A view of trauma from the perspective of different psychotherapeutic paradigms. How to «work through» trauma? Part 2

Second part of broadcast, in which both my colleague Anna Nechaeva and I participated. I hope that the information about trauma that we managed to present will be useful and relevant to you.

08 April, 2024

Anna Nechaeva: I think here we're really starting a conversation about some resources, about what resources a person has, with the help of which they can process traumatic experiences, generally strong experiences. And of course, what you're talking about in terms of attachment, about relationships with parents, the presence of close, trusting, warm, supportive relationships, is certainly such a fundamentally colossal resource that includes many, many little things, starting from the fact that it's overall some kind of support, close contact, the ability to share feelings with someone, ending with the fact that parents transmit some beliefs about the world, coping strategies for difficult situations, support the child's self-esteem, including again, through beliefs and giving some kind of assessment. Well, in general, this is such a central place. In this sense, traumatic experiences can happen to a person who has a reliable attachment with their parents too, and there is the window of tolerance, as I initially mentioned, such a phrase from EMDR therapy, I think it's very good overall, it can be used everywhere. And this window of tolerance is indeed different. It depends on a multitude of factors. And attachment, relationships, are a very important factor. But also just some features of a person's nervous system, as well as just situations in which they are currently in. How much they're there, as they say, in a resource, whether they're unwell or not. Actually, how many strengths they have... Yes-yes, in the flow, in the resource, in the moment. How good they feel in this specific situation they're in right now, some specific one they've found themselves in. What they can rely on, whether specifically at the moment there is access to some people nearby from whom they can get support or not. The same person can react differently to some incoming situation at different times, traumatize somewhere, process it somewhere.

I would like to share the EMDR perspective on trauma, on how it's all organized. I really like that the whole model on which EMDR is based doesn't contradict any of the approaches; it's more complementary and very understandable, quite simple.

In general, everything is built and conceptualized based on the model of adaptive information processing. I think you're actually talking about something similar through psychoanalysis and gestalt. Essentially, the idea is that we have our own information processing system, which always tries to process it in some adaptive way. Accordingly, most situations we can calmly digest, and a certain network is created, these neural chains of memories form into such a large network where there is access to different memories, where there is access to some of our resources, the realization that we coped with this situation, for example, I can do this and that, from this situation I learned something about myself, I was told something good here, and so on.

So, when these situations occur that cause such an extra level of arousal, not fitting into the window of tolerance, they cannot be processed. This system malfunctions, and then other chains are created too, these are also neural chains. This is maladaptive information. And it's interesting that there's actually no connection between them, it's some kind of isolated experience, it doesn't integrate into the general system of adaptive information about oneself.

And then it turns out that when a person, for example, in the present encounters some trigger that plunges him into that maladaptive chain, he as if loses the connection with all these memories of adaptive information about himself and the connection with resources in the present. And I think everyone has felt this on his own experience, when some situation plunges us into some kind of state of complete self-doubt, fear, danger. And we as if lose that self that we know, that we rely on, we end up completely...

Maria Dolgopolova: ... the self, that remembers how to act constructively.

Anna Nechaeva: Yes-yes-yes. In this sense, I like this model because it really highlights this moment, how we feel that we are getting into a different version of ourselves, as if a little bit, into some other story.

It's also important to say that in these maladaptive chains, usually the experience and the situations that are stored, are associated with some quite negative belief about the world or about oneself. Usually about oneself, like I am helpless, for example, or I am guilty of something, I am bad, I am not good enough. That is, these beliefs are usually irrational, they do not describe the situation fully and are quite negative.

I understand that they can be related to some secondary traumatic experience. I heard about this in the context of the Gestalt concept, but it seems to me that it's a universal thing, that the primary experience is really the moment when we became a victim of some shock, and secondary traumatization is about how others reacted to us. For example, if in the primary trauma there was sexual violence, then in the secondary experience, there, I don't know, our best friend refused to talk to us about it because it was too scary. Some reckless relative said that we were stupid because the skirt was too short, and it turns out that there is already real secondary traumatization, which reinforces and intensifies these feelings that I am bad because this happened to me.

Anna Nechaeva: Well, yes, it turns out that, for example, the feeling of being in danger, for example, that the world is dangerous, is supplemented from above with "I am bad, I am guilty." And this is like additional traumatization on top of the whole story. So, in EMDR, three such clusters of negative beliefs associated with trauma are distinguished. And the first one is related to responsibility and the feeling of defectiveness, like "I am responsible for what happened, I am bad, not good enough." There's a lot associated with shame, with feelings of guilt, and so on.

The second one is about safety and vulnerability, like "I am in danger." So, it's interesting that, for example, some situation happened to me where I was really in danger. And it's as if it cannot end. So, I am no longer in those circumstances, but I still live as if I am in that situation, I am still in danger. I don't know, a dog attacked me, for example, and this situation cannot just end, close. I constantly experience that there are many of these awful dogs around, and I am still in danger.

The third cluster concerns power and control, like "I don't influence anything, I am powerless, I am helpless." And in that situation... it varies, but in that situation "I was really powerless and helpless, and I still experience that I am powerless and helpless," although in reality everything may not be like that at all in the present.

Maria Dolgopolova: I think the invention was also in the fact that they somehow try to initiate this more constructive information processing by involving the body, by involving eye movement. I think that's what will really distinguish EMDR from other approaches that have expressed themselves on these issues.

Anna Nechaeva: Yes, that's the methodology itself, of course, processing through bilateral stimulation. So, it's called "processing and desensitization through eye movement." That is, it's from side to side, actually, it can be done there with tapping on the shoulders, and even with auditory stimulation. There's even a special device where you hold handles, they vibrate in one hand, then in the other. So, there are some hypotheses about how it works, but there's no clear scientific evidence that yes, it works exactly like that. Brain science has not yet progressed so far as to assert with 100% certainty why and how it works. Some people associate it with the moment of processing in sleep, when eye movement in rapid eye movement sleep, some talk about connections between hemispheres, and so on. In general, this process really initiates this system of adaptive information processing.

Maria Dolgopolova: By involving alternative bodily experience? In a way, while you're moving your eyes, while you're feeling all these vibrations, the usual panic circle, the chain of previous neuronal reactions, becomes harder to activate, because you're doing something else or not in the same way?

Anna Nechaeva: It can even be activated stronger at some point. This bilateral stimulation specifically initiates the processing of this event. Moreover, you can process the past, the present, and the future with it. Well, let's stop at the past, at the trauma only. So, with this bilateral stimulation, what you couldn't process, what happened to you, begins to activate and delve deep enough. So, often, when working with this method, people start to actively encounter their, I don't know, shame, fear. That is, they begin to emerge on a bodily, emotional level. And then, through the same processing, they gradually find their resolution and calm down. New thoughts come, emotional experience is processed. Cognitively too, accordingly.

What's interesting, I'd like to add one more thing here, that with the help of the same stimulation, positive aspects can also be reinforced. So, reinforcing the sense of safety, strengthening one's belief in oneself, one's resources, and so on.

When I asked, "But how does this work?" Like, we're doing the same thing, yet the negative is processed while the positive is strengthened, right? The answer lies in this adaptive model of information processing, because our inner self somehow knows what is adaptive for the organism and what is not. I found it interesting how it relates not only to therapeutic approaches but also to spiritual practices. I don't know much about them, but from my experiences with various meditations and spiritual practices, there's also this belief in an inner essence that knows how to best unfold internal experiences, about trusting some inner essence, some even talk about a divine core.

Here, there's nothing like some esoteric story; it's more of a rational explanation, but there's something common about how there's this adaptive system inside us that really knows how to handle things best; we just need to help it, sort of direct it.

Maria Dolgopolova: Listen, I had a few questions for you before we stray too far from this innovative method. One question is, how exactly does it happen... Is bilateral stimulation happening simultaneously? Meaning, a person recalls memories, and this bilateral stimulation occurs. Or is it somehow alternating, I don't know, you talk for a minute, then these stimulations, and they alternate? How does it visually work in practice?

Anna Nechaeva: First, there's some preparation of the specific memory. Well, it's clarified, what did the person think about themselves in this memory? Some negative belief about themselves in this situation is identified. Then, some overall level of distress about the situation is clarified, their emotions, their body is engaged, what do you feel when you recall this. So, it starts with actualizing this memory first, and then accordingly...

Maria Dolgopolova: Warm-up.

Anna Nechaeva: Yes, yes, yes. It's like a warm-up, the warm-up is happening.

And then for the person... there's also an important moment — it's the double fixation. So, the person thinks about their memory, lives in it, and watches their hand. And while this set is going on, it lasts for about 30 seconds. The person doesn't say anything; they just observe what's happening in their mental, emotional, and physical layers. And any changes that occur while the hand is moving, when there's a pause, when the set ends, they simply recount what happened in those 30 seconds. And while we're fixing this... So if we were working in gestalt therapy, I'd start delving deeper into what came up, delving into those memories, talking about them, but here we don't do that. We move on, accordingly. As Woody Oren — the trainer who brought EMDR to Russia — says, it doesn't matter what happens; what matters is that there's a change happening. As long as there's change, there's processing happening. When the changes stop, and after several sets nothing else happens, it means either we've hit a blockage and need to help, or it's already processed, depending on the situation. That's how it happens.

Maria Dolgopolova: Yes, yes, that's clearer. I also spoke with colleagues about this method. It's not often, but several different ones gave me similar feedback. Specialists who are already practicing in another field are trained in this method, and they can't just do it there, it's not allowed. Well, that's usually how it goes. The feedback was that a person learned this method, applied it to their clients, achieved some progress that they couldn't achieve before with the previous arsenal. But at the same time, there was feedback about themselves, like "I feel worse." I mean, that on the clients where it seemed like it would work, they tried it, we made some progress, and there really was a new result, but it just doesn't work for them personally. I know this from a couple of specialists, that a person learned this method, has some successful experience practicing this method with others, but it doesn't work for them personally. It was also interesting to hear your impression, did you personally manage to shift any of your traumatic memories and situations in a positive direction thanks to this method?

Anna Nechaeva: Yes, well, not when I do it to myself, but when, accordingly...

Maria Dolgopolova: When someone else does it for you.

Anna Nechaeva: Listen, yes, on the first training day, in the first module, I chose to work on a topic related to social anxiety. And there's a standard protocol that moves between the past, present, and future, so they work on situations in the past, and in the present, what triggers, and my fantasies about the future.

And there, I was just amazed. I worked with a specialist in the training format. And quite deep things came up for me right away. That surprised me because during the processing, thoughts and feelings came up that, for example, I understood intellectually were correct. But emotionally, I didn't feel them, and there they just naturally started to happen on their own. Why do I feel anxiety in the group, for example? I just felt it naturally, how disconnected I felt from the other group. And right there, during the processing, literally within 15 minutes, these, the one who worked with me, not 15 minutes a bit more. It's like I was able to join and feel a part of the group in a specific situation. And I actually felt calmer when I came to this group later, it's a regular one for me. And it really stuck, and it's significantly better. It was just amazing for me.

Maria Dolgopolova: Also, well, great, interesting, really seems like it.

Anna Nechaeva: Of course, it's not a magic wand; it's a certain method of therapy, it's also difficult, it doesn't work well everywhere. It's also very intensive. For example, I have clients who, in conversation, tend to escape a bit from their feelings about a traumatic situation, to get lost in their heads, and EMDR sort of "catches" them. It can penetrate like a drill into the psyche, well, it can be very painful.

Maria Dolgopolova: I think it's also useful for those clients who don't like talking to others about their traumatic experience. You're just digesting it inside you to some extent during this procedure. You're not obliged to disclose it, what's happening there.

Anna Nechaeva: Ideally, you do disclose, you tell what happened, but there's a topic called the double-blind protocol. It's very rarely used because it's difficult for the specialist to use. But if the person absolutely refuses, you can completely use the double-blind protocol, and the person doesn't tell what specifically is happening to them.

Maria Dolgopolova: The processing will happen, but they won't tell what they transformed there.

Anna Nechaeva: Yes, yes, yes, yes. But there are pitfalls because these processes can get stuck sometimes. Processing doesn't always go smoothly, actually. Often, specialist help is needed, but in the double-blind protocol, you have very limited options to influence. You don't understand what's happening. But it may be better than nothing, and it may slightly reduce the intensity, and then the person will be able to talk about the situation, for example, after some time.

Maria Dolgopolova: I also want to speak later about gestalt and psychodrama, but I also wanted to ask the last question before we move away from this. What do you think you were lacking? Why did you even take on a new method? What was missing in the old ones?

Anna Nechaeva: Oh yes, that's such a question, certainly a matter of personal exploration. Actually, here I understand, I really love gestalt, the philosophy of gestalt, this sort of creative process, creating some contact, an individual dance with each client. And overall, there's a very good methodology and theoretical system that everything fits into, but still, gestalt, as a whole philosophy, is quite vague, very much freedom, very much responsibility.

There are pros and cons to this. Accordingly, in EMDR, everything is quite clear. And there are protocols there. It's somewhat similar to CBT. So, there are protocols for such a case, for this case. You go, you understand what you're doing. But at the same time, it's not CBT; there's still space for the spontaneous process of the person.

During the processing, we don't control what will come up, and the process can go anywhere. And I like that. But at the same time, you still stick to some structure, you have a sense that you have a specific tool. You were given there, like, some super saw, a multitool that you can use specifically, weaving it into the gestalt space, which is so free.

Maria Dolgopolova: Okay. By the way, we touched on this before the broadcast, but you said that in this method, there are some specific criteria for when we can consider trauma worked through. We'll come back to this topic in relation to other approaches. We, just to clarify for the listeners, before the broadcast, discussed a situation where clients, if they are aware, if they have some therapy experience, later begin to review their lives, say: "aha, there's such trauma, such trauma," trying to understand if these traumas have been worked through or not, or if they still limit them from realizing their bright future.

And what do you think about the criteria we're talking about? Do we need these criteria? Would you say that in gestalt, there are no such criteria? It's quite an interesting question.

Anna Nechaeva: Yes, and clients really asked me directly, what does it mean that the trauma is worked through? How do I understand if my trauma is worked through or not? And in gestalt, of course, there's a general understanding still of how much this situation uncontrollably intrudes into the present, how aware I am about what's happening in the present, how strong are the feelings I experience when I remember those events, how I think about myself and the world, thinking about those events. But they are quite vague. You can't get away from the fact that some things can be worked through more, some less, and they'll still be with us. To some extent, it's already part of our history. That is, it's somehow there, but a bit murky. And that's how, in principle, I described it while working only in gestalt.

In EMDR, it's much clearer, as with many things there. There are criteria right there, which you... there are scales by which you assess. There are two scales. For each memory. There's the Subjective Units of Disturbance Scale (SUDS), it's called the subjective discomfort scale. This is where you ask the person at the beginning to say how disturbing, unpleasant, uncomfortable, intrusive this memory feels to you, rate it from zero to ten, how do you feel about it now. And then, accordingly, after the processing, you ask again, control how this number changes. And it's very clear there, I've been practicing this for some time already, SUDS was 9, oh, it became 3. It's very clear how much... It can actually rise later.

Maria Dolgopolova: But is this an integral indicator, so to speak, does it come from different questions?

Anna Nechaeva: No.

Maria Dolgopolova: Or do they just ask the person how much this memory bothers you now? How much does it bother you? That is, by subjective questioning method.

Anna Nechaeva: Subjective questioning, yes, and it's purely subjective history, indeed.

And it can change, actually it can decrease after processing, and then sometimes it further decreases over time, sometimes it increases, on the contrary. It's not that simple either, sometimes some old unprocessed memories feed, for example, the one you worked on, or something happened in the present, in short. But overall, the trend is quite clear, and there's always a desire to reduce this indicator to zero. I mean, it's not that you shouldn't have any emotions about this memory, but it shouldn't be disturbing, unpleasant, intrusive. Actually, I see it in myself and in clients, they say the picture just fades, this memory. I can't even get into that memory, like before. Something changes, I start to see it somehow dim, for example. These emotions, like shame, for example, they go away.

And the second criterion... I said that each memory is associated with some negative belief about oneself, related either to safety, or responsibility, and so on. So, every time we work with a memory, we also formulate how I would like to think about myself in this situation? There's a negative cognition - what I originally think, and how I would like to think - positive cognition. I'm okay, for example, I did my best, I'm good enough.

And at the beginning of the processing, we ask, how much do you believe in this positive cognition from 1 to 7? If the memories are painful, the person says, "Well, honestly, at 1 or 2. No, I understand in my head that I'm doing okay, but emotionally I don't believe it." And in the process of processing, this positive cognition grows. And so, we also strive for it to reach 7, that is, the maximum score for this scale.

And there, accordingly, it's seen and qualitatively how the person's attitude changes, the picture fades, I don't know, becomes insignificant, and it's directly visible in the numbers.

Maria Dolgopolova: Yes, thank you for explaining, I think those curious about this new method would also find it interesting to know how it can look.

About me

Maria Dolgopolova – a certified clinical and a jungian psychologist (Moscow Association of Analytical Psychology, an IAAP training candidate studying in CGJung Institute in Zurich) with a background in gestalt therapy (Moscow Institute of Gestalt and Psychodrama, Gestalt Associates Training Los Angeles) and in psychoanalysis of object relations.


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