The Trauma Paradox
When considering the crux of the trauma experience, we can suggest in the simplest terms, that unprocessed experience/trauma is a felt-sense of danger that derives from nervous system dysregulation. Again, in the simplest terms, trauma recovery is the return to or discovery of a felt-sense of internal safety; and the ability to keep orientating towards safety over and over again. The qualities of experience (both danger and safety) are specific to the unique individual, but the overarching idea remains the same.
In my clinic practise, something that continually arises is the client’s inability to distinguish what is truly dangerous and what is truly safe. I call this ‘The Trauma Paradox’.
When we exist in survival physiology there is a chronic underpinning of danger. Existence is danger. The nervous system is either in a sustained high tone sympathetic or parasympathetic response; or there is a constant ping pong between each polarised state (fight or flight/shut down). In this case, there is no window of tolerance. That is, there is little ventral vagal access; no ability to self-regulate. Over time a faux window of tolerance is created in order to cope with the sense of danger by implementing a series of defensive accommodations. This faux window becomes a haven of safety. Yet the safety is merely mimicked. In truth there is still no internal safety. Creating a false sense of safety is the only way to survive.
The danger becomes the safe place.
When working with clients who orientate within survival physiology (who exist within a map that only contains danger in every direction), I have found that accessing safety may require a gentle, repetitive and consistent re-orientation process. Safety, or regulation, may seem foreign or dangerous. It is unknown. So, when a client has developed a steadfast faux window of tolerance (a life steeped in only danger), accessing new levels of true regulation may actually trigger further dysregulation.
The safety feels dangerous.
This is the trauma paradox.
So, the question becomes, how do we disentangle the confused response in the nervous system? How do we allow the client to re-regulate and orientate towards safety, when danger is all they know and are comfortable with?
Down-regulation
Uncoupling
Neural regulation
Integration
Down Regulation – turning down the felt-sense of danger, just enough to make space for present awareness and processing.
Here we are working with deactivating the chain reaction that occurs in the fight or flight response. One of the clearest descriptions I have read that denotes what happens in the body when it senses danger is in ‘Healing the Fragmented Selves of Trauma Survivors – Overcoming Internal Alienation’ by Janina Fisher.
‘Faced with potential threat, the brain and body instinctively mobilise the emergency stress response, preparing the individual to take action: fleeing, fighting, ducking and hiding. As danger cues are perceived by the sensory system, a chain reaction of neurochemical events is set in motion. They amygdala (a structure that serves as the brain’s smoke detector and fire alarm) begins to ‘fire’ more rapidly, activating another limbic system structure, the hypothalamus, to initiate an adrenaline release to ‘turn on’ the sympathetic nervous system. As the adrenaline release speeds up heart rate and respiration to increase oxygen flow to muscle tissue, the body prepares to engage fight or flight impulses. The individual feels braced and strong; the events unfold in slow motion; an icy calm replaces fear; the eyes narrow; and the body prepares for action, clenching fists, engaging the leg muscles, biceps and shoulders. As fight and flight responses unfold, release of another neurochemical, cortisol, begins to activate reciprocal activity in the parasympathetic nervous system… As the body mobilises for fight and flight, the parasympathetic system prepares to freeze (like a deer in the headlights) to avoid exposure or to submit or ‘feign death’ (Porges, 2011) if the individual is trapped with no way out, no way to defend. The parasympathetic system also helps the body recover from the massive adrenaline expenditure of energy involved in fighting and fleeing, facilitating feeling of depletion, exhaustion, ‘just need to sleep’ or numbing.’
Down regulation is an access point to deactivating the neurophysiological danger response and can be achieved in many ways. When I work with this intention, I am working with both relational resonance (better known as co-regulation) and also the use of craniosacral touch.
I have found that safety can be accessed through careful attunement and presence as well as touch. In this way, a kind of reparenting process begins to unfold; which when dealing with developmental trauma is necessary to access the felt-sense of safety/attachment that was either breeched or never developed with mother.
As babies, we rely on our parents, and more specifically our mother, to provide our sense of safety. We need to be fed, changed, talked to, gazed at and held. Our parent’s role is not only to meet our basic needs, but also to model and mirror a way of being. This interaction establishes our map for what is safe and what is dangerous. It also is meant to help us respond to danger appropriately.
It is through presence, talk and touch that this re-connection to safety and healthy attachment can be provided by the therapist. While this process may occur unconsciously for the client, the therapist can set the intention to create this reparenting experience for the client and also closely attune to how it is received and adapt, constantly assessing ‘ what does my client need to feel safe now and how can I respond?’. An attuned therapist can respond moment by moment with nuance of tone, volume, speed of voice, and choice of words, appropriate eye contact – both duration and intensity, facial expressions, breath, pauses, gesture and movement. When working with touch the nuance may come from the weight, level of fascial involvement, placement, length, and the response to the client’s continued experience throughout the touch process.
Understanding the somatic pattern-matching process and to working uncouple unhealthy somatic associations
The somatic experience of trauma is effectively the existence of past experience living in the present body. The sensations that trigger the feeling ‘I am in danger’ are old and do not belong here. There are two things to consider here. A) How do we turn off or turn down the fight or flight response enough to start working with the somatic experience? We can only start working with these once it feels safe to do so and the client can be present with symptoms without hyper-arousal. B) How do we explore the somatic experience and uncouple the past from the present?
Note this is not only about completing or turning off the danger-response. It is also about dis-identifying the patterns that have been learned and ingrained in the system. It involves relabelling our sensations, which gives the internal, somatic experience space to shift. In the book Nurturing Resilience, Cathy Kain refers to these processes as ‘pattern-matching’ and ‘uncoupling’.
Pattern-matching is a process that the nervous system is constantly performing in order to make sense of new experiences. A healthy regulated nervous system that has access to the pre-frontal cortex and ventral vagal can sort through new experience, check the ‘files’ from the past and either match it, or start to record a new experience based on many facets of reality (qualia).
A system that is operating in survival physiology bypasses the more developed part of the brain where rational thought occurs. Instead it accesses the more primitive part of the brain where danger is grossly assessed and action is taken quickly (in order to survive). Here there is no room or time to process qualia. When we are operating from this space of survival it is as if there is an override process in play. The nervous system is operating from the sense that death is imminent. There is no time to make new experiences. Instead the system looks at records/files from the past and matches new experience to an old experience, that is a close enough fit. Experiences are marked as either dangerous or safe. The thing is, in the case of prolonged exposure to trauma, there are often few or nil experiences of safety. And therefore, the pattern-matching process leads to perpetually recording our new/present experiences as danger. Because it is all we know. We unconsciously attribute old experiences to present experiences. From a somatic perspective, we incorrectly couple old somatic sensations of danger to new experiences.
As therapists, in order to work with pattern-matching and uncoupling we must create a safe space of exploration and self-inquiry. The process may go as follows:
Identify somatic sensations
Identify existing labels that go with them. (E.G. When I feel the weight in my chest, I feel anxious like I cannot breathe)
Inquire if it is possible to sit with the feelings and notice any correlating emotions or thoughts. (E.G. I feel scared. I am worried that I will die)
Inquire origin of somatic and mental/emotional experience (E.G. When I was little my mother locked me in the pantry and I felt like I was trapped and couldn’t get out and would die there)
Question if the source exists now. Is the danger still present or has it passed? (E.G. No, I know I am safe now and that the experience is over. I am safe. My body is safe.)
If the experience can be identified as no longer valid, can we sit with it and allow it to dissipate? What happens once we let our body know that we are safe? (E.G.I feel my chest relaxing. I can breathe deeper. I feel a big release in my shoulders also. I feel teary. I am relieved. Note: relief is a common side effect once past and present have been disentangled.)
Note: Sometimes the dissipation can occur naturally through this process. Sometimes when deeply ingrained it can be supported by somatic resourcing. This entails finding a source in the body of positive nourishing sensation. By sitting with the resource and/or expanding it, can the traumatic sensations be neutralised? (see more in point 3) below).
For complex trauma clients, this process can take time and repetition. The nervous system needs a space to be learn… to be taught over and over again and achieve neural recalibration. We are effectively creating pathways to safety thanks to neuroplasticity.
Neural Recalibration - Orienting towards the present experience and resourcing
Once the past has been disentangled from the present, space must be made to actually feel the present somatic experience, to get it know it, access the safety that is available and reidentify in the here and now. mark the body and the world it exists in as safe. Weather on the table or within a talk therapy setting, this can be achieved by bringing attention to the space that exists once the past/old/unneeded somatic experience is released. The space is an opportunity to experience in a different way. It is in the space where ventral vagal can be accessed. It is in the space that the pre-frontal cortex comes on line. Where new experiences can be properly assessed and organised. It is where we can begin to live in the here and now. This is where neural recalibration can occur. Past becomes past and present becomes present.
As a therapist we can work with full body presence/somatic awareness and also use anchoring as a means of establishing positive resources that can be accessed by the client outside of the therapeutic setting. This promotes a step towards self-empowerment and the ability to self-regulate, independent of another. Ultimately it is through careful co-regulation and modelling that the therapist can support the client to move towards independence. (Again, this fits in with the idea of reparenting as per earlier in this article).
Careful use of language is important during this phase of treatment. There must be space for the client to self-inquire and find their own true shift in somatic experience. At the same time, gentle guidance may be helpful to a) support self-inquiry b) hold them within the positive experience (it is common for clients to want to jump back to the old danger space) c )anchor the changes and develop tools that can be taken out of the room into daily life.
E.G. ‘ Take a few breaths in and feel the space that you have created. What do you feel here now? Allow these sensations to grow and expand. Let your body get to know them and remember them so you can take them out the room and into your life.’
You may also ask the client to describe the most connected safest place in the body. You may also direct them to place their hands there If appropriate. It may then become an anchor to return to again and again.
E.G Place all your attention (and hands) at this place and feel (mirror the client’s verbal expression – it is important that they provide the felt-sense language). Notice how your body responds when you place your attention here. Let your body remember this place as a resource. Know that you can return to this place and activate these positive sensations time and again.’
This technique draws on the principles of positive suggestion stemming from hypnotherapy. It is important to understand the nuance that as a therapist you are letting the client direct and explain the felt sense, but you are guiding the expansion and anchoring of the present positive state, to inhibit the possible return to the old state of danger. Client response will vary. Some will be able to stay here with gentle guidance. Some will forcefully go back to the past danger or to a different state of danger. This indicates that a) the uncoupling was not complete and needs to be re-experienced. It may also mean that the couple (somatic sensation and emotional/mental experience) was not accurately identified. or b) that there are multiple patterns to uncouple before the client can begin to experience in the present. In these such cases, multiple sessions are required to gently uncouple the various patterns and work simply with the space that arises from each. When enough space I accessed, the present may be accessed as well as a felt sense of safety.
As therapists, it is important not to force the client to safety, but sit in the danger with them for as long as they need. We must let go of our need to fix or complete a process. It is about sitting with them in the danger (holding their hand so to speak), shining the light on the way to safety and letting them know ‘hey there is something different over there. We can explore if and when you are ready. But I am here with you as long as you need. I am not going anywhere. I am not pushing you. I’m with you.’ This stance lets the client know that they are safe with you. When they ae safe with you, they can slowly start to find their way to safety. They need to lead it and feel it. We can only walk by their side… hold whatever space they exist in at any moment. Our ability to be present with them in the here and now, whatever it may look like, is a resource in itself. It is what allows them to unfreeze and start to move. It is their movement that will ultimately lead them to present-time safety.
Integration
Once a client has accessed a change in their somatic experience, the nervous system needs time to integrate. Without the proper integration time that spans across all facets of self, the client may unconsciously return to their old way of being, because it is what they know. Integration allows time for the whole self to process and catch up with the changes that have occurred. In order to achieve as much integration within a session as possible I work with a number of methods.
Sacral holding. Using craniosacral therapy, I hold the sacrum and suggest that I will be quiet while their system integrates. Many clients will follow my silence and their system achieves further down-regulation.
Feet holding and leg traction. I find that this is very grounding and brings the client back into their physical body
Spatial and physical reorientation. With my voice I guide the client to orientate within the room, with their breath and gentle movement of the body.
Standing orientation. After time on the table I direct the client to stand, with eyes closed and allow the body to find natural stillness. This is akin to making a new neurological footprint. The body can often sway and move finding a new equilibrium – a new sense of home. Clients can often access an emotional release here and feel a sense of being ‘physically different.’
Grounding and mental emotional reorienting. I sit with the client and give them tea and nuts while their rational brain processes their experience. In invite them to share or ask questions. Often this time sees them verbalising their experience of change - what they let go of and what they accessed. I am careful to mirror their expression back to them.
Self-care. Once the mental/emotional integration is complete, we work to design self-care tools that may have been accessed in the session and can be used in daily life.
Taking time to go through this detailed integration process ensures that change has been registered at every level of self. It has been a somatic and implicit experience as well as a mental/emotional explicit experience. It has filtered though from the bottom up and the top down.
The traumatic experience of a client is so incredibly unique that it is impossible to decipher a clear one size fits all treatment. I do however, strongly believe that working with all the stages above creates stepping stones through the individualised processing journey that may lead to feeling safe in the present.
It is when a client finally can identify safety in the present and leave the old danger response in the past, that the trauma paradox is released. It is the ability to continually identify when the paradox arises and independently disentangle it, that the client has truly recovered and established a safe place in the present.
The Empty Baggage, 2013 by He Xun