by Pete Walker
But back to cooking which became a central piece of my self-remothering work. It was not until I understood more about the dynamics of my flight response that I realized how much I rushed around when I was cooking. Via increased mindfulness, I discovered that the smallest unforeseen obstacle could set off what felt like a small electric shock in my chest. Examples of these obstacles include something spilled, a lid too tight to open, an extra unanticipated task, or the clock showing me that I was behind schedule. In an instant, anyone of these normal hindrances could send me rushing around the kitchen in a low grade panic. Whenever this occurred, I would then inhale my meal as soon as it was ready just to get the ordeal over with.
This is an example of what a common, everyday flashback looks like in adulthood. It is so often minor daily frustrations that trigger us into flashbacks, rather than incidents that repeat the gross insults and ordeals of our childhoods.
With ongoing recovery work, I realized that anything to do with food could easily flash me back to the family dinner table - the battlefield of my dysfunctional family.
Many productive grieving sessions came out of this. They lead me to an epiphany that doing anything intricate with lot of steps to it also flashed me back to feeling picked apart by my parents. I subsequently discovered that angering at my parents, whenever I was triggered by doing something complicated, significantly reduced my fear.
There was, however, a huge part of my food trauma that I could not shrink until I started the somatic work described in this chapter.
Since then, years of practicing somatic mindfulness has greatly reduced my hair-triggerable anxiety around cooking. This is however still a work in progress. In terms of the cycles of reactivity, my occasional flashbacks around food and food preparation can look like this. I have thirty minutes to cook and eat my breakfast before I leave for work. I come into the kitchen and… “Oh No, The sink is full of the dishes that I forgot to clean last night!” I immediately notice that I am about to launch into frenzied dish washing, when Flashback Management Step# 1 rises to the front of my consciousness. “I am having a flashback.”
I go directly to Step# 7 and attempt to “ease back into my body.” I sit in my favorite stuffed chair, close my eyes, and bring my awareness to my abdomen, where my anxiety typically makes its most strident charge. I can feel tightness in and just below my diaphragm. I feel afraid and get a picture of my father’s big hand squeezing my small intestines.
I start to hypochondriasize about the possible long term effects of having this tension in my abdomen. My mindfulness instantly alerts me to invoke the thought-correction of Step# 8. I slowly repeat my current favorite anti-endangerment mantra: “I am safe; I am relaxing.”
I slow and deepen my breath, and feel the muscles in my belly as much as I can. I feel the slow cycle of these muscles relaxing and contracting with the ebbing and flowing of my breath. The cycle gradually becomes more fluid as I attend to it.
After about fifty inhalations, I feel a swollen sensation of tiredness diffusing like ink throughout my body. My gut momentarily retightens to ward off that awful deadening feeling of the abandonment depression.
But I surrender to the deadness. I do this because I know the tight feeling is fear and that it will soon morph into the screaming critic excoriating me about being late. I say no to the critic’s Siren call of “you can do this if you hurry,” tempting me back into flight.
I stay with the deadened, tired, lifeless feeling and try to feel it more, welcoming it. I sense myself beginning to become one with the depressed sensation.
Because I am so well practiced, the depression starts to gradually morph into a widening sense of relaxation. It spreads throughout my body, and my body begins to feel like an easy-chair.
I look at my watch and it has taken twenty minutes of my “precious time.” I realize my critic is trying to sneak back in and is goading me with the remark “it has taken twenty minutes of my precious time.”
I disidentify from the critic and shift into my refathering self and thought-correct the critic. “It’s ok Pete, this is all small potatoes. You are not in danger [Step# 2], and this is definitely no emergency.”
I take a moment with the angering part of grieving [Step#9] and reinforce my boundaries against my internalized parents. “Screw you Helen [mom] and Charlie [dad] for frightening me so much about making mistakes that I freak out when things don’t go perfectly!
“Ooh, that got a few nice tears. What a relief. How many times have I been stuck in that driven-ness and not known how to stop?!”
I return to thought-correction. “So, like I was saying Pete, it’s ok. You always show up at your office an hour early anyway. You can take 20 minutes off the routine. You can stay in this relaxed state a bit longer and still have time to get everything done in a relaxed manner.”
I feel the sense of triumph I sometimes see in my clients when they have worked hard to successfully manage and resolve a flashback. “It worked!” This time I broke the cycle and did not let my triggered flight response get much further than some momentary rushing.
I stopped the cycle of reactivity from devolving into an inner critic diatribe against myself. I didn’t indulge the outer critic and let it make me try to pin the undone dishes on my wife. I chose to stay with the depression. I bypassed the shame and fear that I have gotten stuck in ten thousand times before when I could not accept my current state of being. I refused to abandon myself like the sinking ship I thought I was – like Helen and Charlie abandoned me as a kid on a daily, hourly, yearly basis.
I am also happy to report that I now cook regularly, and triggering is relatively rare. I have even gotten to enjoy my own cooking so much that I rarely eat out.
A RELATIONAL APPOACH TO HEALING ABANDONMENT
This chapter is a reworking of a professional article I wrote to guide therapists in their Cptsd work. I have kept that point of reference in many sections of this chapter in the hope that it will help you know what it is reasonable to expect from a therapist.
Further on in this chapter, there is a section on how to find a therapist. I hope this information will help you know what to look for, and ask for, when and if you are shopping for a therapist.
Finally, if therapy is not an option for you, I end the chapter with guidelines on how to create a co-counseling relationship with a friend. If that also is not possible, I list recommendations for online forums where you can interact with others who are sharing about their recovery journeys.
The Relational Dimension Of Psychotherapy
Many Cptsd survivors have never had a “safe enough” relationship. Healing our attachment disorders usually requires a reparative relational experience with a therapist, partner or trusted friend who is able to stay compassionately present to their own painful and dysphoric feelings. It is essential that they are comfortable with feeling and expressing their own sadness, anger, fear, shame and depression.
When a therapist has this level of emotional intelligence, she can guide the client to gradually let go of the learned habit of automatically rejecting his feelings. This in turn also helps him to avoid getting lost in the cycles of reactivity we explored in the last chapter.
Safe and empathic eye and voice connection with a therapist who has “good enough” emotional intelligence models to the client how to stay acceptingly present to all her own affects.
Daniel Siegel calls this the “coregulation of affect.” Moreover, Susan Vaughan’s work demonstrates that this coregulation of affect promotes the development of the inner neural circuitry necessary to metabolize overwhelmingly painful feelings.
Furthermore, there is increasing neuroscientific evidence suggesting that this process is physiologically accomplished through the agency of a set of neurons called mirror neurons. In one experiment measuring neural activity in two monkeys, one monkey watched as the other cracked open a nut. The observer’s neural activity was identical to the performers. Perhaps mirror neurons are involved when the client learn
s to be as non-reactive to his painful feelings as the therapist.
RELATIONAL HEALING IN COMPLEX PTSD
[Versions of the following article were first published in The Therapist and The East Bay Therapist.]
Many traumatologists see attachment disorder as one of the key symptoms of Complex PTSD. In the psychoeducational phases of working with traumatized clients, I typically describe attachment disorder as the result of growing up with primary caretakers who were regularly experienced as dangerous. They were dangerous by contemptuous voice or heavy hand, or more insidiously, dangerous by remoteness and indifference.
Recurring abuse and neglect habituates children to living in fear and sympathetic nervous system arousal. It makes them easily triggerable into the abandonment mélange of overwhelming fear and shame that tangles up with the depressed feelings of being abandoned.
A child, with parents who are unable or unwilling to provide safe enough attachment, has no one to whom she can bring her whole developing self.
No one is there for reflection, validation and guidance. No one is safe enough to go to for comfort or help in times of trouble. There is no one to cry to, to protest unfairness to, and to seek compassion from for hurts, mistakes, accidents, and betrayals.
No one is safe enough to shine with, to do “show and tell” with, and to be reflected as a subject of pride. There is no one to even practice the all-important intimacy-building skills of conversation.
In the paraphrased words of more than one of my clients: “Talking to Mom was like giving ammunition to the enemy. Anything I said could and would be used against me. No wonder, people always tell me that I don’t seem to have much to say for myself.”
Those with Cptsd-spawned attachment disorders never learn the communication skills that engender closeness and a sense of belonging. When it comes to relating, they are often plagued by debilitating social anxiety - and social phobia when they are at the severe end of the continuum of Cptsd.
Many of the clients who come through my door have never had a safe enough relationship. Repetition compulsion drives them to unconsciously seek out relationships in adulthood that traumatically reenact the abusive and/or abandoning dynamics of their childhood caretakers.
For many such clients, we are their first legitimate shot at a safe and nurturing relationship. If we are not skilled enough to create the degree of safety they need to begin the long journey towards developing good enough trust, we may be their last.
Emotional flashback management, therefore, is empowered when it is taught in the context of a safe relationship. Clients need to feel safe enough with their therapist to describe their humiliation and overwhelm. At the same time, the therapist needs to be nurturing enough to provide the empathy and calm support that was missing in the client’s early experience.
Just as importantly, the therapist needs to be able to tolerate and work therapeutically with the sudden evaporation of trust that is so characteristic of Cptsd. Trauma survivors do not have a volitional “on” switch for trust, even though their “off” switch is frequently automatically triggered during flashbacks. In therapy, the therapist must be able to work on reassurance and trust restoral over and over again. I have heard too many disappointing client stories about past therapists who got angry at them because they would not simply choose to trust them.
As the importance of this understanding ripens in me, I increasingly embrace an Intersubjective or Relational approach. That means that I believe that the quality of the clients’ relationship with me can provide a corrective emotional experience that saves them from being doomed to a lifetime of superficial connection, or worse, social isolation and alienation.
Moreover, I notice that without the development of a modicum of trust with me, my Cptsd clients are seriously delimited in their receptivity to my guidance, as well as to the ameliorative effects of my empathy.
In this regard then, I will describe four key qualities of relating that I believe are essential to the development of trust, and the subsequent relational healing that can come out of it. These are Empathy, Authentic Vulnerability, Dialogicality and Collaborative Relationship Repair.
1. EMPATHY
I used to assume that the merits of empathy were a given, but I have sadly heard too many stories of empathy-impoverished therapy. In this regard, I will simply say here that if we are hard and unsympathetic with our clients, we trigger the same sense of danger and abandonment in them that they experienced with their parents.
In terms of a definition, I especially like Kohut’s statement that: “Empathy involves immersing yourself in another’s psychological state by feeling yourself into the other’s experience.”
When I delve deeply enough into a client’s experience, no matter how initially perplexing or intemperate it may at first seem, I inevitably find psychological sense in it, especially when I recognize its flashback components. In fact, I can honestly say that I have never met a feeling or behavior that did not make sense when viewed through the lenses of transference and traumatology.
Empathy, of course, deepens via careful listening and full elicitation of the client’s experience, along with the time-honored techniques of mirroring and paraphrasing which show the client the degree to which we get him.
Noticing my subjective free associations often enhances my empathic attunement and ability to reflect back to the client in an emotionally accurate and validating way. When appropriate, I sometimes share my autobiographical free associations with the client when they are emotionally analogous. I do this to let her know that I really empathize with what she is sharing.
This is an example of this. My client tells me with great embarrassment that she stayed home all weekend because she had a pimple on her nose. She is ashamed of the pimple and of her “vanity’’ about it. She moans: “How could I be so stupid to let such a little thing bother me?” I suddenly remember cancelling a date once when I had a cold sore. At the time, I also got lost in a toxic shame attack. I share this with her, minus present day shame about it. She tears up and then laughs, relieved as her shame melts away. Months later, she tells me that her trust in me mushroomed at that moment. Guidelines for being judicious about this kind of self-disclosure will be discussed below.
Of the many benefits of empathy, the greatest is perhaps that it models and teaches self-empathy, better known as self-acceptance. To the degree that we attune to and welcome all of the client’s experience, to that same degree can the client learn to welcome it in her- or himself.
2. AUTHENTIC VULNERABILITY “Realationship” Makes Healthy Relationship
Authentic vulnerability is a second quality of intimate relating. Authentic vulnerability often begins with emotionally reverberating with the client. I have found that emotional reflection of the client’s feelings is irreplaceable in fostering the development of trust and real relational intimacy.
Emotional reflection requires the therapist to be emotionally vulnerable himself and reveal that he too feels mad, sad, bad and scared sometimes. Modeling vulnerability, as with empathy, demonstrates to the client the value of being vulnerable and encourages her to risk wading into her own vulnerability.
I came to value therapeutic vulnerability the hard way via its absence in my own therapy with a therapist who was of the old, “blank screen” school. She was distant, laconic and over-withholding in her commitment to the psychoanalytic principle of “optimal frustration.” Therapy with her was actually counter-therapeutic and shame-exacerbating for me as we reenacted a defective child/perfect parent dynamic.
Therapeutic Emotional Disclosure
Thankfully, I eventually realized that I had unresolved attachment issues, and sought out a Relational therapist who valued the use of her own vulnerable and emotionally authentic self as a tool in therapy.
Her tempered and timely emotional self-disclosures helped me to deconstruct the veneer of invincibility I had built as a child to hide my pain. Here are some examples that were especially helpful. “God, t
he holidays can be awful.” “I get scared when I teach a class too.” “I’m so sorry. I just missed what you said. I got a little distracted by my anxiety about my dental appointment this afternoon.” “I feel sad that your mother was so mean to you.” “It makes me angry that you were so bullied by your parents.”
My therapist’s modeling that anger, sadness, fear, and depression were emotions that could be healthily expressed helped me to renounce the pain-repressing, emotional perfectionism in which I was mired. With her, I learned to stop burying my feelings in the hope of being loved. I renounced my just-get-over-it philosophy and embraced vulnerability as a way of finally getting close to people.
I needed this kind of modeling, as so many of my clients have, to begin to emerge from my fear of being attacked, shamed or abandoned for feeling bad and having dysphoric feelings. In order to let go of my Sisyphean salvation fantasy of achieving constant happiness, I needed to experience that all the less than shiny bits of me were acceptable to another human being. Seeing that she was comfortable with and accepting of her own unhappy feelings eventually convinced me that she really was not disgusted by mine.
The therapist’s judicious use of emotional self-disclosure helps the client move out of the slippery, shame-lined pit of emotional perfectionism. Here are some self-revealing things that I say to encourage my clients to be more emotionally self-accepting. “I feel really sad about what happened to you.” “I feel really angry that you got stuck with such a god-awful family.” “When I’m temporarily confused and don’t know what to say or do, I…” “When I’m having a shame attack, I…” “When something triggers me into fear, I…” “When my inner critic is overreacting, I remind myself of the Winnicottian concept that I only have to be a ‘good enough person.’”