Four Concrete Steps for Working with Trauma

with Bessel van der Kolk, MD and Ruth Buczynski, PhD

Editor’s note: These people are top of their field and always worth the time!

Step 1: Start with Self-Regulation

Dr. van der Kolk: I would say the foundation of all effective treatments involves some way for people to learn that they can change their arousal system.

Before any talking, it’s important to notice that if you get upset, taking 60 breaths, focusing on the out breaths, can calm your brain right down. Attempting some acupressure points or going for a walk can be very calming.

Dr. Buczynski: So this is learning to modulate arousal?

Dr. van der Kolk: Yes, and there’s alarmingly little in our mainstream culture to teach that. For example, this was something that kindergarten teachers used to teach, but once you enter the first grade, this whole notion that you can actually make yourself feel calm seems to disappear.

Now, there’s this kind of post-alcoholic culture where if you feel bad, you pop something into your mouth to make the feeling go away.

“The issue of self-regulation needs to become front and center in the treatment of trauma.”

It’s interesting that right now there are about six to ten million people in America who practice yoga, which is sort of a bizarre thing to do – to stand on one foot and bend yourself up into a pretzel. Why do people do that? They’ve discovered that there’s something they can do to regulate their internal systems.

So the issue of self-regulation needs to become front and center in the treatment of traumatized people. That’s step number one.

Step 2: Help Your Patients Take Steps Toward Self-Empowerment

The core idea here is that I am not a victim of what happens. I can do things to change my own thoughts, which is very contrary to the medical system where, if you can’t stand something, you can take a pill and make it go away.

The core of trauma treatment is something is happening to you that you interpret as being frightening, and you can change the sensation by moving, breathing, tapping, and touching (or not touching). You can use any of these processes.

It’s more than tolerating feelings and sensations. Actually, it is more about knowing that you, to some degree, are in charge of your own physiological system.

There needs to be a considerable emphasis on “cultivating in myself,” not only as a therapist, but also as a patient – this knowing that you can actually calm yourself down by talking or through one of these other processes.

So, step number two is the cultivation of being able to take effective action. Many traumatized people have been very helpless; they’ve been unable to move. They feel paralyzed, sit in front of the television, and they don’t do anything.

“Programs with physical impact would be very, very effective treatments.”

Programs with physical impact, like model mugging (a form of self-defense training), martial arts or kickboxing, or an activity that requires a range of physical effort where you actually learn to defend yourself, stand up for yourself, and feel power in your body, would be very, very effective treatments. Basically, they reinstate a sense that your organism is not a helpless (tool) of fate.

Step 3: Help Your Patients Learn to Express Their Inner Experience

The third thing I would talk about is learning to know what you know and feel what you feel. And that’s where psychotherapy comes in: finding the language for internal experience.

The function of language is to tie us together; the function of language is communication. Without being able to communicate, you’re locked up inside of yourself.

“Without being able to communicate, you’re locked up inside of yourself.”

So, learning to communicate and finding words for your internal states would be very helpful in terms of normalizing ourselves – accepting and making (the communication of internal states) a part of ourselves and part of the community. That’s the third part.

Step 4: Integrate the Senses Through Rhythm

We’re physical animals, and to some level, we’re always dancing with each other. Our communication is as much through head nodding and smiles and frowns and moving as anything else. Kids, in particular, and adults, who as kids were victims of physical abuse and neglect, lose those interpersonal rhythms.

“Rhythmical interaction to establish internal sensory integration is an important piece.”

So, some sort of rhythmical interaction to establish internal sensory integration is an important piece that we are working on. With kids, we work with sensory integration techniques like having them jump on trampolines and covering them with heavy blankets to have them feel how their bodies relate to the environment because that’s an area that gets very disturbed by trauma, neglect, and abuse, especially in kids.

For adults, I think we’ve resolved rhythmical issues with experiences like tango dancing, Qi Gong, drumming – any of these put one organism in rhythm with other organisms and is a way of overcoming this frozen sense of separation that traumatized people have with others.

Dr. Buczynski: These are four keystones that can make healing from trauma faster and more effective. In order to give patients the best chance for recovery, consider these steps as you plan your interventions and treatments.

Pema Wisdom

“At the root of all the harm we cause is ignorance. Through meditation, that’s what we begin to undo. If we see that we have no mindfulness, that we rarely refrain, that we have little well-being, that is not confusion, that’s the beginning of clarity”

from When Things Fall Apart by Pema Chodron

From This Day Forward

Is it so wrong to wake each day and rewrite the plan? I think the folly is waking each day only to go through the motions you went through yesterday without asking the questions:

  • How can today be better (based on your measure) than yesterday?
  • What can I do today to create a life more reflective of my values?
  • When do I begin the authentic life?
  • How will I hang on to my own truth today?
  • Where will I find joy today?

Otherwise you will wake in 30 years and wonder what you’ve been doing. You will look behind you and sadly surmise you’ve been asleep. You might even see years of unconscious avoidance of the journey worthy of your greatness. But that’s OK because today is a brand new adventure. You will make the most of each moment and you will begin anew, again. But it’s the conscious mindfulness that will set you apart today and all the other days you choose to live in the present. And this worthy of deep respect for the self.  This honesty empowers you to do the same tomorrow and there-in lies the path to authenticity. Isn’t this what grounds us and allows more and more days like this where we develop a deep respect for ourselves?

Designing Therapy Spaces: Part 3

In part 1 & 2, we looked at some general aspects of healing spaces: the need for orderliness, supportive environments for practitioners themselves, and some color tips. This time we’ll discuss lighting the space. Most practitioners understand warm lighting with table lamps but because of the expense, we often cut corners and an unsteady, cheap lamp is not advised. Natural light is always an excellent choice.

Recently, I read a book that included personality traits the general public assigned to their favorite brands. Out of 300 descriptors, researchers distilled the list to 5 and I think these could be helpful when considering how others would describe our space. The 5 words (in no particular order) are sincerity, excitement, competence, sophistication, and ruggedness.

77b861e5d3b3964f98a90696c04c08c9Competence and sophistication might be your credentials,education, and your experience. Sincerity might be covered by your orderly and carefully appointed work space. Ruggedness might be the sturdy furnishings that are slightly masculine – see part 1 & 2. But excitement might need to be covered by a bit of dramatic flair in your office. Although folks feel less exposed with softer lighting and overheads with dimmers, this may be an opportunity to have a bit of fun with illumination of a different sort. A gas fireplace is an awesome touch but not always practical or appropriate however you have some creative license here. Be playful and have some fun. Remember, you spend the most time in your office and your well-being is a top priority!

FINDING YOUR LIFE’S WORK EVERY DAY

Ruminating on how many times I see an article promising the reader relief from their boredom (as in ‘find your life’s work’), I realize there was a time that I too seemed dumbstruck with the overwhelming needs in the world. But then I reflected on the previous few decades and decided I was already ‘living my destiny’ and I became empowered then to simply stay the course. Understandably, not everyone is as old as me, but my point here is that you may already be fulfilling your destiny whether or not you’ve figured out how to make a living at it.

We seem to have raised our kids to expect fame and fortune when one finds that magic destiny although those of us who’ve been down the entrepreneurial path know it takes a large fortune to make a small one – riches usually aren’t at the end of that rainbow. So what’s up with all of this? Did my parents spend so much time thinking they were missing something? I wonder if this is another one of those 1st world problems…. we certainly have the luxury to do a bit more than scrape together enough food to eat for the day and find a dry safe place to sleep at night, unlike many in this world.

Another misconception is that anything worth doing requires a GREAT idea. But most successful people, no matter how you define success, have had many small ideas, most of which didn’t pan out or were downright failures. So isn’t it more important to keep supporting your causes until you’re to the point you can reinforce them a bit more? Do we really think, like in some movie, some super idea will come to us in a dream? Then we’ll wake up, act as we never have before and take the world by storm?

The secret may be you are already doing your life’s work. You just haven’t found freedom there.  And that may be because freedom still involves sadness and loneliness. Is it how we’re defining freedom that has us stumbling? There will still be good days and bad days. You will still complain about the love of your life. The children you adore will be annoying and you’ll forget to take the garbage to the curb. Without the mundane, we can never appreciate the exciting and without suffering, we can never appreciate ecstasy. If your life feels meaningless, go out there and work towards solutions. Feed the hungry and clothe the poor. I know from experience that it helps put things in perspective. Otherwise my friends, you will reflect on a life a inaction when you are my age and realize you already had the answers but didn’t realize it at the time.