3. ) You do a lot of trauma work.  Can you talk about the types of modalities you use when treating trauma?  

Sinead: I do a lot of work helping people cope with the dissociation that is so typical of traumatic stress.  As mentioned earlier, dissociating is adaptive in the context of trauma because it provides a very strong coping mechanism to get through overwhelming stress in the moment. The problem is that after the trauma has stopped, time goes on, but the dissociation can continue to be triggered by even minutely similar experiences.  This can lead to problems in their lives, because it means that they’re not able to be present when they need to be.

With traumatic dissociation, it’s often something they don’t really recognize as being a trigger and somehow, it gets that system set off.  For example, they may be in a moment with their family.  Everything is safe, but there’s some sort of reminder that triggers that earlier traumatic experience.  Then, they can essentially zone out – they’re not really present anymore.  Internally, they are highly activated, even though externally, they may appear somewhat slowed.

And, people may not understand why they’re not present, why they’re responding this way in certain situations.  You can see it in therapy.  Sometimes, when you’re working on something that’s a little too intense or hard to tolerate, as a clinician, I can see the dissociation occur in the client.  Sometimes, it’s mild and brief and other times it’s more dramatic.  I’ll check in with the client to see if they’re “still there” and they’re usually able to tell you that they’re disconnected from the moment.  Then, the work is about bringing them back and stabilizing them.  Not doing anymore trauma exploration or insight-oriented work at that point, but rather, working on ways to bring them back to the present, to a place where they can feel safe and connected again.

KP:  Since “checking out” mentally or not being present is so ubiquitous in our society, is your perspective that any kind of dissociation is rooted in trauma, even if it comes from a more subtle experience than the type you’re talking about?

Sinead: No.  When I provide psycho-education to my clients, I really normalize the experience of dissociation in different contexts.  What you’re looking at are degrees on the spectrum.

I tell them that “checking out” and being somewhat dissociative is something that all of us do.  And, I give them examples: like when you’re driving down the street and you’re zoned out.  You’re not paying attention to the houses or streets you’re passing, but nevertheless, you end up at your house.  In that situation, you’re not really thinking about the driving process, but you’re thinking about something else – perhaps about work, or even nothing at all – but you still manage to get where you need to be.  Another simple example I tell teens is when they’re in class and they zone out and the teacher is talking and they realize they haven’t heard a word; it’s like a “spacing out” which is normative.  Sometimes, it can be a good way to disconnect from information overload or boredom.

But, when it gets to dissociation that’s induced from trauma, then the spacing out tends to be more dysregulating emotionally; it’s harder for them to come back to the present moment and they’re not able to stay connected as much to people around them.

With trauma, I work with clients on developing the skills to self-regulate.  The first step is to identify the triggers that tell them they may be starting to dissociate, with the goal of noticing and responding to these before they actually enter into a dissociative state.  Or, if they’ve already dissociated, then in therapy I’ll try to help them find a way to re-connect to the present. For example, I may ask them to identify something in the room that’s the color green and they pick out something and then I’ll ask them to describe it.  And, so what you’re really doing is getting them to focus on something concrete, specific and neutral – something that’s not related to any traumatic content.

Another technique I use is to engage one of the senses, like the sense of smell or touch.  For example, I may use something as simple as the Purel anti-bacterial soap that I have in my office.  I’ll have them put it in their hand and I’ll ask them to notice the temperature of their hands, the moisture, the smell of the Purel, what it feels like to rub their hands together, etc.  Just really reconnecting them to the benign present moment and the experiences of the body, rather than thoughts.  When people are disconnected, it’s harder to use the executive functioning of thinking, so you want to help them just access getting back into their body, feeling stable, connected, noticing things in the room that are about the present, rather than talking about the past.  And, they end up reconnecting to me as the other person in the room, which can help stabilize them as well.

KP:  Is that part of what you’re doing in the Sensorimotor Processing work you’re learning?

Sinead: Not exactly.  What I just described is really just a basic grounding process to help them get back into what we call the “window of tolerance” – which refers to a place where one is emotionally stable enough to take in and respond to information effectively. With dissociation, clients are either hyper-aroused (over-stimulated on an emotional level) or hypo-aroused (under-stimulated).  If you’re in one of those states, it’s going to be hard to engage in therapy on a more cognitive level, because the emotions are not regulated enough.  Doing the grounding or distracting techniques can help bring them back into that window of tolerance.

I’m currently training in Level I of two levels offered in the Sensorimotor Processing training.  Level I is about concrete trauma and Level II is more about developmental trauma, such as attachment related disorders or chronic, long-term traumas.  In the population I work with, we don’t see much specific, isolated traumatic events. It’s usually more numerous, accumulated traumas due to developmental stress, as well as specific traumatic events.

The Sensorimotor work focuses on the unconscious movements a client makes while they’re in session as they’re talking about something.  They may be speaking about something that isn’t necessarily about specific trauma, but as they’re speaking, you may notice a particular shift in their body.  Maybe it’s about how they’re holding their body, or a small clenching of the hand, or there’s a tapping of their leg.  Once I notice that, I just draw their attention to it and ask them to focus on it and see what they notice.  And, I try to work with that to see if there’s something that movement is trying to do that has been truncated in the past.

The whole idea is that traumatic memories are not just stored in the brain, but they’re also stored in the body. Sensorimotor is going from bottom level up, rather than top level (cognition) down.  Starting from the bottom, we’re exploring what is locked in the body; are there traumatic memories there and is the movement something that was truncated or influenced by the traumatic experience.  So, you focus on that piece to see if you can complete that truncated movement.  That way, you have what they refer to as “an act of triumph” – rather than being locked into that traumatic part where they’re not able to move.

KP:  Can you clarify what you mean by a “truncated movement”?

Sinead: A truncated movement is the movement that was not able to happen in the moment of the trauma due to either the freeze response or an external force preventing the person from moving in that moment. Therefore, if the movement wasn’t able to occur, the person can potentially be stuck in that moment even after the trauma has ended. They don’t feel a sense of safety in their bodies and may perpetually be in a state of freeze/fight/flight years after the original trauma has subsided.

I’m beginning to experiment with this work with my clients.  It’s something I’m planning to continue to learn about as an added modality, to see how it can help clients, beyond just using more traditional talk therapy.

KP:  This sounds pretty similar to Hakomi therapy, which is another experiential, body-centered therapy that I know a bit about.  It does appear that body-oriented psychotherapies are at the cutting edge of effective trauma work.  And, this brings up another point, that essentially everybody has experienced “trauma” in some form or another in their lives – whether it’s the more dramatic kind like a car accident, abuse or another form of violence, or things that are perhaps less direct, like societal oppression, in the form of racism or poverty.

Sinead:  Yes, nobody comes out of this life unscathed.  Everybody has some sort of trauma that they have gone through whether it’s attachment related or getting fired from a job, getting a divorce, or even for a child, the birth of a new sibling can feel somewhat traumatic.  It’s degrees, right.

KP:  It’s interesting because when you bring in the body piece, you can start to tap into material on a deeper, less conscious level.  For example, somebody may be talking about a relationship with their family member and be saying everything is fine, but then you notice a certain posture or tone of voice.  Then you explore that and perhaps they notice that they actually feel guarded or defensive on a physical level when talking about that relationship.  That exploration essentially reveals some new important information that may have been just barely out of consciousness.  I find that exploration with clients to be very fascinating.

Next Section: 4.) Can you briefly describe how you use Internal Family Systems (IFS) theory in your work?