Rethinking Trauma - Amazon S3 · 2018-08-17 · Rethinking Trauma How to Help lients reak the ycle of Traumatic Memory ... Healing the Traumatized Self: Consciousness, Neuroscience

How to Help Clients Break the Cycle of Traumatic Memory Peter Levine, PhD - TalkBack - pg. 1

Rethinking Trauma

How to Help Clients Break the Cycle of Traumatic Memory

a TalkBack Session with

Ruth Lanius, MD, PhD; Ron Siegel, PsyD; and Ruth Buczynski, PhD


Table of Contents

(click to go to a page)

What Stood Out Most ........................................................................................... 3

How Community Can Help Overcome the Effects of Trauma ................................. 6

Strategies for Working with Implicit Memories ...................................................... 9

The Future of the Field of Trauma Treatment ......................................................... 11

About the Speakers ............................................................................................... 13

TalkBack Session: How to Help Clients Break the Cycle of Traumatic Memory

with Ruth Buczynski, PhD; Ruth Lanius, MD, PhD; and Ron Siegel, PsyD


Dr. Buczynski: I am back now with my two colleagues. Now we are getting into the TalkBack portion.

We are going to chew on the ideas that we have heard from Peter, think about them more, and give you

some ideas and ways of thinking about them.

I am joined by Dr. Ronald Siegel and Dr. Ruth Lanius.

Ron is a licensed psychologist in Boston and the Assistant Clinical Professor of Psychology at Harvard Medical

School. He is the author of many books, and tonight I will mention Wisdom and Compassion – he is coauthor

of Wisdom and Compassion in Psychotherapy, and that has a foreword by His Holiness the Dalai Lama.

Ruth is a physician and a Professor of Psychiatry at the University of Western Ontario in Canada. She is also

coauthor of the book: Healing the Traumatized Self: Consciousness, Neuroscience and Treatment.

So, I can’t wait to jump in with you both and get your thoughts on this. There were a lot of interesting ideas

here. I am going to start the way I always do with the question: “What stood out to you?” and we’ll start with

you, Ron.

What Stood Out Most

Dr. Siegel: Peter Levine has been such a pioneer, and what stands out to me most is his pioneering

observation that animals, when they are involved in some kind of a threat situation will, at a certain point,

often move into a freeze response.

When they come out of this freeze response, they have some sort of discharge: they are either shaking in

some way, or panting, or very often they are continuing whatever the motor response would have been in

the moment in which the trauma had occurred.

His fascinating observation is that we are animals, too – clearly, we are mammals – but we don't see

ourselves doing this, at least not readily, not fluidly and not reliably. So, what’s up? His conclusion is that we

with Ruth Buczynski, PhD; Ruth Lanius, MD, PhD; and Ron Siegel, PsyD

TalkBack Session: How to Help Clients Break the Cycle of Traumatic Memory


learn not to do it.

For us, the discharge involves things like crying, or shaking, or continuing whatever the procedural memory

might be of the motor sequence that would be involved in what had gone wrong – and yet we don't play that

out. We tend to inhibit that.

And he raises the question, “Could that be curative of trauma, if we could help people to connect with that?”

and he’s discovered that indeed, it seems to be.

That’s a masterful contribution, which has then come up in Pat

Ogden’s work, in Bob Scaer’s work, and in the work of many other

people who have expanded on this core discovery, which is very

important.

Also, we see the vital importance of other people. We have seen that

come up over and over in different elements of the trauma series.

We see this in neurobiological research. Stephen Porges’s work about

the mammalian branch of the vagus nerve that is involved in facial expression is about the way in which our

interpersonal connection that is done in part through facial expression is part of the curative process of

healing trauma.

Peter brings in very interesting anthropological evidence from Navajo and Hopi tribes, and shows how, when

people experience trauma, the way that they come back – the way they heal – is through reconnection to the

tribe. So that is a very important contribution.

I’ll just mention a couple of other things. Peter warns about the problems of

being too attached to declarative or explicit memory, and he speaks so nicely

about how we learn to do that, starting in elementary school – this idea that,

“Don't tell me about your subjective experience; tell me about some objective fact.”

I’m always thinking of – for those of you who are old enough to remember – Sergeant Friday in Dragnet.

People would be talking about their implicit memories – they’d be talking about powerful subjective

experiences, and he’d go, “Just the facts, ma’am!”

That captures this bias – and Peter does a really nice job of highlighting the dangers of that, particularly the

“For us, the discharge

involves things like crying,

or shaking, or continuing

whatever the procedural

memory might be of the

motor sequence that

would be involved in what

had gone wrong – and yet

we don't play that out.”

“Our interpersonal

connection is part of

the curative process

of healing trauma.”


grievous danger of the therapist having some narrative for what happened and forcing it down the mind and

the voice of the patient.

Then finally, of course, there’s the importance of staying with the

body in the here and now, both as an avenue into implicit memory,

but also as a way to get safety – a way to have a sense of “It’s okay; it’s just experience happening in the here

and now.” He puts it so eloquently: “Revisiting trauma rather than reliving trauma.”

Dr. Buczynski: Thanks. How about for you, Ruth, what stood out to you?

Dr. Lanius: Peter’s groundbreaking work helps us to normalize the responses to trauma.

As Ron talked about, the fight, flight and freeze responses that also occur in animals help to normalize this

experience.

So often our patients will tell us that when they had a freezing response, they felt useless – they feel so guilty

that they couldn’t act to overcome whatever they needed to overcome at

the time of the trauma – they simply couldn’t move.

Putting this in perspective with what happens in animals and relating it to

what happens in humans can be incredibly helpful.

And then what I also really like and what stood out for me was this sense of empowerment he talks about.

As we work with trauma and with the body, we can help to empower the person from the bottom up – from

body up – helping them to move through very difficult experiences.

Also, Peter touches on the extremely important concept of the intergenerational transmission of trauma.

If a person has been traumatized – has difficulty regulating their emotions or knowing what they feel – this

not only has huge implications on their offspring, but also affects

the whole community.

This is what we’re seeing, especially with the veterans coming back

from Iraq: they are dysregulated; they have anger outbursts; they

feel numb; they can’t have loving feelings; they get disconnected

from their partner and their families and very often their marriages break up – you see this intergenerational

“There’s the importance of

‘Revisiting trauma rather

than reliving trauma.’”

“Peter’s groundbreaking

work helps us to

normalize the

responses to trauma.”

“If a person has been

traumatized this not only has

huge implications on their

offspring, but also affects the

whole community.”


transmission of the trauma.

This has effects on the whole community – on the entire country.

Whenever we are talking about trauma, it is so important to realize that these effects can occur and we can

intervene by treating the trauma.

Peter beautifully illustrates how we can use the entire community to help overcome some of those

intergenerational effects.

How Community Can Help Overcome the Effects of Trauma

Dr. Buczynski: Let’s stay with that idea for a minute – maybe we could look at the story he told about the

tribal woman who was traumatized in Brazil, and how the tribe helped to treat the trauma using the entire

community.

We are not as tribally oriented in the United States and in many parts of Europe, but how can we make that

useful in our more individualistic culture?

Since you have both talked a little bit about this, I’d like to hear from both of you on this. Let’s start with you,

Ron.

Dr. Siegel: That’s a great question. It reminds me of Chris Peterson before he passed away, who is one of the

leading figures in the positive psychology movement.

He was looking over the last 15 or 20 years of research and said, “In

terms of what makes for human well-being, it’s about other

people.” That was his summary conclusion.

As a field, I think we’re coming around to this and we’re seeing it from so many different angles.

Desmond Tutu, for example, says that in many African cultures, if you were to ask somebody “How are you?”

the person would say, “We’re fine,” or “We’re having a difficult time.” The idea that one could even have well

-being or the absence of well-being disconnected or autonomous from the rest of the community is absurd.

And yet, as you point out, we have a culture that has such an emphasis on this kind of individuality.

“The whole hardwiring that

we have for social

interaction interfaces with

what happens with trauma.”


I’m also struck by the whole hardwiring that we have for social interaction and how this interfaces with what

happens with trauma.

We are talking about basically not having a sense of safe connection with others – which is such a risk factor

for adverse events later in our life becoming traumatic and leaving scars.

We have so many different avenues pointing to the importance of this interpersonal realm.

So, how do we deal with that in therapy?

It begins, if we are doing therapy, in the nature of the therapeutic

relationship. We know that the therapeutic relationships that are successful

are those in which the therapist is experienced, warm, empathic and understanding, and it behooves us to be

warm, empathic and understanding.

Even though the literature doesn’t say we have to actually be that way, it will certainly help if we are more

empathic and understanding – to be experienced in that way.

And a lot of that has to do with our own work – our own capacity to be with all of our own split-off traumas,

all of our own fears, all of our own longings, so that when we are sitting with a traumatized person, we can

actually be present – because it is not easy to do that.

Most of us, while not in full-blown dissociation, disconnect to some extent when somebody is talking about a

really painful experience, because we don't really want to feel it.

We need to do our own practice – whether it is a mindfulness practice or our own therapy practice as a

patient or a client – in order to be able to be open to patient

experiences.

Interestingly, we can also help people to have a sense of

interpersonal connection internally.

Loving-kindness practices are now taught very much in the

West, and we tend to teach them by saying, “First, begin with a

benefactor – begin by imagining somebody who is naturally loving and kind, and imagine sending loving-

kindness toward that person and then having that person send it in turn toward oneself.”

“It behooves us to

be warm, empathic

and understanding.”

“We need to do our own

practice – whether it is a

mindfulness practice or our own

therapy practice as a patient or

a client – in order to be able to

be open to patient experiences.”


It is an internal process, in a sense, but it is with an imaginary other that can bring some of this sense of

connection and safety.

Self-compassion practices can do the same thing: imagine, if we are feeling bad about ourselves, writing a

letter to ourselves from the vantage point of a compassionate friend.

That is done internally in that the “live other” isn’t there, but yet we get the same feeling of love and

connection that can be so healing.

There are also the 12-step programs and how they can provide this sort of support – they become the tribe,

if you will, in an otherwise often alienated culture, because these are people who understand and with whom

we can be honest.

Group therapy can do this; certainly being part of a church or a temple or a meditation group can do this.

We can write gratitude letters – this is another positive-psychology intervention, and one that Martin

Seligman found to be the most powerful single intervention you could do.

You think of somebody who has been helpful to you who you never adequately thanked, and you write a

letter to them thanking them, and then actually deliver the letter!

All of these are ways to create a sense of connection in an otherwise easy-to-be-alienated culture.

Dr. Buczynski: Thanks. I have found, in particular, that the more we explore the whole idea of self-

compassion and the research, the more we are finding that self-

compassion is a reparative experience.

Dr. Siegel: Self-compassion is really about creating a connection even if

the other person isn’t there.

Dr. Buczynski: Yes, and maybe more necessary in our individualized culture than it might be in a more

tribally oriented culture.

Ruth, what are your thoughts on that particular story and how we can use this idea even in our more

individualized culture?

Dr. Lanius: I want to continue this idea of self-compassion for a minute, which I agree is absolutely key – that

internal connection.

“Self-compassion is

really about creating a

connection even if the

other person isn’t there.”


When we are working with severely traumatized individuals, establishing that self-compassion is often so

difficult and takes a long while, but the lack of self-compassion is at the core of the pathology.

What we often do – and I’m sure you do this as well – is to work with the adult self and the child self to begin

that process of self-compassion.

When you first discuss it with people, often they are very

hesitant and they are very anxious and frightened about it, and

it’s important to give them the distance and the space between

these two states of self so they can slowly come together at a

pace that feels comfortable for each person.

That is the first step of reconnection within oneself, which then

helps to reconnect with all the things that Dan has already talked about.

I can’t stress group therapy enough, especially with people who have been chronically traumatized – it is so

important to first start by building that sense of community where it

feels safe, because often interpersonal connections are so difficult for

these individuals to maintain.

To have a group of people who have gone through similar experiences

where they can start to feel a sense of connection, where they can feel validated, where they can start to

support each other, cheer each other on, and not judge each other, that kind of group therapy is absolutely

essential for healing the traumatized self.

Strategies for Working with Implicit Memories

Dr. Buczynski: Moving on, Ron, what are some good strategies for working with patients’ implicit memories?

Dr. Siegel: Yes, Peter does a nice job of stressing the importance of staying with the here-and-now, moment-

to-moment experience in the body and using this as a kind of base from which to then reach into the implicit

memories.

If we look at the wide variety of trauma interventions that are out there, some of which have good data to

“When we are working with

severely traumatized

individuals, establishing that

self-compassion is often so

difficult and takes a long while,

but the lack of self-compassion

is at the core of the pathology.”

“Group therapy is so

important to building

that sense of community

where it feels safe.”


support them, they all do this in one way or another.

EMDR – eye movement desensitization and retraining – is one, and what does that do?

The theory is you are helping to cross the corpus callosum because implicit memories are stored in one side

of the brain and declarative memories more on the other.

So, therapists will use either flashing lights, a moving object, or tapping on one side or the other – basically

bringing attention to some sensory experience in the present,

and once doing that, giving in to implicit memory – what

comes up about the trauma (which is mixed with declarative

memory in EMDR) – and then coming back to the sensation in

the present.

Whatever the research winds up telling us eventually about the importance of crossing the corpus callosum –

whether that is important or not or whether this would work vertically – what we are doing is we are doing

what Peter is talking about: we are bringing attention to the present, and out of the safety of the present, we

are dipping into these traumatic experiences.

Many people use EFT techniques – emotional freedom techniques – to work with trauma successfully. The

particular places in which people are doing tapping are supposed to be connected to the meridians from

Chinese medicine and Vedic traditions.

But again, whether or not that pans out in the research, we are having

this idea of bringing attention into the body in the present and using that

as a kind of secure base.

We even see similarities to this in Gendlin’s Focusing where the first

move is always called clearing a space, which is finding some way to find

the right balance between the intensity of a traumatic memory and – whether it is implicit memory or explicit

memory – the safety of the present moment.

We’re working with the idea of titrating between the intensity of what we are trying to reintegrate and the

safety we get from the present, which is part of all these techniques.

Peter does a really nice job of talking about the importance of doing this kind of titration so that people can

“We are bringing attention to the

present, and out of the safety of

the present, we are dipping into

these traumatic experiences.”

“We’re working with the

idea of titrating between

the intensity of what we

are trying to reintegrate

and the safety we get

from the present.”


indeed revisit but not relive the trauma.

We don’t want the trauma to be re-traumatizing.

He talks about the dangers of it being re-traumatizing, which is very important, because many clinicians

attached to the idea of “I’m going to help this person reintegrate” have unfortunately injured folks by

bringing up material without sufficient safety in the present.

Dr. Buczynski: Yes, that is clearly something that can happen without enough training or care – unintentional

consequences.

The Future of the Field of Trauma Treatment

Dr. Buczynski: Ruth, where you see the field going – the field of the treatment of trauma.

What will we be thinking about? What is most promising?

Dr. Lanius: We will be seeing, hopefully, exactly what you have created

through this session, which is an integrative approach.

We need to keep this sort of integrative approach in mind when we see

patients or clients, and we need to individualize the treatment.

People will require different approaches at different times as Ron just talked about.

When we think about trauma and the treatment of trauma in stages or as an approach, we need to create

safety, and that can be through mindfulness, through emotional regulation, through safe relationships and

through empowerment within the body, and then we can move on to trauma processing.

Again, we want to use various techniques, including the body and

exposure-based treatments such as EMDR.

Throughout this whole process, we want to always foster

reconnection.

I can’t stress enough how important it is to be familiar with a

“We will be seeing,

exactly what you have

created through this

session, which is an

integrative approach.”

“When we think about trauma

and the treatment of trauma

in stages or as an approach,

we need to create safety, and

then we can move on to

trauma processing.”


variety of treatment techniques.

Our trauma patients are very complex patients. One technique alone is

unlikely to help these complex disorders.

It’s important to have an integrative treatment approach that we

individualize – we can win with that, and I think you have done a

wonderful job in bringing all of these approaches into your courses.

Dr. Buczynski: Thank you – and let me just say thank you to the two of you.

It has been so much fun working with you and sharing our mutual thoughts. See you soon.

“Our trauma patients are

very complex patients.

One technique alone is

unlikely to help these

complex disorders.”


About the speakers . . .

Ruth Lanius, MD, PhD is a professor of Psychiatry and the director of the PTSD Research

Unit at the University of Western Ontario. She established the Traumatic Stress Service and

the Traumatic Stress Service Workplace Program, both

specializing in the treatment and research of PTSD and

related comorbid disorders. She currently holds the

Harris-Woodman Chair in Mind/Body Medicine at the

Schulich School of Medicine and Dentistry at the

University of Western Ontario.

She has authored more than 100 published papers

and chapters in the field of traumatic stress, regularly

lectures on the topic of PTSD nationally and

internationally, and has published Healing the

Traumatized Self: Consciousness, Neuroscience,

Treatment, together with Paul Frewen.

Ron Siegel, PsyD is an Assistant Clinical

Professor of Psychology at Harvard Medical School,

where he has taught for over 20 years. He is a long

time student of mindfulness mediation and serves

on the Board of Directors and faculty for the

Institute for Medication and Therapy.

Dr. Siegel teachers nationally about mindfulness and

psychotherapy and mind/body treatment, while

maintaining a private practice in Lincoln, MA.

He is co-editor of Mindfulness and Psychotherapy

and co-author of Back Sense: A Revolutionary

Approach to Halting the Cycle of Chronic Back Pain.

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Rethinking Trauma - Amazon S3 · 2018-08-17 · Rethinking Trauma How to Help lients reak the ycle of Traumatic Memory ... Healing the Traumatized Self: Consciousness, Neuroscience