Adult Grieving as a Response to Childhood Loss or Trauma

Posted on by February 8, 2015
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Most people think of grief as a response to the loss of a loved one, but grief can be a response to any type of loss, including the loss of something that never was (such as a happy childhood).  This post explores the experience of grief in the present as a response to having bad experiences (from abuse, neglect, or trauma) in the past as a child.  Grief of this sort is a necessary and restorative process that permits a person to bring new life and a renewed sense of hope to childhood hardship and deprivation.  Looked at in this way grief allows us to cleanse ourselves of hurt and loss and continue to grow and to expand our sense of ourselves.

Many people do not realize that they may be suffering in the present from having been mistreated, deprived or traumatized as a child.  Partly this is the case, because it is hard to know that something is missing if one has never had the experience of it’s presence.  If you did not have loving, attentive, nurturing parents who were joyful about life and about you as their child, you might not know that this is something that you lacked.  If you were emotionally abandoned or neglected, you may not know what it is like to be emotionally accompanied or cared for.

A child’s need for love and nurturing is as essential as a plant’s need for water and sunshine.  If you did not receive love, nurturing and attention consistently in your childhood, you may  be experiencing pain in the form of grief as an adult and not realize that this is why.  Many children who were mistreated were led to believe that they do not deserve to be treated with love, respect and compassion.  Allowing yourself to fully feel the pain of what you did not receive in the past allows you to empty out these old hurts and disappointments to make room for experiencing joy and the promise of each new day.  As Pete Walker puts it, “…the broken heart that has been healed through grieving is stronger and more loving than the one that has never been injured.  Every heartbreak of my life, including the brokenheartedness of my childhood, has left me a stronger, wiser and more loving person than the one I was before I grieved”

Often a person does not begin to grieve their childhood losses until they have reached a point in their lives where in they can emotionally afford to do so.  This may be because the person has found a therapist with whom they feel safe enough or because they find themselves with a social support system that is stable and strong enough for the first time.  The self compassion borne out of grieving the losses of your childhood makes it clear that you did not deserve the abuse or neglect that you suffered and that you are hurting now because you were hurt then and not because you were bad then.

If you were neglected or abused as a child your emotional or intellectual development may have been truncated.  This may be because you needed to use your energy to protect yourself rather than to grow and develop naturally emotionally and intellectually.  There may not have been opportunities for you to participate in normal, age appropriate activities such as playing, asking hundreds of curious questions, using your imagination, experimenting with language and cause and effect, or to getting to know yourself and your own emotional internal world in an intimate way.  Moreover, these losses and the feelings of grief associated with them may have been unacknowledged or even actively denied by those around you.  In some cases the lack of acknowledgement of loss can be more emotionally devastating than the loss itself.  The grief associated with unacknowledged childhood loss may be outside your awareness, but actively affecting you to this day.  The next post in this series will cover how counselling can facilitate the grief process which is necessary to recover from childhood loss.

 

Normal Versus Complicated Grieving

Posted on by May 12, 2014
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This post covers what grief is like both in situations where the bereaved is grieving effectively and when this is not the case.  While this post refers to grief as a response to the death of a loved one, there are many reasons that a person may experience grief.  For example, grief in the present can result from something that happened in the past such as childhood neglect or abuse.  I will cover this in depth in a subsequent post.

Counsellors distinguish between so-called normal (or uncomplicated) grief and abnormal (complicated) grief.  Uncomplicated grief looks like depression in many ways and in fact grief can sometimes precipitate an actual depression.  Much like a depressed person, a bereaved person often experiences disturbances in sleep and/or appetite and may become absent minded.  It is also common for a bereaved person to cry and/or to sigh a lot.  The bereaved often withdraw socially and lose interest the outside world for a period of time.

Those experiencing normal grief reactions also often dream of the deceased.  These may be regular dreams in which the deceased simply appears or they may be distressing dreams or nightmares.  Some bereaved people avoid reminders (such as places or objects) of the deceased, while others intentionally go to and seek out places or things that remind them of the deceased.  Relatedly, some may treasure certain objects that belonged to the deceased and may carry these objects around with them.  Another experience associated with normal grief is for the bereaved to find themselves searching for or even calling out for the deceased.

Grieving takes time and some move through it more readily than others.  Although there is no standard amount of time that it takes to recover from a significant loss, as noted in the previous post there are standard phases which involve particular tasks that the bereaved tend to pass through.  How long it takes a person to pass through these phases varies.

Although grieving is a completely natural and normal response to loss, counselling can facilitate the grief process.  It can help a person to more readily and more thoroughly move through the phases and accomplish the tasks associated with the grieving process.  Talking about a significant loss can help a person to accept it and to work through the feelings associated with it.

When a person does not grieve effectively it is refer to as a complicated or abnormal grief reaction.  This is when the normal phases and tasks associated with grieving are not experienced or accomplished.  Complicated grief can take several forms.  Grief can become chronic, it can be delayed, it can be exaggerated or it can be masked.  Each of these types of complicated grief reaction is described below.

As the name implies, a chronic grief reaction is one that does not come to a satisfactory conclusion.  This can be for a myriad of reasons, but it requires an assessment as to which of the tasks of grieving is not being accomplished and why.  A delayed grief reaction is one in which the grief process is suppressed entirely or in which it is experienced but in a minimal way which is not sufficient to the loss.  An exaggerated grief reaction is one in which a person becomes emotionally overwhelmed by grief and may resort to maladaptive coping strategies such as the use of alcohol or drugs or some type of compulsive behavior.  Masked grief is when a person does not allow himself to experience grief such that the feelings get subverted into physical (psycho-somatic) symptoms or some type of maladaptive behavior.

Counselling can help with all of these types of complicated grieving.  The goal of counselling in complicated grieving is to identify and resolve the reasons that the grieving process is absent, delayed, excessive, or prolonged.  In prolonged and excessive grief the bereaved person is usually conscious of the fact that they are experiencing difficulty grieving, whereas in absent and delayed grief reactions the person is not.  In either case, the therapy generally involves assisting the bereaved to experience thoughts and feelings that s/he has been avoiding.  The counsellor seeks to become part of a social support system that would give the client the permission, compassion and the strength needed to grieve effectively.

Are you experiencing grief?

Posted on by November 20, 2014
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Grief is a normal reaction to any significant loss.  Anyone including children can experience grief at any point in their lifetime. The feelings associated with grief can include sorrow, numbness, pining, rage, lethargy, guilt, sadness, depression, frustration, anger, loneliness, helplessness, relief, shock, anxiety and despair.

What gives rise to grief may be something tangible such as losing a loved one or it may be something intangible such as a change in the nature of an important relationship, a deterioration of a state of health, the lost possibility of a dream that was held dear or the realization of a loss of a state innocence in childhood.

It is not uncommon for grieving to be delayed and to start inexplicably long after the loss occurred.  It is also not uncommon for a loss sustained in the present to bring up residual grief from past events.  This can make it difficult for a person to identify that they are grieving or what they are grieving about.

The process of grieving is generally considered to take place in stages with certain tasks associated with each stage.  While there is something of a progression from one stage to the next, it is common for the stages to be experienced in a circuitous way, with a stage being passed through and then subsequently revisited.  The stages are described below.

The first stage of the grieving process is to accept the reality of the loss.  This may sound obvious, but it is not as straightforward as one would think because people tend to experience a sense of disbelief when a significant loss first occurs.  This disbelief is compelling.  It has the quality of being like waking from a dream and not being sure whether something really happened or was part of the dream.  Coming to a realistic acceptance of the reality of the loss takes time and takes place on many levels including intellectual, emotional and possibly spiritual.

Once the loss is acknowledged and accepted, the next stage is to experience the pain associated with the loss.  This, too, is not as straight forward as it sounds at first blush, because many people attempt to cut off from their difficult feelings and to deny the pain that they are experiencing.  Regrettably, unacknowledged pain has a way of back firing and taking a toll on a person’s wellbeing at some point.  For example, it is not uncommon for unacknowledged grief to resurface later as depression.

Once the pain associated with the loss has been experienced, the next stage involves adjusting to the new environment without that which has been lost.  This is a process of reinvesting and finding meaning and purpose again in one’s present life circumstances, post loss.  Once a person has reinvested in their life without that which has been lost, the final step is to move forward with one’s life.  Although moving through these stages is not a completely linear process, fortunately each time the stages are passed through the experience tends to become less intense and painful.

The capacity to grieve is essential to being able to fully feel all of the emotions associated with being alive.  Although difficult, grief is a restorative, life-affirming process.  Grief usually precedes relief. It is a natural process involving the letting go of the hurt and pain associated with loss so as to be able to open one’s self to life again.  Moving through grief brings new life and hope after loss.  Successful grieving rejuvenates the capacity to invest in living and loving.  These are the hidden gifts in grieving.  It cleanses the heart of the pain of loss to ready it to open anew to life and love.  Grieving allows a person to rekindle the passion to engage in life.

The next post in this series on grief will cover normal versus “complicated” grieving as well as the tasks that are essential to grieving fully.

Dissociation: What Is It And How Is It Treated?

Posted on by November 20, 2014
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The term dissociation has been part of the psychological lexicon for over a century.  Pierre Janet could be considered the father of the phenomenon of dissociation.  His work, beginning in 1887, laid the foundation for our present day understanding of the phenomenon of dissociation.  Janet hypothesized that consciousness is comprised of various levels, some of which can be held outside of awareness.

As the word implies, dissociation involves a disconnection of that which is normally associated.  As a psychological phenomenon, it refers to a disconnection of some dimensions of experience from the mainstream of conscious awareness.

The phenomenon of dissociation  exists on a continuum.   In very mild forms it occurs in everyday life such as when we miss an exit on the highway because we were daydreaming or when we absent mindedly mislay our keys because we were attending to something else as we put them down.  In these instances we are acting without conscious awareness or, put slightly differently, our actions are disconnected from our conscious awareness.  At the other end of the spectrum, dissociation can involve entire personalities with independent, disconnected sets of memories co-existing within a single body without awareness of the other(s) as in the case with dissociative identity disorder.  Somewhere in between these two ends of the continuum is a range of dissociative experiences and phenomena.

Dissociative processes are often a response to anxiety or trauma.  As a defense against something intolerable, the the mind segregates from ordinary consciousness experiences which are too difficult to bear.  Dissociation has been described as an attempt of the mind to flee what the body cannot escape.  Dissociation as a response to unbearable stress has adaptive value because it serves to moderate the degree of stimulation a person experiences so as to make organized coping possible.  In this sense, dissociative processes can thus be thought of as adaptive responses to aversive or traumatic situations.

The primary characteristic of dissociative processes is a detachment from reality.  This is in contrast with a loss of reality as in the case of psychosis.  There are three main types of dissociative behavior including amnesia, absorption, and depersonalization.  Dissociative amnesia involves finding oneself in situations wherein you have performed actions of which you have no memory.  Dissociative absorption involves becoming so involved in an activity that you are unaware of what is going on around you.  Dissociative depersonalization is the experience of events as if you are an observer who is disconnected from your body or feelings.

How is dissociation treated?  It is generally treated in phases as is the case with other trauma related disorders.  The primary focus of treatment is the integration of the dissociated experiences once there is sufficient safety in the therapeutic context.  The goal is for a person to be able to tolerate (without autonomic nervous system hyper or hypo arousal) integrating the dissociated experiences while remaining grounded in the present rather than reliving the experience as though it were happening again.  Integration involves developing an awareness of reality of the past and the present as it is, accepting it, and reflectively adapting to it.

Anxiety Series Part Four: The Neurobiology of Anxiety

Posted on by May 12, 2014
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The Neurobiology of Anxiety

This post explains the neurobiology of anxiety in very simple terms.  It covers some of the basic brain structures and functions as well as the neurotransmitters involved in the experience of anxiety.  Just understanding how anxiety operates on a physiological basis can be reassuring to those who are suffering from it.  For one thing, understanding anxiety in physiological terms is helpful because it becomes clear that what you are experiencing is very real. It is not something in your imagination or that you should expect yourself to be able to simply use your will to make go away.

The experience of anxiety primarily arises from the limbic system of the brain (often called the emotional brain). In simple terms, the limbic system is comprised of the thalamus, the hypothalamus, the hippocampus and the amygdala.  Each part of the limbic system plays a role in generating anxiety, but it begins in the thalamus which is a relay station for incoming information about the external world. The thalamus takes information from our senses (sight, sound, touch, taste, and smell) and assesses it for possible danger.  This information then travels through the brain down what is often referred to metaphorically as either the low road or the high road.

The low road refers to circuitry involving the amygdala which is the early warning or alarm station of the brain.  This part of the brain operates unconsciously.  It is an automatic response to what is perceived as immediate danger. The high road circuitry involves another part of the brain referred to as the cortex, the part of the brain that is needed for conscious thought, the formulation of ideas and the attribution of meaning.  The part of the cortex which is significant to anxiety is the prefrontal cortex which processes information, maintains conscious attention, forms behavioral repsonses and makes meaning of sensory experience.

When danger is perceived by either road, the brain mobilizes it’s response to the stress.  This response is often described as “fight, flight or freeze”.  It involves the hypothalamus-pituitary-adrenal  (HPA) axis which is the brain system that initiates the stress response to prepare the body to respond to a stressor. The hypothalamus initiates the response by releasing a peptide called corticotropin release factor to the pituitary gland.  The pituitary in turn releases adrenocorticotropin to the adrenal gland which releases adrenalin and cortisol.  The HPA axis starts the sympathetic nervous system arousal which results in increased heart rate and respiration and the redirection of blood flow.  This response also uses up neurochemicals such as serotonin, dopamine and norepinephrine.
Thus when the stress response is initiated, it causes changes in neurochemicals, breathing, blood flow and motor responses.  These responses are meant to be short term reactions to danger in the environment, but they can be initiated not only by actual dangers but also by thoughts of danger and particularly thoughts that have been associated with danger in the past.  When an experience has been associated with danger in the past, even the anticipation or thought of that experience can trigger the stress responses described above.  One of the greatest factors determining whether a stress response will be initiated is the meaning attributed to the potentially threatening experience.  When stressors (be they internal or external) are constant, the stress response described above functions continuously and anxiety results.

A goal of symptom management for anxiety is to find ways to trigger the parasympathetic nervous system to slow the physiological arousal associated with the stress response described above.  Another goal is to prevent the stress response from being triggered using cognitive control and physical self management techniques such as exercise and meditation.

 

 

Anxiety Series Part Three: Approaches and Techniques

Posted on by December 6, 2014
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Approaches and Techniques

In this post I will cover several approaches to help you manage anxiety.  As discussed in the previous post, the first step to managing anxiety is to simply notice and name it.  You cannot address that which you turn away from, and it is common to turn away from anxiety because it is unpleasant and because some consider it to be a sign of moral weakness.

In order to manage your anxiety it is important to identify the pattern(s) it takes.  How does it manifest itself?  What tends to precede and follow it?  Does it follow a typical course once it begins?  Does it fit a pattern which is associated with a diagnosis such as generalized anxiety disorder, panic disorder or social anxiety disorder?  How does it differ depending on your life circumstances?  There is power in simply noticing and naming a problem because it is the first step toward addressing it.  You cannot change that which you cannot identify or acknowledge.

Once you have identified the pattern(s) of your anxiety, the next step is to notice how you talk to yourself in general about things that provoke anxiety.  It is common for people with anxiety to talk to themselves in a negative way, layering pessimistic (even catastrophic, “what-if”) thoughts on top of self judgment for being anxious.  It is important to break this habit and instead to be as compassionate with yourself as you can.  It is also important to speak to yourself as kindly, constructively and positively as possible.  The way we talk to ourselves influences our state of mind as well as our physiology.  Learn to notice when your thoughts are telling you that something is worse than it really is and train yourself to be more realistic and compassionate instead of pessimistic and critical.  You don’t have to believe everything that you think.

You may be thinking to yourself that it is easier said than done to just start thinking positively and kindly.  This is true.  You probably developed your thinking habits over a substantial period of time and it will take some time and concerted effort on your part to change them, but it is possible.

Let me give you some suggestions for how to start to train your brain to talk to yourself well.  You start by monitoring your own thoughts, in particular the ones which are anxiety provoking.  There are three basic distortions which contribute to anxiety: over-estimating the likelihood of a negative outcome, over-estimating the severity of a negative outcome and under-estimating your ability to cope with a negative outcome.

Look for examples of each of these distortions as well as of instances of self judgment in your thinking.  Write them down.  Then cross them out and replace those words with words that are more realistic and kind.  The more consistently and systematically you do this the more habitual it will become to think realistically and with kindness toward yourself.

When you write the counter statements, it is helpful to write them in the positive, to keep them in the present tense and in the first person and to have them be statements that you can actually believe.  In time you won’t have to write the negative thoughts down because you will learn to mentally intercept and counter the types of thoughts which needlessly provoke anxiety before they have an opportunity to do so.  It just takes practice and repetition to learn more constructive ways of thinking.  When you have gotten to the point that you can catch yourself in the midst of anxiety provoking negative self talk use the following shorthand to correct yourself: notice and name, reframe and counter.

The next strategy corresponds to the step referred to as attending and befriending.  When you notice that you are anxious, find your way to some place that is quiet and calm.  Tune into how the anxiety feels in your body even though this seems counter-intuitive.  Where and how do you experience the anxiety in your body?  Try not to fight against it because doing so just adds another layer on top of the anxiety.  Rather, just be with it and note that there is a you who is noticing it (in other words notice that you are not the anxiety, you are the one who is able to observe it). This subtle distinction helps to give you a significant distance from the anxiety, so that you are not completely identified with it.

When it gets too overwhelming to attend to the anxiety switch to noticing your breath instead.  Deliberately breath deeply and fully from your abdomen.  It is difficult to be tense and to breath from your abdomen at the same time.  When you feel that you can, go back to noticing how the anxiety feels in your body.  Has it shifted in any way?  If so, notice how.  Pay particular attention to how you can tell that the anxiety is dissipating in your body.  Keep shifting between paying attention to how the anxiety is experienced in your body and then breathing deeply and slowly from your abdomen until the anxiety subsides or at least lessens.

The next strategy is related to the step referred to as acting out and reaching in.  This is where you take concrete steps to approach (as opposed to avoid) the things that make you anxious.  Make a list of the things that you are avoiding doing because they make you anxious.  Prioritize the list.  Break the items on the list down into very small steps.  Give yourself a very simple goal to accomplish — something extremely manageable from the list.  It doesn’t have to be a whole item, it can be just a small step or two toward one of the items.  Once you have accomplished some part of something check it off the list so that you can see that you have made some progress.  Make a commitment to yourself to keep working away at your list on some sort of a regular basis.  Each time you accomplish something, check it off the list and give yourself credit.  If you can’t bring yourself to accomplish something from the list, you can start by imagining yourself accomplishing it until the idea of actually doing it is no longer overwhelming.

Stay tuned for the next post in this series which will be about the brain and the neurobiology of anxiety.

 

Anxiety Series Part Two: How To Manage Anxiety

Posted on by December 6, 2014
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Managing Anxiety in Three Steps

In this post I will discuss a three step approach to managing anxiety.  The three steps taken together describe a process in which you will take control of your anxiety and your life. In addition to the things described in this post two key things you can do to make a significant difference right away are to forgive yourself for feeling anxious (it truly is not your fault; no one chooses to feel anxious!) and to maintain healthy life habits including adequate exercise, good nutrition, sufficient sleep and good relationships.  In the next post in this series I will cover specific techniques associated with each of the steps described below.

Noticing and Naming

The first step is what I call “noticing and naming” or “N&N”.  This step involves becoming intimately acquainted with how anxiety manifests itself in your life.  When does it show up?  What does it look like when it does?  What tends to precede and to follow it?  Are there identifiable patterns that you can see and name?  What does it look like over time – in the beginning, in the middle and at the end?

Because anxiety is unpleasant, we tend to turn our attention away from it as a coping strategy.  This strategy, though understandable, can back fire because it allows anxiety to fester and grow unchecked.  Not noticing and naming it, allows it to be in control of you rather than the other way around.  The trick here is to become intimate with your anxiety.  This may seem counter-intuitive, but that which you can notice and name (i.e., take into your awareness) is much less likely to control you than that which you cannot bring yourself to be fully aware of.

Attending and Befriending

The next step is to “attend to and befriend” your anxiety.  What is meant by this is to stay with it and to have compassion for the anxiety itself and for yourself as you experience it.  The more you fight against anxiety the more deeply entrenched it becomes.  If you can learn to open to it, learn what it is trying to tell you (it usually has to do with safety) and learn to embrace rather than reject it, it will have less of a grip on you.

The way to do this is to approach it and yourself with a friendly kindness and compassion.  See if you can tune into what it is trying to protect you from.  Try to feel grateful to it for it’s efforts to keep you safe (I know this sounds strange, but try it anyway.)  Also see if you can simply be aware of and attend to it’s presence with out fighting it.  If possible, just notice how it feels in your body and how that feeling changes and discharges over time.

Acting Out and Reaching In

The next step is where you will take action to deal with your anxiety both outwardly and inwardly.  I call this step “acting out and reaching in”.  This is where you will reverse the tendency to avoid anxiety provoking things and get pro-active.  You will take productive steps toward dealing with the things that you feel anxious about rather than avoiding them.  If you can’t accomplish them right away, you will create a list so that you don’t have to remember them and then you will cross them off one-by-one as you get to them so that you are able to see yourself making concrete progress.

As you take these steps you will also reach in by remaining mindfully aware of the anxiety that arises in you as you move forward.  Without fighting the anxiety or judging it or yourself for having it, you will watch it with compassion as it rises and then dissipates.  (And, it does always dissipate!).

Stay tuned for the next post in which I will cover specific techniques associated with each of these steps.  If you are finding your anxiety to be overwhelming and feel you could benefit from the assistance of a therapist, please feel free to contact me either by phone or using the contact form below to discuss how I may be of assistance to you.  I offer counselling sessions in person, by phone and through video formats.

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Anxiety Series Part One: What Is Anxiety And Are You Suffering From It?

Posted on by December 6, 2014
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Are You Suffering From Anxiety?

Of all the disorders listed in the Diagnostic and Statistical Manual (DSM), anxiety disorders are the most common. Almost everyone either knows someone who suffers from anxiety or has suffered from it themselves at some point. One study showed that anxiety disorders affect approximately ten percent of the population. They constituted the number one mental health issue among women and number two among men, second only to drug and alcohol abuse. Another study indicated that at least one third of all office visits to primary care physicians were prompted by some form of anxiety.

Out of control anxiety can take several forms including panic, phobias, obsessions, compulsions, post traumatic stress and chronic stress. Common to all of these is that the sufferer is trapped in a state of physiological hyper-arousal which cannot be explained by present circumstance. Another common denominator is that the sufferer has a diminished capacity to attend to anything other than the anxiety symptoms they are experiencing. In other words, anxious people experience a fixated fearfulness without sufficient environmental cause in the present to explain it. Nonetheless, the fear anxiety sufferers feel is very real.

What Does Anxiety Feel Like?

Anxiety is often experienced in several dimensions, often simultaneously. Physiologically it can be experienced as increased heart rate, muscle tension, dry mouth, shortness of breath, shaking, sweating, choking, digestive discomfort, dizziness and hot flashes or chills. Psychologically it can be experienced as a fear of dying, of losing control, of going crazy, or as a sense of detachment, startling easily, exaggerated apprehension or unease and as an inability to concentrate or focus on anything other than the anxiety symptoms. Behaviorally, anxiety can interfere with your ability function in any number of capacities including at work, as a parent or in various social settings and tends to result in avoidance of activities in an attempt to ease anxiety symptoms.

Because anxiety is experienced in each of these distinct dimensions, it is important to also address it in these dimensions, i.e., physiologically, psychologically and behaviorally. Before delving into these dimensions the very first step in addressing your anxiety is to forgive yourself for having it. No one chooses to be anxious. It is not your fault and it is not the kind of thing you can simply will away, nor is it a moral weakness.

There are many explanations for why you may be anxious ranging from your genetics, to your life history, to your present day circumstances or some combination of these, but none of these reasons makes you weak or somehow culpable. The very fact that you are reading this blog indicates that you have achieved a useful level of self awareness and that you have a desire to better your situation for yourself and possibly for those who care about you. This takes courage. Give yourself credit for your willingness to make some changes and for believing in your ability to do so.

Soothing Anxiety That Is Out of Control

A certain amount of anxiety is adaptive. We evolved the capacity to register threats to our well-being and to achieve a heightened awareness of them in order to respond to and to survive them. Some anxiety is thus necessary and useful for managing life’s challenges.  Typically the range of our responses to danger is described as “fight, flight and freeze”. We either prepare to combat the danger (fight), escape from it (flight) or play dead (freeze) in relation to it. These responses to real threat in the environment are adaptive.  They keep us safe.

What is not adaptive is when our flight, fight and freeze responses get stuck on over drive and/or become chronic, that is, when they are not a realistic response to present-day circumstances. For example, when our anxiety gets so intense as to become incapacitating as in a panic attack or relentless as in generalized anxiety disorder. In these examples it ceases to serve a useful function and becomes a problem in itself to the person experiencing it.

If you are one of the many unfortunate people who are affected by anxiety you may wonder what you can do about it short of or in addition to taking medication. The blog posts to follow in this series are intended to help you answer this question. I will cover several skills and coping strategies that can help you when you are experiencing non-adaptive anxiety.

All strategies will have a greater chance of success if you maintain a generally healthy lifestyle involving wholesome nutrition, adequate exercise, proper sleep and good relations. Relief from anxiety which has run amok involves using a multi-pronged approach which will touch upon many aspects of how you live your life.

Although the strategies I will cover in upcoming blogs can be accomplished on your own, if you are really suffering and unable to find sufficient relief on your own, you may want to work in conjunction with a therapist to assuage your anxiety. If you are interested in working with me to help you reduce your anxiety please click here (contact) to fill out a simple form and I will contact you about your options regarding counselling. I offer a free thirty minute consultation for you to determine if I can be of assistance to you. I offer counselling sessions in person, by telephone and through video formats.

Recent research suggests that shifting a person’s mental/emotional state toward a state of relaxation and greater well-being is something that can be accomplished interpersonally. In other words, the regulating of affect such as the soothing of anxiety can be accomplished between people, with one person (the regulator) monitoring and attuning to the other person’s (the regulated) internal state and coaxing the other person’s state increasingly more toward one of well-being (i.e., wherein less anxiety is experienced). In the literature this is referred to as “dyadic affect regulation”. A dyad just refers to a pair of two.

Research also indicates that this is precisely how as infants we learned how to regulate our emotions, that is, in a dyad with our primary caregiver(s). In these early life pairings with our primary caregiver(s), we learned bit-by-bit over time how to modulate our affects through the interactive ministrations of our caregivers as they met our needs for soothing, comfort, and pleasure.

If our caregivers did not or could not serve this function for us as well as we needed them to as we developed (for example, if our caregivers themselves struggled with anxiety or were not consistently available to us), it may have made it more difficult for us to be able to regulate our emotions on our own as adults. Fortunately, however, these skills can still be learned at any age and working with a skilled therapist trained in how to impart these skills can make a significant difference.

How Do You Know if You Are Just Experiencing An Ordinary Amount Of Stress As Opposed To Serious Anxiety?

There are several ways to discriminate between serious anxiety and a normal stress response to life difficulties which everyone experiences periodically. Below are several questions you can ask yourself to help you to discriminate between the two.

Assuming that there are not external circumstances which explain your anxiety, one question to ask yourself is whether your anxiety is interfering with your normal day-to-day functioning. For example is your anxiety significantly or chronically disrupting your sleep or your appetite? Is it affecting other bodily functions like your digestion? Is it interfering with your capacity to work, to parent or to socialize? If you answered yes to any of these questions, there is a greater chance that you are experiencing something beyond an ordinary normal stress response.

Another question to ask yourself is whether you feel you have any control over your anxiety or if you feel powerless in relation to it. Are you able to notice that you are experiencing it and then do something to relieve it without the use of substances? The more you feel powerless over it and that it controls you, the more likely it is that you are experiencing something beyond ordinary life stress.

A related question to ask yourself is how you manage your anxiety. How do you respond to that which worries you? If your only or primary strategy is avoidance at the expense of adaptive action, it is more likely that you are suffering from debilitating anxiety.

A final question to ask yourself is whether there is a substantive circumstantial reason which explains your anxiety. In other words, does your anxiety have a focus which is based on something that is actually happening in your life and in the present? Anxiety generally has some focus, but the question here is whether it’s focus is real and whether it warrants the degree of anxiety being experienced. If there is not a present-day circumstantial explanation for how you are feeling, it is more likely to be an issue with anxiety.

Overall if what you are experiencing is highly intense or long-lasting or interferes with your ordinary life significantly, cannot be controlled by you and is not explained by circumstances, it is more likely that you are suffering from serious anxiety.  Take heart, there are very effective ways to manage anxiety both in conjunction with and independent of taking medication.

Check back soon, for the next blog in this series to learn coping skills and strategies to manage your anxiety.

Non-Verbal Communication as Cues and Clues for Clinicians: An Attachment Perspective

Posted on by December 6, 2014
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When clients have had insecure childhoods, healing and growth can be facilitated by thinking of therapy as a reparative attachment relationship in which the therapist deliberately tunes into the non-verbal interactive dynamics at play. The following post explores this idea.

Attachment Theory and Non-Verbal Communication

Attachment theory explains how a person’s internal emotional world and external interpersonal behavior is related to the environment, threat and the need for security throughout the lifespan.i Our first “environment” is the one we inhabit as infants. As infants we are utterly dependent on our primary caregivers for all of our physical and emotional needs. Our attachment to them is not a choice – it is a biological necessity.

Security for an infant means having physical proximity to caregivers to provide food, warmth and protection etc., but also emotional availability to provide affect regulation (the monitoring and modifying of states of emotional arousal to remain within tolerable limits).ii Affect regulation involves caregivers recognizing, identifying, modulating (as needed), and reflecting upon (as development permits) their child’s emotional experience, as they can not yet do this on their own.

When caregivers actively soothe states of distress and encourage states of comfort and pleasure, they are modulating affect.iii When this happens consistently, infants (and children) will experience the attachment relationship as a source of relief, comfort, and pleasure wherein emotions are welcome, understandable and manageable.iv

This begs the question of what happens when caregivers are not responsive to their infant’s needs for soothing and protection? For example, when caregivers are generally angry in response to distress? Or they are responsive only some of the time? Because infants are thoroughly dependent on their caregivers for their survival, they must adapt to them. Infants accommodate the idiosyncratic strengths and/or weaknesses of their caregivers by adopting corresponding behavioral strategies (which are in essence, affect regulating strategies) in something of a hand-in-glove manner.

In attachment theory, three primary behavioral strategies have been identified. These include the so-called secure, avoidant and ambivalent strategies. Wallin explains: “Confident of their mothers’ responsiveness, secure infants could well afford to be attuned to their own attachment-related feelings and needs: They could be aware of and could express them. Avoidant infants, anticipating mother’s rejection and their own anger in response, could afford neither to be aware of nor to express their attachment-related feelings and needs. Hence the avoidant strategy of inhibiting or minimizing such internal experiences. Ambivalent infants, responding to their mother’s unpredictable availability, apparently developed a strategy for amplifying or maximizing both the awareness and the expression of their attachment related feelings and needs as if to ensure continuing care.”vThus the avoidant strategy involves a hypo-activating adaptation (downplaying) of attachment needs and behaviors and the ambivalent strategy involves a hyper-activating adaptation (escalating) of attachment needs and behaviors to fit the care giving environment.

Infants and caregivers communicate using an intricate “body language” which involves touch, tone, sounds, gestures, facial expressions, eye contact and action tendencies. Spoken (verbal) language generally only begins gradually around the second year of life. Moreover, the brain structures which encode memory in a verbally accessible, symbolic form don’t generally come online until the third year of life.viThe period prior to the establishment of deliberately accessible (explicit) memory is referred to as infantile amnesia, because “memories” as we generally think of them cannot be consciously retrieved. Nonetheless experience from this period is “remembered,” is highly formative, and will be experienced later as a sense of knowing how to be and how to be with others.vii This type of memory is referred to as procedural or implicit memory; it is non-verbal, non-symbolic, and generally unavailable for conscious recall or reflection. Its content involves procedures, emotional responses, and patterns of behavior.

When implicit memory is activated the person has a sense of unconsciously “knowing how” and of “familiarity with” rather than of conscious recollection. These memories can be a therapeutic gold mine because they contain unarticulated content about the self and about the self in relationship. For this reason intersubjective and relational theorists refer to this set of memories as “implicit relational knowing”.

Reparative Attachment: The Potential of Therapy

It only stands to reason that those feelings, thoughts and behaviors which might jeopardize crucial attachment relationships would be defensively excluded from awareness and behavior and that those which sustain and protect it would be emphasized. It also stands to reason that a new attachment relationship could offer new and distinct possibilities for what can be safely known, felt and acted upon.

To the extent that a therapist has the capacity to facilitate, witness, tolerate, integrate and reflect on that which was historically off limits, new facets of a client can be encouraged to emerge. Thought of in this way, therapy has the potential to permit a client to “risk feeling what he is not supposed to feel and knowing what he is not supposed to know” by explicitly deconstructing (reflecting upon) past attachment patterns while experientially creating new ones in the present.viii

So how do attachment oriented therapists access that which is disavowed, unknown, undeveloped and not available for conscious or symbolic recall in their clients? The answer to this question leads to the realm of ‘non-verbalizable’ experience and non-verbal communication.

A shorthand for working with implicit relational material is to consider that what we cannot put into words we often either enact with others, embody somehow, or evoke in others.ix I will explain each of these in turn and then offer clinical anecdotes to illustrate them.

Enactments

An enactment involves the action(s) stemming from the words spoken i.e., the resulting interactive dynamics or the relational effects of the words. Do they push us away or draw us near? Pull us into the past or move us toward the future? Do they serve to obfuscate or do they reveal?

I once had a client who was a troubled, bright young man. He was the oldest of three and he was furious with his parents for their failings and particularly for ‘parentifying’ him in his youth. He and I had good rapport and we were making considerable progress in his therapy. At around our tenth session or so, he told me he could not believe he was capable of being so open with me or how much he was learning about himself in therapy. Then, surprisingly, at our very next session he announced that he was finished with therapy. He explained maturely that he believed that he had simply outgrown my usefulness to him. Not wanting to come across as disappointed or defensive (which I was a bit), I outwardly graciously accepted his termination of me. Then an extended awkwardness hung in the air between us. He kept asking me in various ways if I thought I could be of more assistance to him and I kept reassuring him that he should trust his own intuition about it.

Gradually it dawned on me that he needed me to tell him that he could benefit from more and that I had more to offer him. Because of his childhood, it was outside of his relational repertoire to know how to ask for more, what that “more” might be or how to trust that I would not disappoint him (as had his parents) if he allowed himself to ask for, need, or want it. Beginning to grasp the enactment at play, I said, “I am feeling this interesting pushing and pulling going on right now. You say you don’t want more therapy with me (action: pushing), but then ask me to tell you that I have more to offer you (action: pulling). Does this fit with your experience of what is happening right now?” He said, “Yeah, especially the pushing and pulling part, my girlfriend tells me I do that all the time.” For this to be reparative for him, I had to demonstrate that it was okay for him to want/need more from me even if he didn’t know what that was yet (we would figure it out together), I would not let him down, and none of this would jeopardize our relationship.

Embodiments

The ambivalent and the avoidant attachment strategies are associated in adulthood with distinct bodily expressions. The ambivalent (hyper-activating) strategy usually involves an internal physiology which includes sympathetic nervous system dominance, a low threshold for nervous system arousal, and diminished cortical control over emotional reactions.x Outwardly there is a tendency toward more pronounced and demonstrative facial and bodily gestures, a preference for physical proximity and for postures involving moving forward and reaching out. Physical movements tend to be less contained and sometimes agitated.xi

The avoidant (hypo-activating) strategy internally generally involves a deactivation of the sympathetic nervous system, a bias toward left-hemisphere cortical processing and parasympathetic nervous-system activation.xii The outward bodily expression of this strategy often involves more restricted movement, less facial expressiveness and limited direct eye contact. It also tends to be associated with pulling back or pushing away and other movements associated with withdrawal as well as diminished bodily responsiveness to relational overtures.xiii

The young man discussed above had an avoidant strategy. He rarely made direct eye contact. When asked about feelings of need or vulnerability, he would often pull back his torso, neck and head and extend his arms straight out in front of him with his palms facing out, his eyes closed and his head shaking “no.”

One day I asked him if he would do an experiment with me: To simply look directly into my eyes for as long as he could tolerate it. After balking, he tried it a few times. Each time he was able to maintain eye contact with me a little bit longer and, as he did so, I said really simple encouraging things like “good” and “that’s it.” I also reflected back to him what I noticed about changes in his face, his breathing and how he held his body. For example, I noted that his shoulders came down a little with one of his exhales and that his eyes and his jaw softened a bit and so on.

While engaged in this exercise, it was as though we fell under a dyadic spell together with all of his awareness focused on staying present with me in this unfamiliar way and all of mine on simply noticing and reflecting back what I witnessed. Afterwards, crying slightly, he told me how hard it was for him to look at me without thinking how I might “just disappear right before his eyes.” Later, he asked me how he could know that our relationship wouldn’t end in a wrenching and painful way as so many of his others had. A long and important conversation followed.

Evocations

Clients may also evoke in (meaning relocate to and cause someone else to experience) that which they feel or think but cannot know, name or experience directly. Recent neuroscientific developments have shed some light on how evocations take place. The human brain comes equipped with “mirror” neurons which permit us to sense the emotions and intentions of others. Mirror neurons make emotions contagious explains Goleman, by “letting the feelings we witness flow through us, helping us get in sync and follow what’s going on. We ‘feel’ the other in the broadest sense of the word; sensing their sentiments, their movements, their sensations, and their emotions as they act inside us…we become like the other – at least a bit.”xiv

I had this experience with a client who was an elderly woman who spent a lot of time in her apartment knitting, sewing and doing artwork. She had convinced herself that she had developed a “mental illness.” While she talked (and talked and talked), she had precious few words to describe what she thought was the problem. All she could tell me is that “it” would come over her and she would not be able to enjoy anything, and then “it” would disappear as mysteriously as “it” appeared.

She claimed she was not depressed or anxious. We spent many sessions trying to discern what “it” was, what preceded “it” when “it” happened, what contributed to the abating of “it” and so on, but we got nowhere. In each progressive session she talked more and I talked less. Usually this would be good, but nothing of therapeutic value was transpiring and I was finding it very hard to stay present with her.

She also kept testing the boundaries of our relationship by trying to involve me in her social life. I explained repeatedly that it was not possible given that I was her therapist and then she would try again a bit harder and from a slightly different angle. Feeling exasperated one day, I said, “You know, I am feeling really stuck and frustrated right now; I want to help and attend to you in the ways that I am able, but it is almost as though I am not really here with you somehow, like you could just be talking to yourself. There is no a back and forth rhythm to our conversations.” She looked like she had seen a ghost. She said, “How strange, that is exactly how I feel at home when “it” comes over me. I feel all alone with nothing but my own stories and thoughts spinning around in my head. I feel lonely, stuck and frustrated.” It wasn’t until I tapped into the experience she was evoking in me that either of us knew what she needed help with.

Conclusion

These anecdotes illustrate how therapists can use attachment theory to interpret and work specifically with non-verbal client communication by thinking of it as cues and clues to undeveloped relational potential awaiting expression through a reparative therapeutic dynamic. Each anecdote involves an interactive tension between repeated experience and reparative experience and the forces acting toward familiarity, stasis and restriction of relational experience and those acting toward exploration, change and expansion of relational experience. “We find aspects of ourselves in the minds of others,” says Wallin. “Whether in the course of childhood development or psychotherapy…the self is discovered (or perhaps created) primarily as it is recognized and understood by others…in a relationship of attachment.”xv

Biography

Sarah Flynn, MREM, MA, RCC is a therapist in private practice (Synergia Counselling and Consulting) in the neighbourhood of Fernwood in Victoria, BC. She specializes in attachment, relational trauma, dissociative processes, non-verbal communication, and helping those with loved ones with mental illness. She offers individual, couples and family therapy as well as attachment oriented therapeutic case consultation. Feel free to contact her with questions or comments by phone at +1 (888) 316-0819 (toll free) or by email at sarah@synergiacounselling.com, or to visit (www.synergiacounselling.com).

References in the Body of the Article and Reference Section

i Bowlby, J. (1988). A Secure base: Clinical applications of attachment theory. London:Routledge.
ii Gerhardt, S. (2007). Why love matters: How affection shapes a baby’s brain. New York: Rutledge
iii Siegel, D.J. (1999). The developing mind. New York: Guilford Press.
iv Siegel, D.J. (1999). The developing mind. New York: Guilford Press.
v Wallin, D.J. (2007: p.35). Attachment in psychotherapy. New York: The Guilford Press.
vi Schore, A. (2003). Affect dysregulation and disorders of the self. New York: Norton.
vii Wallin, D.J. (2007). Attachment in psychotherapy. New York: The Guilford Press.
viii Wallin, D.J. (2007: p.3). Attachment in psychotherapy. New York: The Guilford Press.
ix Wallin, D.J. (2007). Attachment in psychotherapy. New York: The Guilford Press.
x Schore, A. (2003). Affect dysregulation and disorders of the self. New York: Norton.
xi Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: Norton
xii Schore, A. (2003). Affect dysregulation and disorders of the self. New York: Norton.
xiii 0gden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: Norton
xiv Goleman, D. (2006: p.42). Social intelligence: The revolutionary new science of human relationships. New York Bantam Dell.
xv Wallin, D.J. (2007: p.51). Attachment in psychotherapy. New York: The Guilford Press