We know plenty of strategies for engaging our trauma patients. But do we know what to avoid?
How to help patients heal is not always clear. And trauma patients, given all their diverse history and symptoms, can be some of the most challenging.
So it almost goes without saying that, when working with clients who have experienced trauma, there are extra precautions practitioners need to consider.
Let’s take eye contact for instance.
While many of us would say eye contact is essential, Stephen Porges, PhD has written about the importance of averting eye gaze when working with trauma patients.
Direct eye contact can be interpreted as threatening and may trigger a negative reaction from someone who has experienced trauma.
In his book, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, Stephen describes what happens to the social engagement system of trauma survivors.
Trauma can turn off the social engagement system. Attempts to engage a person with trauma history, rather that eliciting spontaneous social behavior, may trigger defensive and aggressive behaviors.
From a clinical perspective, traumatized individuals often present features of gaze aversion and flat facial affect. If we were to monitor the physiological state of those individuals, we would observe an ANS (Autonomic Nervous System) that is poised to fight or flee (i.e., high heart rate and low vagal regulation of the heart). The traumatic experience functionally retunes neuroreception to conservatively detect risk when there is no risk.
Most therapeutic strategies attempt to engage with direct face-to-face eye contact. Working with traumatized individuals creates a great challenge to therapists, since the normal social engagement behaviors of the therapist may trigger fear and reactive defensive strategies.
But this precaution leads to a new problem.
If we avoid eye contact, how else can we engage with a client?
Dr. Porges offers a solution that involves an entirely different sense all together. This is a strategy you might not have considered.
Music therapy provides a special portal to reengage the social engagement system that does not require an initial face-to-face interaction. Music can be used to stimulate the social engagement system without requiring face-to-face reciprocity. Since melodic music contains acoustic properties similar to vocal prosody, music may be used to recruit the social engagement system by challenging and modulating the neural regulation of the middle ear muscles.
If the social engagement system is effectively recruited, positive facial expressions will emerge, eye gaze will spontaneously be directed at the therapist, and the traumatized individuals will shift to a more calm and positive physiological state.
Through the use of music therapy, it’s possible to stimulate a patient’s social engagement system without triggering defensive behaviors.
So, to get to the eyes, you could go through the ears.
Intrigued? I was.
To find out more, you might want to check out Stephen’s book, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.
Stephen Porges is the creator of polyvagal theory, Distinguished University Scientist at the Kinsey Institute at Indiana University Bloomington, and Research Professor in the Department of Psychiatry at the University of North Carolina at Chapel Hill.
We’ve talked with Stephen before about how the polyvagal system can help us understand reactions following trauma. His research is often illuminating.
He’s also a profoundly wise person, and I’m always glad to share his thoughts with you.
What are some techniques you’ve used with trauma survivors to avoid triggering a fear response? Please share your thoughts in the comments section below.
Hello, v interesting article!! Thank you!! I’m researching into therapies for trauma particularly complex trauma, so one technique I use in my clinic is to stimulate the Vegas nerve with cupping. I also bleed the areas of cupping. The area is just below c7 to treat the parasympathetic nervous system… it seems to recalibrate the entire system… I also use Ashwaghanda and meditation… so I love this idea of music therapy to allow trauma survivors to re engage with the world and others… so that they can Perhaps have a chance to feel Like a part of this world… I suppose it has to be holistic at the end of the day so I’m busy collecting some gems to get people back onto their feet… vitamin D also… I cold go on!!
I’ve used Resource Therapy founded by Professor Gordon Emmerson with success. During therapy the client allows their eyes to close. Focus is drawn to feelings within. Trauma release is rapid & empowering for the client. Marcelle Yoxon Clinical Resource Therapist.
Very difficult to close ur eyes when y have trauma though…
I have mild cerebral palsy, I grew up being bullied often about my speech impairment, consequently as a symptom I found eye contact incredibly hard to maintain speaking to anyone. I’ve had all sorts of therapy in the last 20 years, such as CBT, hypnotherapy etc, some have helped no doubt but the trauma and shame stills sticks to my “soul” like tar that has become deeply cemented and stubborn to chip off.
I wonder now if music therapy will help me gain trust and improve my eye contact when communicating with people.
Thanks a lot. Innovative strategy.
Thanks a lot. Innovative strategy.
Thank you for this information. I have worked with children, youth and their families for almost 20 years. I have been trained in Self Regulation Therapy by Dr. Lynne Zettl and Dr. Edward Josephs in Kelowna, B.C.Canada. One of the things I have used with my client’s is music. E.g., listening to their favourite bands while using movement (especially side to side movements engaging their outer thigh muscles) at the beginning and end of the session, and while we engage in jointly creating a collage of their interests and or goals. Of course these strategies are tailored to the individuals as they may not work for everyone.
very fine, and a valid argument for the classical psychoanalytical setting too 🙂
EMDR is most definitely a go to application. I’ve witnessed clients resolve traumatic experiences within a single session. Naturally starting first with what the client identifies as least traumatic from their list of traumatic experiences. On-going sessions include follow up from previous and interest to continue with next on list or revisit ones from previous session.
In absence of EMDR, I’ve found, where locations provide, taking therapy outdoors. Going for a walk and talking makes a session regarding trauma naturally more relaxed and less intense. Gaze aversion is less of an issue given the informality of walking.
Walking also allows the body’s parasympathetic nervous system to become more responsive. Client’s breathing also becomes more engaged with the body, minimizing unconscious response during stress for shallow breathing or breath holding.
Walking outdoors is also helpful should the client begin to dissociate. In those moments, I can use the sounds, the feeling of wind, or the rays of the sun to assist the client in returning to their body’s experience in the present.
It’s been my experience, many clients appreciated the opportunity to leave the formality of the therapy office. Many times afterwards, clients shared feeling more willing to talk about their trauma, even sharing more than anticipated & remembering aspects previously forgotten with less fear and anxiety. Naturally, such an approach would not be advised should the client also display forms of psychosis.
I use colouring mandalas found in numerous mandala colouring books. We sit and colour while talking about things of importance to the client. This is especially helpful with young clients (children and teens).
Hi I have been learning about the Poly Vagal theory and am interested in the mind body integration. Understanding how it works is one thing but treatment and stimulation of the vagal nerve is another. how do we stimulate the vagal nerve to activate the anterior portion of this very influential nerve? thanks in advance
There are many breathing exercises and somatic techniques that stimulate and tone the cavalry nerve. They’re too complex to explain here but if you look, you’ll find them.
This is most interesting. I came across a deeply traumatised person who was teaching herself a music instrument, reconnecting with sounds and music at her own pace. Thank you so much for sharing. It brings meaning to what was observed.