How to Work with Emerging Defense Responses to Trauma (Beyond the Fight/Flight/Freeze Model)
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with Pat Ogden, PhD;
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with Pat Ogden, PhD; Stephen Porges, PhD; Bessel van der Kolk, MD; Janina Fisher, PhD; Kathy Steele, MN, CS; Deb Dana, LCSW; Ruth Lanius, MD, PhD; Thema Bryant-Davis, PhD; Ruth Buczynski, PhD
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There is more material in this hour than I could process.
Two lessons stood out for me:
1. the three defense mechanisms of crying, vaping, and pleasing are rooted in biology.
2. the labels we use though indispensable, are also so limiting.
All three defense mechanisms have a distinctive “smell” when I engage in them, which is helpful to know.
The lock-downs have thrown many older folks into contemplative life, whether we were ready or not. That is no organic social stimulation, as opposed to algorithmic, a heightened sense of the shortness of life, and an imperative to fully know ourselves while we still can. The coming decades could be brilliant.
Thank you for your all good work.
Thank you so much again!
My first take away is the distinctions between Colapse/Submit and Please/Appease responses. Be aware the cues in the therapy session is so relevant to effective intervention.
Also is new for me the “Cry to help” response, and the way to approach involving both right and left brain to deep Connection and put clear boundaries.
I had observed and now more accurate all these patterns in organizations: fight, flight, freeze, dissociation, please, submit, cry to help… in different ranges of intensity, and arise a big question: Could many of these nervous system survival’s adaptive responses appear as a normal way of living because modern society and culture norms? Or necessarily came up from trauma?
With Gratitude and appreciation
Frethman
Thank you so much for highlighting these often overlooked strategies and in particular linking them with how people in marginalised and oppressed groups will have had to develop them to prevent violence and / or to gain acceptance. As the programme discussed, this can be seen very clearly for people experiencing racial prejudice and discrimination but also for women, people in LGBT++ communities and those with disabilities. In my experience, acknowledgement and discussion of this has been absent even on top quality trauma trainings.
What is often attributed as ‘natural’ characteristics in women and say, gay men (lovely / fun / creative), could also be seen as survival strategies. I would say that one of the most damaging aspects is having to repress both the appropriate anger and the fight parts for fear of even further violence and rejection. There is a huge cost to keeping this out of the way and protecting society from what it doesn’t want, or is unable, to hear. As a queer person and therapist living in apparently more liberal times in the West, it feels possibly more important than ever to be raising these issues and teaching therapists about them.
Thank you for the continued support to encourage me to listen to and trust my nervous system during a therapeutic relationship. The reticence I might have for broaching an activation of my nervous system is possibly shaped by my implicit cultural bias(s) and/or unresolved trauma(s), yet recognizing, naming, and discussing the activation is a powerful therapeutic tool when used in a competent manner. Continued professional supervision to explore transference was also highlighted here in a beautiful, gentle way. Thank you for the excellent neurobiology explanations and clinical case examples. Does this make sense?
Today’s session helped me recognize two patterns I have seen in a few specific clients: ‘attach/cry for help’ and the ‘collapse/submit’. I appreciate the way the session today presented side:side ways of working with the ‘collapse/submit strategy/state from both a polyvagal/nervous system approach and somatic approach: both sets of exercises made sense and I could imagine using them in various situations. I also appreciated how the sessions provided ways to recognize and work with times when the therapist might be triggered or their nervous system activated; how this could potentially be information in session to help identify the client’s survival strategies and a few tips on how therapists could address it skillfully as well as regulate/take care & responsibility for self.
Thank you contributors, organizers, and mentors- I feel very grateful right now.
Interesting with Deb`s suggestion of playing it out: the No (and the Yes) from the different nervous system states. I might try this with some of my clients at the right time.
And: from a long time back (30 years) I remember a few clients who were idealizing me, and I felt puzzled uncomfortable about it, as I felt it was too much, and sometimes difficult to handle (At the time I was more doing acupunture and bodypsychoterapy). I`ll try to go back in my memory to see what was maybe behind it.
I feel that now, as I have more psychotherapeutic experience, I am more able to catch it, before it gets out of hand.
Thanks so much… this is all so supportive and informative. I am not a therapist, but find this all to be really eye-opening and helpful as I do art-as-harm reduction and art-as-wellness work in Kensington, Pa with unsheltered folks, many of whom are in active addiction… knowing, as Gabor Mate says, ask ourselves not so much why the addiction but why the pain/trauma…
Kathryn Pannepacker
Artist/Uplifter
This was so helpful, and refreshing. First of all, it helped me to gain some further clarity on these three adaptive responses, and the intelligence behind them. I am deeply aligned with this way of working, and appreciated the suggestions and ideas for both the cautions of pitfalls we may fall into with each, as well as strategies we could enlist. I found it particularly helpful to hear about how the collapse/submit response can lead a client into further situations of abuse, as I have observed this in the stories several clients have shared. I also appreciated hearing how role play, and even modeling certain nervous system states and options for “no” and “yes” in each state can assist a client in discovering options they haven’t previously known were there. I could say a lot more, as I have many wonderful take aways, but I will stop here and say a heartfelt Thank You to everyone presenter today!
This information has been so effective in helping this counselor recognize the traumatic bases of presentation for so, so many of the patients currently coming in. With covid precautions continuing, I suspect many of us MH folks are still working in relative isolation, and it’s been hard to keep connected to collegial resources. This has helped so much with that. Thank you so much for making these trainings available–and for concluding each video with your encouraging words.
Thank you for expanding our education on these three additional defense strategies. I have trauma client who has been described by male authorities at work as “too deferential”; we are now working on her tendency to please and appease AND collapse and submit. I think it important to note that there can be multiple defenses utilized by one client.
I appreciate the polyvagal therapist’s suggestions for using self of the therapist sessions for experiential demonstration and co-regulating with the client.
Fascinating. I’m finding this so helpful in having a name(s) for some of the behaviours and frustrating dynamics I have experienced with a client who demonstrates perpetual collapse/ submit and seemingly treatment resistant behaviours. Looking forward to using my own nervous system responses as a barometer of what’s going on in theirs…and in regulating mine in order to regulate theirs…. also looking forward to introducing them to the 3 different systems..dorsal..sympathetic…ventral and in using the somatic approach to shift out of these states. Thank you so very very much for this!
Wow! Please and appease! I wonder if that goes on with any of my clients? The session today has provided me with some insight and maybe I will notice more, I will certainly try to!
I also like the idea for working with the nervous system by role play and answering questions in the three different states.
Thanks so much for today’s session.
I like how Dr. Dana refers often to the client’s nervous system; it is a compassionate and accurate way to describe their experience -without blaming or shaming. Even when therapists label or name the client’s experience as for example an abusive relationship – it can inadvertently be shaming or blaming. As if they are wrong about their choices – whereas this way it really speaks to the client’s survival/ coping responses at play. I like her language because it opens the door for a client’s non judgement and self compassion which eventually gives them the confidence and awareness from which to make their choices.
Thank you for making this available. I am an 80 year old grandmother and therapist who sees the ill effects of untreated trauma, both within my family and in my role as Family Court Evaluator. This new/old learning has provided me with hope for those who come behind me, and hope for for a kinder and gentler next generation. It has also given me a clean window into helping my own grandchildren who have lived through adverse situations. Day by day, each one of these insights help me help my grandchildren. This information is a daily practice outside the therapy room. With much gratitude.
Excellent Session. Please and Appease is what I would generally call co-dependent which is a label I really don’t like. Thinking of this as a survival strategy is so much more effective. Cry for Help also associates with words like needy which I also don’t like. It connects patient with shame. And collapse state again refers to chronic depression which is where so many of my clients shut down. So basically today gave me some new more helpful terminology which hopefully will give new understanding and lead clients away from states that are basically stagnant.
Thank you for these presentations! I actually watched them last year and since that time I’ve been making it my mission to keep learning about CPTSD and it has given me a whole new perspective as a therapist. Wish I had learned all this years ago. I’m thinking that traditional diagnosis and ways of healing will eventually be obsolete including DSM. Hope so!
Module 3, I’ve experienced these situations without knowing the terminology and more importantly useful strategies to deal with them more cobstructively. How much I have been missing?!
These are such enlightening sessions, thank you!
Thank you so much for offering these videos for free. I am a survivor of childhood trauma, an RN, wife, and mother of a daughter who is also a survivor of trauma. I will begin be paying more attention to my own nervous system, talk about how my nervous system feels at appropriate times, and check in with my daughter or patients by also asking them questions about what they notice about their nervous systems. I also have an idea about different questions I can ask my daughter and/or patients (and myself) to learn about/help them learn about how and why they began to respond in the way they are and explore ways to develop healthy responses.
Thanks so much for this awesome training! Every week I learn new things! One thing that stands out for me from today’s session is about clients who are people pleasers. I have a new client who told me when she scheduled her first session that she’s a people pleaser and that it was a problem with her last therapist. I see her this week and now have new ideas about addressing her people pleasing behaviors. Thanks again!
Mary Bright, LCSW
Tampa, Florida
I am considering working with a womens health healing program.
I have a friend who faints and has old relationship history of neglect.
I can be too nurturing and desire to be more neutral to be effective.
This framework is really helpfull to work with PTSD clients. Thank you so much to all for sharing al the experiences and informations that you build up in many years of work! I am so gratefull.
I will explicitly use the question/method of how to word one of my client’s trauma, and navigate their nervous system’s responses. Plus, with another client, the modelling of saying ‘no’ in the three nervous system states to another client, while getting them to observe their nervous system responses.
Thank you for sharing these seminars.
That was incredibly helpful – thank you. I found that last example really helpful in a number of ways. 1. the power of language and finding the words that the client felt best described their own situation rather than me as a therapist ascribing words for them. 2. the importance of getting the nervous system ready for change – practicing alternatives and tuning in to be self-empowered to make the choice to leave and have the resources to do that. Very powerful, thank you.
Two things,
Not pathologise (eg. label pt. BPD) a very sophisticated defence response
keep connecting with pt’s ANS .the ladder of polyvagal theory to follow the states and not the stories.
thanks
This session was helpful on so many different levels. It refined my traditional F3 understanding of trauma responses, stretching and expanding my understanding of how to better assess client presentation. It also deepened and refine my understanding of the interventions within the vagal system of work ( a big shout out to D Dana!! great cases and description of strategies- the role playing and also the self-checks in as a therapist). This session brought me back to three clients I am currently working with and others ways to proceed with them. Thanks for this session.
It is so helpful to me as a budding student/therapist to hear how these changes happen slowly. This idea helps me see that just because I do not see changes in a client right away does not mean that change will not happen in the future. Thanks for another great module!!!
I loved “A sympathetic state masquerading as socially engaged.” I will remember that about Please and Appease, thank you so much
That was great! I have made a lot of notes! As someone who works exclusively with people with personality difficulties, its really interesting to hear about the number of trauma symptoms that can be misdiagnosed as PD. Thank you so much.
I am feeling so grateful for these videos! I found Deb Dana’s “no” exercise from the 3 states (Dorsal Vagal, Sympathetic, and Ventral Vagal) to be super interesting and would like to practice more of these experiential exercises. Thank you!
Although I’m not yet employed I have used these resources for my personal recovery and I really appreciate the sensitivity around micro movements for example as I have though throughout the last 10 years for a professional to ignore the emotions will definitely have a detrimental effect on all involved and from a patients perspective this is mostly ignored when recovery is trying to be sourced. Thank you for this amazing information
I am going to play closer attention to these responses to see how they show up in practice, both in clients and myself.
I believe I have a client in collapse/submit state – I have only approached her as having chronic depression and have often felt quite frustrated with her. I can’t wait to meet with her again with a new, fresh and probably much more accurated understanding of her and how to work with her. Thank you!!
Very helpful to hear these different perspectives on different trauma responses. In particular, the Please/Appease connects to my understanding of TA Drivers and I’d like to see some work on locating our approach to trauma treatment in a range of psychological models. That way we can value ‘new’ understandings and respect older traditions; an integrated approach
Watching made me recognize I need better training in somatic and polyvagal therapeutic methods. Not sure if the gold package will give me enough of the fundamentals to apply what is here. Also, I know a young woman who was diagnosed with borderline personality disorder and treatment resistant depression, and I intuitively disagree with the diagnosis and want to figure out a strategy for helping her because she is not my client.
I NEED TO EDUCATE MY CLIENTS ABOUT THE NERVOUS SYSTEM TO BRING ABOUT CONVERSATION IN THE FUTURE OF CHECKING IN WITH WHERE THEY ARE. WOULD LIKE MORE INFO ON MAPPING THE NERVOUS SYSTEM
Check out Deb Dana’s books
Thank you. I came to my own somatic understanding , my own experience put to the service of counter transference. Blessings .
I really appreciate how you so often close with the importance of therapeutic work not only for the specific patient but for the world at large. So many of the social and even physical health problems have mental/emotional health concerns at their root. It’s time to #StopTheStigma
Fabulous, thank you I learnt so much
Seeing how the attach/cry for help response presents itself. I currently have a client with that response and it’s very triggering to me. This tips and information are useful for treatment my client and caring for myself.
If you are triggered, it is a gift as one of my therapists taught me. It is a treasure to discover and unpack for yourself while giving you the opportunity to heal. The bonus is becoming better at your profession and in your relationships. It is the ultimate in self-care. Noticing and being present about it is the first step which you have done. I think that being present for both oneself and one’s client is one of the most important lessons of this series. It is the way one can create safety and boundaries. Only when one feels safe can one risk growth and change.
Thank you so much for these guiding videos. I am able to identify my clients operating with these defense responses. I realized that i do use some of these skills and techniques however was not sure how it may land with my clients.
Very helpful and informative. The frameworks presented provide are similar to ways that I work with clients, but did not have the best language for. This really helps to articulate these ideas and ways to weave them into clinical practice. I also work with clients on naming positive stress responses (seeking help, self-compassion, calming practices) and how one can re-train their stress response. Felt very aligned with this session. Thanks so much Ruth and NICABM!
Among the most valuable aspects of today’s session for me was receiving help in distinguishing between the attach/cry response and BPD and the caution not to pathologize this adaptive survival response. It was so helpful to be reminded that the attach/cry for help originates from a place of feeling like one may not survive, rather than that of seeking attention. This helps me formulate a response focused on supporting a sense of safety rather than providing comfort. Hearing Deb Dana paraphrase the client as, “This is what I need, and no one has ever given it to me,” is an immensely useful way to conceptualize how I might offer a sense of safety to my client who might be crying out for help in this way. Thank you to all who contributed to this learning opportunity.
Yes. Thank you for articulating what I tried to say myself.
Thank you for a very informative session! I’ve been thinking about a client of mine who has too often shown signs of wanting to please me. I now feel I have some strategies for working with her on this issue.
Very helpful information- gives me personal insight and better understanding of latest on nervous system! New way to name experiences. I appreciate the respect and understanding shown in these approaches. Thank you.
Today’s session gave words to states of mind that we have all seen and tried to respond effectively to, but simply didn’t have the words or conceptual framework to describe. Thank you for creating both. I plan to use this framework to work in a more collaborative way with my clients, helping them to recognize and understand, at a deeper level, what might be preventing them from moving forward. Once we both have this recognition and understanding, the intervention plan and process will improve.
Thank you for this presentation. I was easily able to identify with some of my clients in each of these defenses, but my biggest take away is how collapse/submit can present as chronic depression or treatment resistant depression. I will be more aware and vigilant to assess this more. Thinking of a specific client. Thank you, Diana M. Trevino, LMFT in Southern California
Thank you. Very helpful. I know someone socially who has the ‘cry for help’ behaviour. And yes, it puts people off. I am learning to respond with empathy, but firmness. Thank you.
Interesting and extremely well-presented material that overflowed with attunement to the client. So grateful to all involved.
I recognize please and appease in one of my clients. I will be using what was presented to introduce this survival state to him and begin the process of self-recognition and using scenarios to help move beyond it. This refines the approach we have been taking (trauma informed). Thank you.
I found the parts referring to marginalized or members of minority subcultures very useful and uncommon knowledge, will use in my counseling as an elder to help clients to see that their defence mechanisms need reviewing and replacing. Thank you for this informative work.
That was very informative and helpful – opening up new and critical areas of us empowering our clients and improving our work – creating a desire for more study and training – moving into new ways of working. Thank you – you are all great. RMP UK