Dr. Jamie Marich with Thomas Zimmerman about Jamie’s forthcoming (Jan. 2023) book, Dissociation Made Simple, https://www.penguinrandomhouse.com/books/710427/dissociation-made-simple-by-jamie-marich/
Trauma has the potential to promote disconnection from the present, from experience, from the body, from the self, and from more full engagement with the broader world. These responses were in the service of survival. They may have been essential. Sensory grounding is a go-to resource in trauma work because our senses bring us home. They can help bring us into the “safety” of the present when we want to be or when we need to be more present.
Sensory grounding is a needed resource in trauma work, where we ask clients to “glance” at a traumatic memory, but advise them not to fall into a memory. Sometimes, simply interacting with the memory in any way can cause it can cause us to fall or dissociate into it. Sensory grounding in the present brings you home. It brings you into a place where the bad thing isn’t happening right here, right now.
If you already do 5-4-3-2-1 grounding, you do a version of what I’m about to walk you through. However, I want to show you a way to do this that includes several things that may be different than many common approaches. You will notice several things:
- Ask permission of parts to engage in this (or any other) exercise. Asking permission gives parts the chance to consent. Absent that, they know how to communicate discontent and they may communicate it in ways that looks like what we used to call “resistance.”
- Let the client know how long we will be in this exercise (and it should be really quick).
- Teach the exercise quickly.
- I’m not asking for verbal feedback in the middle of the exercise, but I am keeping my eyes on the client and reading nonverbals. I don’t want to slow the exercise down when I’m first teaching it. I’ll ask at the end, which is okay, because this exercise is only going to take 60-70 seconds total the first time we do it.
- I’m adding additional “tasks” to the client’s noticing to promote more active engagement with the senses. Because, for instance, it’s possible to touch in a fairly disconnected way. It’s possible to notice objects in a fairly disconnected or dissociated way.
- We will have already identified something in the room that the client can use for the sense of scent (a candle or essential oil) and possibly taste/temperature (a warm or cold drink) prior to engaging in this exercise.
Script: When we have difficult experiences, those experiences may be stored in the part of the brain that doesn’t or can’t know that the experience is over. Sometimes, accessing a memory takes us out of the present and puts us into an experience when we did not feel safe. I’d like to show one strategy that you can use to find your way back into the present. Often the present may not feel “safe,” but it is likely to be safer than the experience from the bad memory. The exercise will ask you to very briefly engage your senses, one at a time. We will spend only a few seconds at a time getting information from each of the senses. If we keep it very brief, many people are able to tolerate this exercise well. If anything difficult comes up, we can stop. Is this an exercise that any part of you might object to, assuming that we do it quickly and that you can stop anytime you like?
If there is an objection. Stop and explore that objection. See if there is a way to do this that is not objectionable to that part that allows us to continue. Otherwise, full stop (parts will need to know that they can stop).
Vision: I invite you to look around the room and notice several things you see. Notice several objects and notice the color of those objects. Also notice that if you were to go up and touch these objects, would they be hard, soft, or some other texture? [Wait 5-10 seconds]
Touch: Place an open hand on the table or furniture next to you for just a moment and notice if it is colder, warmer, or the same temperature as your hand. [Wait 2-5 seconds] Good. Move your fingertips across the surface and notice if it is completely smooth or has a texture. [Wait 2-4 seconds] Good. Move your fingertips across the texture of that surface and just notice if the temperature changes as you move. [Wait 2-5 seconds] Good.
Hearing: I’m going to be very quiet, notice whatever you hear in order of loudest first. [Wait 5-8 seconds] Good.
Smell: I’ll give you a few moments to smell the essential oil [or other object] that you selected. [Wait 5-10 seconds] Good.
Taste: I’ll give you a few moments to taste, smell, or feel the temperature of the drink that your brought to session. [Wait 5-10 seconds] Good.
How was that? [explore] What was your experience with that exercise? [explore] Which of those senses seemed to be the most helpful in bringing your awareness more into the present? [explore]
As with all resources with client with complex trauma, send the client home to practice first at their baseline and not when something has happened that has severely triggered them. Once the nervous system becomes comfortable with this resource, then use it as a fire extinguisher.
Using age, space, and topography to find an individual representative memory related to a presenting issue or a theme.
• Identify a negative cognition.
• What age do we need to work related to that theme and negative cognition?
• Home, school, or community?
• Where (what room) in that space do we need to work?
• Put yourself in that space at that age and related to that theme and negative cognition, what memory comes?
• Target that in EMDR Therapy.
Strategies for more effectively managing time in Phases 3-6 of EMDR therapy.
A video demonstration of a quick body scan for use in the preparation phase of EMDR Therapy.
- Understanding that Pervasively Traumatized Nervous Systems are Different than Non-Traumatized Nervous Systems
- Don’t Tell Clients What they Will or Should Feel in Resourcing, Think of it as an Opportunity to Get Helpful Information
- Car with a Cinder Block on the Gas Petal Metaphor
- Pairing Body Scan and Resources
- The Importance of Asking Permission and How Long Resource will Last
- Modeling a Single Breath and Using that Information Select a Breath that May be More Tolerable
- With Some Clients, the Goal is to Find a Resource that Isn’t Actively Triggering
- Using Body Scans without Much of an Agenda
- Understanding What a Resource “Working” Looks Like… If it Calms You, It May Only Calm You for a Moment
- Noticing the Body is Also a Crucial Phase Two Resource
- Body Scanning is a Good Strategy to Promote Embodiment, So Clients Can be Imbodied Enough to Notice
- Homework: Practice Resources During the Times of the Day When Anxiety Isn’t Going Straight Up, Noticing the Layer Below is a Good Way to Lower Baseline Anxiety in the Short Term and Prepare for Reprocessing
- Calm Place
- Why We Don’t Encourage Other People in Calm/Safe Place
- When Calm Place Without Someone Specific is Triggering
- The Problems of Trying to “Borrow Good Memories from a Bad Developmental Era”
- Calm Place Will Go Bad… And When It Does…
- Some Completely Expected Reasons Why Resourcing May Go Bad
- Resources Going Bad Are Rarely the Therapist “Fault”
- Container as a Powerful Resource for Working with Complex Trauma
- The Importance of Visualizing or Drawing from Somatic Memory
- Drive Through Bank Teller as Helpful and Accessible Container
- Building the Container Larger and Stronger than Needed
- Photoshop Metaphor for Container
- Don’t Test the Container with Real Trauma Containered in the Limbic Brain
The AIP Model
- The Difficult Stuff Connects to Right Now/Existing Adaptive Information
- Enough Adaptive Information Must Be Present
- You Can’t Easily Connect Maladaptive Information to Maladaptive Information
- What’s Complex About Complex Trauma Related to the AIP Model?
- A Different Way of Thinking About Complex Trauma
- Mountain Ranges of Adaptive Information vs Mountain Ranges of Maladaptive Information
The Mount Everest Metaphor
- You Cannot Metabolize a Trauma the Size of Mount Everest into Adaptive Information the Size of a Walnut—You Can’t
- Where to Start with Complex Trauma?
- Where Not to Start
- Types of Targets that Make Good Early Targets with Complex Trauma
The Whale Metaphor
- What are the Whales?
- What is the Size of the Client’s Boat?
- You Cannot Land a Whale into a Canoe
- Helping the Client Build a Bigger Boat
- What Clients Learn when Working with “Smaller” Wounds First
- Test the Gear
- Learn How to Notice Effectively
- They Learn that the Can Heal
- Healing Builds Adaptive Information/Makes the Boat Bigger
- If the Client in a Canoe Connects to a Whale we Need a Strong Pair of Scissors to Safely Disconnect
- Blocking Beliefs and their Relation to Negative Cognitions
- Problems Communicating Between/Connecting Parts Across the Lifespan
- The AIP Model and Attachment Wounding
- Judgements of the Child State in the “Adaptive Self”
- When the Right Now Selves Isn’t Healthy Enough
- The Whale Metaphor and Attachment Wounding
- Attachment Wounds “Sound” Small, but they are Existentially Awful
- Existential Loneliness
- Attachment Figures are for the Child State in the Memory
- Attachment Resources as a Very Powerful Pair of Scissors to Disconnect from the Whale
- Creating an Attachment Resource
- Client Obstacles to Creating an Attachment Resource
- Putting the Attachment Figure in the Neighborhood
- Attachment Figures are Not Identical to Actual People in Childhood
- Borrowing Qualities
- Keeping Difficult Stuff Out
- Deciding on a Relational Slot
- Adding Qualities to the Attachment Figures: Food, Presence, Nurture, Reading, Attending, Protection, Guidance
- Expect that Grief May Appear When You Imagine Getting What Didn’t Happen
- Using the Somatic Memory of Rocking One of Your Own Children or Grandchildren
- Leveraging the Capacity to Imagine
- Naming the Attachment Figure
- Avoiding Relational Slots that are the Same Slot as an Abuser
- How to Use an Attachment Resource Between Sessions
- This is a Resource for Living, Not Just in Session
- Assessing for Attachment Wounding
- When You Can and Can’t Borrow Qualities from a Deceased Person
- Dip Your Toe In: Phase One
- Be Careful What You Ask
- Safer Ways to Work with Lava
- Assess for Adaptive Information
- Helpful Assessments, Helpful Questions
Dip Your Toe In Metaphor
- Understanding Traumatized Nervous Systems
- Bodies Can be Triggering
- Inside Can be Triggering
- Noticing Can be Triggering
- Calming or Slowing Down Can be Triggering
- Paying Attention to the Body Before an Audience Can be Triggering
- Performance Anxiety Related to All of This Can be Triggering
- Resistance Not a Useful Concept
- Dip Your Toe In Provides Needed Information
- Beware Agendas
- Beware Informing Clients What the Should Feel or What Mindfulness Will Do
- Therapist Agendas: Back to How we Teach Mindfulness, and the Cinderblock on the Gas Pedal
- Many Clients with Complex Trauma Believe that they have Failed Trauma (and are about to Fail EMDR Therapy)
- Aspirin for a Headache Metaphor
- Introduction to This Podcast and to Thomas Zimmerman, Ms.Ed., LPCC
- Goal is to Move a Memory
- Leveraging Generalization
- The Difference Between Feeder and Adjacent Memories
- Rethinking Abreactions as Events that Take Offline the Client’s Capacity to Notice
- A Bit about Dissociation
- When a Whole “Heard” of Memories Come
- We Have an Important Navigational Role to Play
- Existential Loneliness as Abreaction
- The Dive Metaphor
- Reorienting Clients who Are Too Active on the Thought Channel Too Soon
- Notice What Stinks
- Using Perspective Changes or Channel Changes
- “When Healing Comes, It Will Come to You”
- What Reprocessing Looks Like
- The Dip Your Toe In Metaphor
- Strategies for Approaching a Traumatized Nervous System Carefully and Respectfully
- The Lens Metaphor
- The Inside and Noticing Can be Triggering in a Traumatized Nervous System
- Using Externalized Breathing as a Bridge Technique to Approaching the Body More Safely
- In EMDR Therapy, You Cannot Connect a Lie to a Lie
- Attachment Resources as a Powerful Set of Scissors that Let you Safely Disconnect from “Whales” of Memory
- Psychoeducation and Modeling Related to Healthy Attachment
- Identifying Specific Deficits and Working Every Session to Address those Deficits
- What a Resource Means
- Accessing and Strengthening Positive Information
- Does the Client have a Brake?
- Is the Client in His Body Enough to Notice?
- Does the Client use Benzos or Marijuana?
- Does the Client have the Capacity to Feel Worse Today?
- The Impulse to Want to Avoid Causing Harm
- Working with Trauma is Like Working with Lava
- Normalizing Mistakes and Missteps
- The Real Risks of Not Doing Trauma Work with Clients
- We are the Only Professionals on the Planet that Can Do This… Whose Job it is to Do This
- You Learn to Do This by Doing This
- The Really Good News About EMDR Therapy: It Breaks in a Very Limited Number of Places
- The Performance Anxiety of New EMDR Therapists (from GoWithThat.wordpress.com)
It’s a lot easier to explain EMDR to clients if you have a solid understanding of trauma and the concrete differences between traumatic memories and “more normal” memories.
- The Goal is to Move a Single Memory
- Differences between Normal and Traumatic Memories
- Additional Questions to Consider in Phase One, Including Assessing for Complex Trauma
- Conducting a Trauma Sensitive Phase One that Avoids a Detailed or Chronological Trauma Timeline
- Starting the Process of Developing Attachment Resources for Attachment Wounding
- Metaphor: Difference Between Walking Across Ohio and Riding in Bus Across Ohio
- Metaphor: Don’t Tackle Mount Everest First with Clients With Complex Trauma
- Events Have a Beginning, Middle, and End… Attachment Wounds are About Everything
- Using the Videotape Approach with Complex Trauma