In the “Fish Tank” episode, the Husband shared about his experience with EMDR. He talked about having headphones he listens to, and small paddles or “dongles” that he holds one of in each hand. He said that he hears beeps and feels vibrations on alternating sides as part of the experience. He talked about the family therapist having a box where she could adjust the speed or other settings of those beeps and vibrations as needed.

In response to this episode, a friend shared a picture of one kind of these devices, though there are different kinds and different ways of doing EMDR with the different tools. This is just one example, and very similar to what the husband was describing.

While he found it particularly useful for his depression, the device itself may be triggering to some survivors of certain kinds of organized or ritual abuse. Some clinicians use a light bar of colored lights instead of this kind of device, which may be triggering to survivors of pornography or traffficking type settings. In addition, EMDR does not help everyone with everything, and we have been told by many survivors and clinicians alike that timing and containment of some sort is critical to a positive experience with EMDR.

That said, many survivors who have used EMDR in safe ways with good clinicians when they are ready for it as an intervention, describe very positive experiences and good results.

This podcast episode was not about EMDR or when to use it or who should or not, but simply about the husband’s experience of it while being treated for depression. The picture is provided simply for those who wanted to see to be able to understand what he was talking about with the “dongles”.

You can listen to other episodes about EMDR specifically to learn more about it, or check out their website HERE.

Pam Stavropoulos, PhD

We welcome Pam Stavropoulos, PhD (Politics), Grad. Dip. Psychotherapy to the podcast to share about her research work with complex trauma at Blue Knot Foundation.

Specifically, she shares with us about the recently released 2019 updated Practice Guidelines for the Treatment of Complex Trauma, which you can read HERE. It is available for download for free, with permission to share.

In the podcast, she shares about the research behind the updated guidelines, and also mentions therapist compentancies, which you can read HERE.

A list of selected publications can be viewed HERE.

Dr. Chefetz is a psychiatrist in private practice in Washington, D.C.

He was President of the International Society for the Study of Trauma and Dissociation (ISSTD) from 2002-2003, and is a Distinguished Visiting Lecturer at the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy & Psychoanalysis, and the Washington Baltimore Center for Psychoanalysis. . He is a Certified Consultant at the American Society of Clinical Hypnosis and is trained in Level I and II EMDR.

Dr. Chefetz was editor of “Dissociative Disorders: An Expanding Window into the Psychobiology of Mind” for the Psychiatric Clinics of North America, March 2006, “Neuroscientific and Therapeutic Advances in Dissociative Disorders,” Psychiatric Annals, August 2005, and “Multimodal Treatment of Complex Dissociative Disorders,” Psychoanalytic Inquiry, 20:2, 2000, as well as numerous journal articles on psychodynamic and psychoanalytic perspectives on trauma and dissociation. In 2015 he published Intensive Psychotherapy for Persistent Dissociative Process: The Fear of Feeling Real, with W.W. Norton, in their Interpersonal Neurobiology series.

His website is HERE.

Dr. Cathy Kezelman AM is a medical practitioner, mental health consumer advocate, President of Blue Knot Foundation National Centre of Excellence for Complex Trauma. She is a current member of NSW Child Safety Standing Committee for Survivor and Faith Groups. She is past director of the Mental Health Coordinating Council (MHCC), past member of the Mental Health Community Advisory Council (NSW) foundation member of the national Trauma Informed Care and Practice Advisory working Group, member of Independent Advisory Council on Redress. 

Cathy worked in medical practice for 20 years, mostly as a GP. Under her stewardship Blue Knot Foundation has grown from a peer support organisation to a national centre of excellence combining a prominent consumer voice with that of researchers, academics and clinicians advocating for socio-political trauma-informed change and informed responsiveness to complex trauma. She is a prominent voice in the media and at conferences, as well as author of a memoir chronicling her journey of recovery from child sexual abuse: Innocence Revisited - a tale in parts. She is co-author of multiple seminal Blue Knot Foundation documents including 2019 Practice Guidelines for Clinical Treatment of Complex Trauma. 

Blue Knot Foundation is Australia’s National Centre of Excellence for Complex Trauma. It empowers recovery and builds resilience for the more than five million (1 in 4) adult Australians with a lived experience of complex trauma. This includes those experiencing repeated ongoing interpersonal trauma and abuse, often from childhood, as an adult, or both as well as their families and communities.

Formed in 1995, Blue Knot Foundation is at the forefront of pioneering trauma-informed policy, practice, training and research. It provides direct services to survivors: specialist trauma phone counselling and educational workshops for survivors and their family members, partners and loved ones as well as an extensive professional training program for workers, professionals and organisations from diverse sectors supported by supervision and consultancy services. It also has extensive resources including fact sheets, videos, publications and website information at www.blueknot.org.au. 

It has launched new 2019 updated Practice Guidelines for Clinical Treatment of Complex Trauma. Co-authored by Dr Cathy Kezelman AM, President and Pam Stavropoulos PhD, Head of Research these clinical guidelines update the 2012 internationally acclaimed and extensively endorsed Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Evolving research and clinical insights, as well as the continuing challenges of treating people with a lived experience of `complex’ trauma, mean that the original 2012 Blue Knot guidelines, still a valuable resource for students or clinicians new to this work, have required updating.

 The 2019 guidelines have also been extensively endorsed by leading academics, clinicians and researchers in the complex trauma and dissociation field prior to their release, including by the peak international body – International Society for the Study of Trauma & Dissociation (ISSTD). The new guidelines provide an integrative guide for diverse practitioners working with complex trauma and dissociative clients.

In addition a companion guide to the 2019 Guidelines – combined Complementary Guidelines which provide an overview of the differences between working with complex trauma clients and standard counselling approaches as well as a guide to therapist competencies for working with complex trauma and dissociation have also been released.

 Hard copies and free downloads of each publication are available from Blue Knot’s Practice Guidelines portal. We have endorsed the guidelines and encourage you to explore them!

This week on the podcast, we discussed an article published by Sarah Clark of the Stronghold System on their website, PowerToThePlurals.com, and shared in her facebook support group AlterNation.

Their article discusses the Theory of Structural Dissociation.

In the article, they consider it to almost be a theory of structural integration instead, and call the theory out for being ableist due to it emphasis on functioning through one ANP in therapy rather than whoever presents, and because of the emphasis on integration as the only treatment option. As they said in the podcast interview, the theory of structural dissociation is being used to push integration as the only option “because it sets up the idea we were never “split off” in the first place, so it’s easier to integrate us back to together again”. Here’s the quote from their article that they reference in the podcast:

We read in the same book (page 7) ‘’Structural dissociation involves hindrance or breakdown of a natural progression toward integration of psychobiological systems of the personality that have been described as discrete behavioral states.’’ (Putnam, 1997).

This is what most people refer to when explaining that we are not broken, not split off. We are all born with different states and early childhood trauma survivors can’t integrate in early childhood due to that trauma. But as you can see it was actually Putnam in 1997 who introduced this idea.

They also say that the authors of the theory appropriated or borrowed terms from other authors who used them much earlier. Here’s a quote from their article:

Charles Samual Myers, who in 1916 wrote about Apparently Normal Part (ANP) and Emotional Part (EP) after acute trauma in WW1. So it is fair to say that the theory of Structural dissociation borrowed these terms, not introduced them, as is readable in the haunted self. (page 4)

Drawing conclusions from this, they clarify that you can accept parts of the theory from the original authors, rather than crediting this theory for your understanding.

They go on to say that the Theory of Structural Dissociation is a model about trauma, not a model about dissociation. Here’s the quote from the article:

It is also good to realize that the theory of Structural dissociation is neither about DID, nor is it about alters, as many of us Plurals know them. They speak of ‘dissociative parts of the personality’, caused by trauma. Nota bene, not early childhood trauma, trauma in general. As this theory also explains single trauma, repeated trauma in adulthood and (early) childhood trauma. It is used to describe changes that are diagnosed as (c)PTSD, trauma related borderline personality disorder, DID and more.

This, along with their perspective that because of DSM5 criteria, DID does not actually have to be a “disorder” if the person’s System is not distressed by it and functioning well. From this, they issue a call to the community to refer to themselves as “Plural” culturally, rather than DID therapeutically. They also are calling for “Functional Multiplicty” to be an option in treatment, rather than integration pushed as the goal.

This, they say, is more effective for positive cooperation amongst a system and healthy functioning as a system, with greater participation in therapy than what the Theory of Structural Dissociation offers. They say:

The theory of Structural dissociation idolizes integration. And although they say that ‘’no one has to go away’’, they also clearly explain to therapists, to not engage with us ‘dissociative parts of the personality,’ unless absolutely needed. Instead it is suggested that the therapist speaks whenever possible, through the ANP fronting…

… And in DID, in particular, requiring all communications to relay through one particular (perhaps malleable or favored) ‘alter’ that sounds a lot like silencing to me. Because the therapist (or any other outside person,) can never know (for sure) whether the part who is presenting, is truly conveying all information which is coming from inside. This book talks a lot about shame, but forgets that our ANPs might not feel comfortable repeating what those EPs just said inside, and that the information may be so overwhelming for them as to cause them to have intense dissociative symptoms.

You can see in the article that they use a picture of a slide from a presentation by Kathy Steele to show that the Theory of Structural Dissociation is being taught to only talk to one ANP and focus on integration in that way.

Following this perspective and logic, they conclude in their article, that the Theory of Structural Dissociation is ableist:

We know from a 6 year follow up study that only 12.8% of participants were able to reach integration as described in the theory of Structural dissociation. (page 4 )

That is a very low percentage. In any scientific research for medicine or therapy for example, a 12.8% positive outcome would not be tolerable. Yet the whole theory of treatment within Structural dissociation is based on it.

A chronic disorder, often debilitating, with a much-respected and idolized healing option with only 12.8% success rate, sounds ableist to me.

A 12% success rate is definitely a call for improved access to and quality in treatment, absolutely, and worth talking about - that’s why we shared it on the podcast.

That said, I don’t know how someone would pin-point integration on a timeline, when to us it feels more like a process than an event (Dr. Siegel said this on our podcast!) - so that 12% seems interesting to qualify with things like how they defined integration and what kind of follow-up support they received and who continued maintenance therapy or not and what kind of life stressors they had and those kinds of questions.

However, there is more to this piece we need to look at to see everything. This study mentioned is one of Bethany Brand’s from Top DD Studies, and I interviewed her earlier for the podcast last summer - unfortunately, it was one of the lost episodes because of technology glitches. But what I know from this study is that it does give a 12% success rate for integration, but it also mentions ANOTHER 12% who are “successful” without integration in a final-fusion kind of way. Further, the study also emphasizes other ways success can be measured and were noticed in the study, including: reduced hospitalizations, reduced suicide attempts, and improved GAF (global assessment of functioning) scores. These are significant and worth mentioning.

But, following this discussion on the podcast, Dr. Peter Barach reached out to us (as a friend and colleague, not in any clinical role) in response with more information. He also clarified that:

I think she has some incorrect ideas about what is generally recommended these days as treatment for DID. I think if you take a look at the ISSTD treatment guidelines, you won’t find what she says to be there. The term “integration” refers to “better integrated functioning ,” not to “fusion” of all the alters I to one.

Kluft argues that fusion leads to the most stable outcome of treatment—that’s his opinion, but the only data on that point comes from a series of people he treated himself. Fusion doesn’t always happen, and it’s also clear that some people with DID don’t want it.

He also shared further insights that we shared in the episode “Clinical Response” in the episode following the interview with the Stronghold System. Here is some of what he clarified in response:

Charles Myers wrote a book (1940) describing veterans of World War I in France who had shell shock, which of course is now called PTSD. He said that there are "emotional" personalities, referring to behavior during flashbacks and trauma-related nightmares, and "apparently normal" personalities who are detached from the experiences of reliving trauma.

I think he used the term "personality" in a much looser sense than we think of parts or alters, whatever word we use, in DID. He was not talking about survivors of childhood trauma.

Myers was not talking about parts or alters with different names and ages. An example of this is a veteran with PTSD working as an auto mechanic who hits the ground when there is a loud noise at work, such as a tire popping suddenly off its rim. This is an automatic response without thinking or planning, and leaves the veteran feeling embarrassed.

Here Dr. Barach clarifies that Myers was not talking about DID, but about a PTSD kind of response. In a plural system, the ANP and EP are distinct personalities as in parts or alters, as in distinguished by identity (age, gender, name, etc.), whereas what Myers was referring to was functioning - the veteran being able to function in a work setting upon returning from war (ANP), but having a limbic response triggered (EP). When Van der Hart uses the terms ANP and EP, he is applying them in an extended way to explain the continuum of dissociation.

Further, Dr. Barach points out that Van der Hart does give Myers credit when using the ANP and EP terminology, so it is neither appropriated or used without acknowledging the source.

Van der Hart always mentions Myers when he uses those terms ANP and EP, so I disagree that he and his coauthors have appropriated or stolen these labels. Van der Hart is also clear that the structural theory of dissociation is talking about ANPs and EPs that are more elaborated than the ANP and EP ideas of Myers.

He then explains this here, using quotes from both Myers and Van der Hart:

Here's what Myers wrote:

"“Now and again there occur alterations of the 'emotional' and the 'apparently normal' personalities, the return of the former often heralded by severe headache, dizziness or by a hysterical convulsion. On its return, the 'apparently normal' personality may recall, as in a dream, the distressing experiences revived during the temporary intrusion of the 'emotional' personality.”

Here's an excerpt from a 2010 article by van der Hart and others:

"the EP range in forms from reexperiencing unintegrated (aspects of) trauma in cases of acute and posttraumatic stress disorder (PTSD), to traumatized dissociative parts of the personality in dissociative identity disorder (DID; APA, 1994)."

Dr. Barach then concludes that it’s not accurate to say that Myers was talking about the same thing as DID when he wrote about ANP’s and EP’s, even though that was the original source of the terminology.

He also explained that he wouldn’t consider the OSDD diagnosis as something being used to “step-down” a DID diagnosis, but rather it being related to how the system itself is presenting within the context of what they are dealing with at any given time. He said:

The DSM is a bunch of cubbyholes with labels on them, but the disorders aren't "real" in the same way that a flower or ice cream is real. The DSM is a system of categories. That's all it is.

How things end up in one category or another is a matter of psychiatric politics. For example, PTSD used to be classified as an anxiety disorder. But now it's in the trauma disorder category.

… Well over 95% of people with DID report a history of extensive childhood trauma; there are even some studies confirming the trauma histories of groups of people with DID. But DID is not in the trauma disorders category. It's in the dissociative disorders category. Go figure.

Also the whole issue of OSDD versus DID to me exists only because some psychiatric folks wanted two categories! There are people diagnosed with OSDD whose inner parts never "front," and who don't lose time, unless there is heavy stress. So if I evaluate them on a low stress day, the diagnosis might be OSDD, but an evaluation on a higher stress period of life might lead to a diagnosis of DID.

In regards to whether someone can have DID but it not be a “disorder”, Dr. Barach clarifies that:

“every diagnosis in the DSM requires either "clinically significant distress" or "functional impairment."

So, if one were going for “functional multiplicity”, then that functioning needs to include being able to work, manage relationships, and other ways of functioning. He said:

If someone had parts, wasn't distressed by having them, but wasn't functioning well in relationships or work because of the parts fighting for control or switching a lot, that would count as a disorder.

This put into words what we were trying to explain in the podcast in the follow-up episode, about how (for us) functional multiplicity becomes a natural part of the healing process as internal cooperation and collaboration improves.

In that way, for us, functional multiplicity is a part of the process rather than an end goal alternative to the end of treatment. We - only speaking for our system - are not far enough in treatment to know, experience, or be able to speak of anything else or what we will choose at the end of treatment or understand what that will look like.

However, we understand from our own experience of searching for a good therapist for over a decade, that there is a critical time period where plural systems - especially those in areas without access to treatment - are, indeed, functioning for years and years as multiples (or “Plural”). Even if you are able to find a good therapist, and begin treatment, therapy takes years and years. It makes sense that Functional Multiplicity would be a fantastic goal during this time, regardless of what the “end of treatment” looks like, we think. This is a quality of life issue, in those years after the trauma that caused the multiplicity (or “plurality”), the decades of waiting for help and access to treatment, and the years and years of treatment itself.

In regards to whether DID requires a trauma history, Dr. Barach went on to say that:

She said that there are people who have DID without a trauma history. Well, maybe so, but that is actually an empirical question--and where's the data? There are a number of published case series showing an extremely high rate of childhood trauma (like 95% or more) reported by people in clinical settings who have DID. There are also some people who believe they have DID, but actually they don't--they have just assigned names to aspects of themselves.

We would add that there may be Plural systems who deny trauma as part of the dissociative process, who just do not know yet about their own trauma.

That said, there are people who identify as “Plural” who report no trauma history, who say they have no disorder because they are not distressed by it and functioning just fine.

This is an important cultural development clinicians need to know about, whether they agree with it or not, just for cultural competency, that there are people in the “Plural Community” who do not consider themselves to have DID.

That said, if these people are functioning just fine and not distressed about being Plural, then they would not be seeking treatment for DID - which is likely why clinicians are less familiar with this (more recent) cultural population.

Finally, Dr. Barach responded to one last point:

Although the proponents of the structural theory may say that treatment should take place through the ANP, that treatment idea does NOT necessarily follow from the theory. And while the structural dissociation folks may be teaching therapists to work directly only with an ANP, that is not what a lot of other experienced teachers in the dissociation field are teaching (including me). I well remember Richard Kluft saying very clearly that you cannot treat someone with DID unless you are working with the "alters" (to use his preferred term).

In fact, when I reached out to Kathy Steele herself, to clarify what she was teaching from the slide used in the Stronghold System’s article, she was very responsive.

I try to work with the "adult self" to the degree possible, but do work with parts. I have a sequence of decisions on when you can work through the adult, when to work with a group of parts together and when to work with a single one, and then I work my way back up the ladder. I have never said I only work with the adult part or only ANPs.

We can say that we saw Kathy Steele present in Kansas City, in which the same slide used in the Stronghold System article was also displayed. But throughout the presentation, she did give many examples of how to work with different kinds of parts. So we followed up on this, and not only did she clarify further, but she also was eager to adapt her language so that would be more clear in the future what she meant::

I do emphasize that an "adult" needs to be active in therapy, which is maybe where the confusion comes in. By this, I do not mean any one part, but rather am focused on capacities necessary for successful therapy: the ability to contain behaviors, the ability to reflect, the ability to cooperate on mutually shared therapeutic goals. And in early therapy I always focus on helping the client as a whole to find those capacities and use them. I don't think any diagnosis - no matter which one - precludes these, and these capacities are either explicit or implicit in every single therapeutic approach.

I will think about maybe not using the term "adult" for these capacities to avoid further confusion.

This is why we do the podcast, for this kind of exploring and these kinds of conversations.

Working to understand the article on Power to the Plurals is important for understanding the client experience and cultural implications, while advocating for improved care and quality of treatment.

Working to understand the clinical response helps us to engage in treatment as we understand what is going on and why we are doing the things we are doing, and to better educate other clinicians and those still waiting for access to treatment.

This is empowering to us all, and a beautiful thing when we work together, even good practice at attunement and being receptive and attending to one another. Well done, everyone!

Kathy Steele, MN, CS has been in private practice in Atlanta, Georgia since 1985, and is an Adjunct Faculty at Emory University. Kathy is a Fellow and a past President of the International Society for the Study of Trauma and Dissociation (ISSTD), and is the recipient of a number of awards for her clinical and published works, including the 2010 Lifetime Achievement Award from ISSTD. She has authored numerous publications in the field of trauma and dissociation, including three books, and frequently lectures internationally on topics related to trauma, dissociation, attachment, and therapeutic resistance and impasses.

CLICK HERE for a link to the workbook mentioned in the podcast!

Christine Forner (Ba, Bsw, Msw, Rsw) has been in the healing profession in one form or another since the age of 16, when she worked on a crisis line for teens. Christine spent the first part of her career in the front lines working at local sexual assault centres, long term therapeutic setting and shelters for domestic violence survivours.

Since 2011, Christine has worked in her own private practice, which specializes in complex trauma and dissociative disorders. Christine has over thirty years of working with individuals with Trauma, Post Traumatic Stress Disorders, Traumatic Dissociation, Developmental Trauma and Dissociative Disorders, with specialized training in EMDR, Sensorimotor Psychotherapy, Psychotherapeutic Meditation techniques, Neurofeedback and Havening. Christine is also the current clinical supervisor for WayPoints, a center in Fort McMurry, Alberta that specializes in sexual assault and domestic violence. Christine teaches locally and at an international level on the issue of dissociation, complex trauma, and the intersection of dissociation and mindfulness.

Christine is the current President for the International Society for the Study of Trauma and Dissociation.

Christine has also served on the board of the ISSTD since 2010 and was the ISSTD treasurer from 2011-2017.

She is the author of Dissociation, Mindfulness and Creative Meditations: Trauma informed practices to facilitate growth (Routledge, 2017).

As well as avidly working with those who have been hurt the most, Christine has dedicated her professional life to educating others on the logic, normality and commonality of dissociation. The summation of her work is to educate practitioners about the vital importance of their presence, patients and care with those who have been through the most severe and brutal injuries so that they get treated with dignity and compassion. The four qualities of presence, patience, dignity and compassion applied to every aspect of the therapeutic process can result in profound inner healing; something every human deserves to experience.

Rachel Lewis-Marlow is a somatically integrative psychotherapist, dually licensed as a Licensed Professional Counselor and a Massage and Bodywork Therapist. Rachel is also a Certified Advanced Practitioner in Sensorimotor Psychotherapy and has advanced training and 30 + years of experience in diverse somatic therapies.

She is the co-founder of the Embodied Recovery Institute which provides training in a trauma-informed, relationally oriented and somatically integrative model for eating disorders treatment.

In her private practice, Rachel specializes in working with people recovering from trauma, eating disorders, and dissociative disorders. She has extensive experience as a teacher and presenter, focusing on accessing the body’s unique capacity to give voice to the subconscious and to lay the foundation for healing and maintaining psychological and physical health.

She authored a chapter on the application of Sensorimotor Psychotherapy to eating disorders treatment in the recently published book, Trauma-Informed Approaches to Eating Disorders.

Daniel J. Siegel received his medical degree from Harvard University and completed his postgraduate medical education at UCLA with training in pediatrics and child, adolescent and adult psychiatry.  He served as a National Institute of Mental Health Research Fellow at UCLA, studying family interactions with an emphasis on how attachment experiences influence emotions, behavior, autobiographical memory and narrative.

Dr. Siegel is a clinical professor of psychiatry at the UCLA School of Medicine and the founding co-director of the Mindful Awareness Research Center at UCLA. An award-winning educator, he is a Distinguished Fellow of the American Psychiatric Association and recipient of several honorary fellowships. Dr. Siegel is also the Executive Director of the Mindsight Institute, an educational organization, which offers online learning and in-person seminars that focus on how the development of mindsight in individuals, families and communities can be enhanced by examining the interface of human relationships and basic biological processes. His psychotherapy practice includes children, adolescents, adults, couples, and families. He serves as the Medical Director of the LifeSpan Learning Institute and on the Advisory Board of the Blue School in New York City, which has built its curriculum around Dr. Siegel’s Mindsight approach.

Dr. Siegel has published extensively for the professional audience.  He is the author of numerous articles, chapters, and the internationally acclaimed text, The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (2nd. Ed., Guilford, 2012).  This book introduces the field of interpersonal neurobiology, and has been utilized by a number of clinical and research organizations worldwide. Dr. Siegel serves as the Founding Editor for the Norton Professional Series on Interpersonal Neurobiology which contains nearly seventy textbooks.  The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (Norton, 2007) explores the nature of mindful awareness as a process that harnesses the social circuitry of the brain as it promotes mental, physical, and relational health. The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration (Norton, 2010), explores the application of focusing techniques for the clinician’s own development, as well as their clients' development of mindsight and neural integration. Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind (Norton, 2012), explores how to apply the interpersonal neurobiology approach to developing a healthy mind, an integrated brain, and empathic relationships. The New York Times bestseller Mind: A Journey to the Heart of Being Human (Norton, 2016) offers a deep exploration of our mental lives as they emerge from the body and our relations to each other and the world around us. His New York Times bestseller Aware: The Science and Practice of Presence (Tarcher/Perigee, 2018) provides practical instruction for mastering the Wheel of Awareness, a life-changing tool for cultivating more focus, presence, and peace in one's day-to-day life. Dr. Siegel's publications for professionals and the public have been translated into over 40 forty languages.

Dr. Siegel’s book, Mindsight: The New Science of Personal Transformation (Bantam, 2010), offers the general reader an in-depth exploration of the power of the mind to integrate the brain and promote well-being. He has written five parenting books, including the three New York Times bestsellers Brainstorm: The Power and Purpose of the Teenage Brain (Tarcher/Penguin, 2014); The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child's Developing Mind (Random House, 2011) and No-Drama Discipline: The Whole-Brain Way to Calm the Chaos and Nurture Your Child's Developing Mind (Bantam, 2014), both with Tina Payne Bryson, Ph.D., The Yes Brain: How to Cultivate Courage, Curiosity, and Resilience in Your Child (Bantam, 2018) also with Tina Payne Bryson, Ph.D., and Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive (Tarcher/Penguin, 2003) with Mary Hartzell, M.Ed.

Dr. Siegel's unique ability to make complicated scientific concepts exciting and accessible has led him to be invited to address diverse local, national and international groups including mental health professionals, neuroscientists, corporate leaders, educators, parents, public administrators, healthcare providers, policy-makers, mediators, judges, and clergy. He has lectured for the King of Thailand, Pope John Paul II, His Holiness the Dalai Lama, Google University, and London's Royal Society of Arts (RSA). He lives in Southern California with his family.

You can see his website HERE.

The website for the Mindsight Institute is HERE.

The parts of the brain video referenced in the podcast is here:

Uploaded by Dr. Dan Siegel on 2017-08-09.

Kelly McDaniel, LPC, NCC, CSAT, author and psychotherapist, has been a licensed clinician since 2005.  In 2008, Gentle Path Press published McDaniel’s first book Ready to Heal: Breaking Free from Addictive Relationships.  Written for women, her book addresses the cultural and psychological issues that complicate love and sex. In Ready to Heal, Kelly created the concept of Mother Hunger® to explain the origin of problematic bonding. Each year since 2008, Kelly has been teaching both locally and nationally about women, relationships, and trauma, and in 2012, Gentle Path published the second edition of Ready to Heal with an expanded chapter dedicated to Mother Hunger.

In 2012, McDaniel collaborated with 9 other colleagues to write and publish Making Advances: A Comprehensive Guideline for Treating Female Love and Sex Addicts. In January 2019, she hosted a four-hour webinar sponsored by the Institute for Trauma and Addiction Professionals for 30 clinicians on the topic of Mother Hunger.

McDaniel’s new book Mother Hunger Living With a Broken Heart, informed by the past 10 years of clinical work, training, and neuroscience, describes the complex betrayal trauma that delivers a child’s first heartbreak.  The concept of Mother Hunger frames the lonely legacy of bonding to a compromised caregiver. McDaniel’s work is being used to treat women in various programs and facilities throughout the U.S. including The Center for Healthy Sex in Los Angelnces, The Meadows in Wickenburg, Arizona, and The Ranch in Tennessee.  McDaniel has offered trainings for clinicians through The Society for the Advancement of Sexual Health, The Rape Crisis Center in San Antonio, Texas, Sante Center for Healing in Argyle, Texas, and Life Healing Center in Santa Fe, New Mexico. 

McDaniel has successfully trademarked her Mother Hunger Intensives; custom curated, one on one healing experiences for women. You can see her website HERE.

Dr. Roger Solomon is a psychologist and psychotherapist specializing in the areas of trauma and grief. He is on the Senior Faculty of the EMDR (Eye Movement Desensitization and Reprocessing) Institute and provides basic and advanced EMDR training internationally. He currently consults with the US Senate, NASA, and several law enforcement agencies.

Dr. Solomon has provided clinical services and training to the FBI, Secret Service, U.S. State Department, Diplomatic Security, Bureau of Alcohol, Tobacco, and Firearms, U.S. Department of Justice (U.S. Attorneys), and numerous state and local law enforcement organizations. Internationally, he consults with the Polizia di Stato in Italy. Moreover, Dr Solomon has planned critical incident programs, provided training for peer support teams and has provided direct services following such tragedies as Hurricane Katrina, September 11 terrorist attacks, the loss of the Shuttle Columbia, and the Oklahoma City Bombing.

Dr. Solomon has expertise in complex trauma, and collaborates with Onno van der Hart, Ph.D., and others on utilization of EMDR as informed by The Structural Dissociation of the Personality (TDSP). He has authored 42 articles and book chapters pertaining to grief, trauma, complex trauma and dissociation, and law enforcement.

You can see his website HERE for more information.

You can check out the EMDR Institute website HERE.

Today on the podcast, we welcomed Pat Ogden, PhD, a pioneer in somatic psychology, is the Founder and Education Director of the Sensorimotor Psychotherapy Institute.

Dr. Ogden is an internationally recognized school specializing in somatic–cognitive approaches for the treatment of posttraumatic stress and attachment disturbances.  Her Institute, based in Colorado, has 19 certified trainers who conduct Sensorimotor Psychotherapy trainings of over 400 hours for mental health professionals throughout the USA, Canada, Europe, and Australia. The Institute has certified hundreds of psychotherapists throughout the world in this method.  She is co-founder of the Hakomi Institute, past faculty of Naropa University (1985-2005), a clinician, consultant, and sought after international lecturer.

Dr. Ogden is the first author of two groundbreaking books in somatic psychology: Trauma and the Body: A Sensorimotor Approach to Psychotherapy and Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (2015) , both published in the Interpersonal Neurobiology Series of W. W. Norton. She is currently working on a third book Sensorimotor Psychotherapy for Children, Adolescents and Families with Dr. Bonnie Goldstein. 

Her current interests include Sensorimotor Psychotherapy for groups, couples, children, adolescents, families; Embedded Relational Mindfulness, culture and diversity, challenging clients, the relational nature of shame, presence, consciousness and the philosophical/spiritual principles that guide Sensorimotor Psychotherapy.

You can learn more about Sensorimotor Psychotherapy on her website HERE.

We recently had Scarlet from the Labyrinth System as a guest on the podcast, and they were one of the very first YouTube channels educating about Dissociative Identity Disorder. You can see their channel HERE.

They mentioned the genetic test that helps you know which medications may be more helpful than others. It is called the GeneSight test, and you can see their website HERE.

We also spoke with Ashton Parker, from the Infinite System, who has started a collaborative website about Self-Help for those with Dissociative Identity Disorder. You can see the website HERE.

In the podcast episode, Emma’s Top Ten, she told the story of a baby bird we saw today at the park. Here is our youngest daughter having a little chat with the baby bird:

Here is the list of ten things Emma shared that she has learned from our therapist:

10. Now time is safe.

9. Now time is different.

8. Memory time does not change now time.

7. She (the therapist, or even ourselves) is real, all the time.

6. We can ask for reassurance; sometimes that’s all you need.

5. You know better than anyone else what you need, and what is right for you.

4. It’s not our secret.

3. You always have a choice.

2. Turn the lights on.

1. You are not a little girl anymore.

Today on the podcast, we welcomed Robert Cox, LPC.

Robert Cox is a licensed professional counselor in Missouri, and owner of Life Recovery Consulting where he specializes in trauma, addiction, and autism. He is also host of the “Mindful Recovery” podcast.

We got to speak again with Dr. Peter Barach, who taught us all about attachment.

He tells the story of being in class with Mary Ainsworth (who developed attachment theory),who was a student herself of Bowlby (pioneer of attachment theory).

Attachment theory explains the infant-mother dynamic, emphasizing the importance of a secure and trusting mother-infant in healthy development.

John Bowlby (1907-1990) was a British child psychiatrist and psychoanalyst, known for his theory on attachment. Key points to Bowlby’s theory include:

• Infants are born already biologically wired to be cared for and attach to a primary caregiver;

• Bowlby was influenced by Lorenz’s imprinting studies (baby ducks!);

• Attachment behaviors are instinctive, which matters to trauma because those early attachment responses can be activated (triggered!) by conditions that threaten closeness or connection: separation, insecurity, and fear;

• These innate behaviors are part of the survival instinct process;

• The initial attachment experience serves a lens for all future relationships as the infant grows into a child and then into an adult; and

• This initial experience provides an “internal working model” that serves as (1) a model of others as being trustworthy, (2) a model of the self as valuable, and (3) a model of the self as effective when interacting with others.

Dr. Barach then also explained the attachment styles identified by Ainsworth, through her strange situation experiment:

This research led Ainsworth to identify attachment styles that could predict behavior and patterns of relationship as the child grew older:

This, Dr. Barach explains, plays out even with adults, like the model of Bartholomew and Horowitz here:

Considering that different insiders may have different attachment styles, Dr. Barach discussed disorganized attachment as it applies to DID.

He also provided the example from the Robertsonresearch film “A Two Year Old Goes to the Hospital”. That link will take you to where you can purchase the entire film, but here are some clips:

Dr. Barach then shared with us a new book, Attachment Disturbances in Adults, by Dr. Daniel P. Brown, whom he heard after listening to the Therapist Uncensored podcast. Dr. Barach stated that Dr. Brown’s theory is about how CPTSD comes from disorganized attachment that is then followed by abuse. We have followed up by contacting Dr. Brown for an interview.

Many thanks to Dr. Barach for visiting with us again!

BIO:

Dr. Peter Barach attended Johns Hopkins University and the University of Michigan. He received a Ph.D. in Clinical Psychology from Case Western Reserve University. He is Clinical Senior Instructor in Psychiatry at Case Western Reserve University School of Medicine in Cleveland, Ohio. Since 1984, he has been in private practice in the Cleveland area with Horizons Counseling Services. His clinical approach is relational and supportive. He specializes in working with people with dissociative disorders and adult survivors of trauma. He also works with depression and anxiety. He is also trained in EMDR and clinical hypnosis.

 Dr. Barach is the author of scientific and clinical articles on dissociation and Dissociative Identity Disorder (DID). He is a past president of the International Society for the Study of Trauma and Dissociation. Within the dissociative disorders field, he is known for having first highlighted the link between disordered attachment and the origins of DID. He also chaired the committee that produced the first set of treatment guidelines for adults with DID in 1993 and has participated in revisions of the guidelines. In addition to his writings on dissociation, Dr. Barach served as a script consultant for broadcast media and as a reviewer for several journals. He has also served as an expert witness in civil and criminal matters.

In addition to maintaining a private practice, Dr. Barach currently works for the Cleveland VA Medical Center, where he evaluates veterans who have applied for disability compensation. He is not appearing on this podcast as a VA employee. The opinions he expresses are his own and do not necessarily represent the Department of Veterans Affairs or its policies.

 You can see the website for the International Society for the Study of Trauma and Dissociation HERE.

 You can see the ISSTD Guidelines for Treating Dissociative Identity Disorder in Adults (Third Revision, 2011) HERE.

You can read his article Multiple Personality as an Attachment Disorder (Barach, 1991) HERE. 

His website for Horizons Counseling Services, Inc. is HERE. 

We were so excited to have Robert Oxnam as a our guest on the podcast!

Robert Oxnam was president of the Asia Society for over a decade (1981-92). In the 1990s, Oxnam frequently travelled to China as a lecturer for prominent Americans seeking in-depth knowledge of the country, including Bill and Melinda Gates, Warren Buffet, and former President H. W. Bush. In 1992-93 he was Special Correspondent for the MacNeil/Lehrer NewsHour, hosting an acclaimed nine-part special on China.

Oxnam was educated at Williams College (B.A. 1964, Phi Beta Kappa) and Yale University (M.A. 1966, Ph.D.) He taught at Trinity College, CT (1969-75), Columbia University (1990s), and Williams College (Bernhard Professorship, 1995). He is the author of two novels about China, and has published several books about Chinese history and U.S.-China relations.

In 2005, Hyperion Press published Oxnam’s psychological autobiography – A Fractured Mind – revealing his long struggle with Dissociative Identity Disorder (formerly called Multiple Personality Disorder; DID is usually caused by severe child abuse at very young ages). The book elicited widespread media coverage including CBS’s 60 Minutes, ABC’s Good Morning America, NBC Today Show, PBS, New York Times, Time Magazine, Daily Telegraph, and BBC.

Today, Oxnam divides his time between his art making and dealing with those in the mental health community. He has been appointed as Special Advisor to McLean Hospital/Harvard University and is collaborating with outstanding research figures to create a nationwide public education effort to “de-stigmatize” DID. He frequently lectures about DID at universities and conferences around the U.S. and abroad. Oxnam often says, “my work as an artist is not in spite of DID, but rather because DID gives me a whole inner community of artists and critiques.”

You can see his website HERE, including photos of some of his art.

DAY ONE SESSIONS

Video Links

KEYNOTE SESSION: A HISTORY OF DID

DID 101

IS DISSOCIATION ALWAYS MALADAPTIVE?

PARENTING AS PLURAL

BEING A VETERAN WITH DID

THE IMPORTANCE OF ART

BOOTSTRAPPING

LIFE COACHING

PLURAL ACTIVISM

COMMUNITY INCLUSION

Day Two Sessions

Video Links

Selves-Advocacy

Depersonalization, Derealization, and Denial

Polyvagal Theory

Traumagenic & Endogenic

Recruits, Rebels, & Adventurers

Worldwide Issues & Advocacy Panel

Plural Authenticity

(S)RA and RA/MC Myths Debunked

Medical Neglect

Safe & Inclusive Spaces

Day Three Sessions

Video Links

Mapping for Selves

Self-Hypnosis

Coming Out as Plural

Support People of Plurals

Recovery from Therapy

Tulpamancy

Closing Remarks

In 1884, considering how the emotional processes work, William James put forward the argument that emotional experiences arise from direct perceptions of bodily change. This meant that we do not feel our emotions because we choose them, but because of some neurological process that causes them. This idea that emotional experience does not start with a conscious experience but our experience of bodily changes was shared by Carl Lange (1885). Both James and Lange believed that bodily and behavioral responses precede the conscious experience of emotion, resulting in what it today known as the James–Lange theory of emotion.

In 1927, Walter B. Cannon critiqued the James–Lange theory arguing that visceral changes do not always result in the presence of an emotion. This meant that the first theory could not be entirely true, otherwise we would experience a new emotion anytime our heart rate changed or breathing slowed or sped up, for example. He suggested that the range of visceral changes in the body resulted in too little differentiation to explain the range and variety of emotions experienced by most people under normal circumstances.

In 1983, Cannon’s  claims were questioned with evidence suggesting that emotional responses may at least in part be distinguished on the basis of patterns of autonomic activity (Ekman, Levenson, & Friesen), that separation of the body from the brain can in fact reduce the intensity of emotional experience (e.g., following spinal injury, Montoya & Schandry, 1994), and that artificial stimulation of the viscera (e.g., via intravenous injection of peptides) can induce emotions (Harro & Vasar, 1991).

Then, in 1994, neuroscientist Stephen Porges proposed the Polyvagal Theory. Polyvagal Theory offers an explanation regarding how the vagus nerve, which connects the brain, to the heart, to the viscera (the organs of the belly), relates to our human ability to connect and communicate with each other.  Learning about the vagus nerve helps us understand our physiologic responses to perceived safety and danger.   The latin root of “vagus,” means “wander,” and is used for this nerve because of how it runs throughout the body. 

Picture from Wikipedia, of Stephen Porges in white shirt and tie. He has dark hair, a light beard, and is looking to the left smiling.

In 2011, he released his book The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation (Norton). This was a year after the National Institute of Mental Health changed their funding to neuroscience only, and researchers latched on to his two decade old breakthrough theory as a foundation for further research and application to treatment model development.

Blue cover of Porges’s book reads “The Polyvagal Theory” at the top right, with brain structure picture in the middle and with subtitle written below. Author’s name is at the bottom center.

His work has been a breakthrough in the field of trauma study, giving neurological evidence for the trauma response experience. It’s been huge for clinicians and huge for survivors alike. Though the research is still filtering down into common clinical practice, it has profound implications for understanding and treating trauma - including attachment and dissociative disorders.

In 2018, Deb Dana released her book, The Polyvagal Theory in Therapy, which brought the application of the polyvagal theory to psychological treatment to the forefront. Now the latest research and most popular explanation of trauma responses, it has also provided a way to reconnect trauma treatment back to funding sources. These applications also correlate with shame theory, in regards to connection with others being one critical - even necessary - aspect of healing.

Orange and white book cover, with “Polyvagal Theory in” in orange letters, and “Therapy” in blue letters, with author’s name beneath.

WHAT IS THE POLYVAGAL THEORY?

It’s a theory that explains the connection between the vagus nerve and trauma response, emotional regulation, attachment, and self-expression.

The vagus nerve is the tenth cranial nerve, the longest and most complex of 12 pairs of nerves that go from the brain (CLICK HERE for an illustration). It runs from the brain to every major organ in the body, branching off along the way into “accessory” nerves. So when there are many vagus nerves, they call it “poly” vagal nerve as a whole unit because there is more than nerve that branches off the main nerve as it runs to the organs of the body.

It’s a “theory” because they don’t know for sure that what Porges proposes is true.

Specifically, the theory proposes that there is a connection between this nerve (and all its branches) is the source of visceral experiences and the main body organs: the lungs, heart, and gut - even just in response to the facial expressions or voice tones of others - and is expressed in your own facial expressions and tone of voice, as well.

In The Body Keeps Score, Bessel van der Kolk explained:

The Polyvagal Theory provided us with a more sophisticated understanding of the biology of safety and danger, one based on the subtle interplay between the visceral experiences of our own bodies and the voices and faces of the people around us. It explained why a kind face or a soothing tone of voice can dramatically alter the way we feel. It clarified why knowing that we are seen and heard by the important people in our lives can make us feel calm and safe, and why being ignored or dismissed can precipitate rage reactions or mental collapse. It helped us understand why focused attunement with another person can shift us out of disorganized and fearful states. In short, Porges’s theory made us look beyond the effects of fight or flight and put social relationships front and center in our understanding of trauma. It also suggested new approaches to healing that focus on strengthening the body’s system for regulating arousal.

Thus, the polyvagal theory attempts to combine physiology, behavior, and psychosocial processes in a unified framework (Berntson et al., 2007). According to Porges, evolutionary developments over time have linked together neuroanatomical and neurophysiological connections between the vagal regulation of the heart and the neural regulation of the striated muscles of the face and head (Porges, 1995, 2003a, 2007b). This, Porges proposes, means that the vagal influence on the heart is also related to behaviors that are involved in social engagement (Porges, 2003a). It is important to note that Porges also argues that social engagement is not a learned behavior, but an emergent behavior of neurophysiology - an idea contrary to many of the already established prevailing theories today.

However, he explains his case using fetal development. The vagal nerve originates in the brain stem, and during fetal development projects to and from the striated muscles of the face and head (Patestas & Gartner, 2006). These fibers function to regulate the facial muscles (for facial expressivity), muscles of mastication (for ingestion), neck muscles (for looking behavior), laryngeal and pharyngeal muscles (for vocalization and intonation), as well as the middle ear muscles (for listening to human voice). Porges notes that all of these muscles are also observed to be used in socialization behaviors such as maintaining eye contact, listening to speech, and making appropriate facial expressions (1995). He then makes the polyvagal theory conclusion: that social engagement is contingent upon the self-soothing physiological states - which, he says, are ultimately determined by the vagus nerve (Porges, 2003b, 2009a; Porges & Lewis, 2010). He implies, then, that when it feels like you can’t control your emotions, it’s because you really actually can’t - not without stimulating, or activating, the vagal nerves in some way.

Because it is still just a theory, we must be careful not get swept up in the excitement of its popularity. Taking a critical look, the polyvagal theory has many tenets that have not actually be empirically verified yet. It also has challenges that must be addressed. Some of these are:

1. the term polyvagal is a misnomer, as polyvagal theory divides the vagal system  into  two  efferent  systems  not  many;  Ritz  (2009)  has  suggested that “bivagal theory” would be a more accurate description;

2. the term nucleus ambiguous perfectly represents the perplexity of the brainstem, as the name reflects the ill-defined borders of this region (Loewy & Spyer, 1990);

3. current techniques are unable to ascertain where the vagal outflow originates (Berntson et al., 2007; Grossman & Taylor, 2007), and this has  made it impossible to verify Porges’ claims regarding potential functional differences between the vagal efferent systems, at both psychophysiological and behavioral levels (Berntson et al., 2007; Ritz, 2009), which leaves his entire theory hanging without actual evidence;

4. much of the research used to substantiate polyvagal theory has been carried out with juvenile rather than adult populations (for example, vagal regulation has been associated with self-soothing in neonates (Huffman et al., 1998), facial expressivity in infants (Stifter, Fox, & Porges, 1989), and emotion regulation in infants and pre-school aged children (Hastings et al., 2008; Porges, Doussard-Roosevelt, Portales, & Greenspan, 1996; Stifter & Jain, 1996)), while the research on adults has been much more subjective (Lower resting (tonic) high-frequency HRV has been linked to decreased regulation of negative affect and maladaptive coping (Fabes & Eisenberg, 1997; Pu et al., 2010), as well as poorer romantic attachment and marital quality (Diamond & Hicks, 2005; Smith et al., 2010). Further to this, smaller changes in high-frequency HRV in response to laboratory stressors have been associated with emotion regulation difficulties (Austin, Riniolo, & Porges, 2007; Hughes & Stoney, 2000; Sahar, Shalev, & Porges, 2001), and inferior social functioning (Egizio et al., 2008));

5. there is also research that actually refutes the polyvagal theory (for example Gyurak and Ayduk (2008) did not find a direct relationship between resting HRV and emotion control, and Demaree and colleagues have reported that cardiac vagal control does not predict emotional expressivity in response to film clips (Demaree, Robinson, et al., 2004; Demaree, Pu, et al., 2006), although this could be explained by methodology and by how the vagal nerve itself actually works - supporting evidence in healthy adult populations tends to emerge during highly emotional situations (e.g., increased levels of daily stress, Fabes & Eisenberg, 1997), and not situations that do not warrant substantial emotional responses (e.g., passively viewing film clips, Demaree, Pu, et al., 2006), and so it may only be under conditions of actual danger or threat that relationships between ANS function and socio-emotional behaviors clearly emerge in healthy adults;

6. the polyvagal framework neglects the occurrence of situations where mobilization occurs without fear, such as during play and exercise (Porges now (2009b) attributes this to defensive fight–flight arousal coupled with dynamic VVC activation to insure safe interactions; and

7. researchers are unable to distinguish the vagal efferents originating from the NA and the DVNX (Berntson et al., 2007; Grossman & Taylor,  2007). This means it is currently impossible to verify Porges’ claims regarding the different qualitative functions of the vagal efferent systems.

It’s application to therapy appears to be useful, however, regardless of whether this is because of the neuroscience behind eye contact and facial expressions or because of the very separate and distinct shame theories regarding the processes of connection and attachment. It may turn out that these do, indeed overlap and explain each other, or it may be coincidence and shame theory is just on target in regards to developmental trauma and chronic shame.

HOW DOES IT WORK?

Both research and personal experience have long shown that our behaviors are guided by our emotions (Davidson & Irwin, 1999). Experiencing emotions biologically means changes in subjective experience, appraisal, expression, physiological arousal, and goal-directed behavior. Still, emotions are not a tangible thing we can touch outside ourselves or even always immediately or easily recognize within ourselves. Experiencing emotions involves several processes: the perception of an emotional stimulus, the production of an affective state and emotional behavior, and the regulation of that affective state and emotional behavior (Phillips, Drevets, Rauch, & Lane, 2003). When emotional stimuli are perceived, messages are sent from the central nervous system (CNS) to the rest of the body, either by nerve cells or chemical hormones. These initiate changes in autonomic, neuroendocrine, and somatic systems. Thus, the experience of an emotion is exclusively internal unless it is expressed outwardly through behaviors. Because of this, the only way to “measure” emotional responses in another person is through facial, vocal, and postural cues. (Hugdahl, 1996; Gross & John, 1995). Recognizing, comprehending, interpreting, and responding to these cues in others are all a vital part of social interactions (Darwin, 1872/2009). We will come back to this piece later, when we talk more about the impact of chronic trauma and related shame.

Any nervous system tissue outside of the brain and spinal cord is referred to as the peripheral nervous system. This second system carries motor and sensory information from the brain to the body and then relays information back to the CNS. Although the peripheral nervous system and CNS are theorized as being anatomically separate, they are functionally interconnected (Jessell, 1995). The peripheral nervous system has been further divided into the somatic system, which controls muscular activities, and the autonomic nervous system (ANS), which controls the body’s internal environment: breathing, heartrate, digestion.  (Sequeira, Hot, Silvert, & Delplanque, 2009).

We don’t have to think about these.  They just happen.  It’s unconscious, and not a choice. 

It’s also important to remember that the term “autonomic” is actually misleading. The CNS can actually inhibit or bypass lower reflex mechanisms of the ANS via activity in areas such as the hypothalamus, amygdala, and prefrontal cortex (Jessell, 1995). This piece will come up again later when we talk about trauma response in the brain.

What makes the polyvagal theory unique is that Porges proposes that emotional dysregulation and psychopathology result with abnormalities in how the ANS functions, rather than something being wrong with its structure. To over-simplify, when Porges talks about the “myelinated” vagal nerve, he is referring to the ANS. There are two branches of the ANS: the sympathetic (SNS) and the parasympathetic (PNS).  When he talks about the “unmyelinated” vagal nerve, he is referring to the PNS. He uses this terminology because his theory is based on the writings of John Hughlings Jackson back in 1884, which is based on evolutionary theory. Regardless, the vagal nerve communicates with and connects to all the major organs.

Sympathetic responses include fight and flight in response to danger, and parasympathetic responses include calming back down again when you are safe.

This is why things like taking slow, deep breaths helps so much: not only does it literally slow down your breathing and heart rate, but it also tells your body to slow it down, too. It shifts that panic cycle to the positive, giving a feedback loop for feelings of safety and calm in the same way anxiety escalated into panic. Further, slow deep breaths activate different parts of your ANS, bringing an actual neurobiological balance back to your body as you breathe in and out.

Every ANS response is in service of survival. It is completely natural, expected to happen, and should be happening.   It’s supposed to happen.  It’s what helps you get out of danger and keeps you safe and then gets you well again as you recover after danger.

We often think of the flight-or-fight as part of the response to trauma, and as survivors who dissociate, we are also familiar with “freeze”. But in 2004, Bracha added the terms “fright” and “faint” to the acute stress response spectrum, making a distinction between tonic immobility (fright) and flaccid immobility (faint).   This was important because prior to this distinction, Porges (1995, 2004a, 2007b) and Gray (1987; Gray & McNaughton, 2000) both used the term freeze response, but there  is  confusion  as  to  what  point  in  the  defense  repertoire  “freezing”  should  refer  to (in  Porges’  work,  freezing  refers  to  refers  to  the  DVC  being  up-regulated and resulting in vasovagal syncope, whilst Gray encapsulated freezing as being analogous to the orienting response (which occurs higher up the hierarchy).

Bracha made a clear distinction between these responses by proposing a freeze–flight–fight–fright–faint hierarchy. The three initial responses in the hierarchy reflect normal responses to acute stress.  The  initial  orienting  response  involves  “stop,  look, and  listen”  behaviors  and   Bracha termed this as the freeze response (in the polyvagal hierarchy orienting occurs when the vagal brake is removed, prior to activation of the SNS). This is followed by flight and fight responses (commonly attributed to SNS activation). The next response according to Bracha is fright, also known as tonic immobility, which is less common as a response to acute stress, and will be discussed below.

This response evolved as an alternative to flight–fight tendencies (Alboni et al., 2008). During fright the body is immobile, but should the chance to escape arise the body will be able to rapidly initiate a mobilization response. This form of immobility can be distinguished from the last stage of the hierarchy which involves flaccid immobility. This last stage Bracha termed faint, and it corresponds to Porges’  description  of  the  body  when  the  DVC  is  up-regulated, resulting in vasovagal syncope (i.e., a temporary loss of consciousness). This final stage in the response hierarchy is the least common form of reaction to acute stress and is usually only initiated in times of severe life threat, with the exception of some clinical disorders.

Later, Schauer and Elbert (2010) added “flag” and “faint” to the response process. Flag is associated with slow heart rate, low blood pressure, corresponding cognitive failure, and emotional numbing. As the flag state progresses further emotional involvement is thought to decrease, which is consistent with a dissociative shut-down response (Schauer & Elbert, 2010). The final stage of the hierarchy, faint, occurs when the PNS (DVC) is up-regulated without SNS activation, which can result in vasovagal syncope. Bracha terms this as flaccid immobility because the body is now shut down and no longer prepared to protect from or mobilize away from danger (2004).

In her 2012 doctoral thesis, Megan Christine Barnsley combines these into the following model:

Figure 2.4. Diagram of Porges’ (1995, 2004a, 2007b) polyvagal hierarchy integrated with Gray and McNaughton’s (2000) revised reinforcement sensitivity theory, and Schauer and Elbert’s (2010) defence cascade. VVC = ventral vagal complex. SNS = sympathetic nervous system. BIS = behavioural inhibition system. BAS = behavioural activation system. FFFS = fight–flight–freeze system. DVC = dorsal vagal complex.

In this way, human beings, like all other mammals, are able to automatically adjust to various levels of safety or danger, whether that is internally or externally or even just perceiving threats or dangers. But this is more than just an automatic response: the vagal nerve also acts as a helper in overriding even the automatic response for emergencies when your body needs to respond even more quickly because of danger. So for example, if the vagal nerve withdraws from the heart, that can stimulate the heart rate to increase much more quickly than a message from the SNS can tell the heart rate to increase (Berntson, Cacioppo, & Quigley, 1993a) - that way by the time your muscles get the message to run, your heart is already beating fast and ready to go.

Simplified, your body uses the nervous system to initiate the fight-or-flight response, but the vagal nerve can beat it to the punch, so that all your organs are ready to go at the starting line by the time the race begins.

The vagal nerve can also do the opposite of flight-or-fight, which is known as rest-and-digest, to alert the body when the race is over and you are safe, so it’s okay to calm down. This is sometimes referred to as the “vagal brake” in reference to the myelinated vagal nerve, because it “stops” the flight-or-fight response. In our previous example with the heart, activation of the vagal nerve back to the heart again is what tells it to slow down.

Literally and metaphorically, it is the touching of the heart that brings healing and peace.

Some research seems to support Porges and his theory regarding the vagal brake. Examples confirmed are the process of self-soothing in infants (Huffman et al., 1998), and higher self-regulation in adults (Fabes & Eisenberg, 1997). However, research has not yet confirmed any link between the vagal brake and actual emotional expressivity (Demaree, Pu, Robinson, Schmeichel, & Everhart, 2006; Demaree, Robinson, Everhart, & Schmeichel, 2004; Pu, Schmeichel, & Demaree, 2010). Further, it cannot be assumed that greater vagal activity relates to greater health, because there are clear examples where too much really is too much: infant death syndrome, stress-induced asthma, stress-induced gastric ulcerations, and vasovagal syncope (see Ritz, 2009). The question remains, then, regarding the actual influence of the vagal nerve.

The changes in heart rate variability, or HRV, are one way to measure this influence. When a person has developmental trauma, chronic shame and/or chronic stress, or other experiences that induce repeated patterns of the flight-or-fight response, the power in the low-frequency domain of HRV tends to increase whilst the high-frequency power decreases (Berntson & Cacioppo, 2004). This effect is noted to be associated with anxiety, depression, chronic illness, and autoimmune disorders (Berntson & Cacioppo, 2004; Thayer & Friedman, 1997). However, it’s also true that the same effect happens when either the SNS or the PNS are out of balance, one being used more than the other. This complicates understanding the true impact of the vagal nerve itself, but also explains why safe touch and sensorimotor therapies such as EMDR, equine therapy, progressive muscle relaxation, grounding skills, etc. work so effectively with survivors. We will discuss this further in a bit, but it implies that what needs to be integrated is not actually so much the personality as the mind-body experience itself.

So researchers focus on exactly that: what integrates these systems to work together, in balance, to keep the entire system online.

Thayer and Lane (2000, 2009) proposed a general model of neurovisceral integration for the brain, visceromotor, neuroendocrine, and behavioral responses to explain how the body rapidly responds to environmental stimulation. This model focuses on the function of the entire autonomic network as being implicated in goal-directed behavior and adaptability (Benarroch, 1993; Thayer & Brosschot, 2005). This emphasizes the brain’s link to emotional responding (Benarroch, 1993), and gives the prefrontal cortex the stage in a top-down effect in integrating the mind-body experience.

This is what you experience in traditional talk therapy. You are able to share your experience, think about it, reflect on it, and make meaning from those experiences. It works because engaging the cortex activates the vagal nerve to the heart, sending safety signals back to your brain ((Wong, Massé, Kimmerly, Menon, & Shoemaker, 2007; Milad, Quirk, et al., 2007; Milad, Wright, et al., 2007).

However, it’s also what can make talk therapy difficult. When you have a new therapist that you are still unfamiliar with, or while still establishing safety, or when confronting difficult material, or if you have a therapist who is not attentive or maintaining attachment-connection or who is otherwise unresponsive in some way, it disrupts the process. Literally. Much like the attunement/misattunement research from shame theory, which we will discuss in a moment, there is a same kind of disconnect that actually happens in the brain during attachment rupture or when the frontal cortex gets kicked offline.

A withdrawal of parasympathetic activation and an increase in sympathetic activation, which is consistent with defensive responding, is what causes dysregulation. Dysregulation of these cortical pathways may result in prolonged increases in sympathetic activation, which in the long term could result in potential autonomic imbalance. Prolonged action readiness and SNS over-activity have been linked to deficits in self-regulation and psychopathology (Thayer & Brosschot, 2005). For specific and extensive literature review application to each specific diagnoses, please CLICK HERE for Megan Christina Bensley’s doctoral thesis on the social consequences of physiologic states.

Aside from specific application to DSM-5 diagnoses, Porges explains how these neurophysiological adjustments in our bodies have consequences for daily living. These physiologic states, or “modes”, can be categorized primarily into three groups of purpose or functioning:

Safe and Social (engagement) – located in our face and our heart;

Flight and Fight (mobilization) – located in our lungs and limbs; and

Shutdown (immobilization) – located in our stomach.

We don’t choose to do these.  It’s a sequence.  It happens in a certain order.

We start out in the safe zone, and then when exposed to trauma or a threat of any kind (even perceived), we drop down the “ladder” into flight to try and get away. When we cannot get away, we drop down to fight. When fighting doesn’t keep us safe, we drop down to shutdown. This is the sequence in response to any kind of danger perceived by the body as a threat.

Behaviorally, we see this expressed in many ways. When we are safe, and our body feels safe, then our affects are bright and there is a great deal of range in our tone of voices and in our facial expressions. As we drop down the ladder, the changes in the vagal nerve literally flatten our affect by withdrawing signals to the facial muscles, our voices become more monotone, and our facial expressions are more limited. In the same way, as we move back up the ladder, our affects brighten and our voices and facial expressions have more range in presentation.

Further, they are responses to our external world, our internal world, and the way we perceive the world around us, but they also are the filters through which we see our world - which makes them reinforcing and happen in patterns for some people. This is especially true when we get stuck in one of these “modes”, and begin to filter all experiences through them.

For example, someone stuck in “fight” mode will perceive the world as a more dangerous place than it may be, and/or may find themselves in actual dangerous situations (or reenacting traumas) because they are focused on and looking for those situations that verify their internal experience of the world.

Or, someone in “flight” mode may have difficulty making eye contact, establishing relationships, or connecting with others even in superficial ways.

Trauma survivors experience these modes through triggers. They may feel safe and connected with their partner, or with their therapist, or in their own home, but if they have a sensory trigger like a smell or a sound or something that looks like something from the past, it may trigger a literal change in mode. The survivor then shifts from “safe and social” to “flight and fight”, with increased heart rate and panicked breathing, and maybe even literal running away or fighting against something familiar, or even to complete shutdown and being nonresponsive in a “freeze” or dissociated response.

The insight comes in understanding that switching or a “meltdown” or “spacing out” or some other trauma response may really not be coming from nowhere, but an actual physiological response to a particular trigger.

This perception at a neurological level was described by Porges when he coined the new term “neuroception”. Neuroception refers to how neural circuits in the brain and body distinguish whether situations or people or environments or experiences are safe or whether they are dangerous - such as why we may appreciate a hug from a friend, but not from a stranger. So basically, when this neuroception is faulty, there is an incongruence between whether you feel that you are safe and whether you actually are safe. This faulty neuroception, then, explains the neurobiological process of everything from autism to schizophrenia to anxiety disorders to reactive attachment disorder to dissociative disorders.

Neuroception is our body’s ability to detect risk outside of our body, bring that information in, and accurately and appropriately respond to that risk.

Each “mode” has its own neuroception “key” that unlocks specific behaviors. The safety and socialization mode has the neuroception key that encourages eye contact, prosocial behaviors, smiling, conversation, full range of voice, closer proximity of bodies, and safe touch. The neuroception of danger unlocks fight and flight behaviors such as being mobilized for running away or getting aggressive. But when something is life-threatening, that neuroception unlocks the behaviors of immobilization, or “freeze”, like dissociation.

And, when you are in one mode, you lose access to the behaviors in the other mode. Neuroception unlocks some behaviors in response to what is happening or perceived to be happening. But it also inhibits alternate behaviors that you could choose if you were in a different mode.

That is why, when you are dissociating, it is hard to maintain eye contact. It is hard to follow conversation. It is hard to perceive others around you as safe. It is hard to remember now time.

This is part of why, they think, that trauma survivors are so often abused or violated in different ways again and again as they become adults and even into adulthood. Once they are already dissociated, they lose access to the behaviors that would get them away from danger now that they are an adult - even if they could not get away while they were a child.

It’s also why those younger parts or child alters can be so difficult to orient to the present place and time.

This is why, in your therapist office, during your appointment, you may feel connected and strong and present and confident, and then later while on your own feel such a rush of panic or fear or do the opposite of what you had agreed on during safety planning.

This is why it takes domestic violence survivors so many times to actually leave such abusive situations.

When in the mode where your life is being threatened, or you feel (perceive) that your life is being threatened (even if only a trigger of memory time intruding into now time), you literally do not have access to the behaviors that you are able to do just fine when feeling safe and secure.

That’s unhealthy neuroception, when there is incongruence in any of those areas. Someone may be in danger but not recognize it. Someone may be safe, but think they are in danger.

Healthy neuroception is when there is congruence between what is happening and how your body is responding. It means that you are able to accurately to detect whether you are safe or in danger (in the present moment), correctly shift into the appropriate mode for that level of safety or danger, and then respond in a way that matches that mode and that level of safety or danger.

Healthy neuroception looks like connecting with someone safe when you are falling in love. It looks like mutual friendship and connection. It looks like recognizing the right therapist when you finally find them.

It also looks like recognizing red flags and acting accordingly, instead of dismissing what your intuition is telling you to do about it. It looks like setting boundaries when someone is being too intrusive, or when your workload is too much, or in ways that protect your Self, your time, and your energy. It looks like appropriate self-disclosure, by not sharing too much to everyone but also making an effort to connect with your sacred few.

THE CONNECTION BETWEEN TRAUMA AND POLYVAGAL THEORY

When someone experiences trauma, they shift into either immobilization or mobilization, unlocking behaviors of flight, fight, or freeze. We know this. But what we are learning from polyvagal theory, is that these behaviors are neurobiological responses.

When someone grows up with chronic trauma, or ongoing trauma, or gets stuck in one of those modes like dissociation, then that in and of itself becomes traumatic. Now, not only is there incongruence between what is actually happening and what it feels like is happening, but it also feels like you have no choice in how to respond or may even be unable to respond even if you wanted to try.

Here is Stephen Porges explaining it himself, in this video from The National Institute for the Clinical Application of Behavioral Medicine:

Uploaded by NICABM on 2015-12-09.

So like in his example of having a panic attack even though he wanted to get his MRI, and even though he was really actually interested in the results because of research he studies, he was unable to do it.

Once we are mobilized, or immobilized, it is difficult to shift back into safe mode.

This is why nightmares are so disturbing well into the next day. This is why flashbacks interfere with our functioning. This is why it is so hard to remember that now time is safe, and that memory time really is in the past.

Further, specifically in regards to dissociation, “shutdown” mode (immobilization, or dissociation) is different for human beings than it is with wild animals.

There are two words used to describe immobilization behavior in wild animals: tonic immobility and thanatosis.

Thanatosis is when an animal perceives a predator and “plays dead” - in Texas, we see this with armadillos on the side of the road. It is sometimes called “playing possum” in English. It can resemble a state of shock, but from which the animal can spontaneously recover with no apparent trauma symptoms.

Tonic immobility is a little different, and often called “animal hypnosis”. We see this survival technique everywhere from a kitten being carried by its mother’s mouth to a tiger frozen behind prairie grass ready to pounce its prey. This state of tonic immobility may last from minutes to hours, and again, the animal recovers spontaneously with no apparent trauma symptoms.

If you want to see a more extreme example of this, search “tonic immobility shark” on YouTube, and watch videos of divers seemingly putting sharks to sleep while they are diving. The shark is not actually sleeping, but demonstrating tonic immobility: it is neither fighting for its life or trying to get away. The shark, and the example of the kitten in its mother’s mouth, recover completely and quickly without any adverse affects because they never entered an actual fear response. They are able to jump from immobilization right back into safety mode.

Tonic immobility, shark trance, Michael Rutzen, Bahamas

Humans, however, have an added layer of consciousness and awareness, so that when danger happens or they perceive danger happening, they also experience fear. This is a fear-induced tonic immobility, which leaves the body in that state much longer and comes out of that state very slowly. Further, humans cannot move as far as quickly, not enough to flush out all of those chemicals from the parasympathetic response to trauma.

So then, when the trauma itself involves some sort of being pinned down or any kind of confinement, there is even a great degree of immobilization that becomes quite literal externally and not just internally.

Awareness of this is further complicated by other abuse dynamics, including neglect, shame, not being rescued, having no one to tell, and having no one externally intervene.

These are the roots of dissociation from a neurological standpoint: that when in a fear-induced state of tonic immobility, you are also aware of the parasympathetic response to fight or run away even though you cannot physically do so, and those neural circuit signals get sent to your brain because all that information - the sensory input experience, the physical input experience, the memory itself, the parasympathetic response - all of it has to go somewhere.

This is where Bessel van der Kolk writes in The Body Keeps Score, that:

Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think… [There are] automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted or violated at any time…

When we live in a constant state of hypervigilance, it is because of the amygdala, a part of the limbic system in the brain. The amygdala is “a cluster of brain cells that determines whether a sound, image, or body sensation is perceived as a threat” (ibid, p. 33). It warns us of danger and activates the stress response, including the vagal nerves.

When this is activated, another part of our brain, Broca’s area in the frontal lobe, is shut off. That part of our brain is what helps us put our thoughts and feelings into words. This is why it is so difficult to tell our stories, and why it was so difficult to ask for help even if you ever got the chance, and why it is so difficult to jump into talk therapy even once you do find a therapist you feel safe with and trust.

This also disrupts sequencing, which makes it difficult not only to put pieces of the story together, but is part of why memory time and now time can be so confusing. It’s also why we think we are intelligent people, but then in trauma response moments behave in ways that are impulsive instead of logical. It’s why the past feels present, how Littles get frozen in time, and where time goes when we lose it.

The polyvagal theory explains why so many years later, we still organize our lives “as if the trauma were still going on - unchanged and immutable - as every new encounter or event is contaminated by the past” (ibid, p. 53).

Our brains literally do not know that we are safe now, and because of the polyvagal nerves, we don’t, either.

So when we have external information that tells us we are in danger, or internal information (such as a trigger that takes us to memory time instead of staying in now time), all of that sensory information comes into our body through the limbic system, and another part of our brain - the thalamus - is what makes sense of it and sends it on to the amygdala for quick responses and to the frontal cortex for slower responses.

What we learned from the polyvagal theory is how the thalamus can kind of mix up where that information needs to go. The amygdala can process danger signals from the thalamus before we are consciously aware of what’s happening in the frontal cortex, and when this happens memory processing gets split up into separate pieces instead of metabolized as a whole experience. This is when it feels like time freezes, when sensory memories get stored separately from the emotional or physical memory, and the experience of the memory may get stored somewhere else. This is dissociation.

Now we have our experiences separated into “parts”. Some might hold memories, but without the context, or maybe it doesn’t feel like ours. Sometimes we might feel an emotional response, but not have the memory it’s connected to, and the same thing happens with body memories. Or maybe it is something you should remember, but don’t at all remember it. Regardless, the brain is doing this before you are even conscious of it, before the frontal cortex is ever engaged to make choices about how to process what you are experiencing or how to understand what you are remembering.

It means dissociating is something your brain did on its own, not something you did wrong.

It means dissociating is something that’s an automatic process under the right conditions, not because you failed or didn’t try hard enough or weren’t strong enough.

It means dissociating is something your brain did when it was trying to protect itself and your body, which is how it is designed, and not at all “crazy”.

It’s not about logic. It’s not about reason. It’s not something you can think about and decide to do differently. It’s literally the wiring of the brain in response to what is happening to the body in an actual attempt to survive.

This is also why what van der Kolk said (p. 66) is so true: “Flashbacks and reliving are in some ways worse than the trauma itself. A traumatic event has a beginning and an end - at some point it is over. But… a flashback can occur at any time… There is no way of knowing when it’s going to occur again or how long it will last.”

The amygdala is not able to discern between past and present, and so when the polyvagal nerves are sending danger signals to the organs of the body, and the brain gets the message that something life-threatening may be happening, there’s no stopping to ask the frontal cortex to sort it out first.

When the processing by the thalamus is interrupted by the danger signals from the vagal nerves, there is no story of the experience “with a beginning, middle, and end, but isolated sensory imprints: images, sounds, and physical sensations accompanied by intense emotions, usually terror and helplessness” (ibid, p. 70).

When Broca’s area is shut down so that there are no words to describe that terror and helplessness, and no means to connect those sensory imprints, that terror and helplessness becomes very real, with no sense of time to wait it out, sort it out, or crawl out of it back into the present.

But this is also why understanding Polyvagal Theory is so important: because while it explains what goes so terribly wrong internally, and it describes the horrific experience survivors endure, it also gives us hope.

Falling “down the ladder” is a metaphor created by Dana in her book that applied the polyvagal theory to the therapeutic process. What she meant was that we “fall” down from safe mode into danger mode (mobilization, or flight and fight), and then even further into life-threatening mode (immobilization, or dissociation itself). But that also means we can go back UP the ladder, too.

Using the sensory input and connection to engage the vagal nerves, we can use our own bodies as a resource to help us move from immobilization back into safe mode.

That’s powerful.

There are some formal ways of doing this that many are already familiar with: yoga, sensorimotor, deep breathing, progressive muscle relaxation, EMDR, pet therapy, equine therapy, grounding skills, diffusing oils, and other techniques that utilize sensory input to engage the vagal nerves.

And, as it turns out, these all have some things in common: deep breathing, connection with an Other, and some version of physical touch or processing.

And they work, because the vagal nerves don’t just warn us of danger.

They confirm safety, too.

This is why it’s so jolting to look your therapist in the eyes, until you are already regulating more in safe mode on your own. This is why safe touch when appropriate is so powerful and grounding. This is why you don’t just read a note from your therapist or a friend or a partner, but you hold it and touch it. This is why you rub your face or your hands together when you are trying to stay present. This is why petting a puppy or touching a horse is so difficult and first, and feels so far away, and then so intense when you do.

Connecting these aspects to the neurological processes understood by polyvagal opened the door to shame theory, which explains the patterns of negativity and dismissal of anything good in connection to ourselves.

Guilt is feeling bad for something you DID.

Shame is feeling bad for who you ARE.

This goes all the way back to infancy and early years growing up, whether our needs were met or not, and whether or not our caregivers acknowledged our emotional responses by mirroring them, and whether or not they engaged with us in all of those connecting ways: eye contact, facial expressions, and safe touch.

That’s “attunement”, and the vagal nerves were built for it. That’s what confirms safety.

You can see the old video about this “attunement” and what happens when it isn’t given, if you look up the “Still Face Experiment” on YouTube.

A mother and baby are playing.

The mother has good eye contact, mimics the faces the baby is making, and they are touching with their hands.... that's all "attunement".

But then, as part of the experiment, the mother looks away and puts her hands down. Then she turns back to the baby with a flat affect and doesn't make any expressions at all.

The baby does three things: First, the baby tries hard to touch and reach and make the same sounds and faces they were just doing that was so happy for them both.

When that doesn't work, the baby gets angry and tries to push the mother away, because what is happening is so unpleasant.

When she won't go away, but still isn't tuned in, the baby can only resolve the misattunement by matching her, which he does by physically turning away and also making a flat face without expression.

It's so sad, and may even be triggering to some. But it shows how this works, and what is so distressing when we do not have that connection.

For the sake of the baby, at the end of the experiment, the mother does "repair" the misattunement by turning back to the baby and reengaging, so you can feel the relief and the baby is okay.

Copyright © 2007 ZERO TO THREE http://www.zerotothree.org Ed Tronick (http://www.umb.edu/Why_UMass/Ed_Tronick), director of UMass Boston's Infant-Parent Mental Health Program (http://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health/) and Distinguished Professor of Psychology, discusses the cognitive abilities of infants to read and react to their social surroundings. The video is an excerpt from Lovett Productions' HELPING BABIES FROM THE BENCH: USING THE SCIENCE OF EARLY CHILDHOOD IN COURT.

But if you had a caregiver who was flat and turned away your whole life, or neglectful, or dismissive, or otherwise disengaged, and you had to match that, then it makes sense that these pieces are really hard for your brain. It also explains why you “act out” the way you do sometimes, just like that baby, even though you are grown: asking for help, pushing help away, or matching the unavailability of help by pretending you don’t need it.

Because that’s what is under shame: that your infant self still depended on your caregiver for survival, which is what kicked in the vagal nerves. Because you depended on them for survival, you couldn’t think they were “bad” even when they were not meeting your needs. Instead, you thought YOU were bad for needing in the first place.

But thanks to the vagal nerves, we know that healing comes the same way, and that this can be repaired. Eye contact. Emotional connection. Mirroring back your experience. Being present with you in those trauma responses. Reciprocity of caring and response. Safe touch when it’s appropriate. That’s the stuff of healing.

This matters in your choice of therapist. This matters in your choice of spouse. This matters in choosing healthy and safe friendships. This matters in your choice of parenting style that you so desperately want to be different than what your own experience was like.

This matters because not only do we understand our world through neuroception, but there is also a process called introception - which is our own awareness of our own life, body, and potential to control both.

This is the birthplace of presence, the ability to be oriented to time and place. It is a state of existence, rather than avoidance. It is the ability to reassure yourself, and to know how to connect when you need reassurance from others.

This grows into emotional regulation, which then grows into your internal and external experiences being more congruent.

Only then do we know when we are safe, and where we are safe, and with whom we are safe.

Only then are we safe enough to remember.

Because isn’t just the talking that heals us.

It’s the connection with whom we are talking that confirms safety and holds us in the present, even when we start to remember.

And that’s what helps us connect our Selves.

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