Interpersonal.neurobiology Quotes

Those who are nurtured best, survive best.

The problem is, when you depend on a substitute for love, you can never get enough.

It wasn't that I gave up on her healing, but, as she continued to struggle to get in the door and actively needed her self-hatred to stay functional, I began to realize more deeply that her patterns had meaning and that it wasn't useful for me to predetermine what recovery might look like for her.

if we use how we were taught yesterday to teach our children today, we are not preparing them well for tomorrow.

Structural dissociation occurs during confrontations with overwhelming events when mental efficiency is too low.

Integration is not the same as blending. Integration requires that we maintain elements of our differentiated selves while also promoting our linkage. Becoming a part of a "we: does not mean losing a "me." Integration as a focus of intervention among a range of domains of integration becomes the fundamental basis for how we apply interpersonal neurobiology principles to the nurturing of healthy relationships.

the greater the wounding, the more numerous and powerful our protectors need to be.

As EP, survivors have been unable to create a complete personal story and are unable to share the original experience verbally and socially. They are stuck in the traumatic experience where they relive rather than retell their terror.

traumatized individuals (as EP) “are continuing the action, or rather the attempt at action, which began when the thing happened; and they exhaust themselves in these everlasting recommencements” (p. 663).

Presence depends upon a sense of safety. The

I have another self … weltering in tears … I carry it deep inside me like a wound.

the practice of nonjudgmental, agendaless presence [is] the foundation for safety and co-regulation.

we are adaptive rather than disordered

As long as I was aligned with listening rather than with an intention to receive a particular response or to shift something, we would stay on safe ground.

emotional regulation flows naturally from being in the presence of someone we trust

listening to one another activates our mirror neurons and resonance circuitry (Iacoboni, 2009) so that we can be said to literally begin to inhabit one another's embodied emotional universe.

However, if the perpetrator is a parent who is always there, it is possible for these defensive action systems to be evoked simultaneously with normal life action systems in chronically abused children.

The core issue in traumatization is that survivors have been unable to realize fully what has happened to them and how it affects their lives and who they are. In other words, the inability to realize involves many ways of not knowing massive psychic trauma

Hyperarousal causes traumatized people to become easily distressed by unexpected stimuli. Their tendency to be triggered into reliving traumatic memories illustrates how their perceptions have become excessively focused on the involuntary search for the similarities between the present and their traumatic past. As a consequence, many neutral experiences become reinterpreted as being associated with the traumatic past.

Early traumatization is a major risk factor for more severe symptoms that persist over time. Thus childhood traumatization plays a central role in the development of trauma-related disorders in children and adults.

We have a tendency to become detached observers rather than participants. There might also be a sense of disassembling a complex, flowing process to focus on a small part of it. If we expand our focus to include emerging, one of the first changes we may notice is the bodily sense of being in the midst of something, of constant motion, lack of clarity (in the left-hemisphere sense), and unpredictability.

We now know that the placebo effect is real medicine that operates mainly through the activation of brain opioid systems.

...we are not seeing reality as it is; rather, we see the spectrum of light most useful to our survival." -Aldrich Chan

The very act of perception is transformation; we transform the code of the universe to the world we see.

Their suffering essentially relates to a terrifying and painful past that haunts them.

lack of agenda is the primary essence of safety, giving our people implicit permission to bring forward any aspect of themselves that needs attention.

We humans are always seeking the warmest attachments we can imagine

James Coan says, "In truth, because so many neural structures are involved in one way or another in attachment behavior, it is possible to think of the entire human brain as a neural attachment system.

Which end is nearer to God, if I may use religious metaphor, beauty and hope, or the fundamental laws? I think that the right way of course, is to say that what we have to look at is the whole structural interconnection of the thing;

Through mirror neurons and resonance circuitry, we are taking in each other's bodily state, feelings and intention in each emerging moment (Iacoboni, 2009). This gives us an approximate empathic sense of what is happening in the other person, but it is important to be aware that the information is also being filtered through our implicit lens. This filtering colors our perceptions and pretty much guarantees there will be ruptures that invite repairs, as our offers of empathy will sometimes not reflect what the other person is experiencing.

... the roots of security and resilience are to be found in the sense of being understood by and having the sense of existing in the heart and mind of a loving, caring, attuned and self-processed other, an other with a mind and heart of her own.

Through a polyvagal lens, we understand that actions are automatic and adaptive, generated by the autonomic nervous system well below the level of conscious awareness. This is not the brain making a cognitive choice. These are autonomic energies moving in patterns of protection. And with this new awareness, the door opens to compassion.

Neglect is a form of traumatization in which there is an absence of essential physical or emotional care, soothing, and restorative experiences from significant others. In children these experiences are developmentally requisite, and in adults they may be needed under certain circumstances, such as the aftermath of potentially traumatizing events.

This is why people who have experienced severe abuse and trauma often have difficulty explaining their experiences. They have a problem because clinicians, friends, and family often don’t have the concept of an immobilization defensive system in their vocabulary.

Attuning inwardly felt like a welcome home celebration.

When such reactivation takes place, the traumatized individual often is unable to suppress the intrusion of EP with its traumatic experiences.

May we each find a forest-bathing path that can be a daily balm in this taxing world.

The room was very quiet with that familiar deepening that arrives when something is happening underneath, beyond the words.

We are deeply sensitive to one another's presence

approval... often brings anxiety lest we not be able to repeat the desired behavior.

Only when we are in a calm physiological state can we convey cues of safety to another.

Thus, to fulfill our biological imperative of connectedness, our personal agenda needs to be directed toward making individuals feel safe.

social isolation and lack of self awareness can occur partly because there are simply no words to tell the story.

consciousness (hypoarousal). When individuals are extremely hypoaroused they may not encode much of what is happening, may feel the event is not real, and may experience emotional and bodily anesthesia. To the extent that individuals nonetheless recall the events, all of these experiences make it more difficult for them to eventually fully integrate the experience.

Interpersonal neurobiology asks us to place no boundaries on where and how it might illuminate our world. It is possible that every moment has the potential to be therapeutic in some way.

Although most psychotherapeutic approaches "agree that therapeutic work in the 'here and how' has the greatest power in bringing about change" (Stern, 2004, p. 3), talk therapy has limited direct impact on maladaptive procedural action tendencies as they occur in the present moment. Although telling "the story" provides crucial information about the client's past and current life experience, treatment must address the here-and-now experience of the traumatic past, rather than its content or narrative, in order to challenge and transform procedural learning. Because the physical and mental tendencies of procedural learning manifest in present-moment time, in-the-moment trauma-related emotional reactions, thoughts, images, body sensations, and movements that emerge spontaneously in the therapy hour become the focal points of exploration and change.

We only experience a fraction of the reality we are a part of. What if we turn our eyes toward the interior of reality? Is it possible that the interior follows the patterns of the exterior? Might our state of consciousness reflect only a fraction of what may be potentially experienced?

On the other hand, EPs experience these traumatic memories far too intensely, as “too real” (Heim & Buhler, 2003; Janet, 1928a, 1932a; Van der Hart & Steele, 1997). This is certainly not normal memory.

If we are not safe, we are chronically in a state of evaluation and defensiveness” (Porges, 2011b, p. 14). It is a ventral vagal state and a neuroception of safety that bring the possibility for connection, curiosity, and change. A polyvagal approach to therapy follows the four R’s: Recognize the autonomic state. Respect the adaptive survival response. Regulate or co-regulate into a ventral vagal state. Re-story.

Each time I experience the unseen wisdom of a person's system, it deepens my trust in the inner process unfolding and my awe at the way we are organized to be protected until the possibility of healing arrives.

Neuroception precedes perception. Story follows state. Through a polyvagal framework, the important question “What happened?” is explored not to document the details of an event but to learn about the autonomic response. The clues to a client’s present-time suffering can be found in their autonomic response history.

mirror neurons are active when a person is recognizing their own face...the very act of self-reflection may have been made possible via mirror neurons, which allow us to reflect on an internal representation of self.

One gift of nonjudgmental, agendaless presence is that a wide road of acceptance opens, so that the inner world of our people gradually begins to sense, experience and trust that every part is equally valued and equally welcome.

Without realizing it, I fought to keep my two worlds separated. Without ever knowing why, I made sure, whenever possible, that nothing passed between the compartmentalization I had created between the day child and the night child.

observations suggest that the survivor as ANP typically engages in tasks of daily life such as reproduction, attachment, caretaking, and other social action tendencies, and avoidance of traumatic memories, which support a focus on daily life issues. In contrast, the survivor as EP primarily displays evolutionary defensive and emotional reactions to the (perceived) threat on which he or she seems to be fixated. Third, survivors should be very susceptible to classical conditioning, because, as we discuss below, EP and ANP strongly respond to unconditioned and conditioned threat cues.

Top-down cortically mediated techniques typically use cognition to regulate affect and sensorimotor experience, focusing on meaning making and understanding. The entry point is the story, and the formulation of a coherent narrative is of prime importance. A linguistic sense of self is fostered this process, and experience changes through understanding

As connection to the therapist is established, the therapeutic relationship offers an opportunity for the client to experience a present attachment, but it also brings up transferential tendencies associated with past attach ment relationships (Sable, 2000). Informed by the experience of interperesonal trauma and betrayal, posttraumatic transferential relationships can be exceptionally potent and volatile. In response to the therapist, clients experience fear, anger, mistrust, and suspicion, as well as hope, vulnerability, and yearning, and they are acutely attuned to subtle signals of disinterest or interest, compassion or judgment, abandonment or consistency (Herman 1992; Pearlman & Saakvitne, 1995).

When the traumatic event is the result of an attack by a family member on whom victims depend for economic and other forms of security (as occurs in victims of intrafamilial abuse) victims are prone to respond to assaults with increased dependence and with paralysis in their decision-making processes. Thus, some aspects of how people respond to trauma are quite predictable - but individual, situational and social factors play a major role in the shaping the symptomatology.

In various paradigms of practice, we have called these protectors "defenses" or "resistances", as though they were objects that needed to be moved out of the way. This is understandable, because we see that these parts of ourselves sometimes cause injury if we view them only from the outer perspective, without opening to the ways they are sheltering our inner world.

This shift from intellectual to embodied compassion is at the heart of deep forgiveness, or what we call compassionate release that gives us the gift of not needing to fend off the ones who hurt us anymore. It is a letting go at a different depth.

Remembering that the impulse to control is an indication that we are having a neuroception of danger, perhaps we can be compassionate rather than critical of ourselves when we do step in to overtly manage the process. Perhaps we can begin to ask inside about the nature of the threat that brings on the need to assert control and fix. As always, dropping the questions into our right hemisphere and not expecting a particular answer in this moment opens the way for a deeper understanding to emerge bit by bit.

It might be possible that 'triggered' may not be the most helpful word ... For me, there is a felt sense of violence in this word, while 'touched and awakened' more accurately describes what happens to these sequestered neural nets. This gentler wording helps us cultivate a sense of meeting the experience every time we are so 'touched' with an appreciation for what it might be offering.

A major problem for survivors is that their sense of self is too restricted and rigid within dissociative parts, because it has been derived from a range of experiences and action systems that is too limited, and excludes too much of the survivor’s history. When survivors are unable to bind actions adequately with a sense of self in the moment, they experience symptoms of depersonalization.

Perhaps our misunderstanding of the role of safety is based on an assumption that we think we know what safety means. This assumption needs to be challenged, because there may be an inconsistency between the words we use to describe safety and our bodily feelings of safety.

In bottom-up approaches [to processing trauma], the body's sensation and movement are the entry points and changes in sensorimotor experience are used to support self-regulation, memory processing, and success in daily life. Meaning and understanding emerge from new experiences rather than the other way around. Through bottom-up interventions, a shift in the somatic sense of self in turn affects the linguistic sense of self.

It is when we feel as though we are trapped and can’t escape the danger that the dorsal vagal pathway pulls us all the way back to our evolutionary beginnings. In this state we are immobilized. We shut down to survive. From here, it is a long way back to feeling safe and social and a painful path to follow.

If people have harmed us, that part is usually a protector whose need to cause injury comes from desperate attempts to not feel destroyed by the pain and fear they are carrying. Generally they are not conscious of this process, but it likely mirrors what has been passed down through the generations in the family.

Joshua is one of the people who taught me about respecting pace, particularly when it is very slow. I do believe we all heal as quickly as we can given the co-integrating nature of our embodied brains, so when the process unfolds very slowly, it often speaks to us of the magnitude of what is coming [emerging to be healed].

With an increased need to connect, missed moments of joining can quickly turn from misunderstandings to painful withdrawal into a shame state. While this is possible for anyone, those of us with difficult early histories filled with shame may be at highest risk of feeling the pain of missed connection and amplifying our reactions.

Therapies often convey to the client that their body is not behaving adequately. The clients are told they need to be different. They need to change. So therapy in itself is extraordinarily evaluative of the individual. And once we are evaluated, we are basically in defensive states. We are not in safe states. Dr. Buczynski: And teaching is, as well. Dr. Porges: Yes. I have given a few lectures on mindfulness, and in these lectures I state that mindfulness requires feeling safe. Because, if we don’t feel safe, we are neurophysiologically evaluative of our setting, which precludes feeling safe. In this defensive state, we can’t engage others and we can’t recruit the wonderful neural circuits

Attuned communication. The ability for attuned communication, indispensable for establishing secure attachment between parent and child (or therapist and patient), rests on our capacity to accurately sense someone else’s state and communicate, nonverbally (most important) and verbally (less important), our felt understanding of their emotional experience.

Resolving the past comes after you learn to cope in the present both with your external and with your inner world.

Dreaming can be understood as another form of consciousness that requires its sibling, waking consciousness, to imbue it with meaning

What endures in states of extreme suffering and euphoria? Meaning.

the brain is not idle, passively receiving information, but produces perceptual expectations influencing how sensory information is ultimately interpreted

Mutual defensiveness moves parents and children away from intersubjective experience and joint influence and into a desire to gain control of the situation. To

Attunement requires presence but is a process of focused attention and clear perception. We

To state this more succinctly, awareness of the body’s state influences how we organize our lives. Knowing your body strengthens your mind.

The key to clinical attunement is to be willing to say “I don’t know” and “tell me more.

When such resonance is enacted with positive regard, a deep feeling of coherence emerges with the subjective sensation of harmony. When

For optimal health and rejuvenation, we all need exercise, rest, time to feel deeply into ourselves, and meaningful and emotionally expressive human contact.

Like neurons, we send and receive messages from one another across a synapse—the social synapse.

Successful therapists learn to be ‘amygdala whisperers’ by leveraging the social brain in order to help clients face their fears.

Romantic love releases surges of the neurotransmitters dopamine and norepinephrine and activates brain regions that drive the reward system in a way that is similar to addiction

Action systems define to a large degree what we find attractive or aversive, and then generate tendencies to approach or avoid, accordingly (Timberlake, 1994).

Thus, the brain remains plastic into adulthood and can be changed for the better through positive interpersonal relationships.

the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn,

by aligning with her autonomic nervous system (ANS) activation instead of trying to move her toward a ventral state, ventral could arrive on its own.

integration of right-centric relatedness and left-centric understanding comes and goes for all of us, but it does seem to gain strength and reliability over time.

I was transfixed by the way her internal mother had simply arrived and begun to tell her story in the sand.

On reflection now, it seems to me she was already telling me what she needed most--a place to settle in proximity, safety, warmth and quiet because she had none of that as a child.

This was the unexpected ... unforeseeable resolution of the paradox ... her personal goodness was no longer the issue because it had been replaced by the sweetness of relationship.

our brains are continuously yearning for the arrival of a co-organizing other

The theory forces us to question whether our society provides sufficient and appropriate opportunities to experience safe environments and trusting relationships.

It is now clear that affective values are built into the nervous system as birthrights, but not ethical and moral values, which are epigenetic emergents of developmental landscapes.

When clients are hyperaroused or overwhelmed emotionally, voluntarily narrowing their field of consciousness allows them to assimilate a limited amount of incoming information, thereby optimizing the chance for successful integration. For example, as one client began to report her traumatic experience, her arousal escalated: Her heart started to race, she felt afraid and restless, and had trouble thinking. She was asked to stop talking and thinking about the trauma, to inhibit the images, thoughts, and emotions that were coming up, and orient instead to her physical sensation until her arousal returned to the window of tolerance. With the help of her therapist, she focused on her body and described how her legs felt, the phyisical feeling of anxiety in her chest, and the beating of her heart. These physical experiences gradually subsided, and only then was she encouraged to return to the narrative.

Attachment is central to the context in which all other action systems mature. If attachment is disrupted early in life, it may lead to maladaptive functioning in various areas of life because the most basic action systems do not function well. Attachment relationships assist individuals in regulating their emotions and physiology, providing basic internal and relational stability.

This wiring is manifest in well-worn neural network pathways, which are stimulated by triggers that remind us, implicitly, of childhood experience—our wounds, triumphs and longed-for experiences.

Each time we offer a reflection, we are also quietly repairing/disconfirming attachment wounds that always contain elements of our parents or others not being able to see us because of their own injuries.

attachment figure—someone who provides a safe haven where the other can be deeply seen and feel safe and secure. At other times we are the expert on the mind, and perhaps on the brain and relationships too, and on the notion of health and unhealth, ease and disease. Yet our patients are also experts in their own right, deeply knowledgeable in other domains. Our patients are certainly expert in being themselves.

Humans perceive the world as subjects, yet we are also objects composed of the same material that we are perceiving from. Our attempts to sense the reality hidden behind veils, is very much like a game of hide and seek.

I have other stories just as mysterious, just as beautiful, just as sacred, but it seems good to stop here and wonder if it is possible for us to begin to let go of our expectations about the shape in which healing may arrive, to trust the treatment plan lying dormant and waiting within our people, to cultivate a gradually gathering stillness so that, in the safety of the space between, healing pathways have the possibility of revealing themselves.

Our brainstems take in the rhythmic movements of [our mother/primary attachment] as she attentively follows our bid for play, our drift towards sleep, our signal that it is time to be quietly together. In our midbrain, our SEEKING system finds the waiting eyes and arms of our mother's CARE system in times of PLAY or GRIEF, patterning the expectation that connections will be restored when they are momentarily lost, that ruptures will call forth repairs.

More important than the words or silence is my inner stance of making room for what is stirring within him, becoming alertly still enough inside that his inner world senses safety, the precursor to him opening into vulnerability.

New evidence (2002) indicates that reparative adult experiences enable those with attachment traumas to increase their ability to cope with stress and restore a sense of security. Healing through new relationships occurs frequently, and makes a person who has experienced trauma increase the ability to cope with stress and negative affect. Religious or 12-step experiences, therapeutic experiences, and intimate relationships all offer possibilities for repair.

The criteria of agency and ownership distinguish structural dissociation from other manifestations of insufficient integration such as intruding panic attacks in panic disorder or intrusions of negative cognitions in major depression.

As discussed earlier, an important remnant of our evolutionary past, the amygdala, rests at the core of the brain. This ancient executive center has retained veto power over our modern cortical executive centers when it detects a threat.

Depression always brings to mind the possibility that the person's SEEKING system may have been turned off ... Our mutual trust in his system's wisdom kept us from being swept away by the despair he felt. We began to ask, "what is this depression, this one who is so still, wanting to tell us?" Then we waited. We stayed with the one who felt dead inside, acknowledging his protective value even when though we had no cognitive awareness of who and what he was sheltering.

Emotions are at the nexus of thought and action, of self and other, of person and environment, of biology and culture. Emotion is a term that evokes many connotations, from the way we “feel” to the ways our lives are integrated across time.

First, there is the separation cry, which is a young mammal’s distressed vocalization when separated from a caretaker. This cry is actually an attempt to regain attachment upon separation, and thus we call it the attachment cry. Other defensive subsystems include hypervigilance and scanning the environment, flight, freeze with analgesia, fight, total submission with anesthesia, and recuperative states of rest, wound care, isolation from the group, and gradual return to daily activities

Some protectors do eventually dissolve in their current manifestation. Cutting or purging stops. Addition to alcohol or drugs abates. Suicide plans become ideation and finally depart, although none of this happens as linearly as I have stated it. Often, they are first replaced by less harmful protectors, and then those may be able to transform, bringing helpful gifts. Most important for us ... is to welcome these parts, listen to them and let them become our guides ... They will have a better sense of pacing than we do because they are so connected to the wounded ones inside. As the ones in distress have less hold on thoughts, feelings, behaviors and relationships, we can know that less vigilance over the inner world is needed.

Sometimes people begin, discover how much pain and fear they are holding, and adaptively decide to take whatever gains they have made and stop. Occasionally we reach the limits of our competence or capacity and must help one of people find someone or a nest of people who can hold their wounds when we can't. We could likely add other situations in which we have parted with someone early in the relationship or at a time that seemed premature. All of this is part of human limitation in both of us.

People with impaired social engagement systems are prone to misinterpret safety as a threat and objective danger as safety. Their visceral feedback system fails to protect them, or prevents them from engaging in the fullness of what life has to offer.

Ruptures are a daily occurrence in all our relationships and ... our systems only need to receive resonance and reflection on the first try at connecting about 33 percent of the time to cultivate security. All the rest is optimally rupture and repair.

Each of our parents and others close to us offer their unique version of attachment, so while we have four categories to give us a general outline of what may occur, we will find that each person's expression of each style is as individual as a fingerprint.

If we trust that our inner world knows what is needed next, one outcome isn't preferable to another. It is so easy for us to want healing to pursue a more linear path: Something arises and it would be best if we could stay with that. There can be a sense of disappointment in therapist, patient, or both if the sensation doesn't return. This might be perceived as a lack in our patient's ability to maintain contact, a reflection of our inadequacy of a therapist, or simply discomfort that the therapy feels stuck.

It makes sense for us to want a symptom, an 'it' to go away. If we begin to sense that we are made up of many selves ... then we might instead say, 'the anxious part of me is really suffering. I wonder how we might help her'. There is often a palpable softening as we gaze on a person inside who has value apart from the distressing symptom. We also may sense more clearly that this experience isn't all of us, but belongs to a part who has had encounters that give this anxiety context and meaning. The change of pronoun, granting personhood, may move us into a more right-centric way of perceiving, which also opens us to a more both/and perspective of broad acceptance, arouses our warm curiosity, expands receptivity to the present moment. It can really be a very profound change.

When the attachment figure is also a threat to the child, two systems with conflicting goals are activated simultaneously or sequentially: the attachment system, whose goal is to seek proximity, and the defense systems, whose goal is to protect. In these contexts, the social engagement system is profoundly compromised and its development interrupted by threatening conditions. This intolerable conflict between the need for attachment and the need for defense with the same caregiver results in the disorganized–disoriented attachment pattern (Main & Solomon, 1986). A contradictory set of behaviors ensues to support the different goals of the animal defense systems and of the attachment system (Lyons-Ruth & Jacobvitz, 1999; Main & Morgan, 1996; Steele, van der Hart, & Nijenhuis, 2001; van der Hart, Nijenhuis, & Steele, 2006). When the attachment system is stimulated by hunger, discomfort, or threat, the child instinctively seeks proximity to attachment figures. But during proximity with a person who is threatening, the defensive subsystems of flight, fight, freeze, or feigned death/shut down behaviors are mobilized. The cry for help is truncated because the person whom the child would turn to is the threat. Children who suffer attachment trauma fall into the dissociative–disorganized category and are generally unable to effectively auto- or interactively regulate, having experienced extremes of low arousal (as in neglect) and high arousal (as in abuse) that tend to endure over time (Schore, 2009b). In the context of chronic danger, patterns of high sympathetic dominance are apt to become established, along with elevated heart rate, higher cortisol levels, and easily activated alarm responses. Children must be hypervigilantly prepared and on guard to avoid danger yet primed to quickly activate a dorsal vagal feigned death state in the face of inescapable threat. In the context of neglect, instead of increased sympathetic nervous system tone, increased dorsal vagal tone, decreased heart rate, and shutdown (Schore, 2001a) may become chronic, reflecting both the lack of stimulation in the environment and the need to be unobtrusive.

It can help us keep our balance to distinguish between the living people who were hurtful and the internalized ones who are now part of our neurobiology. Those who harmed us may never change, but once they become part of us, they seem to partake in our impulse towards healing.

Although Megan "knew" she was not in danger, her body told her that she was. If sensorimotor habits are firmly entrenched, accurate cognitive interpretations may not exert much influence on changing bodily orgamzation and arousal responses. Instead, the traumatized person may experience the reality of the body rather than that of the mind. To be most effective, the sensorimotor psychotherapist works on both the cognitive and sensorimotor levels. With Megan, a purely cognitive approach might foster some change in her integrative capacity, but the change would be only momentary if the cowering response were reactivated each time she received feedback at work... However, if she is encouraged to remember to "stand tall" in the face of criticism, her body and her thoughts will be congruent with each other and with current reality.

We are never too old or too wounded to receive healing waves of the personal delight of another. ... at its best, it transcends being delighted with a particular happening and is instead the reflection to us, and often to one another, of an enduring bond that is bigger than any single occurrence between us. When we are small and see that look on our parents faces, there is such an affirmation that we are good, lovable, welcome. These experiences go deep into us and become an implicit foundation for drawing in warm companions throughout our lives.

The combination of outward privilege and emotional invisibility is one of the most hurtful and confusing ways to live. Nothing appears to be wrong and yet every day is a torturous maze of unreflected chaotic emotional upheaval, ameliorated only be regular descents into dorsal numbness.

Beginning with a genuine sense of care and interest by the focus of the other’s careful attention, resonance extends this positive interaction into a fuller dimension of the other being changed because of who we are. This is how we feel “felt,” and this is how two individuals become a “we.

Trauma is a flooding of dysregulated affective experience that, if it cannot be relationally processed, destabilizes a person’s perceptual experience of his or her own existence and creates an escalating dread of depersonalization that must be stopped at any cost. The brain then takes over.

Coupling the relaxation and sense of safety associated with that imagery with the sensations of the body can ground a person in the visceral reality of tranquility and clarity. It is this grounded place that can serve as a vital resource of safety and strength during the explorations ahead.

Every realization implies promises of action, either promises of accounts of past action or promises of future actions. In certain individuals, the thought of the execution of these actions provokes such anxieties that this representation become impossible. —Pierre Janet (1945, pp. 181–182)

noticing not just their words but also their nonverbal patterns of energy and information flow. These signals are the familiar primarily right-hemisphere sent and received elements of eye contact, facial expression, and tone of voice, posture, gesture, and the timing and intensity of response. The

Comfort, support, and care are essential in maintaining and improving an individual’s mental efficiency (e.g., Runtz & Schallow, 1997), in part because they have important physiological calming effects (Schore, 1994; 2003b), and favorable effects on the immune system (Uchino, Cacioppi, & Kieclot-Glaser, 1996).

If we are to presuppose that the universe is inherently material, that we are emergent organisms from this universe and by nature we seek and generate meaning, meaning itself becomes a substructure of the universe. To think otherwise is to dissociate ourself from the universe, which contradicts the latter belief

In these pages, we keep returning to one foundational principle: providing the possibility of emotional/relational safety for our people, be they patients, children, partners, friends or strangers. We are able to make this offer when they are experiencing their own neuroception of safety, not continuously, but as the baseline to which we return after our system has adaptively moved into sympathetic arousal or dorsal withdrawal in response to inner and outer conditions. When we neuroceive safety, we humans automatically begin to open into vulnerability, and the movement of our "inherent treatment plan" (Sills, 2010) has a greater probability of coming forward. When we have a neuroception of threat, we adaptively tighten down at many levels, from physical tension to activation of the protective skills we have learned over a lifetime (Levine, 2010). In that state, our innate healing path will often wisely stay hidden until more favorable conditions arrive.

Who was my other self? Though we had split one personality between us, I was the majority shareholder. I went to school, made friends, gained experience, developing my part of the personality, while she remained morally and emotionally a child, functioning on instinct rather than on intelligence. —Sylvia Fraser (1987, p. 24)

This reorienting is not an attempt to avoid or discount clients' pain and ongoing suffering. Rather, it is a means to help them observe, firsthand, how their chronic orienting tendencies toward reminders of the past recreate the trauma-related experience of danger and powerlessness, whereas choosing to orient to a good feeling can result in an experience of safety and mastery. As clients become able to do so the new objects of orientation often become more defined and & Goodman 1951). Rather than attention being drawn repeatedly to physical pain or traumatic activation, the good feeling becomes more prominent in the client's awareness. This exercise of reorienting toward a positive stimulus can surprise and reassure clients that they are not imprisoned indefinitely in an inner world of chronic traumatic reexperiencing, and that they have more possibilities and control than they had imagined. These orienting exercises need to be practiced again and again for mastery.

The mindsight tripod. Openness, objectivity, and observation are the three processes that stabilize the mindsight lens in order to see and shape the inner world with clarity, depth, and power. With openness, we accept things as they are; with objectivity, we realize that what we are aware of is just one element of our experience and not the totality of our identity; with observation, we have a sense of ourselves as observers witnessing the unfolding of experience as it emerges moment by moment. Copyright © 2010 by Mind Your Brain, Inc. Used with permission by Daniel J. Siegel, M.D., from Mindsight: The New Science of Personal Transformation (2010).

The depth at which we take in the preceding generations astonishes me. There is likely an epigenetic component to this as well as transmission through the internalizations that get passed down through the generations. Whole cultures are carried forward that way, so it makes sense that family legacies might be transmitted that way as well.

Automatic pilot (Res/App):A way of being that is driven by a state of mind that is devoid of active reflection and that often involves top-down processing. It is reflected in reactive and enduring patterns of thought and bodily posture and movement, in which the past is shaping present perceptual biases, emotional responses, and behavioral output.

The redirection of orientation and attention can be as simple as asking clients to become aware of a "good" or "safe" feeling in the body instead of focusing on their physical pain or elevated heart rate. Or the therapist can ask clients to experiment with focusing attention away from the traumatic activation in their body and toward thoughts or images related to their positive experiences and competencies, such as success in their job. This shift is often difficult for clients who have habituated to feeling pulled back repetitively into the most negative somatic reminders of their traumatic experiences. However, if the therapist guides them to practice deeply immersing themselves in a positive somatic experience (i.e., noting the changes in posture, breath, and muscular tone that emerge as they remember their competence), clients will gain the ability to reorient toward their competencies. They experience their ability to choose to what they pay attention and discover that it really is possible to resist the somatic claims of the past.

Over the years I have come to realize we just can't know how or when resolution will come ... As a dedicated follower, I have been privleged to witness and support the wisdom that emerges ... I expect to be surprised by what the next people will teach me as they pursue their unique path towards resolution and open to inhabiting their inherent health.

I notice that when the other person has been in despair for a prolonged period, I begin to feel myself crumbling into discouragement internally. One of the ways my system seeks to protect both me and the other person is to activate into helpful doing. Even though it is a psuedo-engagement, the intent is to shelter both of us from being engulfed in despair.

Evolutionarily, the function of attachment has been to protect the organism from danger. The attachment figure, an older, kinder, stronger, wiser other (Bowlby, 1982), functions as a safe base (Ainsworth et al., 1978), and is a presence that obviates fear and engenders a feeling of safety for the younger organism. The greater the feeling of safety, the wider the range of exploration and the more exuberant the exploratory drive (i.e., the higher the threshold before novelty turns into anxiety and fear). Thus, the fundamental tenet of attachment theory: security of attachment leads to an expanded range of exploration. Whereas fear constricts, safety expands the range of exploration. In the absence of dyadically constructed safety, the child has to contend with fear-potentiating aloneness. The child will devote energy to conservative, safety enhancing measures, that is, defense mechanisms, to compensate for what's missing. The focus on maintaining safety and managing fear drains energy from learning and exploration, stunts growth, and distorts personality development.

unable to realize she was grown and the incest was no longer about to happen. When traumatic memories are reactivated, access to other memories is more or less obstructed. EP often seems unaware of much, if anything, about the present, and does not necessarily have access to skills and factual knowledge that are available to ANP (Van der Hart & Nijenhuis, 2001).

In any attachment encounter, there is both what we perceive being offered and our embodied response to it. If we call to mind, heart and body three or four people with whom we've had particularly close relationships, how do our bodies respond to their offers of connection? We can begin by being with muscles, belly, heart and breath. How does our body want to move?

Paradoxically, the kind of leading we want to offer is the opposite of taking control. Instead, it begins with accepting responsibility for getting support for our inner world and healing process to such an extent that the need for control recedes in favor of trust in the inherent healing capacity that is awakened when the necessary interpersonal sustenance arrives.

Every waking moment, our brains and bodies assimilate a myriad of sensory stimulation from the environment, as well as images, thoughts, emotions, body sensations, and movements from our internal state. In a millisecond, through operations so complex that they elude the full understanding of even the most brilliant minds, our brains compare this wealth of current data to memories of past experience. The most critical purpose of this comparison is to predict the next moment with sufficient accuracy so that we can make an adaptive physical action (Llinas, 2001). What we expect to happen in the very next instant determines the immediate action we make, whether it is reaching out to another person or for an object, such as a cup of tea.

All things being equal, you should be able to trust most of your feelings. But if they derive from dissociative parts of yourself that live in trauma-time, that is, are not oriented to the present or are hyperfocused only on specific aspects of an experience to the exclusion of others, these thoughts are more likely to be inaccurate and not fit with current, external reality.

Neuroception evaluates risk in the environment without awareness. Perception implies awareness and conscious detection. Neuroception is not a cognitive process; it is a neural process without a dependency on awareness. Neuroception is dependent on a neural circuit that evaluates risk in the environment from a variety of cues and triggers shifts in autonomic state to adaptively deal with the cues.

of the diverse systems within our brains. Optimal sculpting of the prefrontal cortex through healthy early relationships allows us to think well of ourselves, trust others, regulate our emotions, maintain positive expectations, and utilize our intellectual and emotional intelligence in moment-to-moment problem solving. We can now add a corollary to Darwin’s survival of the fittest: Those who are nurtured best survive best.

How do we be with the paradoxes our people bring? We can align with one side of the conundrum and dismiss the other in an effort to relieve the unsettling experience that the logically unresolvable contradiction brings to us and our people. However, if we do this, we are stepping away from our person's experience because he or she is living inside the paradox and can't move away. Staying present asks us to hold the full paradox within our own minds and bodies, to enter the suffering that entails. If we are able to do this and remain in a ventral state, it seems that something happens and we may be able to enter a state in which the paradox begins to reveal its value a little differently than ever before ... As we settled into this broader acceptance together, I believe we made room for the possibility of the arrival of a resolving third thing in its own time.

The core issue in traumatization is that survivors have been unable to realize fully what has happened to them and how it affects their lives and who they are. In other words, the inability to realize involves many ways of not knowing massive psychic trauma (Laub & Auerhahn, 1993). Actually, chronically traumatized individuals often have difficulties with realization not only in regard to their traumatic experiences, but also in daily life.

The objective world around us extends far beyond what we can sense and perceive. Only a sliver of information is received and understood, and not passively so; in fact, we do so rather actively. That sliver of information is transformed and filtered through non- conscious processes that actively select what we end up perceiving consciously. We are always more than we are aware of and there is always more happening than we can be conscious of.

I smiled broadly. " ...This is your body's wisdom speaking to us, sensing when it is safe to go forward, pulling back a bit when it might be too much. You and I are just getting to know one another, so I really respect the caution and protection in your inner world." ... With visible relaxation in her body and strong eye contact, she said, "All my life people have criticized me for being cautious. It means a lot that you like that I'm that way." W

unfolds will often reflect the degree of resolution they have achieved. We can use our bodies and emotions to sense the subjective experience of their wounds, and our insight to understand the ramifications for brain integration. This experience is very far from what is usually called “history taking.” Instead, it is a whole-person to whole-person joining experience that quickly lays the foundation for a powerful therapeutic alliance at many levels.

Learning that we are more than the voices that haunt us can provide hope and serve as a mean of changing our life. As the language of self-awareness is expanded and reinforced we learn that we are capable of choosing whether or not to follow the expectations of others and the mandates of our childhoods and cultures. Thus much of our suffering can be traced back to our stream of thoughts: the voices in our heads and the stories we tell about ourselves.

These initially adaptive responses to immediate danger turn into inflexible and pervasive procedural tendencies when trauma is unresolved. Once these actions have been procedurally encoded, individuals are left with regulatory deficits and “suffer both from generalized hyperarousal [and hypoarousal] and from physiological emergency reactions to specific reminders” (van der Kolk, 1994, p. 254). Traumatized clients often experience rapid, dramatic, exhausting, and confusing shifts of intense emotional states, from dysregulated fear, anger, or even elation, to despair, helplessness, shame, or flat affect. They may continue to feel frozen, numb, tense, or constantly ready to fight or flee. They may be hyperalert, overly sensitive to sounds or movements and easily startled by unfamiliar stimuli. Or they may underreact to stimuli, feel distant from their experience and their bodies, or even feel dead inside.

Since we began with a felt sense of safety this day, several neural streams are initially supporting the renewal of our connection. In our midbrain, the energies of the SEEKING system are animating the CARE system, which can both foster the good feelings between us and support offers of repair should we have a rupture (Panksepp & Biven, 2012). Once in connection, our ventral vagal parasympathetic system is affecting the prosody of our voices, our facial mobility, and the attentiveness of our listening, maintaining social engagement (Porges, 2011). Since ventral lateralizes to the right hemisphere, we more easily stay rooted in the right-centric way of attending that keeps us in connection with this moment and with each other (McGilchrist, 2009). In this intimacy, our brains are coupling in many regions, so there is an experience of social emotional engagement and embodied communication as we become a single system in two bodies (Hasson, 2010). Because we are trustworthy partners in this healing process, social baseline theory tells us that our amygdalae are calming just because we are together (Beckes & Coan, 2011). All of this is happening without doing anything, even without saying anything, in microseconds below conscious awareness because of the safe space we have cultivated over time. We can more clearly understand why Porges says, "Safety IS the treatment".

We live in a world that has a cognitive bias and assumes that our actions are voluntary. We are confronted with questions related to motivation and outcome. We are asked about costs, risks, and benefits. However, state shifts in the neural regulation of the autonomic nervous system are usually not voluntary, although the state shifts have profound impact on behavior. The state shifts occur in a more reflexive manner when we are confronted by specific cues in the environment.

The path of waiting and listening forgoes certainty and exposes us to a sense of tentative unknowing, which is often uncomfortable at best. This may only be tolerable when we have developed some degree of trust in the inherent healing capacity built into the human system and the power of interpersonal receptivity to animate the process. For most of us, this trust arrives because we have experienced it ourselves and can now embody it for others. As this deep learning proceeds in us, we may be able to rest more easily into the waiting because the unknowing is increasingly being held within our expanding window of tolerance. As we are able to work in this way, I believe our people get a felt sense of our profound and enduring respect for their inherent wisdom, something that is likely a unique and healing experience given their history of traumatic relationships. I don't believe I have found any offering that is more empowering than respect.

having clients orient to the stimulus on which they are very fixated helps them consciously and directly attend to reminders of past trauma. This provides the opportunity for the reactions to the trauma-related stimulus to change from involuntary and reflexive to reflective awareness and assimilation. The client's sense of control and efficacy is often enhanced, whereas simply orienting to new, neutral, or pleasurable stimuli may not accomplish this (Ford, personal communication, August 12, 2005).

Coming safely into stillness requires the ventral vagus to restrain the escape movements of the sympathetic nervous system and join with the dorsal vagal system while inhibiting its movement into protective dissociation. For many clients, the autonomic challenge of becoming safely still is too great. Without enough cues of safety from another Social Engagement System to co-regulate or the ability for individual regulation through a reliable vagal brake, the autonomic nervous system quickly moves out of connection into collapse and dissociation.

Our infant muscles let go and mold to the shape of our mother's bodies when we are securely held. Our bodies learn the meaning of the sensations of hunger and thirst from the interpersonal sweetness of our need being seen, met and satisfied by our mother as food is offered. We take in her attentiveness along with the nourishment, and this shapes our openness to all kinds of nurturance throughout our lives. Our hearts beat more slowly and our amygdalae calm when she is in a ventral state, her presence reassuring us of the possibility of safety in connection.

With our increased sensitivity and awareness, we might notice small shifts in breathing or coloring, a little greater tension around the eyes. We might feel our muscles tense a bit or our stomach tighten, perhaps in tandem with theirs, perhaps not. As best we can, we just receive and hold without too much speculation about what it means, and also with awareness of our own human limitations as our perceptions are colored by our own implicit memory. Our availability to deeply listen, even when we get it wrong, is also like the beginning of a ... reparative experience.

In the past, when an apparently healthy patient appeared emotionally agitated and complained of physical symptoms, doctors tended to believe that the symptoms were psychosomatic, “all in the mind,” and therefore not physical or “real.” This is no longer an accepted view of psychosomatic illness. As soon as we recognize that affects emerge from emotional systems that are fueled by brain chemicals that can also exert an eventual effect on the functioning of the brain and the body, then the division between emotional and physical disorders narrows to the point of extinction.

As we speak from a particular perspective, our words not only reveal something about our hemispheric vantage point, but they also go on to reinforce this way of seeing, wrapping us within a distinct perceptual slant. Then, because of our resonance with each other, we are simultaneously issuing an invitation for others to join us in this mode of attending. As we shift towards left dominance, we move internally out of relationship and into isolation, no matter how many people may be present, and we are inviting others into disconnection from themselves and others as well.

We can feel compelled about something or someone, and this feeling may be influenced by survival reactions from the brainstem’s input and the evaluative activities of the limbic area as much as it is a fair assessment of a present situation. Awareness of the comings and goings of limbically induced states can help create an internal mental space of awareness in which to observe and not react to limbic lava or limbic withdrawals when they occur. This mental space enables us to pause and reflect, giving time for the wash of feelings to move on and for new states to be created.

Bit by bit, our people begin to embody the changed anticipation of being cared for and treated with kindness and respect. Part of what strengthens this new way of being comes from us having co-internalized one another. We continue to be their reflective companion on the outside, and they will also feel how we continue to carry them with us in our inner world. It is quite beautiful to watch this healing unfold, often revealing itself as changes in body, feeling, behavior, relational choices first, then later affirmed in more frequent words of tenderness toward themselves.

adequate integrative capacity and the mental skills to fully realize their horrific experiences and memories. But they must go on with a daily life that sometimes continues to include the very people who abused and neglected them. Their most expedient option is to mentally avoid their unresolved and painful past and present, and as much as possible maintain a façade of normality. Yet their apparent normality, their life at the surface of consciousness (Appelfeld, 1994), is fragile. Dreaded memories that are awakened by strong reminders haunt survivors, especially when they have exhausted their emotional and physical resources.

Our REM sleep in 90-minute bursts, in a 24 hour cycle "digests" trauma that is experienced on a daily basis. In dreaming, the brain compares the trauma with early memory traces of similar experience, and files the memories of the day's events according to an affect-based associative system for further use and potential survival value. Comforting figures may appear in the dream to give care, advice, counsel, and relief, if necessary. The nightly dream process helps the dreamer receive positive resolution of his or her experience, and the dreamer moves on to the next day's activities restored, refreshed, and prepared for survival-based action.

What would Buddha do? “Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment”, Buddha. Well, while Buddhism contains many valuable life lessons one of the most important is the difference between pain and suffering. Pain is woven into nature and is inevitable part of life: to desire results in disappointment, to love means you will experience loss and to be born naturally leads to aging and death. By contrast suffering is what our minds make up these experiences when they are not at hand. Suffering is the anguish we experience from worry of not getting the things we need or from loosing the things that we have. It is an anticipatory anxiety.

We can perhaps hold both the desire to separate from these bodily memories and the willingness to be with them in the broad embrace of welcome and compassion. I do believe this kind of acceptance is a lifetime's work that inevitably leads to 'failure' at times. Our biology wants to protect us from what may harm us, and the arising of implicit memory can feel quite threatening. If we can soften towards our own tendency to want to move away and offer to begin again with gestures of inclusion, this is likely what is possible and optimal for us humans. Humility and grace are perhaps the gifts of this tension, gifts that we can then extend to our people in the form of honoring their struggle.

In sensorimotor treatment, traumatized clients are taught to become aware of trauma-related tendencies of orientation and to redirect their attention away from the past and toward the present moment. Repeatedly "shifting the client's attention to the various things going on outside of the flow of conversation [evokes] experiences which are informative and emotionally meaningful" (Kurtz, 2004, p. 40). Redirecting orientation and attention from conversation to present-moment experience-that is, from external awareness to internal awareness, and from the past to the present⎯engages exploration and curiosity, and clients can discover things about themselves that they did not know previously (Kurtz, 2004).

Research on avoidant attachment (a left-hemisphere-dominant form of relating) suggests that a mother's inner state of relative disengagement is reflected in her infant's biological response of needing to go it alone through increased attempts at self-regulation even at one year of age (Hill-Sonderlund et al., 2008). It is as though there is unspoken communication that life is about independence, encouraging mother and baby to move apart into more separate universes--together. For both parent and child, the long-term effects of such isolation are profound, leading to changes in their epigenetic profiles that support increased inflamation, the headwaters of many chronic illnesses (Fredrickson et al. 2013)

There are so many valuable techniques for regulation, for exploring and integrating traumatic experience, and so on. Once we get to know these protocols, they may pull on us in ways that invite us to seize control of the therapy. The other pathway suggests that her system holds the answers and that if I can offer enough safe support, it will likely begin to speak with us. At least cognitively, I can recognize that this person's inner world contains much more information about the root causes of her upset than I do. From this perspective, I am less interested in dealing with symptoms than moving towards making room for the implicit origin to emerge so that the protective systems can take care of themselves.

We might ask what role relational neuroscience plays in these kinds of experiences. For me, it begins with the body. Cultivating an understanding -- and most importantly a felt sense -- of these neural pathways helps us attune body to body with our people as they enter these deeper, more challenging realms. Through resonance, our capacity to attend to our bodies while remaining in a ventral state gradually becomes theirs. An indispensable support comes from our left hemisphere's deepening understanding of the particulars of the healing process. The stability this provides helps our right stay as engaged as possible in the relationship with all its emerging uncertainty. When Joshua became so suddenly depressed, Jaak Panksepp came to mind, so I could remain curious rather than scared. When Caroline entered increasingly intense states with her mother, Stephen Porges helped me remain mindful of our joined windows of tolerance and the necessity of staying in connection for co-regulation and disconfirmation to occur. The whole process of leading, following and responding rests on his statement, "Safety IS the treatment". In the broadest way, Dan Siegel's voice fosters deep acquaintance with the principles of interpersonal neurobiology, which supports hope for healing, confidence in our inherent health, and appreciation for our co-organizing brains. Each of these strands of knowledge increases our trust in the process. You may sense yourself adding to the list those that have been most helpful for you.

How much respect I have for each person’s system knowing what will support healing. Not everyone responds to the process of going directly into the body toward the root of implicit memory. For some, being consistently in the presence of a caring other provides disconfirmation for attachment losses. For others, sand tray or art may be the resonant support, or EMDR or Somatic Experiencing. So many modalities have emerged in recent years, primarily in response to our expanded understanding of the neuroscience of wounding and healing. Each way of working has value and may become even more supportive of our people if it rests on the practice of leading, following and responding. In this way we are able to cultivate a safe space for the fluid emergence of any specific protocol.

As the language areas of the left hemisphere enter their sensitive period during the middle of the second year of life, grammatical language in the left integrates with the interpersonal and prosodic elements of communication already well developed in the right. As the cortical language centers mature, words are joined together to make sentences and can be used to express increasingly complex ideas flavored with emotion. As the frontal cortex continues to expand and connect with more neural networks, memory improves and a sense of time slowly emerges and autobiographical memory begins to connect the self with places and events, within and across time. The emerging narratives begin to organize the nascent sense of self and become the bedrock of our sense of self in interpersonal and physical space

if our attention is what we're going to do next to accomplish a specific goal (often decrease a symptom) rather than openness to what the other person is bringing to the moment, we have stepped into our left hemispheres and out of relationship- and our patient will feel that as a kind of subtle abandonment. This interchange will likely happen below the level of conscious awareness and yet lead our person to step back a bit internally, awaiting the arrival of true presence, without agenda or judgement, so that safety can arise in the space in between. At that moment, the healing power inherent in this co-organizing/co-regulating relationship arrives. We have been returning to this crucial distinction in these pages, as much as possible with ongoing compassion for the challenge we experience as we open to the right remaining consistently in the lead.

... we might be drawn into a more left-centric way of hearing ... and experience the promotion of safety as a somewhat mechanical process in which A inevitably leads to B-- [ie: the belief that 'my being in a ventral state will automatically draw you into one, and if it doesn't then there is something wrong with one of us'.] Viewing it that way encourages us to turn social engagement into a technique, even a manipulation of the other person's nervous system toward what we view as a more desirable state. Ironically, when the left hemisphere is dominant rather than supportive of right-centric attending, we have already moved out of social engagement and thus are in no position to offer safe space to another. When we make an effort to return to it, we have forgotten that neuroception is continually arising automatically and not under the control of our will. The very pressure to activate ventral makes the space between us unsafe.

We may find ourselves in a role similar to that of a gardener as we cultivate a space in which healing can naturally unfold. In terms of neurobiology, this stance encourages us to lean into the reassuring awareness that our systems already contain seeds awaiting our attention. For some examples, we humans are always seeking the warmest possible attachments we can imagine (Cozolino, Siegel), our brains are continuously yearning for the arrival of a co-organizing other (Badenoch, Cozolino, Schore), emotional regulation flows naturally from being in the presence of someone we trust (Beckes & Coan) and even our nervous systems have a preference for the social engagement circuitry that sustains connection (Porges). With this kind of support from the biology inherent in both practitioner and patient, our bodies may begin to open into a welcoming state as others come towards us, with a sense of partnership being established rather than someone doing something to us. However this also means letting go of the potential certainty that comes from feeling we are in charge.

Polyvagal Theory proposes a neurophysiological model of safety and trust. The model emphasizes that safety is defined by feeling safe and not by the removal of threat. Feeling safe is dependent on three conditions: 1) the autonomic nervous system cannot be in a state that supports defense; 2) the social engagement system needs to be activated to down regulate sympathetic activation and functionally contain the sympathetic nervous system and the dorsal vagal circuit within an optimal range (homeostasis) that would support health, growth, and restoration; and 3) to detect cues of safety (e.g., prosodic vocalizations, positive facial expressions and gestures) via neuroception. In everyday situations, the cues of safety may initiate the sequence by triggering the social engagement system via the process of neuroception, which will contain autonomic state within a homeostatic range and restrict the autonomic nervous system from reacting in defense. This constrained range of autonomic state has been referred to as the window of tolerance (see Ogden et. al. 2006; Siegel, 1999) and can be expanded through neural exercises embedded in therapy. See: throughout

I have learned about these mechanisms from clinical populations that express difficulties in social connectedness. HIV patients provide an interesting example to elaborate on this point. In studying HIV patients, I have learned that often their caregivers feel unloved and frequently get angry attending to the needs of the infected individual. Parents of autistic children often report the same feelings and experiences. In both examples, although they often report feeling unloved, what they really are expressing is that the HIV-infected individual or the autistic child is not contingently responding to them with appropriate facial expressivity, eye gaze, and intonation in their voices. In both cases, the individual being cared for is behaving in a machinelike manner, and the caregivers feel disengaged and emotionally disconnected. Functionally, their physiological responses betray them, and they feel insulted. Thus, an important aspect of therapy is to deal not solely with the patient, but to also include the social context in which the patient lives with a focus on the parent–child or caregiver–client dyad. This will ensure that the parents or the caregivers will learn to understand their own responses as a natural physiological response.

If ... we hear ourselves speaking words that convey attunement to the process unfolding in this moment--a felt sense of receiving, cultivating, believing, supporting and trusting--we are more apt to be attending from the right with support from the left. This way of experiencing may also be coupled with attention to felt sense, comfort with being rather than pressure to do, and a respect for the undulating rise and fall of healing that unfolds naturally in the space between. When we are in this mode, we have a tendency to speak more tentatively and to check in with our relational partner about how he or she is receiving what we are offering. This past part is particularly important because it reflects our growing felt-sense awareness that the system of the person we are helping knows more about what needs to happen next than we do. In addition to the humility and respect this engenders, we may also notice that instead of wanting to get rid of some state, we are more apt to acknowledge its meaningfulness and be present to it just as it is. Listening in this way, the so-called negative state may reveal itself as telling an important truth and become an opening toward healing. We may also be aware of the limitation and incompleteness of words, leading us to honor silence as well.

One form of insecurity of attachment, called "disorganized/disoriented", has been associated with marked impairments in the emotional, social, and cognitive domains, and a predisposition toward a clinical condition known as dissociation in which the capacity to function in an organized, coherent manner is at times impaired. Studies have also found that youths with a history of disorganized attachments are at great risk of expressing hostility with their peers and have the potential for interpersonal violence as they mature (Lyons-Ruth & Jacobwitz, 1999; Carlson, 1998). This disorganized form of attachment has been proposed to be associated with the caregiver's frightened, frightening, or disoriented behavior with the child. Such experiences create a state of alarm in the child. The parents of these children often have an autobiographical narrative finding, as revealed in the Adult Attachment Interview, of unresolved trauma or grief that appears as a disorientation in their narrative account of their childhoods. Such linguistic disorientation occurs during the discussion of loss or threat from childhood experiences. Lack of resolution appears to be associated with parental behaviors that are incompatible with an organized adaptation on the part of the child. Lack of resolution of trauma or grief in a parent can lead to parental behaviors that create "paradoxical", unsolvable, and problematic situations for the child. The attachment figure is intended to be the source of protection, soothing, connections, and joy. Instead, the experience of the child who develops a disorganized attachment is such that the caregiver is actually the source of terror and fear, of "fright without solution", and so the child cannot turn to the attachment figure to be soothed (Main & Hesse, 1990). There is not organized adaptation and the child's response to this unsolvable problem is disorganization (see Hesse et al., this volume).

For quite a while, the development of psychiatric medicine has been stifled by man-made concepts, gleaned from complex symptomatology rather than from brain research.

We already have medications such as Substance P receptor antagonists, and the drug aprepitant (a medication currently used to treat nausea), which should, if one can generalize from the animal data, reduce angry irritability (see Chapter 4

Read-out theories imply that affects can only occur either in animals that are intelligent enough to interpret emotional physiology or in animals that have language. This would mean that only human beings and perhaps some other primates are affective creatures. Presumably less intelligent mammals copulate without lust, attack without rage, cower without fear, and nurture without affection. They cannot feel the sting—the psychic pain—of social loss. This may be an extreme depiction of the prevailing view, but it is not far off the mark among those who are actually doing animal brain research

stabilization, symptom reduction, and skills training; (2) treatment of traumatic memories; and (3) personality integration and rehabilitation (Boon & Van der Hart, 1991; Brown, Scheflin, & Hammond, 1998; Chu, 1998; Courtois, 1999; Herman, 1992; ISSTD, in press; Kluft, 1999; Steele & Van der Hart, 2009; Steele, Van der Hart, & Nijenhuis, 2001, 2005; Van der Hart, Van der Kolk, & Boon, 1998; Van der Hart, Nijenhuis, & Steele, 2006).

Some of the prominent ones that have been particularly useful for many trauma survivors include dialectical behavior therapy for borderline personality (Linehan, 1993); systems training for emotional predictability and problem solving (STEPPS; Blum et al., 2008; Bos, Van Wel, Appelo, & Verbraak, 2010 also for borderline personality; short-term psychodynamic treatment of affect phobia (McCullough et al., 2003); and mindfulness and mentalization-based treatments such as acceptance and commitment therapy (ACT; Follette & Pistorello, 2007). In the past decade, manuals that specifically address the

We strongly recommend that anyone using this manual become familiar with the updated International Society for the Study of Trauma and Dissociation Treatment Guidelines for DID and DDNOS (ISSTD Treatment Guidelines, 2011).

The worst part, however, was that I didn’t see anyone else struggling with such a peculiar load. I was ashamed of my wheelbarrow and did my best to make sure that nobody would notice it. After all, what could I answer if someone were to ask me how I came by so many frogs? To be honest, I hardly knew most of my frogs. I thought of them as green monsters and regarded them as no more than a burden that I had to bear.

realized that I could no longer do this alone and that I needed help from someone else to keep the wheelbarrow upright on this stretch of the road. It took a lot of courage and a great deal of trust to dare ask for that help—trust in that other person, but even more, genuine trust in myself.

Often we have been taught, as part of a strategy to manage our behavior, to reject the feedback that our body is telling us.

Epigenetic findings extend to psychosocial development. Isabelle Mansuy and colleagues studied the effects of separation from mother and maternal stress during early postnatal life in mice (Franklin, Linder, Russig, Thöny, & Mansuy, 2011). When the offspring were adults, they exhibited social anxiety (impaired signaling of serotonin). These changes persisted across generations.

If our nervous system detects safety, then it’s no longer defensive. When it’s no longer defensive, then the circuits of the autonomic nervous system support health, growth, and restoration.

If you start looking at the clinical symptomatology of people with trauma histories, we see a lot of subdiaphragmatic issues, whether it’s obesity or digestive issues or other types of neurophysiological problems.

galvanized

impetus

Then one day, when I arrived at the biggest, deepest pothole in the road, I realized that I could no longer do this alone and that I needed help from someone else to keep the wheelbarrow upright on this stretch of the road. It took a lot of courage and a great deal of trust to dare ask for that help—trust in that other person, but even more, genuine trust in myself.

The authors of this book are such people. When you read what they have written, you will find that they have your very best interests at heart.

know my frogs now. If anything, they have turned from green monsters into dear green friends.

turn over the pages, and get to work. Believe in yourself, believe in all your parts, and believe in your therapist. I know you can. I trust in you. —Jolanda Treffers

If you are using this manual in your individual therapy rather than participating in a group, you may ignore the agenda at the beginning of each chapter, as well as the entire Part 8, chapters 33–35, which are focused on group participation. Some topics may not be relevant to you.