Solutions
Being trauma-informed
Hello and welcome to solutions this is the eighth episode of our fourth series of podcasts for solution focused hypnotherapists and I'm Kathy Eland. I'm Trevor Edles and we're both experienced solution focused hypnotherapists. This time we're looking at being trauma informed and how it can help our work our solution focused hypnotherapists. So Kathy what does it mean to be trauma informed? Okay so there are a number of working definitions but basically being trauma informed helps therapists to notice the signs of trauma that they may otherwise have missed when working with clients that didn't mention anything about trauma. It also helps therapists to better support clients who say they have experienced trauma by understanding the prevalence of trauma, recognizing the effects of trauma on clients and those close to them and avoiding re-traumatizing their clients. Okay so leading on from that what is trauma? Good question so according to mind trauma is when we experience very stressful frightening or distressing events that are difficult to cope with or out of our control. It could be one incident or an ongoing event that happens over a long period of time. Most of us will experience an event in our lives that could be considered traumatic. And that's when I go on matter if the authors suggest that it might be more useful to think of trauma as a spectrum because few people are without some scars from life. Yeah so are we going to cover everything people need to know in this podcast Trevor? No but we'll hopefully give people an idea of what to find out more about. Okay so many people have a diagnosis of post-traumatic stress disorder known as PTSD following being in a war zone or being caught up in a bomb attack or similar situation or perhaps surviving a natural disaster. But they are not the only situations that cause PTSD symptoms. People who were abused as children whether that sexual, physical or emotional abuse can show similar symptoms. We also now know that one generation's trauma can be passed down to the following generations through the power of epigenetics and it suggested babies in the mother's uterus and while being born can also be traumatized. Most often it seems the trauma occurs when a person is unable to move or if they can move they like the ability to have any effect on what they're living through. This contrasts with examples of people who've been close to some terrible event but because they were able to get away from the situation they had agency. They were upset but not traumatized. That's so interesting. So during a typical day events will happen and people will forget the majority of what has happened. Anything else that happens will be turned into a narrative memory and may well be stored for a period of time. If asked about those events a person will be able to tell a story with a beginning, middle and end. The person will know that they are talking about an event from the past. Yes but however with the traumatic memory if it's stored as a series of fragments and when the memory is recalled usually involuntarily as a flashback it will to all intents and purposes appear to the person as if it were happening in real time to them. It still has all the emotional impact that it did when it first occurred and deliberately trying to remember the traumatic event can make it seem like the person is experiencing them all over again. The power of the flashback doesn't diminish even though the event may have taken place many years before it can re-traumatize them. Now many people think trauma is something that happens to a person but a better way of looking at it is to see it as what happens inside them. The impact of trauma is that it keeps a person stuck in the past until they can work through it. Trauma affects a person's sense of worth, their relationships and their appreciation of life. An event is traumatizing or re-traumatizing if it leaves a person more limited than before in a way that persists. It leaves an unable to respond flexibly to life's ups and downs. Trauma also separates a person's mind from their body it's as if what's happening or has happened to the body is separate from them. The good news is that seeing trauma is an internal dynamic rather than an external event gives a person agency in terms of healing and reconnection. All right so someone who has been traumatized will continue to organize their life as if the trauma was still going on and every new encounter or event is contaminated by the past. The person becomes focused on suppressing their inner chaos rather being involved in their day-to-day life and this can lead to a number of physical symptoms including fibromyalgia, chronic fatigue, and other autoimmune diseases. Your dissociation is typically experienced by traumatized people. Emotions, sounds, images, thoughts and physical sensations related to the trauma take on a life of their own. They are relived in the present. People often overreact to minor situations. For people with PTSD a flashback can occur at any time whether they're awake or asleep. They don't know when it will occur or how long it will last. People have experienced flashbacks often arrange their lives around trying to protect against them. Traumatized people chronically feel unsafe inside their own bodies. The past is alive in the form of a gnawing interior discomfort and by ignoring or distorting their body's messages they are unable to detect what is dangerous or harmful for them and what is safe or nourishing. Self-regulation depends on having a friendly relationship with others. Without the ability to regulate internally people come to rely on external regulation. For example, medication, drugs, alcohol, constant reassurance or compulsive compliance with the wishes of others. It's very common during a traumatic experience for people to experience depersonalization where people feel that they're seeing themselves from outside their body or they sense that things around them are not real or both. People who have experienced trauma can have problems with adult relationships. This is termed trauma bonding where people have painful narratives about themselves that reflects deficiencies. They often only feel whole in a relationship with someone else. This is called co-dependency and the relationship often doesn't last. Where there has been childhood trauma in their relationship patterns, the adult will look for the same states in their relationships, but the good news is that trauma can be healed with positive relationships. That's good, co-dependency refers to an imbalanced relationship pattern in which one person assumes responsibility for meeting another person's needs to the exclusion of acknowledging their own needs or feelings. And another term used with trauma is the felt sense, which is a way of describing internal bodily awareness. People experiencing a felt sense feel more in tune with their body. Trauma exists within the felt sense and can lead to feelings in the stomach, freezing or even throwing a punch. Traumatic responses happen in the body, it's said, and the mind tries to make sense of it. Yoga and other techniques try to create a union between the mind and body. Traumatic events can lead to what are called contractions, feelings of shutdown in the body. When working with clients, it's often the case that they make plans in the brain that somehow the person sabotages, which of course is called self-sabotage, this is because of these contractions. The first thing the therapist needs to do is recognize these contractions or tensions exist in the system. Using gendling, philosopher and psychologist coined the term felt sense. He said a felt sense is not a mental experience, but a physical one. A felt sense doesn't come to you in the form of thoughts or words or other separate units, but is a single, they're often puzzling and very complex, bodily feeling, which he called an aura. Okay. And the term holding space was first popularized by Heather Platt, a writer and facilitator who described holding space as being willing to walk alongside another person in whatever journey they're on without judging them, making them feel inadequate or trying to fix them or trying to impact the outcome. Holding space refers to the act of being fully present with someone else without judgment or distraction, so the person can share their experiences and perspective. This looks like creating a safe, accepting environment, engaging in attentive listening and offering non-judgmental support. So holding space refers to a shared space between the client and the therapist. Clients who have experienced trauma have an inability to relax unless they're somewhere that feels safe to their nervous system. The therapist needs to create a space where it's safe to feel vulnerable and healing can occur. This space can be thought of as a healing bubble. The client can relax as they enter the bubble. The client can feel grounded and co-regulation and attune them between the therapist and the client helps the client to feel safe. An analogy would be a room full of grandfather clots. His pendulums are swinging completely out of time with each other. After a while they all harmonize. This is referred to as coherence and it allows the client to feel more present. It may be the case that the client feels uncomfortable with eye contact. If that is the case, I'll send to notice what's happening in their body before they look away. Okay. Many of our conscious thoughts are complex rationalizations for the flood of instincts, reflexes, motors and deep-seated memories that emanate from the unconscious. And many behaviours started out as strategies for self-protection. These adaptations to trauma can so interfere with the person's capacity to function that they often believe that full recovery is not possible. A better way of looking at things is to see oppression, depression, arrogance or passivity as learned behaviours. Traumatic adaptations continue until the person feels safe. Okay. And traumatized people often need help to associate intense sensations like hunger or pooing with safety, comfort and agency. This gives them back control of their body and their life. Traumatic memories, as opposed to narrative memories, can last as long as the originating incident, they are frozen in time, unchanging and people are always lonely, humiliating and alienated by the experiences. Traumatic people need to be helped to gain ownership of the body and mind. They need to be able to know what they know and to feel what they feel without becoming overwhelmed, enraged, ashamed or collapsed. They need to find a way to become calm and focused. They need to learn to maintain that calm whenever images, thoughts, sounds or physical sensations remind them of the past. They need to find a way to be fully alive in the present and engage with the people around them. And they need to not have to keep secrets from themselves, including secrets about the ways that they have managed to survive. Trauma survivors need to restore the proper balance between their rational and emotional brains so that they can feel in charge of how they respond and how they conduct their life. They need to escape from being triggered into states of hyper or hypo arousal. They may become disorganized, sounds and lights bother them, unwanted images from the past intrude in their minds and they panic or fly into rages. Alternatively, they shut down and feel numb in body and mind. They're thinking becoming sluggish and they have trouble even getting out of the chair. Therapy should help give people back agency in their life. Agency is the technical term for the feeling of being in charge of your life. And it starts with what scientists call "interaception". Our awareness about subtle sensory body-based feelings. The greater the awareness, the greater our potential to control our lives. There are probably three ways to help traumatize people. The first one, top down by talking and reconnecting with others and allowing people to know and understand what is going on with them while processing the memories of the trauma. Secondly, by taking medicines that shut down inappropriate alarm reactions or by utilizing other technologies that change the way the brain organizes information. And also bottom up by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage or collapse that results from trauma. Top down regulation involves strengthening the capacity of the medial prefrontal cortex, the MPFC, to monitor a person's body's sensations. Mindfulness, meditation and yoga can help with this. Bottom up regulation involves recalibrating the autonomic nervous system, the ANS. The ANS can be accessed through breath, movement or touch. Following talking therapy, many traumatized people will understand the source of the impulses that they feel. However, that still doesn't help them to control those impulses. With nearly every part of their brain not operational, blanked out clients just can't think, feel deeply, remember or make sense of what is going on. And that makes talk therapy virtually useless for them. Okay, so what's needed is for them to become alert and engaged. The bottom up approach to therapy can change a person's physiology and their relationship to bodily sensations. People need to be helped to notice these bodily sensations. Techniques such as emotional freedom therapy, EFT or tapping, rhythmic interactions with other people and drumming or dancing to music also seems to work. The bottom up therapy aims to draw out the sensory information that is blocked and frozen by trauma. It also helps patients befriend rather than suppress the energies released by that inner experience. And it helps completely self-preserving physical actions that were thwarted when a person was trapped, restrained or immobilized by terror. Okay, trauma survivors need to become familiar with the sensations in their bodies and the way that their body interacts with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past. It's useful to encourage people to first notice and then describe the feelings in the bodies. Not the emotions like anger, anxiety or fear, but the physical sensations beneath the emotions, for example, pressure, heat, muscular tension, tingling, caving in, feeling hollow and so on. It's also useful to work on identifying the sensations associated with relaxation or pleasure and help clients to become more aware of the breath, gestures, movements. It desensitizing people to their past and expecting that re-exposure to their traumas will reduce emotional outbursts and flashbacks seems wrong because although it may make people less reactive, it doesn't address the issues of them not feeling a part of and enjoying everyday life events. Therapist needs to help bring online those brain structures that went offline when the person was traumatized. Similarly, the use of drug therapies only reduces symptoms but doesn't get to the root of the problem. But therapists mustn't try to fix their clients because of course this implies that the client is broken in some way although clients may think they are broken. They have simply adapted to their traumatic situation rather than their current situation and besides, no one's perfect. In therapy, revisiting the trauma should be done while people are biologically speaking, firmly rooted in the present and feeling as calm, safe and grounded as possible. Neuroception is a term coined by Stephen Porge to describe the capacity of a person to evaluate the relative danger and safety in their environment. If a person's neuroception is faulty, therapy needs to reset their physiology so that their survival mechanisms stop working against them. They need to be able to respond appropriately to danger and recover the capacity to experience safety, relaxation and true reciprocity. If people hug others as a way of calming themselves down, but people who've been physically or sexually violated are at the same time terrified of bodily contact. For them, therapy needs to help them to feel physical sensations and to tolerate and enjoy the comforts of touch. And when people who are dissociated, the goal of treatment is association, i.e. integrating their traumatic memory into the ongoing narrative of life so that the brain can recognise that it is an event from the past and not part of the present. To enhance someone's self-awareness, it's useful to say things like, notice that, or what happens next. And once the traumatised survivor can pay attention to their physical sensations, the next step is to label the sensations, for example, when I feel anxious, I feel a crushing sensation in my chest. Try saying to them, focus on that sensation and see how it changes when you take a deep breath out, or when you tap your chest just below your collarbone, or when you allow yourself to cry. This mindfulness exercise calms down the sympathetic nervous system, reducing the likelihood of a fight or flight response. Yeah, you can investigate their thoughts and physical sensations further by asking how particular thoughts register in their body, investigating how different thoughts, e.g. my girlfriend dumped me, produced different sensations. As they become aware of how their body organises, particular emotions or memories, they can begin to release sensations and impulses that they previously blocked. And once survivors realise that their post-traumatic reactions were an attempt to save their life, they may feel confident enough to revisit the trauma during a session. And therapists need to help traumatise people to stabilise and calm down. To lay traumatic memories and rear enactments to rest. And to reconnect with other people. Once a survivor can tolerate being aware of their trauma-based physical experiences, they are likely to discover powerful physical impulses, e.g. hitting, pushing or running, that arose during the trauma, but were suppressed in order to survive. These impulses manifest themselves in subtle body movements, such as twisting, turning or backing away. Amplifying these movements and experimenting with ways to modify them begins the process of bringing the incomplete trauma-related action tendencies to completion, and can eventually lead to resolution of the trauma. Taking effective action gives a person back a sense of agency and a sense of being able to actively defend and protect themselves. Processing a trauma needs all the brain areas that went offline during the originating trauma to be now available to the person. Two important areas are the dorsal lateral prefrontal right cortex, which provides a sense of time and perspective and makes it possible to know that an event was in the past. And the sensory areas of the parietal lobe that integrates the images and sounds and sensations of trauma into a coherent story. Without those parts of the brain being available, events are experienced in fragments of sensations, images and emotions. Keeping those areas available allows people to integrate their traumatic memories as belonging to the past. And when working with traumatized people, it's useful to confront the details of the trauma and then stop and go to a place of safety. This process is sometimes called "pengellating". Stopping is achieved by grounding the person in the present moment. And there are a number of techniques that seem to work with trauma survivors, including EMDR, yoga, neurofeedback and others. Science may show some of the symptoms of trauma without having a diagnosis of PTSD or similar. And the DSM-5 doesn't extend its PTSD diagnosis to include child abuse. We may see people with sleep problems, OCD, unwanted thoughts and more. These may possibly be the results of unresolved trauma. It's worth being trauma-informed. Well, I hope you found that informative. Next time, we'll be looking at limiting beliefs and helping people change their habits. Brilliant. So, until then, it's bye for me, Cathy Eland. And it's goodbye from me, Trevor Eddles. We'll see you next time. Bye. Bye.