the nervous system to be safe(r), our organism can begin to settle out of whatever panic, urgent energy, or spiralling thoughts we are experiencing while in a state of hyper-vigilance.

    The suboccipital muscles at the base of the skull are involved in orienting efforts, and are psychologically connected with the instinctual sense of having the right to have strength or power. Defensive orienting involves turning towards perceived dangers or threats, or looking for escape routes or objects for self-protection. Exploratory orienting involves turning towards novelty in the environment (curiosity) or seeking out resources, such as social connection, nourishment, play, comfort, delight, etc. (sucking reflexes to take in this goodness are connected to the exploratory seeking impulse). Defensive orienting can be in or out of proportion to the current conditions. For instance, when we are anxious or in a state of panic, we can experience a startle response where we pull back and hold our breath, freezing in place. Our bodies can become tight or rigid, we hold our breath, and our gaze can become fixed or our eyes can dart around frantically without really taking in our surroundings. This is another way our bodies, emotions and thoughts become stuck. Our minds begin to fixate on the future, getting caught in worry about what might happen again. Orienting can help us to recognize relative safety now.

    From a polyvagal perspective, orienting allows us to engage the same parts of the face and neck involved in the social engagement system, which stimulates the ventral vagus nerve. When the ventral vagus is back online, it provides a face-heart connection that acts as a pacemaker on the heart (or a set of brakes), slowing us down and allowing us to reconnect with the here-and-now and with relationships.

    Instructions:

    • Taking a deep breath, slowly exhale as you let your eyes look around and take in your surroundings. Allow your eyes to slowly look where they want to look, as opposed to where you think they should look. What draws their curiosity?

    • Using your occipital and neck muscles, let your head turn slowly to check out all directions, leading by your ears and exhaling slowly as you do. If you like, also see what happens if you allow your head to look up and down as well. Take all the time you need.

    • Notice if there is anything dangerous or threatening in the present moment.

    • What happens as you taken in your surroundings? What is different inside?

    Note: in Somatic Experiencing®, the goal of orienting isn’t necessarily to become more grounded; rather, we want to develop more accurate neuroception in the present. That is, we are looking to develop a more accurate sense of safety, danger, or life threat in the here-and-now. If our organism accurately detects safety and becomes more grounded as a result, then this practice can indeed support settling and deactivation of anxiety. However, for others who have difficulty trusting themselves to accurately detect signs of danger or life threat because of a tendency to be under-attentive, this practice can also be used for the opposite purpose, especially if an individual’s orienting response was thwarted, resulting in hypo-vigilance.

     

    ABOUT

    Bodynamics is a developmental somatic psychology approach developed in Denmark, that proposes that somatic and psychological development occur simultaneously. This means that the voluntary use of specific muscles not only has a physical function but also a psychological one as well, and that psychological difficulties can be addressed by working with the muscular system and the various character structures that occur at different developmental stages.

    • Bodynamics theory: https://www.bodynamic.com/theory/

    • Seven developmental stages and their associated character structures:https://www.bodynamic.com/theory/the-seven-developmental-stages/

    References

    Foundation for Human Enrichment (2007).Somatic Experiencing® – Healing Trauma[training manual]. Boulder, CO: Somatic Experiencing® Trauma Institute.

    Isaacs, A. (2020, March 26).Creating New Psychophysiological Resources that Heal Developmental Disruptions: Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns[webinar]. Hosted by the United States Association for Body Psychotherapy.

    Isaacs, A. & Isaacs, J. (2016, March 24).Healing Developmental Disruptions: Using the Body to Focus Verbal Therapy

    [webinar]. Hosted by the United States Association for Body Psychotherapy.

    Porges, S.W. (2018, November 3). Trauma and intimacy through the lens of the polyvagal theory: Understanding the transformative power of feeling safe [conference lecture].The Science of Connection: Honoring Our Somatic Intelligence.Santa Barbara, CA: United States Association for Body Psychotherapy Conference.

    Suggested Citation

    Schlote, S. (2020). Somatic Resourcing Strategies[handout]. Guelph, ON: The Refuge.

    Thanks to Anne Isaacs for granting permission to develop this handout.

     

  • 3 Mar 2020 4:10 PM | Anonymous member (Administrator)

    Presented by Stacy Reuille-Dupont, PhD, LPC, CPFT

    In this interactive presentation, I would like to review the concept that mind lives in every cell of our body and movement patterns are expressions of mind. By looking at the physiological sciences of hormones, neurotransmitters, brain/locomotor development, anatomy, and physiology we can concretely evaluate postural dysfunction, misalignment, and tension patterns set up by physical or psychological states.


    Watch Now


    USING THE BODY IN PSYCHOLOGICAL TREATMENT INTERVENTIONS - USABP PRESENTATION 2018

    Note from Dr. Stacy Reuille-Dupont

    Jumping off from my first career as an exercise scientist, I found somatic psychology as a way to bridge and treat physical health symptoms at the level of being. Drawing on my dissertation research regarding perception and participation in physical exercise within a clinical mental health population, I found blending Hakomi’s character analysis with locomotor developmental stages unlocked psychological core wounding and allowed for corrective experiences in the “forced mindfulness” of difficult physical challenge.

    Beyond traditional therapy, these interventions also treated physical health problems of obesity, chronic pain, chronic disease management, addiction patterns, and others that often have roots in the psyche and are impeding if not distracting from deeper work. The nervous system directs it all. When the nervous system becomes dysregulated as a result of wounding (psychological or physical) the body systems adapt.

    These adaptations are brilliant options for the body at the time of pain, however if left unchecked create systemic problems that may lead to chronic disease states, both physical (e.g. diabetes, obesity, pain) and/or psychological (e.g. low self-worth, addiction, stunted personal growth, rigidity in life participation). In our current culture, these adaptations become targets for interventions as independent factions rather than utilizing the intelligence of the whole system. Physical health care often separates itself from mental health due to its cause and effect, tangible nature, however taking a broader approach that includes psychology we treat the problem, not just the symptom. One finds mind present in all forms of body dysfunction from basic building blocks of cellular activity, immune dysfunction, and inflammation patterns to postural deviations as a result of psychological or physical wounding. By honoring the embodiment of personal experiences the body psychotherapist can engage in larger and often discounted conversations about what health is and is not.

    In this interactive presentation, I would like to review the concept that mind lives in every cell of our body and movement patterns are expressions of mind. By looking at the physiological sciences of hormones, neurotransmitters, brain/locomotor development, anatomy, and physiology we can concretely evaluate postural dysfunction, misalignment, and tension patterns set up by physical or psychological states. These states often continue psychological distress and influence overall health. Corrective exercise patterns can be used to free not only the physical system, but the emotional body as well creating whole person health.

    See the companion article for this video presentation.


    https://youtu.be/N-DoXbNeYSI

  • 3 Mar 2020 2:34 PM | Anonymous member (Administrator)

    This article will help in understanding and incorporating physical movement systems into psychological treatment. It is presented by Stacy Reuille-Dupont, PhD, LPC, CPFT

    Movement facilitates the physical wiring and structure of being. Movement creates concrete manifestation of the abstract. The embodied experience becomes tangible. Even a thought or emotional experience is movement at the cellular level.

    - Stacy Reuille-Dupont, PhD, LAC, USABP presentation, 2018


             Many struggle to own the power of physical experience. In fact, on average people with mental health illness die younger and use more health care services. Medical staff struggle to treat and diagnose accurately, and they engage in costly medical treatment more often than those with mental wellness. They often present to physical health care providers with 5 or more unrelated symptom presentations. This is because addiction, trauma, and experience live in the tissues. These experiences create “knots” in the system. These knots embed in layers of muscle and facia that evolve to create adaptive ways of dealing with the world, however many are powerless in their somatic experience of life. They are disembodied and look outside themselves to be fixed. As they become less connected to self they also become less connected to others, community, society, etc. The looking for external solutions to internal problems becomes a distraction. The body has everything it needs to address a problem, but many are so disembodied and scared of somatic sensation they let go of this power and become more disconnected. This is where movement helps. Movement returns focus to the body, it returns focus to deeply knowing one’s truth, and it returns focus to personal power. This article will review areas of the body and psychology impacted by movement and discuss how different movements allow for change in the whole system.

    Endocrine System

                Starting with subtle levels of movement we cannot underestimate the endocrine system. The area I have studied most links the endocrine system to psychological trauma disruptions (Reuille-Dupont, 2014). Whether a trauma is physical (broken bone) or psychological (emotional neglect) the Hypothalamus - Pituitary - Adrenal (HPA) Axis gets involved. As a result chemistry shifts. When chemistry shifts the perception of the situation changes. Shifts can be positive or negative, however if stress hormones are not metabolized they wreck havoc on other tissues and may contribute to increases in chronic pain, inflammation, digestive, and immune disorders (Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002).  Physical movement can also target the HPA axis, however does so in a way that metabolizes the bio-chemicals and dysfunctional muscle patterns (Droste, Gesing, Ulbricht, Müller, Linthorst, & Reul, 2003). The endocrine system is often dubbed the “little central nervous system” for its control and care of the body’s experience. When looking at how the endocrine system influences the perception of experience by changing how the body feels in any given state, the endocrine system becomes a tangible system influenced through thoughts, emotional states, ingestion (food, news, media, social influence, environmental items, etc), and movement. Thus as movement is introduced the body becomes an active vehicle to change perception of experiences.

    Nervous System

                The body is a great antenna, but the brain does not have its own direct inputs, inputs are the senses. Sense experiences all come through the body. The body collects the information, sends findings through nervous system channels and reports to the brain. The brain works tirelessly to categorize and direct responses to stimuli for survival. If one is constantly living in reaction to past events rather than response to current experience the system becomes rigid in response options. To be a responder to present moment experiences one must learn to slow down reaction. This happens by increasing capacity for physical sensation. Therefore the brain judges the situation differently based on present moment reality and not past experience reactions when the body is able to experience the situation with capacity. Movement becomes the vehicle to slow or speed the nervous system response.

                The movement of the nervous system is subtle. For instance, movement can be used to shift posture.  As movement increases, heart rate rises, as heart rate rises the nervous system reports to the brain which determines if this is a good situation or not. In my office (within a large community mental health and integrated care center), I found many examples of people who needed to exercise yet could not. Their brains kept registering rising heart rate, quickening breath, and sweat response as panic and would shut down the system. The physical sensations of exercise were tipping them outside the window of tolerance. Helping people understand the responses in the body is important. It gives space to pause, decide desired outcomes, and options for reaction. It can be as simple as using a pressure point. For many familiar with communication lines within the body, location points for contact are important and we know putting pressure on them influences other systems, such as the endocrine, facia, or muscular systems. An easy one I often teach my clients is the 3rd eye point. By putting pressure on this point (between the eyebrows) we have a direct way to lower heart rate and slow breathing. Depending on the client I have them get into different positions allowing pressure to be exerted on this point and notice what happens. It could look as simple as having them press on it with their hand, I can press on it for them, or have them put their head on a desk, counter, the wall, or other hard surface. There are many points we can use to shift the communication of the nervous system to the brain, and most clients can learn and discretely perform on their own at home, school, or work when needed.

    Heart Rate and the Circulatory System

                Slowing the heart and breath bring us to the circulatory system. All changes, mental or physical, are transmitted through the central nervous system, which controls heart rate via the sympathetic and parasympathetic responses (Appelhans & Luecken, 2006). These responses signal to the brain to expand or contract from experience. Taking a slightly wider gaze on this connection, it is the heart that influences how we respond, it is the piece of us that is in control of everything else. It is often thought the brain directs it all, and make no mistake the brain is very very very important, but it is the heart that tells the brain what to categorize. The heart is the conductor of the orchestra that is the brain. It communicates our experience through heart rate variability. Heart rate variability changes with each breath directing the brain in its categorization of experience. Safe or not? Connect or not?

                The heart has its own electrical system. Looking at electrical theory one can see that electrical systems either repel or collapse into each other. If my experience of you is safe, I will expand my electrical system to meet your’s. We may become one electrical field, and we can see and feel these connections between people. As a result of connecting to you, I will mirror you, viscerally respond to you, and will “know” things about your experience. When people get stuck this system gets rigid. People become stuck in old patterns, orient from fear, or struggle to effectively manage limbic resonance experiences. Some people lack an ability to connect to the somatic experience of another (bound), some people are overly connected (unbounded). Both experiences create problems for social engagement of the nervous system. Due to respiratory sinus arrhythmia, the connection between the breath and heart rate, one influences the other (Porges, 2007). If I want someone to be more active, say to treat depression which is lethargic, heavy, slow, and often stuck energy, I can match the current heart rate with movement and raise it slightly (the next section will discuss movement as treatment).

                A simple way to influence this system in your office is to slow down your breathing. By slowing your breath rate, you will slow your heart rate, by slowing your heart rate your electrical pattern changes in the field. As this happens your client (if they trust you) will match you. Thus processing difficult pieces of psychological work feels more supported and builds capacity to experience themselves and others with less reactivity.

    Musculature and Facia System

                If I can get connected to my client using my subtle breath, imagine what big movement systems can do. The trick to using the bigger systems is to know how to influence them. Posture impacts our psychology and our psychology impacts our posture. For example, if I am stressed I may internally rotate my shoulder joint collapsing my chest, making it more difficult to breathe. The change in my breath rate changes my heart rate and influences my sympathetic and parasympathetic systems. Over time my upper back and neck shift into what is known as forward head. This creates stress on the muscle and joint configurations. The muscles respond by tightening, eventually becoming “knotted”. These knots are deposits of different  pro-inflammatory and biochemicals (Shah, Thaker, Heimur, Aredo, Sikdar, & Gerber, 2015). The muscles begin to shift movement patterns around the trigger points. The adaptation eventually results in dysfunctional movement patterns and stress on the system. This process could start as a physical injury or an emotional one. Remember the body is the vehicle through which all experience is processed.   

                Eliminating the adhesions in the physical structures can help eliminate them in the mind as well (many modalities exist to do this: massage, exercise, dance, yoga, tai chi, chi gong, acupressure/acupuncture, dry needling, rolfing, physical therapy, chiropractic, etc.). The trick is often in practitioner and modality connection. If the client becomes connected to the practitioner and the modality fits the client’s personality it is likely they will find relief from it. In our offices we can use the gross motor systems to program movement to access psychological healing.

    Movement to Heal

                As an exercise scientist and personal trainer/group exercise instructor for over 20 years, I am pretty confident at figuring out how to program someone’s physical strength and endurance. As a clinician for over a decade, I feel like I am pretty good at figuring out how to help shift behavior and belief. However, in my office many of my clients would not participate with me. I couldn’t figure it out. I was starting small, meeting them where they were, and the math of physiological change was solid. I looked deeper and did research around what was getting in the way of actually participating in physical exercise. I thought it was psychological trauma experiences, as many described symptoms while exercising that overlapped window of tolerance literature. For the population I studied, it was not trauma, it was panic that mitigated the ability to participate no matter how strong the belief in exercise as a modality to help address a variety of issues. In addition, exposure to exercise created an expanded range (larger window of tolerance to physical sensations). As a result, I learned that offering movement experiences modulated by psychological theory to address stress disorders, especially panic, helped people adhere to a movement program that addressed physical and psychological disorders (Reuille-Dupont, 2014). With these findings I was able to create a variety of movement programs and experiences clients could use to heal mental health presentations.

                When choosing appropriate movement interventions one must consider the client’s current state. You cannot ask a person with deep depression to engage in high intensity “bouncy” exercise. The energy of depression is heavy, slow, lethargic, stuck. We have to start with movements that match and then increase the upward energy in small increments. For someone with ADHD or high anxiety with racing thoughts yin/yang yoga is miserable. They may even struggle with power vinyasa due to lack of ability to focus well. By programming movement to shift quickly and often, sometimes in a chaotic pattern then increasing the rhythmic content slowly we help them meet the racing mind and teach clients to direct it. In addition, we must consider physical limitations, physical health conditions, physiological understanding of heart rate, sweating, breath rate as they link to panic (findings in my research), disorganized body presentations, and psychosis. Someone having a psychotic or manic episode may be able to work with you but be ready to adapt quickly and often. Below are some ways I use movement in my office.

    Walking is a big focus in my practice. I take them outside and have a treadmill in my office to help people understand heart rate training zones and teach them about the physiology of fear. This allows them to have an experience while walking in a safe environment and learn to modulate their own breath and heart rate. It also helps them get comfortable with tension in the muscles and sweat rates, both can signal danger to the brain and exacerbate psychological symptomology.

    Posture. I often use posture to help determine the psychological structure of a person’s belief patterns: where are they hiding, projecting, collapsing, etc. By watching planes of movement, postural deviations, and simple movements you can see where the body is blocked, armored, or adapting. By using theory around body and psychological wounding presentations I can then choose exercise patterns that match locomotor and psychological development phases.

    Here are 3 examples of movements I use in my office to engage clients in corrective experiences:

    Feet are very interesting places to start. By having the client walk we can see what is happening in the pelvis, spine, chest, and head. All movement should come from the core and should be somewhat equal in gait. You should be able to see rotations throughout the foot, leg, and hip structures. This gives a lot of information about armoring and world view. When working with sexual trauma or eating disorders the feet are a great place to start because they give access to the inner thigh, perineum, and pelvic floor areas of the body that are often hyper/hypo active. By manipulating which part of the foot the client is paying attention to (different toes, heel, arches, etc) we can create sensation in the leg and pelvis. This allows for safe processing and reconnecting with these physical structures and allows healing of psychological wounding and physical issues that may also be present. In addition, it allows discussion around items like safety, security, strength, stability, etc that are often early life psychological wounds. Sometimes I do this work in my office, other times it is homework.

    Tabatta. For this I would suggest you have advanced training, however, I think the example can help you conceptualize how you might adapt movement in your office. Tabatta style training is intense structured work lasting 4 minutes. It is cardiovascular in nature (see about for information on Heart Rate Variability), but can incorporate strength as well. There are a number of similar modifications/training modalities that can be adapted for use with a variety of clients. For these exercises I work with the client to determine core wounding patterns and corrective belief statements. Then I choose an exercise to represent the locomotor development at the stage of core wounding and we run intervals. During the intervals I act in ways that can be corrective - offering help and support, checking for safety, and repeating corrective statements. Often by the end of the 4 minute cycle clients have “wired” in a new pattern. Although I am still doing research on this method, so far the results are positive for corrective change, depth oriented work, and mindfulness ability.

    HITT Training Exercises. I often use these for cravings. These are a variety of movements that include power training (strength and speed together). By asking clients to do a difficult movement for a short period of time we “short-circuit” the craving. Many of my clients have addictive patterns and this “gets them out of their heads”. It changes the physiology and helps get around negative thinking and habitual behavior patterns. Good examples are burpees, jumping lunges/squats, or pushups. A note of caution, make sure you understand the clients true ability and risk for injury before prescribing, and when working with eating disorders assess for ability to maintain the prescribed time limits, some folks will over use and perpetuate exercise addiction behaviors.

                As said in the beginning, movement is what anchors the experience. By choosing the right movement for the right disorder, matching the person’s personality, psychological presentation, and intended corrective experience interventions, movement lends itself to effective mental health treatments and can help heal physical health problems as well. By helping people learn to move effectively, they are also taught about personal power, inspiration, personal space, boundaries, strength, healthy eating patterns (think food/mood/microbiome), and decision making skills. There are many options and ideas, some very simple to start or send the client home to explore between sessions. As you consider adding movement into your practice, where do you think you will start?

    To get the full video lecture on this with more insights and ways to work with clients click here

    References

    Appelhans, B. M., and Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3), 229-240. DOI: 10.1037/1089-2680.10.3.229

    Droste, S. K., Gesing, A., Ulbricht, S., Müller, M. B., Linthorst, C, E., & Reul, J. M. H. M. (2003). Effects of long-term voluntary exercise on the mouse hypothalamic-pituitary-adrenocortical axis. Endocrinology 144(7). 3012-3023. DOI: 10.1210/en.2003.0097

    Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Psychoneuroimmuology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology 70(3). 537-547. DOI: 10.1037///0022-006X.70.3.537

    Porges, S. W. (2007). A phylogenetic journey through the vague and ambiguous Xth cranial nerve: A commentary on contemporary heart rate variability research. Biological Psychology 74(2). 301-307.

    Reuille-Dupont, S. (2014). Impact Psychological symptom severity on leisure time exercise behavior and perceived benefits and barriers to physical exercise. (Doctoral dissertation). Retrieved from ProQuest. (UMI Number 3686498)

    Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial trigger points then and now: A historical and scientific perspective. PM&R The Journal of Injury, Function, and Rehabilitation 746-761. DOI: 10.1016/j.pmrj.2015.01.024

     

    Bio

    Stacy Reuille-Dupont, PhD, LPC, CPFT holds a PhD in Clinical Psychology/Somatic Psychology from The Chicago School of Professional Psychology. She is a licensed clinical psychologist and licensed addiction counselor. Her psychology practice looks at the impacts of physical exercise on mental health symptoms. More at her psychology practice website: www.stacyreuille.com or blog: www.stacyrd.com where she blogs about psychology, movement, and health from the inside out.


  • 2 Dec 2019 5:16 PM | Anonymous member (Administrator)

    Boundary exercises:

    1. Toward and Away
    2. Like it / Don’t like it
    3. Boundary-Setting Script Rehearsal

    “Toward and Away” is a well-known physical proximity exercise that can be done with groups, couples, and individual clients.

    One person stands still and their partner, facing them from a few yards away, moves slowly toward the still person until the still one detects some sensation of alarm or hesitation and then tells the person coming toward them to stop. Clients usually need a few attempts at this to become sensitized to the somatic cues of their own boundaries, and it tends to be a satisfying process of self-discovery. Variations can include approaching from the sides, from the back, or with varying speeds.

    In groups, two lines of participants face each other and practice with the person facing them, taking turns. Couples do this with each other. Therapists can also practice this with their individual clients, volunteering as the "still" person if the client needs a demonstration of tracking somatic cues related to boundaries, threat, and safety.

    Like it/ Don’t like it

    One of the ways to introduce different aspects of relational dynamics is to designate one side of the room (or piece of paper if constrained) as “like it most” and the opposite side as “don’t like it at all”. Call out likes and dislikes at intervals, especially in regard to interpersonal dynamics, and have clients organize themselves along the spectrum for each statement, evaluating and expressing how much they (and their neighbors) like or don’t like something. This exercise has endless room for creativity, but examples relevant to the setting of interpersonal boundaries include statements such as:

    1) I like being alone when I’m angry;

    2) I like to resolve conflict immediately;

    3) I respond well to a thoughtful or expensive peace offering; and

    4) I really like being held by someone safe when I’m upset.

    This can be adapted to work with groups, families, couples, and individuals. It creates a safe space to playfully and honestly self-assess, understand each other, and express our individual preferences and shared neuroses.

    Boundary-Setting Script Rehearsal

    A fan of action methods, I have rarely been disappointed by combining somatic tracking with empty chair work to create a powerful therapeutic intervention. Using trauma physiology and affect tolerance to inform the practice of communicating interpersonal boundaries is a satisfying iterative process. The integration of somatic practice and action methods makes space for organic expressions of healthy aggression, dissociative adaptations, attachment behaviors and other coping strategies that make up the meat of therapeutic insight. This increased self-knowledge leads to a greater sense of choice and capacity for effective communication once attended to and worked through.

    The process is this: A client (with moderate affect tolerance) imagines someone they need, or needed, to establish a boundary with in the empty chair. As they attempt to articulate their boundary setting, the therapist helps them identify and process the feelings and instincts that arise and inhibit their honest expression of needs in their actual relationships.

    This exercise is ideal for individual sessions and group therapy. It can be useful in couple and family therapy, although it’s worth noting that the tension of the exercise increases dramatically when the invisible subject in the empty chair also happens to be visible, present and observing the exercise from the same room.

    Provided by By Sonya Denise Ullrich, MS, AMFT, SEP, ABMP

    Sonya Denise Ullrich, APCC, SEP is a practitioner with twelve years of experience in somatic trauma resolution and twenty years in manual therapies. She has a background in Somatic Experiencing, Feldenkrais, PACT couple therapy, and human ecology. She currently practices somatic psychotherapy throughout San Diego county, assists trainings in touch skills for trauma resolution, coordinates regional events for the California Association for Professional Clinical Counselors, and teaches workshops on touch skills for couples.

    She worked in a range of addiction treatment settings in California and Arizona and has developed addiction treatment programming based on somatic trauma resolution and attachment theory. She is passionate about interdisciplinary social science and global health. She is pursuing opportunities to research the use of touch cross-culturally and use participatory methods to develop culturally appropriate programming for trauma resolution.

    Learn more about her work online.


  • 31 Oct 2019 5:00 PM | Anonymous member (Administrator)

    Addiction From The Bottom Up: A Felt Sense/ Polyvagal Model of Addiction

    Many of us working in the healing arts are exploring alternative ways of experiencing and conceptualizing the body, recognizing that the western, post Descartes view of mind/body duality is distorted and harmful. Our current way of understanding and treating addiction reflects this disembodied view. Addiction is seen as a malfunctioning of our computer-like brains.

    Shifting into a bottom up approach allows us to experience the wisdom of the body, and the wisdom of addictive responses. From an embodied place of experiencing, and through the lens of Polyvagal Theory, we understand addictive behaviors as the bodies attempt to keep us  alive when being present is too overwhelming.

    It’s time to look at addiction with a fresh pair of eyes. I have created a new model in the conceptualizing and treatment of addiction. The current brain disease model is failing us, rates are soaring, and people are dying in the streets. We can and must do better than this!

    Over forty years of keeping my client's company I have developed a model that understands addiction as an adaptive attempt to regulate emotional states. Addictive behaviors are self-soothing/self harmful ways to survive when we aren’t able to calm ourselves. These behaviors do not come from sickness: they come from a bodily response to threat and a wired in mechanism of survival. The Felt Sense/ Polyvagal Model (FSPM) addresses addiction where it lives, in the body.


    Download the Felt Sense - Polyvagal Model (FSPM) Model


    This graphic model draws from the work of: Stephen Porges - Polyvagal Theory, a new understanding of the autonomic nervous system, Eugene Gendlin - Felt Sense embodied psychotherapy practice, and Marc Lewis - learning model of addiction. This work is a first in bringing addiction into the exciting world of Polyvagal Theory.

    The objective is to provide a graphic model of addiction that integrates new neurobiological findings in brain research, an alternative learning model of addiction (Lewis, 2015), and subsequent clinical approaches that address embodied trauma therapies. Therapists will be able to understand addiction using a sophisticated theoretical framework and treatment strategies that challenge old, pathologizing approaches. The model is adaptable to any school of psychotherapy or healing practice.

    As I began to learn about Polyvagal Theory, I realized that it enhanced my understanding of what I knew intuitively: Clients were using addictive behaviors to propel themselves from a state of sympathetic arousal to a dorsal vagal response of numbing, and vice versa. Through the lens of the Autonomic Nervous System (ANS), we see these behaviors as adaptive.

    The Felt Sense/Polyvagal Model

    Looking at the graphic depiction of the FSPM Clinician version we can see a number of important theories overlapping.

    Focusing and the Felt Sense

    The term Felt Sense, named by Eugene Gendlin, PhD. (Focusing, 1978) comes from a contemplative practice called Focusing.

    Focusing is a six step process that helps us to find our implicit, embodied knowing about an issue in our life. A knowing that is at first vague. Turning attention inwards and listening with compassion allows a felt sense, a whole sense of the situation, to form. See example below.

    Notice on the Felt Sense Polyvagal Model that each circular state has the words thoughts, feelings, physical sensations, and memories. Each of these different aspects of experience are a pathway into the Felt Sense. In asking questions about these aspects we help the client to deepen their embodied knowing of the issue. As the felt sense forms we pause and stay with the fullness of experiencing. Sometimes a Felt Shift, a physical release happens as the client integrates a new knowing. This shift is the bodies’ knowing and pointing in the direction of growth and healing. The client feels a relief, a settling. Focusing is a natural process that happens all the time. Gendlin didn’t invent it. He found that clients who were doing well in therapy were connected to their bodies. They had access to a Felt Sense. However, because we live in such a disembodied culture, many clients need help to connect, so Gendlin created the steps.

    The following is an example: A client comes in with anxious feelings and a tightening in her  throat. She says that she doesn’t know why she feels this way. We begin the process of quietly turning attention inwards, down into the centre of the body. Tears come as she connects the physical sensations with the feelings of sadness and anger. A beginning of the Felt Sense starts to form. I ask “Can you welcome both feelings?’ she pauses and explores where there are no words. She puts a hand on her throat.

     “ I don’t know how to be with anger”, she says. More sensing into the body.

     More tears flow as she feels the physical sensations of the Felt Sense flooding into her throat  and now down into her chest. A whole Felt Sense of her situation forms; thoughts, feelings, physical sensations, and memories.

    “This goes way back for me. Little girl afraid to be angry, so I cry instead. This needs to stop. I need my anger.”

    Her whole body moves and relaxes with a Felt Shift. She feels her throat loosening, a new piece has come for her. An explicit knowing that has great meaning for her. A need to connect with her anger. Her Felt Sense carries this meaning forward into her life as she welcomes what came in her Focusing practice session.

    Now we can map the felt sense onto the Felt Sense Polyvagal Model to integrate the autonomic nervous system states. This gives us more information about the client’s journey. In the Clinician version she has moved from chaos/sympathetic meme, down to Integrated/Ventral meme in her Focusing Oriented Psychotherapy session. Together we look at the Client Version of the model as she maps her journey from Flight/Fight to Flock.

    Polyvagal Theory

    Looking at the graphic depiction of the FSPM Clinician version, we can see:

    Three circuits of the ANS—Depicted in the solid line triangle at the bottom right legend

    A)    Ventral in yellow at the bottom of the page,

    B)    Sympathetic in red on the right, and

    C)    Dorsal in grey on the left.

    Intertwining States---Depicted in the dotted line triangle at the bottom right legend.

    Intertwining states are states in the system that utilize two pathways. The Autonomic Nervous System has the capacity to blend states creating a greater range of experiences.

    Intertwining states are represented in the model in mixed colors.

    Play is on the bottom right in yellow/red.

    Stillness is bottom left yellow/ grey.

    The FSPM proposes a third intertwining state of Addiction

    Addiction is at the top of the model, red/grey

    This state is a blending of sympathetic and dorsal. Without the presence of the ventral vagus, the Social Engagement System is offline. When trauma and other states of emotional dis-regulation occur, the capacity to regulate through the ventral vagus are compromised. The ANS shifts into survival mode. We can then employ addictive behaviors in an effort to seek relief from suffering.

    Applying The Model

    In addition to providing a new map for teaching the model, I have created a simple version for clients that uses 6 F’s to define the states of the Autonomic Nervous System. Flight/Fight, Freeze, Fixate, Flow, Fun, Flock. With time our clients learn how to identify and track the state that they are in, and to use the tools that we teach them to move more and more into the ventral vagal state.

    A Call to Action

    “Addiction is our teacher” says Bruce Alexander. In his new documentary, Rat Park, he shows us how we have lost connection with each other and with the natural world. He sees addiction not just as a psychological problem, but a global, political problem.

    Addiction is a political problem!

    I invite you to join me in standing up, and speaking up about a new way of understanding and treating addiction. I am currently writing a book about the model. For more information and questions please go to my website.


    Download Felt Sense Polyvagal Model to Share with Clients 


    A Call to Action

    “Addiction is our teacher” says Bruce Alexander. In his new documentary, Rat Park, he shows us how we have lost connection with each other and with the natural world. He sees addiction not just as a psychological problem, but a global, political problem.

    Addiction is a political problem!

    I invite you to join me in standing up, and speaking up about a new way of understanding and treating addiction. 

    I am currently writing a book about the model. For more detailed information and questions please go to my websitehttp://www.focusingonborden.com/


    Jan Winhall, M.S.W. R.S.W. F.O.T.T.  Toronto, Canada. Jan is a psychotherapist in private practice and Director of Focusing On Borden, a centre for teaching Focusing and Focusing-Oriented Therapy. Jan is the author of “Understanding and Treating Addiction with the Felt Sense Experience Model” In Emerging Practice in FOT. Jan teaches internationally and is a lecturer in the Faculty of Social Work at the University of Toronto. She is currently writing a book about her new Felt Sense/Polyvagal Model for treating addiction.

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