Magazine article Psychotherapy Networker

Responding to Extreme Trauma Symptoms

Magazine article Psychotherapy Networker

Responding to Extreme Trauma Symptoms

Article excerpt

In Consultation

Responding to Extreme Trauma Symptoms

How Neuroscience Can Help

By Frank Anderson

Q: I know that the study of neuroscience is intellectually fascinating, but how can it offer practical guidance when I'm working with a client with a trauma history?

A: As both a psychiatrist and a therapist some of the most challenging moments in my career have been with clients who suffer from complex trauma, disorganized attachment, and dissociative identity disorder. The extreme reactions associated with these diagnoses--including rage, cutting, suicidal ideation, panic, numbing, dissociation, and severe shame--have often left me frustrated, helpless, confused, and at times totally overwhelmed. But over the years, my knowledge of neuroscience has increased my ability to understand these reactions and how exactly to work with them while closely monitoring my own reactions. So while neuroscience isn't a therapeutic approach in itself, it does help us understand why different interventions are required to address reactions that originate from different pathways in the brain.

To start, most extreme reactions resulting from trauma fall under one of two categories: sympathetic hyperarousal and parasympathetic blunting. Understanding what happens in the nervous system when clients experience sympathetic activation (a state of high physical energy, high emotion, and low ability to regulate and calm things) and parasympathetic blunting, or hypoarousal (characterized by low physical energy, low emotion, and low access to cognitive functioning), orient me on how to go beyond my immediate reactions when confronted with trauma symptoms in the therapy room.

Know Your Triggers

While being guided by an understanding of the neurobiology of trauma, therapists must never overlook the importance of what the client's hyperarousal or hypoarousal triggers in them. For example, I might be sitting across from someone I've inadvertently triggered when they suddenly blurt out, "You really don't get it, do you? I don't know why I waste my time and money coming in week after week to see you!" In this case, I might struggle with whether to sit patiently and tolerate the intensity or let the person know directly that I don't appreciate being talked to that way. Compare this with the experience of sitting with someone who's looking down at the floor for most of the session and barely speaking. Should I just sit with them and share the silence, or try to come up with just the right thing to say that will pull them out of their current state?

Since I'm very relational and outgoing, I know that sitting with disconnection is much harder for me. I can become a clock-watcher and often work much too hard to try to bring someone out of that state than may be helpful. I have to tell myself, Slow it down, Frank. Just try to trust that there's a really good reason that Jane is needing to be here right now. In contrast, when someone's angry or totally overwhelmed, I have to calm down the controlling parts of me that want to shut down the intensity. My fighter often gets going, wanting to regain control of the situation. It's completely normal for all of us to have these immediate internal responses, and sometimes they're as intense as our clients' responses. But learning how to recognize and relax our physiology in the moment is key in helping our clients.

Helping Clients Shift States

Whether your clients are acutely suicidal and highly agitated or numbed out and dissociated or rapidly switching from one extreme state to another, to move therapy forward, we need to help them separate or get out of the extreme response. The goal is to help them shift states and be mindfully present, feel safe enough, and observe what's going on for them internally. In other words, we need to help clients be with, not in, their trauma. After all, nothing therapeutic can happen when clients are just reexperiencing or reenacting their trauma. …

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