Tag Archive for: psychotherapy

Book Review: Unshame- healing trauma-based shame through psychotherapy by Carolyn Spring

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Shame

 

Everyone has it

 

No-one wants to talk about it

 

But the less we talk about it

 

The more we have of it
Brene Brown

 

Overview

The author, Carolyn Spring, writes about her 9 years experience of psychotherapy. She focuses on her insights into her shame. Carolyn experienced extreme traumatic abuse during her childhood and has used her recovery and the knowledge she has acquired during and since this to support others. She tours with her training seminars supporting therapists, like myself and has researched, created and designed  ‘psycho-educational tools’, books and on-line resources which help survivors of abuse.

In Unshame Carolyn neatly condenses years of therapy into discrete learning experiences, ranging from managing her dissociation to learning to trust present day experience.

Review

Carolyn’s clarity of thought comes through in her writing. As a therapist I have often struggled to fully understand how to help overcome shame. Having read Unshame I see that the functions of shame; to avoid connecting with others, avoid feeling worthy of help and keeping emotionally isolated are all quite disabling for any survivor, making  recovery from shame very difficult to even contemplate let alone begin.

In her book Carolyn cleverly incorporates psychotherapeutic concepts, such as attachment, boundaries, pros and cons of physical contact, directive or non-directive work and what behavioural boundaries to apply. For the psychotherapist reader this can help consolidate or challenge their personal choice regarding working with clients suffering Dissociative Identity Disorder (DID). This may put some readers off, but I felt it really useful to hear how Carolyn experienced different counsellors and their approach to her dissociating. Carolyn writes of  her journey understanding her DID; it being an all consuming experience, of which she would have no recall, to one that she is aware of and can take control. For Carolyn it feels invaluable that she had a counsellor be her witness to explore dissociation with her.

I expect for the reader, if a survivor of trauma, Carolyn’s ability and courage to describe her emotions, confusion, and apparent contrary thinking will help them to recognise this in themselves, perhaps providing hope and faith in their desire and ability to recover. The ability to move from black and white thinking; accepting the greyness and uncertainty of life can be hard for anyone.

Throughout Unshame I can see the importance for Carolyn to have permission to feel, act and think the way she did, at no time was her way of being  ‘wrong’. The importance of recognising it as unhelpful ‘now’ but useful ‘then’ was a constant theme. It is also made clear that shame and symptoms of DID are not anything to do with her ‘not being right’ but a necessary and neurological consequence of trauma, fear and lack of attuned attachment.

Carolyn briefly refers to grounding techniques and the different zones of arousal, green (no arousal, able to be logical), amber (the nervous system getting aroused, emotional and less clarity of thought) to red (aroused, likely to dissociate, or freeze). These ideas are described in greater detail in her teaching videos and seminars.( Positive Outcomes for Dissociative Survivors/PODS )

Also in the book Carolyn covers forgiveness, self compassion and vulnerability. It is humbling being allowed to witness her thinking and movement towards these states.

 Summary

This book is suitable for professionals and survivors of trauma; those with DID.

As a psychotherapist I benefited most from reading how Carolyn grappled with her thoughts, and the insights that arose. I did a lot of reflecting regarding the therapy I offer my clients, reaffirming that trusting process is both important for therapist and client. It is not a book which adds to knowledge that is already available, such as the work of Babette Rothschild in particular, but it does demonstrate it working in practice.

I cannot write from the clients or survivor’s perspective. I feel all peoples experiences will be different. One message to take home is as a survivor you have not done anything wrong. Nothing, absolutely nothing.

Resources

Unshame- healing trauma-based shame through psychotherapy  By Carolyn Spring.  Carolyn Spring Publishing (2019)

Positive Outcomes for Dissociative Survivors/PODS

Carolyn Spring

The Body Remembers- The psycho-physiology of trauma and trauma treatment By Babette Rothschild.  W.W Norton and Company LTD (2000)

The Body Remembers volume 2 -Revolutionising trauma treatment By Babette Rothschild.  W.W Norton and Company LTD (2017)

Emma Dunn Counselling and psychotherapy

Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

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Thoughts and Anxiety

Anxiety often manifests itself as poor eating, irritability due to poor sleep, and an inability to concentrate. First line treatment addresses these manifestations. Anxious people are encouraged to exercise to become physically tired; eat regular meals and to make lists  to feel less over- whelmed. These are useful for symptom alleviation but without identifying the cause there is potential for anxiety to continue. The link between thoughts and anxiety is not being addressed in these treatment. It is understanding the cause that will ultimately decrease the symptoms of anxiety.

Anxiety might be interpreted as a reaction to a real situation. Do you believe anxiety is a reaction to a real situation?

Have you ever considered your thoughts and anxiety as one problem?

The Neuroscience of Anxiety

Emma Dunn Counselling and Psychotherapy

Summary of the brains response to a threat

The stress response is the same whether there is a real threat to our physical safety or a perceived one. An area in our brain called the amygdala is the warning bell that makes us physically alert through a cascade of hormone and nervous reactions. One of the hormones released is cortisol, which further alarms the amygdala so it becomes even more alert to negative stimuli. Meanwhile, another area of the brain, the hippocampus, becomes less responsive. The hippocampus normally provides a control over the amygdala such that positive experiences are noticed as well as the negative ones and we can weigh up rationally what is the best action to take. The more often we are stimulated by anxious reactive thoughts the more readily we get to a state of alertness and vigilance, and less able to keep calm and rational. We attune into (implicit) memories that are not quite clear ‘the sense of something bad going to happen’; thoughts and reality become inseparable, we become less able to access reality, which might appropriately be remembered as as ‘when such and such happened, I was concerned but it all worked out in the end’.

Thoughts

Thoughts and Mindfulness

In the context of Mindfulness there are 3 types of thinking

  • Active-Useful, essential for planning, doing, reaching our goals
  • Flow-thoughts occur but are not judged, they pass by.
  • Fixed-unhelpful patterns of thinking, not usually based on reality.

Mindfulness aims to help us move away from fixed thinking to flow thinking and active thinking.

It is useful to remember that

  1. Thoughts are not facts
  2. We are not our thoughts

We are then in a better position not to let thoughts and anxiety dominate our thinking and behaviour.

A useful way to notice whether a thought is an unhelpful one is whether it creates an emotion, or whether it is helping or not, that is enabling you to do a task or stopping you from doing a task by relating to the past or the future, rather than the present.

Psychotherapy and Thought

Psychotherapy is about understand the workings of the mind, and bringing it into awareness. It is about recognising behaviours that are based on past experiences, and understanding that we do not need to repeat behaviours and thoughts, especially those that cause unhappiness.

The implicit memories that were mentioned earlier, it is these that psychotherapy can help unravel and challenge.
An example
As we grow up we often maintain the beliefs, behaviours and thinking patterns that were familiar to us as children, when they are out of awareness, as adults they can prove to be unhelpful. An innocuous example might be that as a child ‘greediness’ was discouraged. So little Billy, to please his mum would take the smallest bun when offered a plate of cakes. As an adult Billy’s wife offers him a plate of buns, obligingly he takes the smallest, not wanting to be disliked for being greedy, Billy’s wife is upset thinking Billy does not like her cooking. There is something in Billy’s wife’s belief, behaviours and thinking that feels rejected if someone doesn’t accept what she offers.

These actions can be so ingrained that we believe them. Billy believes he is greedy if he takes a big bun and his wife believes she is rejected because he didn’t take the biggest one. These are fixed thoughts. The reality of the situation has not been made explicit, spoken about. In a state of anxiety further implicit memories may be stored (remember these are not based on reality). Billy’s implicit memory might be is that he upsets his wife by eating buns, his wife’s that Billy doesn’t like her cooking. A tiny event reaffirming a whole set of thinking and anxiety based on past experiences not relevant in the present.

Through psychotherapy Billy will gain an understanding that perceptions of greediness are individual. He will identify with his own physiological experience about what it is for him to be greedy, or even whether greediness is an unhelpful experience that represents for him an interpretation of poor self-worth (i.e. he doesn’t deserve a big cake because his mother will not love him, and as an adult, his wife will not love him if he has it) He will become aware through dialogue that explaining why he makes certain choices can avoid future misunderstandings, and stop the perpetuation of irrational decision making. He will learn that other people, including his wife, experience his behaviours in their own way, not necessarily how they were intended.

Psychotherapy and Mindfulness

Thoughts and anxiety can be inseparable. Through Mindfulness practice there can be an awareness of our thinking, noticing spiralling sequential thinking sometimes pulls us away from reality into a repetitive story of stress, and worry; Mindful practice enables us to begin to slow down fixed thinking, replacing it with flowing thoughts.

Psychotherapy acts as an adjunct helping us to notice actions and behaviours that are based on habit, or implicit memories, and previously out of our awareness. It therefore helps us to modify our behaviour and take greater control, strengthening explicit memory formation and the role of the hippocampus, enabling rationality informed by experience.

Thoughts and anxiety lose their grip on each other. Thoughts become focused based on reality, and our physical arousal is appropriate based on actual threat or excitement.

We learn to make our thoughts explicit to help identify reality from ‘make believe’. Relationships improve and anxiety decreases.

Further information about mindfulness can be found below.

If you think counselling can help you please look at my website Insightfulness or visit Counselling Directory or British Association for Counselling and Psychotherapy where you might find some helpful resources.

Resources

Books

The practical neuroscience of Buddha’s Brain. By Rick Hanson, with Richard Mendius

Mindfulness; a practical guide to finding peace in a frantic world. By Mark Williams and Danny Penman

Web Sites

The Mindfulness Project

Oxford Mindfulness Centre

Counselling Directory

British Association for Counselling and Psychotherapy

A Brief Demonstration of how Neuroscience Substantiates Counselling Practice

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Emma Dunn Counselling and psychotherapy

Eye contact in counselling;  An example of  when it might be one sided.

Eye contact is often highlighted as an important part of engagement with an other. When I am counselling others my gaze is focused on the eyes of the person sitting in the other chair; ‘my client’. This is regardless of whether they are looking at me. It is as if I am saying to them I am here, ready, attentive and available for you.

However it is more usual for them, in times of deep reflection to have their eyes averted, almost glazed over.

I noticed myself doing the same, glazing over, when trying to describe to a friend, how I might feel if I could sail. I was trying to describe the sensation of being at one with the boat optimising the energy of the wind. I was disengaged from eye contact but became aware of this only after I had formed the words and understood what it was that I was wanting to express. It was then that I was reminded of the work of John Kounios and Mark Beeman, on the neuroscience of insight and why I believe so passionately about listening to our own experiences, and facilitating insightful moments. Picture Blog 2

Neuroscience is tending to indicate that insightful solutions to problems occur when the right hemisphere of the brain, notable the anterior superior temporal gyrus, is active, working creativity, and the left brain becomes less active- not working at interpreting external, in particular visual stimuli. This is seen clearly when my clients look away and appear ‘vacant’. This is why holding silence can be so powerful, it allows the right hemisphere priority to act on stimuli from the prefrontal cortex and the limbic system where emotion, non-verbal activity is shown to occur. Getting in touch with our feelings and experiences. Then, once some sense has been made, the left hemisphere, logic and language come into play and the state of introspection returns to engagement and ideas are articulated and a clarity follows. Client’s and counsellor’s eyes then meet, as if to provide assurance that the experiences are valid.

It is during the silence, when I as a counsellor have been fully available, I too have been using the right side of my brain. Activity of mirror neurones in the here and now, combined with personal experiences based on my attachment history will inform me in a way that enables me to show empathy. When my client articulates her reflections I too am in tune with the implications and emotions that these generated and our counselling relationship deepens and work progresses.

photo Blog (1)

 

I believe, psychotherapists who practice reverie and/or use  the impact of clients on their sense of self, either as countertransference or somatic experiences, even in dreams or in the supervision process are demonstrating how powerful it can be to allow our right-sided creative, emotional brain to speak to us. The antithesis of active problem solving, where we consciously piece the clues together, reverie allows the insights to suddenly arise within the process of being in relationship.

 

It continues to surprise me when counsellors are fearful of the work of neuroscience which is helping us to understand the work we know can happen in counselling. This brief exploration of insight, demonstrates how concepts from other models for example reverie, relational depth, empathy, dream work and Gestalt ideas can all be substantiated at least in part by science, this is a wonderful truth that endorses psychotherapy and counselling as an effective means of helping people to understand themselves, come to terms with this and make use of experience to reach whatever goals they are aiming for.