Three Quick Quotes and a FREE resource – 9 June 2021
In this week’s email we have:
- quotes from Christiane Sanderson; Ruth Lanius, Robyn Bluym, and Paul Frewen; and myself
- a free psychoeducational resource: ‘Three Phase Treatment Approach’ article PDF
- my ‘snap of the week’
- my weekly blog – ‘What grounding is and isn’t’
Just a reminder too that our ‘Course of the Week’ this week, with £10 off, is ‘Working with Dissociative Disorders in Clinical Practice‘ (6 hours of CPD for just £25), and you can also delve deeper into working with dissociation on our new resource page here.
Please share this email with friends, colleagues and clients and ask them to join our community at www.carolynspring.com/subscribe where they can also get a free copy of our ‘Emotional Resource Guide’. And if you or they have missed any previous emails, there’s a full archive at www.carolynspring.com/three-quick-quotes.
“The counsellor must identify and address the survivor’s fears before implementing any change in the therapeutic way of working. Many adult survivors fear change as they cannot conceptualise a different way of being. They may fear that if they reduce long-standing symptoms and reactions, especially those that have been their constant companions, then they will be replaced with something worse. Invariably, fear and confusion have been such a central part of the survivor’s existence that they cannot imagine or conceive of life without them. These are genuine fears that the counsellor must respond to sensitively.”
Ruth Lanius, Robyn Bluym & Paul A Frewen
A Window into the Brain of Complex PTSD (in Daniel Siegel & Marion Solomon (editors), Healing Moments in Psychotherapy)
“From an evolutionary perspective, our emotions have evolved, in part, to signal danger in the environment and to motivate escape. Yet being unable to escape, as is the case when children have a chronically abusive caregiver, can make individuals unable to use their inborn emotional responses to guide effective escape behaviours. This repeated inability may result in a sense of learned helplessness and the belief (conscious or not) that emotional responses are futile. In turn this sense of futility may lead individuals to disconnect from their own experiences, so as to avoid distress that cannot be relieved through action. Indeed, individuals with PTSD are often unaware of their own emotional responses and have difficulty identifying and describing their emotional states. The latter is well described by the following statement from a patient with complex PTSD: ‘When I get emotions and stuff like that I don’t really feel them. I can say to someone ‘I feel sadness’ because tears are welling in my eyes, but I do not know what that is really. They are just physical symptoms.’”
“‘Just notice,’ my therapist used to say to me in her sing-song therapist voice, every time an emotion washed up on the shore of my body and threatened to drown me. ‘Just notice. Just be curious.’ She wanted me to pay full attention to it, rather than dissociate away from it. She wanted me to learn to ride the wave of it rather than needing instantly to numb it. ‘Just notice.’
Later I learned that ‘just noticing’ activates our medial prefrontal cortex, our ‘front middle brain’, which has the best connections to our brain’s danger detector, the amygdala. ‘Just noticing’ helps to soothe the smoke alarm, and makes us less reactive over time to danger and threat. ‘Just noticing’ brings us into the here-and-now, rather than discharging abruptly into the there-and-then with all its horrors and default of dissociation.”
this week’s free resource
Treating complex trauma is not straightforward – we certainly can’t just dive straight into the narrative or as survivors we risk being triggered and overwhelmed. But neither can we avoid processing traumatic material forever, so what’s the answer? According to the consensus of experts, the answer lies in a phased approach, building the blocks of safety and stabilisation first, before delving into processing the trauma second and then finally integrating these experiences into future living. And in this nearly 50-page booklet I explain in depth what it involves, along with personal narrative of my experience of it.
It’s particularly useful for therapists working with clients with a history of complex trauma, but I firmly believe that knowledge is power, and so it should also come in helpful for trauma survivors as well – to see what the roadmap is for the journey ahead.
The full copy of the ‘Three Phase Treatment Approach’ booklet is available as a PDF here.
‘Grounding never worked for me because I have chronic pain and I don’t want to notice my body,’ said someone recently on Twitter.
Of course, I wanted to say in reply. Of course. Why, after trauma would we ever want to notice our bodies, the too-frequent objects of that trauma? Indeed, trauma trains our brains to ‘dissociate’ from our bodies – to shut off from awareness, to compartmentalise our experience, to say, ‘This isn’t happening’ or ‘This isn’t happening to me.’
It all makes perfect sense. How else can we cope with the overwhelm of pain, with the haunting ache of neglect, or with soul-sickening abuse? The only way to mentally survive such suffering is not to be aware of it. To dissociate is to be separate from the sensations in our body. And so to recover is to get back in touch with our bodies – but oh what a soft and gentle process this should be. We need to edge up to our bodies without triggering their alarm. We need to become body-whisperers, memory-whisperers, trauma-whisperers. It’s okay, we need to say to our bodies, in the tenderest of tones. It’s okay now. I’m here. You’re safe. We need ever-so-slowly to build that trust, to allow this new reality to take root. We can’t just launch at our traumatised body-brains and expect them not to startle.
And that’s the problem with the acquired meaning of the term ‘grounding’. Most people, in using the word, are referring to a set of techniques, of things to do: noticing specific surroundings, focusing on the breath, turning attention inwards to bodily sensations, or repeating well-worn mantras. The aim of grounding is to calm the mind and body again when we have become triggered, distressed or overwhelmed. And that is a worthy aim. But the aim has too often become confused with the technique to achieve that aim.
The aim of grounding is to help someone who feels unsafe to feel safe again. And any particular technique may achieve that aim – but equally it may also thwart that aim. Asking a trauma survivor to focus on their body might heighten their distress, not lessen it. Asking someone, whose breath was crushed out of them during the abuse, to focus on their breath is risky: it might trigger a trauma memory, not soothe and reassure. The technique has to be tuned to the individual. The individual has to know what works for them.
We haven’t always talked about ‘grounding’. We used to talk about ‘calming down’ – but that phrase became muddied by inferences of control, insult, or patronising dismissiveness. And no-one ever calmed down by being told to calm down. Being helped to ‘ground’, however, provides something concrete and specific to do – a technique that will aid the re-regulation of the nervous system – rather than an instruction simply to be re-regulated. So it’s a step in the right direction. But we come full circle if, by instructing someone in a technique to help them to re-regulate (or ‘calm down’), we increase their distress. And we shame them if we infer that their failure to be grounded by one particular technique is in some way their fault.
Rather than the word ‘grounding’ – and certainly rather than the phrase ‘calming down’ – I prefer the term ‘getting the front brain online’. It clearly defines the problem – that my front brain has gone offline – and clearly implies what the solution will look like: that my front brain will be active and engaged again. There’s no fault or blame. It’s not saying that I’m being reactive or even over-reactive. It’s just saying that my front brain has gone offline and that it would be helpful if we could get it back online.
Our ‘front brain’ is our clever, thinking, reflective, strategic, perspective-taking, curious neo-cortex – this most human of assets. And antagonistic to it is our more primitive, survival-based ‘back brain’ comprising our limbic system and reptilian brain: the parts which operate largely without conscious thought, instinctively, to keep us safe.
Because when my front brain is online, things go better for me. I’m able to consider, to reflect, to mentalise, to be aware of what I’m thinking and feeling and to put it into words. It’s where I become aware of automated scripts from the past, and how what I’m thinking in the here-and-now might be layered over with voices from the there-and-then. With my front brain online I can make sense from multiple perspectives and points of view – not just my own. I can see things in grayscale, not just in black and white. I can laugh at myself, and not take myself too seriously. I can respond to accusations without becoming defensive or needing to prove my perfection. I can sift through what’s true, what’s not true and what is yet to be determined as true. I can be curious and open to things I haven’t thought before, and join the dots. I can see patterns, assumptions, and prejudices, and conclusions that I’ve jumped to. I can slow it all down and just wonder what’s going on, and I can take a step back and let all my feelings and thoughts settle before reacting.
In my back brain I’m all action, all re-action, all jump out of the way and ask afterwards what I’m jumping out of the way of. I see things in blacks-and-whites, in all-or-nothings. I leap into the drama triangle and assume the position of victim, rescuer or persecutor. I play pre-programmed responses, of jumping to conclusions, of catastrophe, of outrage, of shame, of despair. I act only to defend myself, even before assessing the validity of the threat. I’m in survival mode, and woe betide the person who wants reason and rationale from me while my back brain is in control.
My front brain lets me feel my feelings, but also to verbalise them – ‘you need to name them to tame them’, as Dan Siegel says. I’m able to see that this is a feeling that I’m feeling, that it’s here now but won’t be later; that emotions have motion; that emotions present one piece of the picture, but not all of it; that feelings are meant to be felt, but not necessarily believed or acted upon. In the green zone with the front brain online, we can validate our feelings whilst also soothing them and making sure they don’t take over.
Sounds pretty ace, doesn’t it? Oh to have our front brain online all the time!
And that’s what the aim of grounding is – to bring our front brain online and re-regulate our nervous system back into the green zone. The aim of grounding isn’t so that we can tick a box to say that we’ve named five things that are green or that we’ve exhaled to the count of four. The aim of grounding is to move out of danger mode back into daily life mode, out from unsafety to safety, out from the amber or red zone back into the green zone, out from the back brain and into the front brain. We do this by increasing blood flow to our frontal lobes, by slowing down our sympathetic nervous system response, by engaging the ventral vagal circuit, by lowering our sense of threat through intentional eye movement: that’s what all the techniques are properly designed to do. The out-breath, for example, engages the parasympathetic nervous system. We don’t need to know this when we’re in a state of panic – we just need to do it. But it’s good to know at least that there is solid science behind many grounding techniques.
But not every technique works for everyone at all times. We need to figure out what works for us as individuals, and what works for us right now.
Sometimes what I need most of all is the sound of a human voice, someone calm and reassuring and ‘for me’. Or touch, or presence, or ‘withness’: that alone will suffice. Sometimes I need problem-solving. Sometimes I need a reality-check. Other times, what I need most of all is space – to be left alone to sort through my jumble of feelings for myself, without pressure or expectation, with privacy and a buffer zone to breathe my way back into my body again, on my own. One of the challenges of recovery for me has simply been figuring out what it is that I need. That knowledge doesn’t come readily to those of us whose needs were so terribly neglected and overridden in childhood: it has to be relentlessly nurtured.
And it’s been important for me to understand that ‘grounding’ isn’t a way of squashing and inhibiting someone’s distress. When someone is upset, their distress is a signal for care or support. True ‘grounding’ comes in the first place from receiving social support – from feeling seen and feeling heard and feeling felt. ‘Grounding’ is most effective when it’s one person’s neurobiology calming down another’s, through direct contact. We don’t tell an infant from across the room to ‘calm down’, to ‘ground’: we go over, we pick them up, we talk softly to them, we rock them and reassure them and comfort and soothe.
And ‘grounding’ isn’t a technique to lob at someone as a way of ignoring their pain, or not having to get involved. Neither should ‘grounding’ be a way of shaming someone into submission – a way, in effect, of emotionally blackmailing them into shutting up, so that we will be bothered no more by their suffering. When people phone crisis lines, invariably they don’t want advice. They don’t want a list of things to do – play a game, do a puzzle, have a warm bath, go for a walk, stroke a pet. They want compassion and empathy from someone who is demonstrating care. They want to feel that their pain has been heard by another human being. That is the most effective grounding.
Neither is ‘grounding’ a wipe-clean approach to trauma that actually avoids having to deal with it. When we are processing traumatic material in a therapeutic setting, we need to feel it to heal it. We need to connect with the distress and the emotional expression that by necessity we dissociated from at the time, so that we can integrate and process it. We need to work it through in the presence of a supportive other. Too often therapists see their clients become distressed – getting in touch perhaps for the first time with their feelings – and instruct them to ‘ground’. Yes, it’s true that we need our front brain to be at least partly online in order to effectively process trauma. But ‘grounding’ is not the answer to distress: empathy is. The techniques of ‘grounding’ can be helpful to modulate the distress but there’s a reason for the distress in the first place – it’s not an aberration of the brain. Distress is meant to be felt, it’s meant to be expressed, it’s meant to be responded to by other human beings and sometimes it’s meant to be acted upon. Distress is often a signal that something in our life has to change and if we suppress it then we will remain in the situation that is causing it in the first place.
As trauma survivors whose distress went unheard and unresponded to in childhood, it can be too easy for us to feel fobbed off by grounding techniques, when really all we want – really all we need – is to be heard. The healing is in the hearing. Of course this always needs to be contingent – therapy is a good time for our distress to be responded to; less good is when we are caring for children, or at work, or at a friend’s birthday party. And so learning the skill of grounding, learning to be able to soothe and re-regulate ourselves, can help to contain our distress long enough until appropriate help is appropriately available. Distress should always be heard and responded to by other human beings; just not necessarily by every human being and just not necessarily immediately. Too often we feel coerced to ‘ground’ and all we’re hearing in that is, ‘Please shut up and stop bothering me.’
And so grounding is not about stopping someone being upset. When we’re upset, we need to feel the feelings, we need to listen to what those feelings are saying – because they are messengers and guides to action. If that distress becomes overwhelming, so that we are unable to notice that we are having a feeling, and we are simply immersed in the feeling – if we are unable to think about and express in words what it is that we’re feeling – then that is when we could benefit from grounding. When it’s the middle of the night and no-one is around, then we could benefit from grounding. If we have caring responsibilities or work responsibilities or even just general life responsibilities, then we could benefit from grounding. That is when we need to do something (a technique) to come back sufficiently into our window of tolerance so that our emotions don’t overwhelm, to just blunt a little the sharp edges so that we don’t smash ourselves against the rocks of our own pain. But these emotions still need to be expressed; they need to be heard. Grounding may put some bubble-wrap around them for a little while, but its purpose is not to suffocate them.
So grounding is about feeling safe again when we’ve been triggered into feeling unsafe – modulating distress until such a time as that distress can be heard and soothed. But let’s not confuse the aim of grounding with any particular technique of grounding – and let’s remember that everyone feels safe in different ways: grounding techniques need to be attuned to the individual and not handed out merely as a way to shut people up from their inconvenient distress.
What activities are most grounding for you? What activities, of what are commonly termed ‘grounding techniques’, are least effective for you? How do you want people to respond to you when you are distressed? How do you respond to yourself?
This blog is available at www.carolynspring.com/blog/what-grounding-is-and-isnt.
snapshot of my week
I was very grateful for lots of blue skies during my recent escape to the north coast of Scotland. (I won’t mention the 70mph winds and wet-to-your-bones driving rain the day after I took this photo!) Just very grateful for my first trip away and time off in 2021 – making up for lost time! Peps had a particularly splendid time on the always deserted beach.