NeuroAffective Relational

ModelSupervision for Wounded Healers

Rev. Caroline Cupp, M.Div, MBE, BCC

October 10, 2014

“When the Lord saw that he had gone over to look, God called to him

from within the bush, ‘Moses! Moses!” And Moses said, ‘Here I am.”Exodus 3:4

Introduction to NARM

History of the NeuroAffective

Relational Model

Developed by clinical

psychologists Laurence

Heller and Aline LaPierre

Explores the impact of

trauma on psychological

and biological development

Integrates elements of

psychodynamic orientations

(self psychology, ego

psychology, and attachment

theory)

The NARM Approach…

Is resiliency-based, using areas of strength to address

coping strategies that have outlived their usefulness

Moves bottom-up and top-down, helping students to

recognize what they feel about their thoughts and what

they think about their feelings

Seeks to promote creativity, curiosity, and connection

Trauma

Trauma is used broadly in the NARM model

Trauma = Greek word for wound

Trauma can include abuse, neglect, and early loss as well as chronic parental misattunement, poverty, early surgeries or incubation, or being born into wartime

Trauma is widespread, so most individuals display some characteristics of those people who have been most deeply affected

Even with loving and capable parents, young children can experience woundedness

Young children cannot experience themselves as a “good person in a bad situation” – failures of the holding environment are internalized as failures of the self

Core Needs and Capacities

Core Needs

NARM recognizes 5 biologically-based core needs that

are essential to physical and emotional well-being:

Connection

Attunement

Trust

Autonomy

Love-Sexuality

When these core needs are met in children, they feel

safe, trusting of the world, and connected to their

bodies and to their emotional selves. As adults, they

can address these needs in themselves and others.

Development of Core Capacities

Core NeedsAttuned

Caregivers

Capacities for Connection,

Aliveness, and Creativity

Core Needs and Capacities

Core Need Core Capacity

Connection Capacity to be in touch with our bodies and

emotions

Capacity to be in connection with others

Attunement Capacity to attune to our needs and emotions

Capacity to reach out for and take in emotional

nourishment

Trust Capacity for healthy dependence and

interdependence

Autonomy Capacity to set appropriate boundaries

Capacity to speak our minds without guilt or fear

Love-Sexuality Capacity to live with an open heart

Adaptive Survival StylesWhen Core Needs are Not Met

Adaptive Survival Styles

Humans are built with the ability to disconnect from

painful experiences

When their core needs are not met, children develop

strategies (Survival Styles) that help them to cope with

the resulting feelings of pain and isolation

Survival Styles have a shame-based identifications that

make sense of early environmental failure. In reaction,

most people also develop pride-based counter-

identifications, portraying the way they want to be seen

by the world

Development of Adaptive Survival

Styles

Core NeedsCaregiver Failures

DisconnectionCompromised Core Capacity

Adaptive Survival Style

Shame and Pride-Based

Identifications

Shame and Pride Based Identifications –

The Rowing Example

When I rowed in college, I had

to find a way to keep in time

with my boat-mates due to my

cerebral palsy

Unlike most female rowers

who use their legs for power, I

had to use my arms

The harder I rowed, the more

built up my arms became and

the weaker my legs

Suffering Comes from Life-Saving Responses

that Have Outlived their Usefulness

We survive by adapting to our environment

Initially, these survival strategies are life-saving responses and successful adaptations to the environment

It is the persistence of survival styles appropriate to the past, continuing when they are no longer needed, that distorts experience in the present

Connection Survival Style

Connection Survival Style

individuals have experienced

trauma at the earliest stages

of their development (pre-

birth – 6 months)

As a result, children give up

their sense of existence.

They disconnect from their

bodies and emotions and

attempt to become invisible

Connection Survival Style, Contd.

Thinking Subtype

Individuals who retreat to

the life of the mind

Intelligence and thinking

are used to maintain

emotional distance from

others

Spiritualizing Subtype

Individuals who spiritualize

their disconnection from

other people

A connection with God,

nature, or animals becomes

a substitute for connection

with other human beings

Connection Shame- and Pride-Based

Identifications

Connection Shame Based Identifications

Terrified

Inadequate,

Shame at Existing

Feeling like they are always on the outside looking

in

Connection Pride-Based Counter-Identifications

Pride in rationality, non-emotionality

Contemptuous of others seen as driven by emotion

Pride in otherworldly orientation

The Connection Survival Style in Adults

Feel shame about needing anything from anyone

Use interpersonal distancing as a substitute for lack of

adequate boundaries

Fear their own impulses, particularly anger

Thinking subtypes tend to relate on an intellectual level

rather than a feeling level

Spiritual subtypes are drawn to therapies and spiritual

movements that reinforce dissociation, such as

charismatic and holiness traditions

Portrait of a Connection Survival

Style – Spiritual Subtype Student BT grew up in an environment of extreme poverty

where both parents used drugs. He experienced a number of losses at an early age, including his mother and grandmother.

In his CPE group, BT often had difficulty naming his feelings. When asked to describe an encounter with a student, he would respond, “It was just a spiritual connection – I didn’t do anything. The goal of the pastor is to disappear.”

At times BT’s peers grew frustrated with him when he dismissed their questions about medical terms and conditions – “None of that stuff should matter. We’re supposed to be connecting with their souls.”

Attunement Survival Style Attunement individuals

learned to limit their emotional and physical needs to the limited amount of nurturing available

Infants learn to depress their own needs and begin to lose touch with them entirely

They can also become very attuned to the needs of their primary caregivers and attempt to alleviate their suffering at the expense of their own

Attunement Shame- and Pride-Based

Identifications

Attunement Shame-Based Identifications

My needs are bad and wrong

I am not entitled to have my needs fulfilled

Attunement Pride-Based Counter-Identifications

I am the shoulder everyone cries on

I don’t need anything – I can take care of everyone around

me

I am indispensible

Attunement Survival Style in Adults

Individuals with the Attunement Survival Style are often

very perceptive of the needs of others

They become caretakers, giving to others what they

want for themselves

Because they cannot express their own needs, they can

eventually become frustrated and bitter

Sadness and depression can be default emotions for

these individuals; expansive and positive emotions can

be more challenging

Portrait of Student with

Attunement Survival Style

JF was the daughter of a teenage mother, herself a survivor of

abuse. As a child, JF was frequently sent off to the homes of

relatives where she received minimal nurturing

As an adult, JF became a human services worker and

passionate advocate for individuals with mental health issues.

She took full responsibility for an elderly relative’s care and

adopted a cousin to prevent him from entering the foster care

system.

In group, JF often has difficulty using “I” language and

identifying her own feelings. She is passionate but often

overwhelmed. Her needs become expressed indirectly, such as

being late to group seminar or her clinical shifts.

Trust Survival Style Individuals who develop a

Trust survival style were

forced to give up their

childhood at a young age,

often to fulfill parental

scripts or roles

Their dependency needs may

have been used against them

Children with this survival

style protect their

attachment relationship with

their parents by developing a

false self in line with

parental expectations

Trust Shame- and Pride-Based Identifications

Trust Shame Based Identifications

Small

Helpless, Weak

Used

Betrayed

Trust Pride-Based Counter-Identifications

Strong and in control

Betrayer

Larger than life

Trust Survival Style in Adults

Adults with the trust survival style use an “as if”

strategy – they act “as if” they care, “as if” they are

present to others. Their commitment to a cause

hides their real goal, which is self-aggrandizement.

Many religious leaders fall into this category.

Trust individuals can be good at making a proper

impression, selling themselves, and motivating

people.

At the extreme end, trust individuals can turn the

tables and become the abusers

Portrait of a Student with Trust

Survival Style ZB is the only child in her family; her mother had

significant mental health issues. ZB is a student in a

prestigious seminary and hoping to become a pastor in a

mainline church.

In her clinical presentations, ZB often refers to her deep

love of her patients and her compassion for their

struggles. Her case presentations make her out to be

the hero of her encounters.

With peers, ZB is self-involved and sulking when she

does not get her way. She takes short-cuts in her

clinical work and blames others when this is pointed

out.

Autonomy Survival Style

The autonomy survival style

is created when parents

discourage healthy displays

of independence and love is

linked to pleasing the

caregivers, who may be

overly enmeshed or

emotionally invasive

For these individuals, love is

associated with duty and

bondage. Pleasing others is

paramount.

Autonomy Shame-Based Identifications

Angry

Resentful of authority

Burdened

Autonomy Pride-Based Counter Identifications

Nice, sweet

Compliant

Good boy/girl

Pride at how much they can take on their shoulders

Autonomy Shame- and Pride-Based

Identifications

Autonomy Survival Style in Adults

Autonomy individuals can be generous and open-hearted, but have difficulty setting boundaries and therefore can feel put-upon

Healthy expressions of independence and self-assertion are experienced as dangerous and to be avoided – there is a strong fear of criticism and rejection

Individuals with this survival style can play the role of the good boy/girl because since it appears it won their parents’ love, it will win others’ as well

They are extremely sensitive to what they perceive to be others’ expectations of them

Portrait of a Student with

Autonomy Survival Style

CG was born into a very conservative Christian family;

his father and grandfather were pastors and it was

expected that CG would follow them into the ministry.

However, CG dropped out of Bible school and chose to

attend a more liberal seminary

CG presented in his peer group as self-deprecating and

unsure of himself. He discounted remarkable

theological insights, attempting to make them palatable

to his peers. CG asserted independence obliquely,

coming in late for group seminars or waiting until the

last possible minute to complete a written assignment.

Discrimination and Dollars: Gay and

transgender employment discrimination

imposes significant financial harm on

businesses, introducing inefficiencies and

costs that cut into profits and undermine

businesses’ bottom lines” Center for

American Progress (2012)

Love-Sexuality Survival Style

• The Love-Sexuality

Style develops around

heartbreak, the

unacknowledged or

rejected loving feelings

by the parents

• Self-esteem is based off

of looks and

performance

• Fear of vulnerability is

primary

Love-Sexuality Shame- and Pride-Based

Identifications

Love-Sexuality Shame-Based Identifications

Hurt

Rejected

Physically-flawed

Unloved and unlovable

Love-Sexuality Pride-Based Counter-Identifications

Perfect, seamless

Does not allow for mistakes

Rejects first

The Biology of ConnectionFight-Flight-Freeze in the Pastoral Encounter

The Nervous System –

The Fight-Flight-Freeze Response The nervous system is the body’s

communication highway; information flows

to and from the brain

The autonomic nervous system controls

involuntary functions such as respiration

and heart rate

Part of the autonomic nervous system , the

sympathetic branch jumps into action when

we are under stress or threat, preparing the

body for a fight-flight-freeze response

When the threat is over, the

parasympathetic nervous system calms us

down and restores us to a state of calm

The Brain – A Brief Introduction

The human brain evolved from the

bottom up, with more complex

structures piled atop more

primitive ones

Brainstem – regulates vital

functions (heartbeat, respiration)

Reptilian brain – regulates

repetitive behavioral-motor

activities (ex: riding a bike)

Limbic system – FEELING brain,

capable of learning, memory,

socialization

Neocortex – THINKING brain,

responsible for rational thought,

ability to think creatively

Flight-Fight-Freeze, Continued

In response to physical danger or when a survival style is

being engaged, emotional processing moves from the

part of the brain responsible for for attention and

motivation to the part responsible for vigilance

In this state, humans having difficulty really seeing what

is in front of them – it’s almost like an old tape that

starts being played over again. They reach for

patterned responses and make false associations

Persons in this state will seek to neutralize the threat in

any way they can – by fighting, fleeing, or freezing

Working with Fight-Flight in Supervision

By being intentionally mindful of times when we are

going into fight-flight-freeze mode, we can begin to

change our pattern of responses

Putting feelings into words – creating a narrative for

what is happening in the reptilian and limbic centers of

the brain – can actually teach the brain new ways to

think and relate

Bottom (Limbic

system)-Up:

What am I

experiencing right

now? How does my

body feel?

Top (Cortical

system)-Down:

What aspects of my

survival style am I

engaging right now?

What else might I

choose to do?

Bottom-Up, Top-Down SupervisionAutonomy-Style student meets with patient Patient asks student to borrow his personal cellphone Autonomy Survival Style engaged in response to threat (Student afraid of disappointing patient, setting boundaries, being disliked) Nervous system engages flight-fight mode, heart quickens Flight - Student makes up a vague excuse why the call won’t work and ends the visit Student brings encounter to peer group Group explores what student was feeling at the time of the encounter Student identifies feeling lost, panicky, heart racing With support, student begins putting feelings into words and connecting feelings to past experiences where setting boundaries caused pain Student explores alternative responses Student encounters second patient who asks to borrow cellphone Student mindful of fight-flight response, connection with survival style and alternative choices based on prior conversations Student able to engage parasympathetic nervous system more quickly Student makes more mindful choice about response to second patient

Simple, right?

Goals of the NARM ModelSupporting Self-Acceptance, Creativity, and Vitality

Overall Goals for Supervision

Increased capacity for self-reference, self-reflection,

and mindfulness

Disidentification from shame- and pride-based

identifications

Increased tolerance for strong emotions in self and

others

Increased self-acceptance, particularly for those parts

of the self that have been condemned, expelled, and

rejected

Survival Style-Specific Goals

Goals with Connection-Style Individuals

Help students learn to listen to and trust their internal

experience

Increased feeling of having a “right to be”

Increased capacity for connection with self and others

Goals with Attunement-Style Individuals

Help students to be realistic about their needs and to

express their needs directly

Increased tolerance for fulfillment and aliveness

Survival Style-Specific Goals, contd. Goals with Trust-Style Individuals

Help them to develop the courage to allow a healthy

dependency on others

Increased ability to show vulnerability

Goals for Autonomy-Style Individuals

Increased sense of personal authority

Increased ability to set limits and say no directly

Goals for Love-Sexuality-Style Individuals

Learn to appreciate the entirety of their bodily experience,

not just outward beauty

Increased ability to appreciate shades of grey rather than

black-and-white beliefs

Techniques for Supervising

Using the NARM ModelEngaging Body and Mind

Overall Techniques for SupervisionParadoxically, the more we try to change ourselves, the more we prevent change from occurring. On the other hand, the more we allow ourselves to fully experience

who we are, the greater the possibility of change.

Focus on the parts of the students that are organized, coherent, and functional – use strengths in the service of weakness

Focus on the past only insofar as it helps to make sense of present experience

Support increased awareness of survival styles and decreased identification from shame- and pride-based identifications

Overall Techniques for Supervision, contd.

Approach interactions with students with open curiosity and support students in their own curiosity about their situations and challenges – our openness and “not knowing” can function as an antidote to preconceived judgments

Challenge not only pride-based counter-identifications, but also shame-based identifications lest the latter be reinforced

Slow down the pace – allow emotional and physical sensations to surface and be given voice

Help students learn to listen on every level of experience

Survival Style-Specific Techniques

Techniques with Connection-Style Individuals

Communicate that they have a right to express their needs

even if the needs can’t be met

Move slowly – don’t be fooled by a restricted affect; there

may be a lot going on under the surface

Techniques with Attunement-Style Individuals

Shift from reliving experiences of abandonment and

scarcity to tolerating fulfillment and vitality

Focus on being mindful of their own needs and desires

Survival Style-Specific Techniques, contd. Techniques with Trust-Style Individuals

Help them acknowledge the sources of betrayal in their lives and how they perpetuate that betrayal by being false with themselves

Techniques with Autonomy-Style Individuals

Accept them as they are – transformation will happen when change is not forced

Support non-efforting and non-goal orientation (doing vs. being)

Techniques with Love-Sexuality-Style Individuals

Work slowly to allow feelings of vulnerability and tenderness to emerge

Support mindful awareness of how doing helps to avoid vulnerability

Finally…

“The quality of the therapist’s presence and their

ability to authentically be with these clients is of

greater importance than any technique. If the

therapist’s s approach is ‘techniquey’, clients will

experience it as a misattunement.”

“Nearly all the wisdom we possess, that is to say, true and

sound wisdom, consists of two parts: the knowledge of

God and of ourselves.

- John Calvin