dbtsession2.txt

- In this session, we are going to be talking about how to develop a trauma-focused lens. This is very important because as clinicians, we come in with a lens. We could talk about it as our worldview, our theoretical orientation, and it's important for clients to understand what our theoretical ori...

- In this session, we are going to be talking about how to develop a trauma-focused lens. This is very important because as clinicians, we come in with a lens. We could talk about it as our worldview, our theoretical orientation, and it's important for clients to understand what our theoretical orientation is. However, when I'm talking about developing a trauma-focused lens, we really want to develop a new way of looking at our clients in order for our clients to have a new way of looking at their own stories. I often say how we think about our clients is how we will treat our clients. So if we see our clients as broken, defective, troubled, difficult, we will engage in a very defended and guarded way, regardless of our theoretical orientation. And so we really wanna put on a new lens of how we look at our clients. And obviously we want to lean in with compassion and understanding, but there are many kind of consequences of trauma that lead to personality disorders and things like that, that many clinicians will say, I can't work with this client. They're too difficult, they're too intense. And trust me, our clients believe the same thing about themselves, that they are not amenable to treatment, that they're going to fail because they're too difficult. And so we want to flip that belief on its head and develop a new lens of how to understand our clients. And when we're talking about a trauma focused lens, we always want to come back to this awareness that there is nothing actually wrong with the client. The client is actually engaging in the world as they should, given the factors that have influenced them. Coming into our office, trauma is very informative of what it means to be in this world, what it means to develop relationships. And so we don't wanna look at them as strange, but actually operating with a wisdom, the wisdom of survival. The problem is, is that that's survival. Wisdom is creating suffering. It is keeping them stuck in the past. And so we have to look then at that suffering with deep compassion, that universal experience that we all have in humanity of suffering. And when we think about the word compassion, compassion comes from the Latin, which literally means with suffering. So self-compassion would be coming alongside your own story with suffering, right? That awareness of how we suffer and when we share in compassion, it's, wow, why is mine? I don't know what it is to have suffered the trauma that you have suffered, but I do understand what suffering is in this life, and I am so grateful that you're sharing your story with me, right? And so we really wanna land in that spirit and having that lens of understanding as we go into embodied DBT. So what are the critical components of what we think about in terms of developing a trauma-focused lens? Well, there are some assumptions or agreements that we wanna walk into together to really understand that. So we can't just necessarily look at a single incident trauma to think about the complexity, because many people who come through our doors may have had a single incident trauma, like an assault, a car accident, having gone to war. But I would say that more of the clients that I have worked with also have early foundational trauma or relational wounding. Now, relational wounding is something that happens to every single person on the planet because nobody was raised by perfect parents. However, the difference between relational wounding and attachment trauma is how well parents or care providers repaired the wound, A wound that's left unrepaired, festers and creates trauma. We also wanna look at those early childhood resources. So a very small child cannot resource themselves. So they're heavily dependent on those early childhood experiences of care, providing nurturance and co-regulation to heal the wound. So many of our clients were left abandoned very early in their stories without having the capacity to heal their own wounds that have festered into trauma, or at least setting up the vulnerability for being traumatised. So when we think about the impact on trauma and attachment, when trauma occurs early in our story, it disrupts the first two survival needs that come online for all human beings. So that first one is survival, and the next one is going to be security. And survival plus security equals safety. So I remember working with a client that had experienced this disconnect from their care provider very, very early on, and their mother even said that they could not tolerate touching their child. And so this client was put on a pillow and carried around never really being touched. So what happens to an infant or a very small child that's so heavily dependent on co-regulation from a care provider, from a care provider that can't tolerate touching them? Many of my clients have talked about early childhood experiences of being upset and being left to cry on floors, or actually punished for needing co-regulation. My mind. So right away, this is kind of the early ingredients for trauma where there's a sense of, I have to figure this out on my own. Help is not coming. It is not safe to trust others, right? Life is dangerous if there is a belief system that comes in early for many of our clients with complex trauma is that they learned very early on that life is dangerous. Let me share another story with you. There was a young man, a little young man, I'll say he was probably about seven or eight years old when I first encountered him. And he had been adopted from Haiti, and he was the most quiet little kiddo that you would ever, ever meet. However, when you looked at the side of his head, his ears had these little holes in them, almost like Swiss cheese. And his adoptive mother talked about that. He had been in an orphanage that had many loving care providers, but not enough care providers for all the children in the orphanage. And this orphanage was frequently overrun by rats. And so one night, apparently some rats had gotten into this little child's crib and had literally started eating his ears. Now, this is a very graphic story, but here's what was interesting. The care providers had been walking and doing rounds through the night, and they had never heard any crying. And so one would think that a child being attacked by an animal would cry, but what had this little child learned very early help is not coming. And so he was quiet, but we could look at that as an early childhood trauma that he'd become very dissociative. He had gone inside of himself to cope with what was happening outside. He was a baby. So there was no way he could fight a rat, right? And he was very dependent on co-regulation. However, he had already learned at such a tender age that help would not come. And so he would go inside of himself to no longer feel that pain to allow that thing to happen to him, which was very sad. And so, yes, now we look at him, oh, what a quiet little child. But he had already developed a pattern of un understanding that adults can't keep safe, life is dangerous, and he has to depend on his internal resources, which is one of the defences of the brain, to go inside and dissociate disconnect from the outside environment for safety. And so we can think about what happened to our clients early on that taught them that people cannot be trusted, life is dangerous, and that they have to resource internally within their own selves to survive. And so we cannot develop a lens that is trauma focused without looking at what has been the impact of early childhood experiences on our client's ability to attach to another person. Now, we also wanna look at the impact of secure attachment. Secure attachment is one of the features that we want to work our clients toward. So we wanna understand right away that attachment is not fixed. It can change over the course of our life. So many clients that are coming with trauma do not have a secure attachment, especially if they've had early childhood traumatic experiences. So we wanna get them towards what Daniel Siegel talks about as an earned secure attachment. And so when there's not early secure attachment, meaning that they have a sense that their parents are there for them to co-regulate and safely guide them into self-regulation, it tends to add a flavour of what we call insecure or avoidant attachment. Those two styles are one where it's come close, but not too close, right? And I can't handle too much emotionality. And so we wanna work through those attachment styles, those styles of not being seen, not being heard, or being completely left alone to self-regulate, right? So that's how we get to that earn secure attachment through our therapeutic work. But we want our clients to understand that that is likely what has happened in light of early childhood disturbances, and that one of our primary go goals is to help them perceive the world as safe, whereas they previously perceive the world as unsafe. One of my favourite authors, Rudy Kipling, who wrote The Jungle Book, came from early childhood experiences of severe childhood abuse. He actually had to be removed from his family, and he lived with a relative throughout the course of his, you know, young life. And he didn't interview as an adult where he talked about that his aunt had always questioned why he had never talked about what had happened to him. And he had to explain to her that children are very much like small animals, that they accept the world that comes to them as eternally established. Wow, that always has landed with me so deeply. This idea that children accept the world that comes to them as eternally established. They will not question the strangeness of the world because they depend upon us to define what it means to be in this world. And so, if you can recall in Rudy Kipling's book, the Jungle Book, right? That story becomes very, very interesting of a young boy in a jungle being raised by wild animals. And there is a scene in it where he is moley. He is talking to the great snake. And the great snake asks him, aren't you scared of me? And Moleys reply is, no, sir, I am well acquainted with wild animals. And so when we think about this, right? This is already a young person who's being set up in so many ways to put themselves in dangerous situations, and we want to have that trauma focused lens. What has happened to you where you've lost the perception of what is safe and what is unsafe in this world? Right? And so we are socially wired creatures for relationship. And so if we cannot trust others, we will lose our sense of trust in ourselves, right? We are neurobiologically wired for relationship. And so trauma impacts our ability to relate properly. We will have difficulty if we have an avoidant or insecure attachment to form close bonding relationships. And those close bonding relationships are definitely the blueprint for healing from trauma. And so we have to help our clients understand that there is a wisdom of survival, and it has created this broken relationship with yourself and with others. Okay? And so when we've had early traumatic experiences, we have an emotional vulnerability and an interpersonal vulnerability. It's very difficult to be in relationship with someone that we don't believe will take care of us or will be trustworthy or safe. And so in rebuilding that, we want them to understand that all of their trauma defences have created strains in their relationships. They've become very hypervigilant, always looking for when the other shoe is going to drop, when this person is going to disappoint them. And that will impact how you all are relating in your therapy sessions. They're going to expect you to abandon them. They're gonna expect you to just get rid of them when you feel like you are at your limit, right? And so they have high fears of being abandoned and rejected, and if that is a part of their story, we still have to see the wisdom of that story that you have to be preparing for eventual abandonment. And so that's our task to talk about. I will continue working with you provided we're making progress. You don't have to put the house on fire. You don't have to sabotage our work in order for to be present with you, okay? And so we really have to help them regulate their emotions, let their emotions tell them that it's safe to be here with us, and to deepen our growth and relationship through looking through that trauma lens, but also recognising that attachment is not fixed and that they can earn a secure attachment through our trauma focus lens.