If you’ve been attending psychotherapy for some time and don’t seem to be getting the results your looking for, the problem could most likely be all the talking. Now you may believe your therapist is attentive, compassionate, and non-judgmental, and they most likely are. And there is positive value in feeling heard, understood, and emphasized with in a safe setting.
Furthermore, they could have aided you in increasing your self-awareness and gaining an increased understanding of the origins of your presenting issues. But for some reason your symptoms continue to persist. And despite a few brief periods of improvement, you feel overall the same as prior to attending therapy. Perhaps, you’ve shared your story repeatedly and don’t quite know what else to talk about. Moreover, knowing where your negative patterns of behavior came from may have left you feeling worse about yourself since you now know but cannot seem to change them.
Talking is Blocking
Your lack of progress and desired outcomes are not the result of a deficit in your intelligence, motivation, or sincerity; they are based in neuroscience. One of the things I tell my new clients is that PSYCHOLOGY is now BIOLOGY. As clinicians, we no longer have to operate out of outdated theories and hypothesis but from research validated understandings of what is occurring in the brain, body, and nervous system. Particularly, in regards to healing from various forms of trauma, cognitive processes, such as talking and analyzing, are some of the primary obstacles to fully recovering.
“What, you may ask. “Are you saying I’m supposed to go to talk therapy and not TALK?” Yes. In large part that is exactly what I am suggesting. This may be a new concept for you, but one that I will show you shortly is based in science and biology. This is the main reason why your current and historical approaches to heal have fallen short. Even if you have never been exposed to some of the information I am about to share with you, I am confident you’ll know it to be true. There is something interesting about truth; it is not just a cognitive understanding but is also associated with a felt sense in the body. When something is true, you feel it.
The Felt Sense of Truth
Sitting in front of thousands of clients ranging from those who have gone to therapy for decades to first timers, when I explain how trauma develops, why they have not been successful in recovering, and then provide them with specific information for how they will, they all feel the truth of it. Contrastingly, when anyone tells you something no matter how bold or forceful that is not true, something feels off in your body or a part of you resists it.
As you read the remainder of this article, I encourage you to not just notice what you THINK about what I am suggesting but also how it FEELS in your body.
Structural Dissociation The Brain’s Circuit Breaker
During a traumatic event, the nervous system is stretched beyond its capacity to regulate the energy triggered in the brain and body. As a result, a neurological process referred to as structural dissociation occurs. The best analogy would be that of an electrical system. People often use a surge protector to plug there electronic devices into in order to safeguard them from being damaged by an excessive flow of electricity. The surge protector cuts off the current of electricity from reaching the device and irreparably damaging it.
The brain has a similar defense mechanism. There is a structure in the brain known as the thalamus. It is a bit like a relay switch for five sense information (sight, smell, taste, touch, and hearing) coming in from signals in lower regions of the brain to be sent to areas throughout the upper brain. This five sense information is communicated chemically and electrically. If this chemical, electrical information is too intense, it will cause cellular death to areas of the upper brain.
As a protective response, endogenous, or internal, opiates flood the thalamus to block the energy from reaching the upper brain a bit like a circuit breaker. The neural network that holds the energy and information of the event is split off and isolated to protect the rest of the brain and allow us to survive the event and maintain a level of functionality. However, the network is now unintegrated and does not work in a cohesive manner with the other neural networks.
The Amygdala and Implicit Memory
In addition, the amygdala, which is the brain’s threat detector, is constantly scanning the environment for any potential danger from social judgment to physical danger also tags anything emotional whether pleasurable or painful and stores it in what is referred to as implicit memory. This type of memory is experienced as a felt sense in the body and has no images, conscious thought, linear time, ability to differentiate people, place or setting, and sees false positives just to be safe. The energy and information of the traumatic event are now stored in the body on a cellular level and contain fragmented sensory data.
Subsequent to the traumatic event, any association whether a smell, visual cue, time of day, day of the year, phrase of speech, etc. will activate the implicit memory in the body, which is then experienced in the present as if it’s happening for the first time even if the incident occurred decades ago. This is what is referred to as a traumatic intrusion or ‘flashback’. These adaptions that allowed one to survive the traumatic event have now left the brain and nervous system altered in a negative way. If you have PTSD (Post Traumatic Stress), C-PTSD, DID, or any other Dissociative Disorder, this is a simplified version of how these states developed.
Neurological Not Characterological
The development of any of these conditions has nothing to do with anyone’s character, intelligence, or courage. It is purely a neurological condition generated by our brain and body’s survival, or adaptive, responses to an overwhelming experience. I will now explain why talk therapy cannot resolve or reset our nervous system to fully recover from the traumatic event. Moreover, I will show how it actually impedes our ability to do so. Successively, I will enumerate what is necessary to access one’s innate healing capacity, release the stored energy and sensory information from the traumatic event, and unlock our greatest inner resources.
Thinking versus Experiencing
One of the initial reasons talking about the event blocks recovery is due to how two of our most important networks in the brain interact. The first of these is what is referred to as The Executive Attention Network. This networks is comprised of large parts of our prefrontal cortex, the most evolved part of the brain. When you are thinking, reflecting & problem solving, memorizing, writing, as I am now, you are using this network. Engaging in these types of activities is highly important to achieving many great things in life and moving us towards attainment of our goals.
The contrasting network is referred to as The Default Mode Network and links areas of the mid and lower brain regions. This network provides us with ‘aha’ or ‘eureka’ moments, creative insights, and more wholistic understandings of issues. Perhaps, you can recall a time when you were struggling to come up with the answer to a problem or challenge. You may have taken a walk, took a shower, or participated in an activity that didn’t require much cognitive activity when suddenly you experienced a spontaneous solution to your dilemma; this is the result of activating The Default Mode network.
Einstein and The Default Mode Network
Stories from the life of Albert Einstein are a great example of the Default Mode Network in action. It was well documented how when struggling with a mathematical or theoretical problem he would leave his work setting, go rowing in his small boat, and stare at the clouds or stars without thinking about the problem. Many of his greatest scientific breakthroughs came as thought experiments generated during this time of not thinking. The Default Mode Network can link together information the Executive Attention Network cannot. And here is the reason why continuing to obsess over a problem no matter how frustrated you become will only impede obtaining the solution: The Executive Attention Network and The Default Mode Network will not activate simultaneously except in rare instances.
That means one network goes on, and the other network goes off. Furthermore, the majority of what we want to access in psychotherapy is stored in the mid and lower areas of the brain and is contained in The Default Mode Network. This means the more you use The Executive Attention Network, the more you keep The Default Mode Network suppressed. Yes. There is a role for the Executive Attention Network in trauma therapy but it is to primarily observe what is arising from The Default Mode Network and the body. Observing and tracking experience, such as physical sensations, emotions, imagery, memories, and additional sensory information and then regulating, releasing, and integrating them is the goal, not analyzing them. This can be done after you have experientially worked through processing and assimilating the trauma.
Our Most Primitive Defense
If you have been repeatedly recalling and talking about events in your life, whether they are historical traumas you have experienced or the crisis du jour, you are unknowingly blocking access to where the trauma is stored and your innate ability to release and resolve it. Again, this is due to the fact that dissociation occurs in the most primitive part of the brain known as the reptilian brain. Animals have this same defense, which is known as tonic immobility. When all options of escape from a predator have been exhausted, the prospective pray will physically collapse into a catatonic state.
The adaptive nature of this is due to several reasons: many predators are triggered by movement; an animal may be hesitant to eat a lifeless animal as a result of concern in may be diseased; or if it is eaten the animal will release natural opiates, go increasingly numb to avoid the pain, and lose consciousness. However, if the animal has an opportunity to escape due to distraction or exhaustion of the predator, it will reactivate its fight or flight network and flee to safety. Once it is in a secure environment, it will shake and tremor until all the energy that was generated for fleeing the threat is released from its body, and it will reset its nervous system and go about its regular business of engaging in activities necessary for survival.
Feeling and Dealing
As human beings, we struggle to complete this process and reset our nervous system largely due to our highly evolved cortical brain. If we began shaking and trembling following a traumatic event, we would likely place the meaning that this is bad and flood ourselves with even more adrenaline and further traumatize ourself. It is often the case that when people are in therapy talking about distressing events, they are either emotionally detached from what they are sharing or it becomes overwhelming to discuss it, which leads to re-traumatization. In therapy the former is referred to as DEALING without FEELING or, in the case of the latter, FEELNG without DEALING. The goal is to both FEEL and DEAL.
The next barrier to trauma recovery using cognitive approaches is associated with trauma triggers. As mentioned prior, the amygdala holds our emotional memories both painful and pleasurable. Whenever it tracks and recognizes any association to the traumatic memory, even if it is a false positive, it will trigger survival responses, such as fight, flight, or freeze states. This causes a massive release of either adrenaline for fight or flight or internal opiates to numb and prevent overwhelm. In either of these instances, large areas of the prefrontal cortex will get shutdown to engage in defensive actions. This will result in an individual either engaging in excessive or irrational behaviors or becoming unable to access cognitive processes, such as thinking, reflecting, and generating adaptive responses to the circumstances.
Continual Re-traumatization
In psychotherapy, continuing to talk about the event or triggers of the event, can continually activate the amygdala perpetuating these survival reactions and re-traumatization. Trauma disrupts this delicate balance between the prefrontal cortex and the amygdala. As an example, I have a bamboo plant in my office. During the day, it always appears to me to be a bamboo plant. However, one evening I had to stop by my office to obtain some paperwork I forgot to bring home. It was late and the office was dark. When I stepped into my office the first reaction I received from my amygdala was there was a man in the corner of my office. However, after my prefrontal cortex was able to reassess the situation, I realized it was my plant.
Following a traumatic event, this can be challenging due to the prefrontal cortex being overridden causing one to lose the ability to reassess. In my case is this was true, I would have ran back out of the building, called the police, and refused to reenter the office until the police searched the building leaving the officers to question whether I was having some sort of mental breakdown. Moreover, I may begin avoiding the office and request all my clients do their sessions virtually and become more and more isolated in my home due to fearing leaving it. This may sound extreme or absurd, but I can assure you countless clients of mine have had these types of debilitating experiences as a result of their trauma.
Regaining Balance Between Thinking and Feeling
The negative alterations between the prefrontal cortex and amygdala as a result of the trauma also leads to difficulties in regulating one’s emotions. Again, focusing primarily on verbal narratives or cognitive management strategies typically is not sufficient to create the neuroplastic changes necessary to restore this balance and gain mastery over one’s emotional states. It requires here and now tracking of one’s physical sensations and emotional energy without adding to it by excessive verbal accounts of things that occurred outside of the present moment. Placing too much emphasis on what one is discussing can impede one’s attention on what is actually transpiring in the present moment and body, which is what is imperative to recover.
There is also a research-validated concept in neuroscience defined as memory reconsolidation. The old fragmented neural imprints or memory networks have to be activated and a new corrective experience needs to occur, which includes release of the energy stored from the trauma. This results in integration of these fragmented neural imprints. They are then reconsolidated and stored in memory in a more adaptive manner. Traditional talk therapy is insufficient to bridge and integrate these isolated neural networks.
There Are No Words
Another deficit of talk therapy is due to the fact that much of the traumatic material is stored in non-verbal parts of the brain. Words cannot capture the depth and totality of this experience; the body tells the story. While it is important initially for a caring other to hear and witness our experience, subsequently the somatic or body narrative is the more crucial account for healing. My aspiration is that this information has helped you understand why your efforts have fallen short and provide you with hope that you can fully recover from what you have endured. I will now explain neuroscientifically how to resolve your trauma and what is actually necessary to achieve this goal. In the process, I will outline four of the most impactful psychotherapeutic models I have found to date that can allow you to do so.
The most concise explanation of effective trauma therapy is comprised of activating the implicit memory in the body, modulating the amygdala’s reactivity, and reintegrating the sensory information and discharging the energy frozen in the nervous system from the trauma. You do not need to talk endlessly about the incident or relive it, which can again be retraumatizing. This is frequently the primary resistance to entering psychotherapy: you don’t want to talk or think about what happened or relive it in any way. I get it. Who would?
Slower is Faster
Using the therapeutic approaches I will now outline, we break things into small pieces to achieve integration, reconsolidation, and release of the trauma. We want this to take place in the calmest manner possible. Long gone are the days of catharsis or beating the therapist’s couch with foam bats. In most of these cases, all that happened was the client went into a dissociative state and just recycled their trauma. In trauma therapy, we have an expression that slower is faster. This does not imply you have to come to sessions forever but that slowing down in the moment and staying regulated is the much faster approach that does not lead to flooding, overwhelm, or re-traumatization.
Experiential Therapies that Produce Neuroplasticity and Memory Reconsolidation
There are numerous experiential therapies that are capable of achieving neuroplasticity and memory reconsolidation. The four I use primary are Internal Family Systems (IFS), Accelerated Experiential Dynamic Psychotherapy (AEDP), Eye Movement Desensitization Reprocessing (EMDR), and Brainspotting. Each of these therapies are rapid and powerful at accomplishing the necessary neuroplasticity to recover from your traumas, whether they be single-incident traumas, such as from assault, accident, or disasters or those created by years of chronic abuse and neglect of various types. This category of trauma is what is referred to as complex PTSD. Obviously, these forms of trauma require more treatment to heal from, but it they can still be resolved much more rapidly than from traditional methods.
EMDR Therapy
The first therapy that educated me about the power of implicit memory and tools for regulating the amygdala was EMDR developed by Dr. Francine Shapiro. In EMDR, you target a traumatic or distressing event by visualizing or thinking about the event if you are unable to access imagery. You then notice where you feel energy, sensation, or tension in the body. The activation in the body is an aspect of the implicit memory. Following assessment of the intensity level of the felt sense, bilateral stimulation of the eyes is initiated by tracking the therapist’s fingers, a pointer, or light bar. This activates both hemispheres of the brain and stimulates what Dr. Shapiro defines as the Adaptive Information Processing (AIP) system.
While undergoing bilateral stimulation, the brain processes and integrates the event by witnessing various images of the target incident and possibly recalling additional images of similarly themed memories in which there is unprocessed material, experiencing different core emotional states in a regulated manner, and feeling assorted bodily sensations or sensory information until it has been reintegrated and energetically discharged. While engaging in this process, the less someone talks the better. Furthermore, I have performed EMDR sessions with a client in which I had no idea what we were targeting and processing. In one scenario, I had just met the person in a substance abuse treatment center, and they told me there was an incident that occurred when they were eleven years old and asked if they needed to disclose the event to me.
I informed them it was not necessary to process the event, to which they were greatly relieved and stated they were not yet ready to share what happened. And if this was required, they would have declined to work on the trauma. We targeted this event by me asking the client to visualize or think about the event, notice where they felt sensation on the body, and identify the negative cognition associated with the event. I then began utilizing bilateral stimulation and completed full processing of the incident with the client. Because this event was not associated with any other similarly themed memories, it was resolved in one session. Not only are these approaches science-based and capable of generating rapid healing, you are often able to target and resolve situations that the client would otherwise not be open and ready to address.
Brainspotting Therapy
The second modality I regularly employ is Brainspotting. This was developed by Dr. David Grand. Dr. Grand was a well-known EMDR therapist and created an approach I would define as an evolution of EMDR. In Brainspotting, you are using the same processing system, what Dr. Shapiro conceptualized as AIP, but instead of bilateral stimulation you are identifying locations in the brain where there is heightened neural activity related to the trauma through eye positions, which he refers to as brain spots. Once these are identified through tracking eye positions, the client then remains passively focused on that eye position until the brain processes and releases the trauma from the body and the implicit networks.
Before proceeding to the next two therapies, I want to acknowledge my explanations of the psychotherapies in this article are a simplified version attempting to contain adequate information to expose you to a sufficient understanding of the power of experiential, neuroscience-based therapies. If you would like to gain a broader understanding of any of them, you can refer to Google or YouTube for a plethora of evidence-based information related to each of them.
Accelerated Experiential Dynamic Psychotherapy
The third of the therapeutic models I employ in my trauma work with clients is the most comprehensive therapy I believe exists, which is AEDP. This model was developed by Dr. Diana Fosha. To summarize, in AEDP the therapist is identifying the types of emotional and relational defenses the client was forced to utilize to survive traumatic or distressing events. The therapist then aids the client in developing awareness of their pattern of doing so, assists the client in regulating their anxiety related to dysregulating emotional experiences they have had to defend against, and using the therapeutic relationship and the clients inner resiliency to access and process previously feared emotional states and process them to completion. This then allows them to not only master these core emotional experiences but taps them into their greatest internal resources and what Dr. Fosha describes as Core State.
Many of the traumas individuals experienced took place in a relational context. By creating reparative attachment experiences and making them explicit, the client is able to move away from there defenses and live a more expansive and open stance towards life and others. AEDP is one of the safest and calmest way to process trauma I have experienced and leaves both the client and the therapist transformed in profound ways. The last therapy I regularly use is similar in certain aspects with AEDP with one major difference, which I will explain, is Internal Family Systems. The integration of AEDP and IFS comprises ninety percent of my approach at this current point.
Internal Family Systems Therapy
IFS was developed by Dr. Richard Schwartz beginning in the early nineteen eighties. Dr. Schwartz expanded upon several previous therapeutic approaches that discovered that just as we exist in an external web of relationships there is an internal system consisting of subparts of our core personality structure. We now know through neuroscience there are numerous neural networks in the brain leading to multiple parts of our personality structure. And as outlined prior, experiencing emotionally traumatic events can cause dissociation and fragmentation of these neural networks. What Dr. Schwartz and others discovered is that these networks not only contain energy and information but also intelligence.
Let’s say I am a six year old child who gets consistently shamed by a teacher or parent. This is a painful and distressing state that I do not have the capacity to regulate. I cannot reach for the adult in this situation to assist me in coregulating this energy, I am unable to fight or flee, so I my brain and nervous system initiates a neurological process priorly described as dissociation. Now there is a fragmented, isolated network containing the dysregulated energy the six year old part of me experienced. In addition to dissociation, I may then form a perfectionistic or high achieving part of my personality to protect me from experiencing additional shaming or from activating the energy of shame frozen in my nervous system.
However, try as I might, I cannot always achieve the goal of perfection. Later in adulthood, whenever my performance is subpar, I begin to experience shame and switch to an alternative strategy of drinking alcohol, binge-eating, or compulsive spending to suppress the feelings of inferiority that are activating in my system. In IFS language, we develop protective parts of the personality to manage or defend against the painful states held by exiled parts of us. In my experience, most people immediately resonate with these concepts because they are true, and they fit with their experience. These defensive strategies were once highly necessary and most likely adaptive. However, as mentioned previously, implicit memory has no linear time associated with it.
The Goal of Therapy
No matter how non-adaptive these behaviors may now be, these parts of us cannot discontinue engaging in them until the part of us holding the pain and distress is healed. People enter therapy either because these outdated strategies are causing distressing symptoms in their life or they can no longer suppress the pain held by emotionally burdened parts of themselves. The chief healing agent in IFS is not the therapist but what is defined as the client’s Core Self. This state can be explained scientifically, spiritually, or by a combination of the two. In my opinion, the description in not important; it is the experience that matters.
As in AEDP, the goal is to work with the client’s protectors (defenses) to address their fears and concerns (anxiety and resistance) and gain access to the exiles (overwhelming emotional experience). The therapist then guides the client in how to connect with their Core Self in order to create reparative relational experiences enabling the exiled part to experience the coregulation and attachment response needed to process the event, bring the wounded part into present time (neural integration), reconsolidate the memory with the new adaptive experience, and unburden (discharge) the energy in the body from the trauma.
Beyond Words
As you can observe from the descriptions of these therapeutic models, this is way beyond repeatedly giving verbal narratives session after session of what happened. Two of my favorite comments from clients are, “I’ve had therapy before, but it was never like this,” and, “I’m not completely sure what we’re doing sometimes, but it’s working.” If you have been suffering from trauma or emotionally wounding events, you do not need to keep talking in circles. We now have the understanding and tools to resolve trauma like never before. Moreover, our knowledge of ways to heal trauma is continually expanding.
It is my hope that to some degree after reading this article you have a greater understanding of why you may be stuck in your healing journey, have an increased level of hope in your ability to heal, and are somewhat more educated in how to do so. If you would like more information on this topic or are interested in obtaining professional support to assist you in recovering from trauma, please contact us at 561-316-6553.
