Fifty Shades of Grey: A Compulsion to Repeat Trauma

Posted on by February 16, 2015
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This post looks at the phenomenon of  “trauma repetition”or “repetition compulsion”, i.e., the tendency to recreate past traumas in the present.  I will use the character Christian Grey from the novel “Fifty Shades of Grey” as an example of this phenomenon.  Many people expose themselves, seemingly compulsively, to situations that are reminiscent of past traumas.  A classic example is a woman who was abused as a child by an alcoholic father who then marries an alcoholic man who abuses her.

In the story “Fifty Shades of Grey”, Christian, the protagonist, was born to a crack addict, prostitute mother with whom he lived until he was four when he was adopted.  As of the first movie (I admit I have not read the book), we know he was badly treated as a young child (for example, he has cigarette burns on his chest from this era), but we don’t know the full extent of the abuse or neglect he suffered.  We do, however, know that when he was fifteen he became involved with an older woman (his mother’s friend) in which he was the submissive (the partner that gives control to another in a Bondage Discipline Sado-Masochism (BDSM) sexual relationship).

In this much touted story, Christian, a twenty-seven year-old Dominant (the partner in a BDSM relationship who takes the active or controlling role over that of the submissive partner), pursues the character Anastasia Steele, a twenty-two year-old innocent, to be his submissive.  Christian is an alpha male.  He is highly aggressive and controlling in his pursuit of Anastasia.  Many have claimed that he displays the characteristics and behaviors of a emotional and/or sexual abuser.  Others claim that he is honest and forthright about his intentions and desires all along.  This blog post is not about this controversy.  Rather, it is about why, given his traumatic history, he would be drawn to being a Dominant in a BDSM relationship.

As a child, Christian was betrayed by the women in his life several times over.  He was betrayed by his biological mother who mistreated him and then gave him up for adoption.  He was then betrayed by his adoptive mother who permitted her friend and contemporary to have sex with her fifteen-year-old son.  And, he was betrayed by the friend, an adult who was engaging in sexual relations with him as a minor.  This is sexual abuse.

With this traumatic attachment history with women, it is not surprising that Christian would want all of the power and control in his relationship with Anastasia.  By the same token, it is also not surprising that he would be drawn to the role of the Dominant in a the context of a highly structured BDSM relationship.  Having power and control means less likelihood of being hurt, i.e., re-traumatized.  However, in another sense Christian is re-enacting his abusive past in the way that he has sex with Anastasia (albeit with the roles reversed) by making the sex (and the relationship) all about power and control.  He victimizes her in ways that are reminiscent of how he was once victimized.

Trauma can be repeated on emotional, physiological and behavioral levels, sometimes simultaneously.  Re-enactment of victimization and the power imbalances associated therewith such as through BDSM play wherein someone who has been abused historically plays the role of the victimizer (Dominant) is an example of the repetition of trauma.  It is common for a traumatized person to compulsively seek out the familiarity of unhealthy relationships suffered in their family of origin or with an abuser and to seek to gain mastery over a set of circumstances in the present that resemble past traumatic circumstances.  Christian is nothing if not masterful in his role as the Dominant.  The irony is that for all his mastery he still loses Anastasia because she does not want him to inflict pain on her in the ways that he wants to inflict it.  She wants a “normal” relationship.  He is trapped in the circumscribed and familiar realm of BDSM wherein power relations are negotiated and defined.  She is not.

If Christian was not a fictional character, I would suggest counselling.  Counselling can help with repetition compulsion in several ways.  Firstly, it can give a person insight into their own behavior.  Often people people who are trapped in these cycles are not even aware that they are compulsively drawn to repeat the past.  Secondly, it would give Christian an opportunity to grieve the losses of his past in a safe setting so that he might not be so controlled by them going forward.  Finally, counselling has the potential to be reparative to the extent it provides Christian with a wholesome and secure attachment relationship from which he could take the risk to explore new facets of himself.

Using Dual Awareness to Deal with Traumatic Memories/Emotional Flashbacks

Posted on by February 8, 2015

In my last blog post on complex post traumatic stress disorder (CPTSD)and flashbacks, I reproduced Pete Walker’s list of thirteen steps for managing emotional flashbacks.  These are all things a person can do on their own when they find themselves thrown into the overwhelming feeling states associated with a past trauma.  In this blog post, I will explain two simple techniques a therapist may use to help a person manage traumatic memories (flashbacks).  These techniques work with the body as well as the mind, as psychological trauma is often stored in the body in the form of “somatic memories”.  These techniques are adapted from the work of Babette Rothschild in “The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment.

The first technique involves developing what is referred to as dual awareness which means the ability to maintain awareness of two or more aspects of experience simultaneously.  Although this may sound simple, it can be difficult for people with with a history of trauma for a couple of reasons.  One reason is that people who have been traumatized may be habituated to focusing their attention inward towards compelling internal stimuli associated with autonomic nervous system activation (such as a speedy heart rate or shallow respiration), and they may therefore interpret the world exclusively from that point of view.  Another reason is that they are frequently triggered into a feeling state of the past by their current environments to such an extent that they feel as though the trauma is happening now.  When this happens people may lose the capacity to discriminate between or maintain simultaneous awareness of the past (when the trauma occurred) and the present (which is trauma free).

It is imperative for trauma survivors to have the capacity for dual awareness in order to address a trauma safely by knowing that their present environment is actually trauma-free.  Key to developing this capacity is to note and promote the distinction between the observing self and the experiencing self.  What is meant by this, is a person’s ability to witness (observing self) what they are feeling (experiencing self).  For example, someone experiencing a flashback may say “my heart is racing and my mouth is dry and I am feeling really scared right now” (experiencing self), and “I see that there is actually no danger to me in this moment” (witnessing self).

A simple technique a counsellor can use to facilitate the development of this type of dual awareness is to have a client bring to mind a mildly distressing event. This exercise intentionally uses a mildly distressing event to begin building the mental muscles associated with the capacity for dual awareness.  As this capacity increases, it can be used to work with more distressing events.  The counsellor would begin the exercise by assisting the client to notice the sensations in their body (experiencing self) using a series of questions .  Then the counsellor would ask the client to direct their senses to their present environment (witnessing self) using another series of questions .  The counsellor would then direct the client to keep their awareness on the present environment while remembering the mildly distressing event (dual awareness).  The counsellor ends the exercise by bringing the client’s awareness back to the safety of the present environment.

A related technique can be used when a client is experiencing an actual flashback.  First, the counsellor has the client notice and name the emotion(s) they are feeling, and what they are sensing in their bodies (experiencing self).  The counsellor then has the client associate these things with the memory of the trauma by asking the client to just name the trauma by giving it a title.  The counsellor instructs the client to be sure to leave out any details associated with the trauma.  Next the counsellor poses a series of questions to help the client locate themselves both in time and space in their trauma free current environment (the witnessing self).  The client is then directed to notice the safety of the present environment while naming the trauma (dual awareness).  Finally, the counsellor has the client name the trauma again (by title only) and ends by having the client notice that the trauma is not happening anymore.

 

Complex Post Traumatic Stress Disorder and Emotional Flashbacks

Posted on by January 27, 2015
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Complex post traumatic stress disorder (C-PTSD), also known as developmental trauma disorder or complex trauma, is a psychological injury.  It is thought to result from prolonged exposure to social or interpersonal trauma, dis-empowerment, captivity or entrapment, and situations where there is a lack or loss of a viable escape route for the victim.  The causes of C-PTSD have been further described as involving stressors that 1. are repetitive and prolonged, 2. involve direct harm and/or neglect and abandonment by caregivers or ostensibly responsible adults, 3. occur at developmentally vulnerable times in the victims life, such as in early childhood, and 4. have great potential to compromise a child’s development.  At present, this disorder is not in the Diagnostic and Statistical Manual of Mental Disorders.

According to Pete Walker who wrote the book “Complex PTSD: From Surviving to Thriving” (2013-2014), one of the key characteristics of this disorder is the presence of what he refers to as emotional flashbacks.   This blog post discusses emotional flashbacks.  It covers what they are, how to identify them and how to manage them.  Much of the material in this post comes from the book noted above.

Emotional Flashbacks: What Are They?

An Emotional flashback is the experience of regressing to the former feeling states of having been an abandoned, neglected or abused child.  A flashback is usually triggered by something in your present environment that takes you back into the overwhelming feeling states of your past.  During a flashback, your fight/flight response (sympathetic nervous system) is often activated and you feel highly, often inexplicably, aroused.

The emotional content of flashbacks generally involves overwhelming feelings such as fear, alienation, despair, depression or grief.  Flashbacks can range in intensity from mild to extreme and range in duration from seconds to weeks.  Typically, during a flashback you feel small, fragile, helpless and afraid.  Emotional flashbacks tend to bring up an experience toxic shame.  This is a sense that you are not alright, i.e., that you are fatally flawed, inadequate, bad, and unlovable.  This sense of toxic shame is likely from a history of having been consistently neglected or rejected or from having been severely criticized as a child.

Toxic shame wreaks havoc on your self esteem.  In an instant you can regress to feeling worthless and despicable.   A tendency to isolate yourself often accompanies this sense of shame.  This is likely because you do not feel worthy of comfort or support and may also be a way to reenact the experience of having been abandoned as a child.

Identifying Flashbacks

It is important to learn how to identify when you are experiencing an emotional flashback.  You will feel much more in control of your emotional world when you have developed this capacity.  Moreover, you will be positioned to take the steps necessary to manage them once you can identify them.

There are several indications that you may be experiencing a flashback and you can learn to become aware of them.  Key among these is feeling like a small, helpless and hopeless child — as though you have lost touch with your adult resourceful self.  Another indication is the realization that your self esteem has plummeted.  For example, you may find yourself becoming highly self critical and focusing exclusively on what is wrong with you.  Yet another indication that you are in a flashback is when you notice that you are having an emotional reaction in the present that is way out of proportion to whatever was the triggering event.  A final clue that you may be in a flash back is a sudden, intense craving to self medicate in some way or other.  Some people self medicate through the use of substances and others through habitual actions.  If you find you feel the need to take or do something to calm down or notice any of the other clues above, you may well be experiencing an emotional flashback and need to take active steps to manage it.

Managing Emotional Flashbacks

Pete Walker has developed thirteen steps for managing emotional flashbacks.  His steps are provided below.

  1. Say to yourself: “I am having a flashback”. Flashbacks take us into a timeless part of the psyche that feels as helpless, hopeless and surrounded by danger as we were in childhood. The feelings and sensations you are experiencing are past memories that cannot hurt you now.
  2. Remind yourself: “I feel afraid but I am not in danger! I am safe now, here in the present.” Remember you are now in the safety of the present, far from the danger of the past.
  3. Own your right/need to have boundaries. Remind yourself that you do not have to allow anyone to mistreat you; you are free to leave dangerous situations and protest unfair behavior.
  4. Speak reassuringly to the Inner Child. The child needs to know that you love her unconditionally- that she can come to you for comfort and protection when she feels lost and scared.
  5. Deconstruct eternity thinking: in childhood, fear and abandonment felt endless – a safer future was unimaginable. Remember the flashback will pass as it has many times before.
  6. Remind yourself that you are in an adult body with allies, skills and resources to protect you that you never had as a child. [Feeling small and little is a sure sign of a flashback]
  7. Ease back into your body. Fear launches us into ‘heady’ worrying, or numbing and spacing out.
    [a] Gently ask your body to Relax: feel each of your major muscle groups and softly encourage them to relax. (Tightened musculature sends unnecessary danger signals to the brain)
    [b] Breathe deeply and slowly. (Holding the breath also signals danger).
    [c] Slow down: rushing presses the psyche’s panic button.
    [d] Find a safe place to unwind and soothe yourself: wrap yourself in a blanket, hold a stuffed animal, lie down in a closet or a bath, take a nap.
    [e] Feel the fear in your body without reacting to it. Fear is just an energy in your body that cannot hurt you if you do not run from it or react self-destructively to it.
  8. Resist the Inner Critic’s Drasticizing and Catastrophizing: [a] Use thought-stopping to halt its endless exaggeration of danger and constant planning to control the uncontrollable. Refuse to shame, hate or abandon yourself. Channel the anger of self-attack into saying NO to unfair self-criticism. [b] Use thought-substitution to replace negative thinking with a memorized list of your qualities and accomplishments
  9. Allow yourself to grieve. Flashbacks are opportunities to release old, unexpressed feelings of fear, hurt, and abandonment, and to validate – and then soothe – the child’s past experience of helplessness and hopelessness. Healthy grieving can turn our tears into self-compassion and our anger into self-protection.
  10. Cultivate safe relationships and seek support. Take time alone when you need it, but don’t let shame isolate you. Feeling shame doesn’t mean you are shameful. Educate your intimates about flashbacks and ask them to help you talk and feel your way through them.
  11. Learn to identify the types of triggers that lead to flashbacks. Avoid unsafe people, places, activities and triggering mental processes. Practice preventive maintenance with these steps when triggering situations are unavoidable.
  12. Figure out what you are flashing back to. Flashbacks are opportunities to discover, validate and heal our wounds from past abuse and abandonment. They also point to our still unmet developmental needs and can provide motivation to get them met.
  13. Be patient with a slow recovery process: it takes time in the present to become un-adrenalized, and considerable time in the future to gradually decrease the intensity, duration and frequency of flashbacks. Real recovery is a gradually progressive process [often two steps forward, one step back], not an attained salvation fantasy. Don’t beat yourself up for having a flashback.

 

Exercises To Manage Anxiety

Posted on by January 27, 2015
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This post offers exercises to manage anxiety. You may find them difficult at first because they involve doing things that feel foreign, awkward, and even counter intuitive. I encourage you to stick with them and to not be hard on yourself if you find them difficult. They do get easier the more you do them. Remember, too, as you do them that no one else will be aware that you are doing them, so there is no need to be self conscious.

One of the best ways to manage anxiety in general is to work with the breath as it stimulates the parasympathetic nervous system which can be thought of as the branch of your nervous system which facilitates relaxation. All of these exercises involve use of the breath.

It is ironic that in order to change (including to become less anxious), we need to have enough compassion for ourselves to accept ourselves exactly as we are. In other words, accepting yourself (and your anxiety) with compassion is the first step toward changing for the better. For this reason, the first two exercises involve deliberately cultivating compassion.

Exercise 1: The Compassion Exercise

Spend a few moments breathing deeply from your abdomen. Notice the sensations of your breath as it enters and leaves your body. Do this until you begin to feel more relaxed. Once relaxed, bring an image into your mind of something that elicits your compassion. It does not matter what you choose. It could be anything. It just has to work for you. It might be a beloved pet or a child or an elderly person whom you love. As you feel the compassion in your body, notice the sensations. What do they feel like? Are they warm? Do they tingle? Do they feel light? Where do you experience them?  Stay with these sensations and notice how they evolve. If they start to dissipate, bring the object of your compassion back into the foreground of your mind. Do this for several minutes until you feel fully in touch with the sensations of compassion as experienced in your body.

Exercise 2: The Self Compassion Exercise

Breath deeply from your abdomen for a few minutes until you feel your body relax. When relaxed, picture yourself as a small child. Focus in on this young version of you for a time. What do you look like? What do you seem to be feeling? What is on your mind? See yourself as clearly as possible. Next, generate compassion for this young version of you. If you are able, try to imagine scooping your young self into a hug. Feel your own arms around your young self in a loving embrace. If you find this difficult, just gently return your mind to the feelings of compassion for your young self. Next picture yourself as an older child and do the same thing again. Do this again for yourself as an adolescent. Finally, imagine yourself in your mind’s eye as the adult that you are now and generate compassion for the present-day you. If you feel comfortable enough, you can even wrap your own arms around yourself and give yourself an actual hug.

The next exercise involves working with the emotional and physical discomfort associated with anxiety. We tend to add layers of discomfort onto the experience of anxiety. For example, the way we talk to ourselves about feeling anxious may become such a layer. We may tell ourselves that we shouldn’t be anxious. Similarly, we may tell ourselves that something is wrong with us that we are anxious. We may even tell ourselves that we are going crazy. This type of self talk exacerbates anxiety. It is an additional form of mental pain layered on top of the physical sensations of anxiety. In addition, because anxiety is unpleasant, we tend to try to push it away; we tense our bodies in response to it, in an effort to distance ourselves from it. This exercise peels away these additional layers to reveal and work with anxiety in it’s raw form.

Exercise 3: Peeling Away Additional Pain

Begin by using your breath to relax. Breath deeply from your abdomen until you feel your body relax. Tune into the thoughts that you have about being anxious. What do you tell yourself? Do you tell yourself that you are inadequate or bad somehow? That you are going crazy? That you shouldn’t be experiencing anxiety? That something really bad is about to happen? Take some time to get the messages that you give yourself about your anxiety into focus. Once they are in focus, substitute the following thought “I love and accept myself exactly as I am“. Say these words to yourself several times in your mind. Each time one of the negative thoughts that you had resurfaces, counter it with this new thought.  It may feel awkward at first to talk to yourself this way, but do it anyway, even if at first you don’t believe it.  It gets easier and more believable with repetition.

Now scan your body for tightness. Look for places where you are tensing against anxiety. Common areas people tend to tighten against anxiety include the shoulders, the jaw, the mouth, and the hands. When you have located where you are tight, imagine that you can direct your breath to right to these parts of your body and do so for each area that is tight. Feel them soften as you do this.

Once you have identified and countered the thoughts you associate with anxiety and located and softened the places where you physically brace against it, you will be able to find the raw sensations of anxiety in your body. Just notice what these sensations feel like and where they are in your body. Is your heart beating harder or faster? Is your mouth dry? Is your stomach upset? Try to describe these sensations to yourself. Become aware of how these sensations shift as time passes. Notice in particular as these sensations dissipate. Tell yourself that this is what anxiety boils down to: nothing more than sensations in your body which have a beginning, a middle and (importantly) an end.

(These exercises are adapted from exercises in the book “Neural Path Therapy”, 2005, by Mathew McKay and David Harp.)

Self Injury: What Is It And Why Do People Do It?

Posted on by November 26, 2014
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Self injury, also called self harm, self abuse or self mutilation, is when a person intentionally hurts him/herself.  It is often a way of coping with intense emotions, but can also be a call for help.  Contrary to what many assume, it usually is not a suicide attempt though people who self harm are more likely to be suicidal than those who do not.  It is most common among teens, but also seen in adults.  It cuts across race, gender, and social class.

Self injury can take many forms: cutting, burning, scratching, biting, interfering with wound healing, hitting oneself or objects, sticking objects into one’s skin, hair pulling and purposely bruising one’s self or breaking one’s bones, to name just some of them.

Typically self-harm is a response to stress.  It may be present day social, occupational, educational or familial stress.  It may also be stress associated with a trauma from the past.  Sometimes it is a response to feeling emotional numbness; other times it is a way to achieve it.  Self harming can serve as a distraction from unbearable thoughts or feelings.  It can be a form of self punishment to feeling bad, selfish, unworthy, undeserving or disgusting. Sometimes people harm themselves because the pain associated with doing so is preferable to the psychic pain they would otherwise be experiencing.

Clinically speaking, the key to assisting people who self harm is twofold. It involves helping people learn to tolerate intense emotions on the one hand and giving them skills to modulate their emotions on the other hand. The so-called emotion regulation and distress tolerance skills associated with dialectial behavioural therapy are useful for both the self-harming clients and the counsellors who assist them.

Attachment Theory, Grief and Loss

Posted on by February 8, 2015
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This post reviews what John Bowlby, the father of attachment theory, had to say about grief and loss.  The implications of these ideas for clinical practice will be covered in the next post in this series on attachment, grief and loss.

Bereavement and grief were the primary focus of Bowlby’s book, “Loss: Sadness and Depression”, the third volume of his trilogy.  In this work, he proposed a framework for understanding normal as well as abnormal grief reactions.

Bowlby was an ethologist.  He considered grief to be a natural part of an attachment behavioral system (also present in other mammals) which was designed by natural selection to discourage the prolonged separation of an infant from his/her primary attachment figure(s) to increase the chances of survival and thus of reproduction.

Bowlby believed that because infants of many species require the protection of older individuals in order to survive, they evolved both physical and behavioral adaptations to capture and hold the attention of and maintain proximity to potential caregivers.  When an attachment figure is judged to be unavailable by an infant, the infant experiences anxiety and attempts to reestablish contact through behaviors such as calling, searching, crying, approaching and clinging.  Bowlby believed that these “protests” against separation on the part of infants serve the evolutionarily adaptive function of keeping protective attachment figures nearby.

Bowlby thought that the same psycho-behavioral tendencies to protest the loss of and to seek reunion with an attachment figure expresses itself when an adult loses a loved one.  In other words, he believed that the same psycho-behavioral phenomena underlie both temporary and permanent separations from attachment figures and regardless of the age of the person experiencing the loss.

Bolwby believed that as with an infant’s reactions to separation from a caregiver, adult grief follows predictable phases generally first involving intense protest, then despair and then hopelessness when the protests do not bring about reunion with the loved one.  After this there is typically a reorganization phase involving a gradual renewal of interest in other activities and relationships.  Though these phases are often experienced sequentially, they are not always or necessarily and may sometimes be experienced in a different order or in a cyclical manner depending on the person and the circumstances.

Bowlby believed that grief involves moving through this sequence of emotional reactions and that while perhaps difficult to experience, it is ultimately necessary for the well-being of the bereaved.  Bowlby further believed that not experiencing these emotions following significant loss can lead to psychological and physical ill health.  Both suppressed (unexperienced) and unresolved (unending) grief are thus considered pathogenic by Bowlby.

Bowlby also proposed a framework for disordered forms of mourning.  According to his framework, disordered mourning runs along a continuum with chronic mourning on one end and the prolonged absence of conscious mourning on the other.  Chronic mourning involves an unusually extended grief reaction combined with a prolonged difficulty engaging in normal activities.  People suffering from chronic mourning may find themselves overly preoccupied with thoughts of their missing partners and not able to function normally for a protracted period.  The absence of grief involves a notable lack of distress whether in the form of anger or despair.  People at this end of the continuum seek little support from others and continue in their regular work and social activities seemingly unimpeded by the loss.  Bowlby believed that both ends of this continuum are problematic and that most people who are reasonably secure with respect to attachment (explained below) will naturally move through the process of experiencing and expressing negative emotions following a significant loss.

Bowlby thought that the way a person responds to loss stems partly from the way that person’s attachment system became organized in childhood.  More specifically, he thought that those whose attachment systems are organized such that they are preoccupied by attachment anxiety (i.e., who anticipate rejection and loss chronically) and those whose are organized to defensively suppress attachment related feelings (i.e., who are avoidant of attachment related distress) are more likely to suffer from physical and/or psychological distress during bereavement.  He believed that those who are secure with respect to attachment are most likely to move through the phases of a normal grief reaction.

In attachment theory a person’s attachment “style” is thought to result from the internalization of their particular history of attachment experiences.  The style in turn results in an identifiable pattern of relational expectations, emotions and behaviors.  Four styles have been identified by attachment researchers: avoidant, anxious, secure and fearfully avoidant.  Those with an avoidant style distrust relationship partners and strive to maintain independence and emotional distance from others.  Those with an anxious style are dependent and frequently worry that a partner will not be available in times of need.  Those who do neither are considered secure with respect to attachment.  Those who exhibit both tendencies are considered to be fearfully avoidant.

Each of these styles involve distinct strategies aimed at alleviating distress and maintaining supportive relations when a person’s attachment system is activated due to a perceived threat.  When proximity seeking is expected to be successful, a person will likely make persistent attempts to achieve proximity, support and protection.  These efforts are referred to as “hyper-activating” strategies because they involve strong activation of the attachment system until the attachment figure is perceived as being available and responsive.  Hyper-activating strategies involve behaviors such as approaching, begging, crying, clinging, being hypervigilant regarding the attachment figure’s intentions, motives and behavior and intense distress and protest if he or she seems insensitive or unresponsive.

If a person believes that seeking an attachment figure will not achieve safety or comfort and may even elicit anger or punishment and thus increase distress, this will cause the person to deactivate the attachment system and seek to handle the problem alone.  The primary function of “deactivating” strategies is to keep the attachment system shut down.  This may involve denying or de-emphasizing attachment needs, avoiding emotional involvement in and dependence on close relationship partners, suppressing attachment related thoughts and attempting to remain autonomous.

Bowlby suggested that attachment reorganization after a significant loss depends on the way a person’s attachment system has become organized over time which results in the patterns referred to here as attachment styles.  Those with an anxious style, find it more difficult to deactivate painful feelings, thoughts, and memories related to the deceased attachment figure.  Those with an avoidant style are more likely to suppress distressing feelings, thoughts and memories of the deceased.  Those with a secure style are more likely to be able to process feelings, memories, and thoughts without either becoming lost in them or having to disengage from them. These styles have implications not only for how a person grieves, but also for how a clinician works with grieving clients. The clinical implications of the foregoing will be covered in the next post in this series.

Attachment Theory and Clinical Counselling Practice

Posted on by February 8, 2015
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This post covers the relevance of attachment theory to clinical counselling practice. Attachment theory is the brain child of John Bowlby, a British psycho-analytically trained psychiatrist.  Between 1969 and 1980 Bowlby published a three volume series on human behavior related to how and why affectional bonds are formed and what happens when these bonds are effected adversely.  This trilogy establishes the theoretical foundation of attachment theory.  In this post, I review several constructs which are central to attachment theory and explain how these constructs are relevant to the therapeutic process.

Attachment theory explains how and why infants and caregivers bond, how such bonds are developed ideally, how the bonding process can go awry and the implications of this on a persons development including their psychological well being throughout the lifespan.  It is only in more recent years that attachment theory, essentially a theory of human development, has been used as a touchstone for clinical psychotherapy practice.

What is a relationship of attachment?  According to attachment theory, a relationship of attachment is characterized by several factors including the need to maintain proximity, distress upon separation, joy upon reunion, and grief at loss.  Another thing that distinguishes attachment relationships is that an attachment figure is used preferentially as a secure base from which to explore the world and to retreat to at times of distress.

A construct central to attachment theory is that of a “secure” vs. an “insecure” attachment between an infant (child) and his or her caregiver.  Secure attachments are thought to develop in a care giving environment where in attachment figures are sufficiently available and responsive to the attachment needs of their infants.  Conversely, insecure attachments develop in caregiving environments wherein caregivers are not consistently available or responsive.  Insecure attachment in childhood is generally thought to take the form of one of three identifiable patterns: the “avoidant”, the “resistant” or the “disorganized” pattern.

It is thought that people develop consistent patterns of behavior for the purpose of defending against the feelings associated with disruptions in care in such a way that allows them to maintain contact with and proximity to their caregiver(s) to ensure ongoing care and thus survival. These childhood patterns translate into adult patterns of behavior which are referred to as “dismissing”, “preoccupied”, and “unresolved” respectively.  In adult terms, a secure pattern is referred to as “secure-autonomous”.

One of the key differences between the secure and the insecure patterns in adulthood is considered to be the capacity to engage in what is called meta-cognitive reflection.  This refers to a persons ability to think in terms of mental states, both ones own and that of others, and to use this awareness to understand one’s own and others behavior and intentions in light of those mental states.  This ability allows a person to take into account both the interpersonal and intrapersonal implications of the states of mind which are relevant to any interaction.  It is thought that the more a person is able to envision mental states in self and in other, the more he is able to engage in sustained, intimate, productive, and satisfying relationships with others.

The relationship between the therapist and the client can be seen as a relationship of attachment.  From the perspective of attachment theory, one of the aims of the psychotherapeutic process is that this relationship have the qualities of a “secure” attachment.  A secure therapeutic attachment can be thought of as safe container or a place of refuge wherein the client is able to process life experiences in such a way that s/he is able to grow and develop in potential beyond what would be possible were it not for the solidity of this relationship.  This developmental potential is co-created through the interactions between the client and the counsellor.

In attachment theory, secure attachment is seen as a precondition to a person’s ability to thoroughly and effectively explore their environment (including their interpersonal environment) and to experience him/herself as a fully active agent and self-effective individual.  When there is a safe and consistent enough base from which to explore and to which to return as needed, a person can afford to take the risks associated with exploring the various dimensions of life.

In order for the therapeutic relationship to be secure the therapist has to be able to effectively attune to the needs of the client in many of the same ways that a parent would attune to the needs of a child.   This involves the therapist being able to identify, name and reflect on the core emotions that the client is experiencing.  The therapist needs to be emotionally accessible and responsive to the clients needs. In these ways a therapy process is akin to a process of being parented, but by someone who is ideally trained know what constitutes a secure attachment as well as how to ensure that the therapeutic relationship is secure for the client.

 

Understanding Betrayal Trauma in the Wake of the Jian Ghomeshi Story

Posted on by November 24, 2014
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Betrayal trauma, a form of traumatic experience that is interpersonal or relational in nature, occurs when someone violates us in such a way that it damages the trust, safety and security of the bond(s) that existed. Interestingly, many women across the nation are experiencing a sense of betrayal upon hearing the news about the former host of the CBC radio show, “Q”, Jian Ghomeshi, even though they only knew him indirectly through his capacity as a radio personality. Ghomeshi is alleged to have physically abused and sexually assaulted several women. Why is it that these women are having this reaction despite not knowing Ghomeshi directly?

In my counselling practice in Victoria, BC alone several women have expressed a sense of feeling vicariously traumatized in the wake of the Ghomeshi story breaking. As these clients and I look beneath the surface of these feelings a bit, we discover that it is because they have been betrayed directly by significant men in their own lives and have never thoroughly resolved these betrayal traumas. These traumas from their pasts have remained in a sense awake in them such that they are reactivated upon hearing news about how others were allegedly abused by Ghomeshi.

How is it that past traumas remain in us to be activated by present day reminders (such as the Ghomeshi story)? In very simple terms, the parts of the brain that organize and “file away” memories can become temporarily disabled when we experience a traumatic event. Although these memories remain unorganized and “unfiled”, they are nonetheless highly potent and likely to become activated by reminders in the present of experiences related to the particulars of the traumatic past. When activated, these memories invoke a sense of reliving rather then of recalling the experience. In other words, a person’s mind and body relives the sensations and emotions associated with the original trauma.

Which types of experiences tend to become traumatizing in the sense described above? It is generally thought that an experience has the potential to be traumatizing in this way when it is perceived as extremely threatening and overwhelms one’s capacity to cope. Thus, the main elements of potentially traumatic experiences are the perception of intense threat coupled with the an inability to effectively deal with that threat. It is easy to see how this could include the potentially overwhelming feelings of being betrayed by someone on whom we rely for our well-being such as a parent (or other family member), a partner, or even a person in a position of authority.

In addition to the adversity associated with chronically reliving traumatic experiences, there are also longer term effects associated with unresolved trauma which can be devastating. Unresolved trauma can lead to anxiety, depression, addiction, poor decision-making, physical pain, disease, trauma repetition and other adverse effects.

It is possible, however, to free ourselves of the debilitating symptoms of unresolved trauma. The next post in this series will discuss how to work through unresolved traumatic experiences so that they become “resolved”.

When Porn Becomes an Addiction

Posted on by February 8, 2015
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Anything that provides pleasure can become an addiction.  This is true for behaviours (such as the use of pornography) as well as substances.  The question is how do you know when a pleasurable activity has become an addiction.  There is general agreement that something has become an addiction when it interferes with other aspects of your life.  In other words if the behaviour detracts from your relationships with others, your ability to function at work, your capacity to engage in other activities, or your status in your community, etc., it may have reached the level of addiction.  Another rule of thumb for gauging whether an activity has reached the proportion of an addiction is if you have made repeated, but failed, attempts to stop or slow the behaviour.  Yet another indication is when those around you let you know that your behaviour has become a problem for them.  If any or all of these factors are the case for you regarding your use of pornography, you may have an addiction.

Counselling can help.  A counsellor trained in treating process addictions can help you change your relationship to pornography.  If you would like assistance from a compassionate, confidential, non-judgemental, trained counsellor to overcome an addiction to pornography, please call now to make an appointment or fill out a contact form on this website and I will respond promptly.