Hearing Baby's Unspoken StoryINTERWEAVING EMDR, EGO STATE AND SOMATIC THERAPIES IN THE REPAIR OF VERY EARLY TRAUMA
Hearing Baby's Unspoken StoryINTERWEAVING EMDR, EGO STATE AND SOMATIC THERAPIES IN THE REPAIR OF VERY EARLY TRAUMA
SANDRA PAULSEN PH.D.
Why Important?
Trauma in attachment period disrupts affect regulation
attachment and relationship expectancies
state switching capacity
These disruptions are the basis of many: dissociative disorders
somatoform disorders
personality disorders
mood disorders
anxiety disorders
Repair is possible by interweaving
Ego state therapy to deconflictualize the self system and
reduce loyalty to the aggressor
Somatic therapy to resource the client
increase capacity for moment to moment tracking
decrease phobic avoidance of somatic and affective experience
enhance capacity to stay in window of tolerance
EMDR to catalyze sequestered trauma and process it to an adaptive resolution
modified for working in attachment period in implicit memory using Early Trauma approach
special procedures for increasing affect regulation
Therapist attention to non-verbal communication to discern unspoken story i
Ego State Therapy Deconflictualize the system by
Using Dissociative Table (Fraser) to give a voice to forsaken parts of self, and access internal dynamics, stabilize relationships between states
orienting alters to present circumstances (person, place, time)
softening the perpetrator introject to reduce loyalty to the aggressor (Paulsen, 2009)
orienting to same body, status of external perpetrator
appreciating survival function
reassure not getting rid of but updating, new way of functioning
repeated reminders
welcome into self system
experiment with loyalty to self instead of perpetrator
experiment with decrease self harm
Somatic Therapy
Somatic empathy - therapist's attunement to client's felt sense
Somatic resourcing - first without reference to body in dissociatives, share in experience of anything life enhancing
Somatic tracking moment to moment awareness, similar to mindfulness
decrease phobic avoidance of sensation and affective experience
Somatic evoked oscillation pendulating between trauma vortex and resource state, "nibbling around the
edges," never going deeply
enhance capacity to stay in window of tolerance
Somatic micromovements to release thwarted sympathetic arousal once introjects allow it
other special procedures
EMDR Modified- Early Trauma sufficient containment, stabilization, preparation
self system deconflictualized
fractionated by time frame, beginning from the beginning (O'Shea & Paulsen, 2007; Lanius, Paulsen & Corrigan, 2014)
not postulating its all memory, but some of it appears implicit memory normal developmentall milestones
how would that have gone in your family
not narrative or verbal as much as somatic, affective nuance
special procedures - resetting affective circuits
repair in imagination "what would you have needed" (see Paulsen, O'Shea & Lanius, 2014, on alexythymic, imagination and affective circuits in Lanius, Paulsen Corrigan 2014)
EMDR - Resetting Affective Circuits
Based on: Jaak Panksepp's seminal experimental discovery of mammalian
hardwired affective circuits, present from birth, needs no learning RAGE, FEAR, PANIC, CARE, LUST, SEEKING, PLAY
Object cathexis not ego cathexis as reprocess each hardwired affect or defensive subsystem (Porges polyvagal systems)
need special procedures for dissociatives
Bringing neocortical resources to bear on subcortical affective circuits wtihout an affective load on the circuits by processing with objectivity
appears to repair intersubjectivity
decreases affective reactivity
decreases dissociative avoidance of affect
adjusts baseline of arousal downward, uniformly report "calmer"
Temporal Integration Contrasts with Strategic Integration and Tactical
Integration
Integration bottom up by time period
Still needs subsequent trauma repair done
Ego state therapy is most commonly used intervention
Once soma and affect tolerance is improved
Described in Lanius, Paulsen & Corrigan (2014).
Story Tells Itself - Therapist Attunement
Listening to the verbal of the narrative as revealed by alters
Listening to the verbals attributed to present time incorrectly (transference material)
Listening to the non-verbals in projective identification
Observing non-verbal behavior (facial flushing, fidgeting of extremities, tearfulness, switching)
Observing therapist mirror neuronal responses
Observing therapist intuition, what's emerging in energy field
Hypothesis testing how the pieces come together
Summary Skillful interweaving therapeutic elements old and new
resourcing in diverse ways until readiness
deconflictualizing the self system, bringing it up to present circumstances
hearing story in the verbals and nonverbals
processing trauma by time period for temporal integration
repair in imagination to meet developmental milestones
Lanius, U., Paulsen, S.L., & Corrigan, F. (2014). The Neurobiology & Treatment of Traumatic Dissociation: Toward an Embodied Self. N.Y. Springer.
Levine, P. A., & Gabor, M. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley: North Atlantic Books.
Panksepp, J., & Biven, L. (2012). The archaeology of mind: Neuroevolutionary origins of human emotions. New York: W. W. Norton .
Paulsen, S.L. & Watkins, J.G. (November, 2005). Best Techniques from the armamentarium of hypnoanalytic, EMDR, somatic psychotherapy and cognitive behavioral methods. International Society for the Study of Dissociation. Fall Conference, Toronto
Paulsen, S. L. (2009a). Looking through the eyes of trauma and dissociation: An illustrated guide for EMDR clinicians and clients. Charleston, NC