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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Being reminded that the 3 different parts of the nervous system have to be mapped for & with a client so they can detect where the trigger is being felt (sympathetic, dorsal or ventral vagal) before enacting any play-to-train self-reliant boundaries was an important reminder. Going back to basics appears to work best with anything whether spiritual, psychological.or physical.
The double consciousness factor of a client not knowing “What do I think” vs what the other person thinks triggering the emotional exhaustion of chameleonizing to stay off the perpetrators residual adverse reaction.was enlightening as it can often be seen as different disorders without enough client openness with a therapist. it’s obvious that insurance requirements of completing help with a client does not align with perfect care since all good relationships take more time.
“This is a learning community for practitioners.” Are practitioners aware of who and how many are being excluded by this boundary and what the social and personal costs are of that exclusion? How can I change myself and the world when I am not welcome at the table – not welcome at even a seconday table where we can try to figure out how to heal ourselves with the limited resources we have available?
This information has been excellent so far. It helps me better understand my own step-children. And I am a coach who practices Equine Assisted and Somatic coaching techniques. Being trauma informed is so important in working with my clients. One, for helping them recognize why they do what they do without shame or judgement, and how to possibly use better strategies. Two, for making sure that I do no harm especially if I find I am working with a client who appears to be out of my scope of practice. And three, to help me recognize when a client might be out of my scope of practice and help them find a licensed therapist. One thing I will mention is that the horses are most excellent in reading Nervous System responses and states of disregulation. They open so any doors for questions that help clients find their own inner wisdom and develop better life strategies. This information will help me make better use of my equine colleagues – for my clients and for my own Nervous System regulation.
This really landed for me.
I’m ready now to become a ripple from the inside out, as there is more work to do on myself as it feels to me.
In terms of attach cry for help energies + dorsal responses on what I feel are generational influences from war times over here in Europe, I first have to get clear + clean enough on this re. my own affectedness before I touch on it with clients. And of course I will do my own work in community.
Thank you so much for all you do Ruth, this especially was a very valuable + enlightening piece for my “personal + professional puzzle”.
All these three trauma responses resonated very well with some of my clients, and to have clarity on each and every concept, and strategies of dealing with them in sessions and what to look for and how to stay grounded and attuned with self compassion with oneself first as a therapist and with your clients too of course. The firm soft boundary, the caring and firm no strategy through engaging the fave and voice, while having the body and other muscles engaged… Amazing
And, the different types of No(s) of the different parts of the nervous system were also amazing… and I hope to learn more, watch more examples seeing it practically…
Thank you for a very useful and what felt like interactive learning experience.
Looking forward to the Shame session
My biggest takeaway was the discussion of the attach/cry for help defence and the possibility of confusing this with BPD. Over the course of 20 odd years of practice I have had clients diagnosed with BPD who could very well have been using this defence. I am going to have to have a hard think about the times I have felt overwhelmed whilst seeing such clients, and be more aware of the different approaches to treatment suggested by today’s experts. An absolutely invaluable session. Thank you!
If BPD is borderline personality disorder, Bessel van der Kolk recently gave a webinar teaching on trauma. In his video, he explained that several separate former diagnoses in the DSM Four have been now regarded as variations on trauma response and are now not “borderline personality disorder” or other descriptive labels. I think he said this has been revised in the DSM Five. He explained that clinicians used the level of “borderline personality disorder” when they did not know how to treat the client. They did not understand 20 years ago that this is probably what we would now understand to be a trauma response. It might be a version of “cry for help.” In other version, it is a client’s maladaptive behavior applied in the interaction with the therapist. It impedes progress by eliciting a care-taking response from the therapist so that the client remains childishly dependent and does not make a satisfactory adult life for herself or himself. If interested in the work of Bessel, contact NICABM for information.
What gave me real emotions of sadness was when Tema mentioned the behaviour “when we do what makes the other happy, they will hurt us less”. This resonated because I was bullied by a toxic boss, for long years. Beyond that experience, as a coach for managers and workers I will be very attentive to ‘compliant’ behaviour, and will insert role play exercises as Deb Dana describes. (I recommend her book to other practitioners because it gives a wealth of practical suggestions and exercises).
I’ll also be careful with learned helplessness and difficulties in relationships. I think Bessel vdK wrote that somewhere between 10 and 25 percent of the population has been traumatised. Imagine what that means in the workplace. So if people exhibit difficult behaviour or difficulties in relationships, I need to consider that possibility. Until here I put all these behaviours under the label of ‘conditioning’, which is not wrong, but I need to differentiate a bit more between the degrees of severity.
Bessel recently said 100% of Americans are traumatized and the most vulnerable and victimized and exploited are teenage girls. His recent teachings on Trauma can be accessed through NICABM.
I would like to thank you for a truly rewarding and insightful course on trauma treatment. The teaching was both academically strong and highly practical, making it easy to translate theory into concrete tools I can use in my work.
Thank you som much for the sessions. I got many ideas how to psychoeducate patients better, how to introduce knowledge about nervous system. I am grateful for the examples. I see how important it is to slow down and recognize exact state of nervous system. It was very interesting to get familiar with the Please Appeace strategy. Thank you!
Thank you for bringing up the potential misdiagnosis of BPD. I am curious if talking in a child-like state is the only differential diagnostic criteria between BPD and PTSD? I feel this should have been expanded upon.
I would like to circle back to yesterday’s episode on disassociation and express my curiosity as to why BPD was not brought up especially in context of the last diagnostic BPD symptom of “Temporary paranoid thoughts or severe dissociative symptoms triggered by stress” – and to differentiate traumatic dissociative amnesia versus the ‘severe dissociative symptoms’ described by the diagnostic criteria of BPD?
Thank you for making this series freely available to the public.
This question identifies an extremely important topic that could in itself be a full-length two hour presentation. Namely, is borderline personality disorder a symptom of PTSD? Bessel van der Kolk has taught that both of these labels were considered perjorative so clients or patients would not be able to receive treatment because treatment modaliities did not exist. This session in particular shows how intricate and complex any of these diagnoses can be. So a clinician has to “be on top of her or his game” to be able to assist clients in overcoming maladaptive defenses. Bessel recently has taught about borderline personality disorder as a defense of victims of chronic childhood trauma. He can be contacted through NICABM to access his latest research findings. It is too complex to explain here to do justice to his explanations. suffice it to say your insight that it is related to a mode of compensation for those with PTSD is accurate. But the pejorative label of “borderline personality disorder” came earlier than the discovery of PTSD and disassocuation. It was concocted by an advisor of an earlier version of the DSM. It iscan adaptive child-like response. As for whether you should talk to various dissociated states is probably a detailed question. These over-views are intended to give generalized “broad brush” introductions to complex topics that can be fully developed by studying the work of the individual presenters. They all have written books and taughts many courses.
I have more of an idea about how to use boundaries in attach/ cry for help situations. It is a fine line, but the strategies today have made me think how I can work on this. Also please/appease as that is something I am finding more common. Deb Dana’s case study demonstrating the valuable micro moments and then the various contributor’s guidance about attuning not only with client’s nervous system, but also our own and using it as a barometer. It is something I have always tried to do and having the reminder that it is an effective strategy is helpful because it enables the collaborative approach. Another really useful session. Thank you
In my work in the U.S. with many victims of domestic abuse, it is often upsetting to myself and other counselors to see how caught up the clients are in their own situations and put their children at risk. so, what is the core problem? The victim-perpetrator dynamic is common in the U.S. and both members of the duo need treatment. Not just the “identified victim.”
Good morning…I am a mexican clinical psychologist. Though it’s expensive for me to buy in dollars (we’re at a rate of 20 mexican pesos for 1 US dollar), I benefit from your webinars and I am deeply thankful for your sharing.
I know some books from Levine, van der Kolk, Gabor Maté, etc. I’ve been in a day workshop with dra Farca, pupil of Dra Ogden.
So your information adds to my clinical practice.
THKS
One of the many that I am taking with me:
“My nervous system is the barometer of the clients’ situation”
Thank you!
I find all this information helpful for re-thinking a lot of cases that seemed stagnated. Also useful to psycho-educate my clients to self-regulate. I used to refer to “the belly’s voice” to help patients look inwards and contemplate, using their intuition, how what was happening (either in the session or in their life) may have triggered their nervous system. Listening to Deb Dana makes me wonder: ¿Is “the belly’s voice” and the nervous system, the same thing?
I’d be interested to know how these nuggets of learning relate to working directly with children and young people, who may still be in a difficult and traumatic situation or only recently been able to leave.
Thanks for some useful suggestions. Helpful even when dealing with friends and acquaintances, not just clients. I’ve currently one in each category so I might be able to use some of what was offered
This course is helping me with the nuances of the nervous system and how to somatically notice myself as a practitioner what is happening in my body. I’ve always worked on grounding during sessions and noticing what happens in my body didnt always connect it with what it meant for the client. Specifically how dorsal vagal shutdown can bring a sympathetic response in my system.
My biggest take away is the idea of actively identifying the nervous system’s activity in session, and even sharing my nervous systems responses with my client
I have a client who has tendency to please me and parent me. WE have talkded about it before yet next time we meetI will give her more detailed info, the things I learnt today iwth a more sicintific approach to make her more aware. thnaks
Hi – I liked the part about how groups may please and appease. I work with athletic teams, and this is quite prevalent when athletes want to please and appease coaches, to their own detriment.
Excellent course. Sure, all of these concepts require quite a bit of practice in order to fully use the wisdom and experience of the course.
But you’ve certainly made me aware of many specific situations which I have, up until now, overlooked the nuances of each mechanism.
As a survivor of long-term, complex trauma, I am finding these lessons extremely valuable. As a survivor, I am able to better understand the failure of a long term therapeutic relationship I had years ago. These talks bring to light how, many times, a misdiagnosis can be made simply because there was such a lack of understanding of the experiences I was having; this resulted in the therapist’s nervous system kicking in, resulting in resignation/collapse and double consciousness. As a therapist, I can now utilize these tools to check in with myself when I notice subtle changes in my client’s behaviors, or energy. I notice I am very attuned to these, which, in many instances, I take to my own therapy sessions.
There are many parts to these lectures that I can use in my daily practice with all my clients, including children, adolescents, individuals, and families. The one I think will be most useful this week will be the please-appease. I look forward to the class tomorrow as I have a client dealing with a very pervasive sense of shame.
Thank you for these awesome presentations.
Maria P.
wow, that is insightful! Thank you!
Thank you all at NICABM, and your presenters, for illuminating the mechanisms of trauma responses, recognition, and healing. For me, it is line up on line, precept upon precept, here a little, there a little. The insights I glean from experts is helping me understand how to recognize and navigate the next steps of my own healing.
Very importantly, as a live-in caregiver, you are giving me precious tools for understanding how – and how not – to engage with the dear souls I assist and coach. That is making me a more valuable partner on their journey to healing, whether in this life or the next, while avoiding unintentionally adding to their challenges by misreading their nervous systems. I can’t thank you enough. The Lord bless you for the manifold ripples of good these masterclasses are sending out.
Your experience of dealing with trauma informed therapists is very common. That language is a red flag that a therapist knows nothing about treating trauma. It is marketing.. What generally happens is clients with trauma seek them out and engage with them. Once the client feels safe enough to display these trauma responses, the therapist gets dysregulated and abruptly terminates the client–adding significant trauma to an already traumatized client–and always sending the message that the failure is the client’s fault. It is strange to me that at no time does any one of these experts acknowledge that dumping trauma clients is a very common response by trauma informed therapists. Those words mean nothing. No trained trauma therapist would ever use them.
Interesting observation!!! Thank you!
This is helping with my own trauma responses.
This made me more aware of where I have my own defensive reactions with clients,
This was most enlighening.
Understanding these defense responses and how to rewire is so important, I hope to learn more specifically about the HOW. This knowledge and these tools are so needed to break the generational chains of abuse trauma and have healthy relationships. Please and Appease has more aspects as a survival reaction than those mentioned in this session, or it maybe it blends with Attachment Cry for Help. Attempting to meet emotional need for love and acceptance from family, friends, or group, attempting to prevent abandonment, and getting cooperation in getting help for physical and material needs from others that you cannot do for yourself. I have wondered if these are not children of the original response to threat, danger of abuse and anger etc. from the abuser. There are many entangled genetic and trauma components along with toxic family systems passed down thru generations.
Do the children of parents with genetic mental illnesses, and generational Abuse/Sexual Abuse Trauma actually physically inherit a nervous system predisposed or born wired with parents and past generations of trauma, and then further damaged by abuse they receive as a child? And then reinforced in a toxic family system that was handed down as well?
Great observations!
Dear Ruth et al,
This was such a very well-crafted episode!
Beyond the f/f/f methods of coping in the world…Cry-submit & please & Appease can be very tricky, I personally suffered with this in my early 20s not understanding what was happening. Now As a therapist It of course is a bit of a Blindspot therapeutically as to how to proceed… The understanding that this is may be a sympathetic state and not ventral or dorsal state was new to me and key to helping me know how to better approach and Assist this client, without further exacerbating this method of coping. Deb Dana is a refreshing, insightful voice in the polyvagal vein…
What was very helpful to hear and start learning more on:
Helping patients get out of the dorsal Vagal shutdown Response.
– being attended to it in patients and also monitoring your nervous system adaptation in session ( As the clinician therapists was truly enlightening to me.
I was reminded about how important it is to use language that fits the present state of the nervous system and how it can be counteractive to label or use language someone is not ready for. I really appreciated the understanding of the function of the three defensive responses of the nervous system and how psychoeducation/understanding these states is an effective way to thank that part for the various protections they provided and move forward with shifting to more of the ventral-vagal state.
Please/Appease (protect from further mistreatment)
Collapse (protect from the pain of present traumatic event)
Attach/Cry (allow for survival).
It is really helpful to think about the defensive responses in this way
I learned that it is possible to teach self-regulation to clients by practicing role-playing the 3 states of the nervous system with them during sessions.
PLEASE PLEASE stop referring to our clients as PATIENTS. It pathologizes and is condescending!
Yes I agree – please !
Thanks you!!
The term patient simply means: “a person seeking or needing the services of a health care professional.” As a nurse for these past decades, I don’t believe that my interactions with my patients have been condescending. That doesn’t mean that there are no physicians, nurses, or therapists who have never been condescending, no matter what they call the people they serve. Far more important is the mindset of the practitioner than the words we use. The dictionary meaning of client includes “anyone under the patronage of another; a dependent” – not what we mean by client in a therapeutic setting, either.
I think referring to individuals who seek treatment with mental health professionals as clients, makes it sound like a retail transaction. It minimizes the importance of mental health care practices. Isn’t this profession about treating mental health challenges/disorders whether neurological or behavioral? I’m not being sarcastic. I truly would like to understand why the term “clients” is the trendy term with many therapists. If there is no shame in seeking therapy, why mask the term identifying the recipient of such care? Or is this an attempt for political correctness or sensitivity towards patients? Please help me understand. Thank you!
I am learning much more about the please/appease response with myself–as well as new alternatives in my own relationships.
Thanks so much for this training!
Michele
This section encourages me to integrate more practicing with clients in the different nervous system states to build their tools and range.
I’m enjoying and beginning to use this program with my clients. I think it would be helpful if presenters who suggest relying on the therapist nervous system or helping client observe their own nervous system could be more precise in what we are looking for. If I say, “Today, my nervous system is telling me X”, what am I actually referring to? I am beginning to try to explain the nervous system function to a client who has a low educational background (in Spanish) and want to use language she can understand and absorb. Even the term “activating your nervous system” seems vague. I have gone over “high activation” and “low activation” but I’m not certain she understood it.
I also at times feel uncertain whether certain reactions in my client are parasympathetic or sympathetic reactions. For example, before she goes into “freeze,” is she in a sympathetic “fight or flight” state or is she in a parasympathetic “collapse” state. Or is it a brief sympathetic, “fight or flight” first, followed by parasympathetic?
NICABM is offering Stephen Porges’ Why the Vagal System Holds the Key to the Treatment of Trauma for 1/2 off as of 6/20/24 ($97). The Polyvagal Institute has resources in Spanish.
the simple wording I use is: relating, in relation (ventral), activated (sympethetic fight/flight) or depressed (dorsal). People will generally understand this. From there you could nuance a bit more (maybe).
Another great session, looking forward to tomorrow!
Question: is it possible/common to see the different survival responses in the same cliënt, in their different parts, as they have multiple trauma’s from different ages? (eary childhood, adolescent)
Janina Fisher recommends tracking ANS states and defense/survival responses to help identify parts.
Thank you very much for today’s broadcast. i found it very helpful. I often use strategies that I learned from you ti work with my many clients. Wirking with trauma is my passion.
I also need to ask a question. I bought your Gold package some time ago but don’t know how to acsess the material. Could you, please, advise. My email adress is verafl@aol.com Thanks beforehand.
Thank you for another thought provoking program.
I NEVER understand what Deb Dana is talking about. The others are clear but Deb’s language is ???????. I have no idea.
Deb’s work is based on a concept about a nonverbal part of the brain, the autonomic nervous system ANS, called Polyvagal Theory PVT. PVT posits that humans interact with others based on three ANS states: 1. ventral sociability-people are more safe than they are dangerous, try to attach. 2. sympathetic action-people are more dangerous than they are safe, try to flee or fight. 3. dorsal collapse-there is nothing I can do and no help is on the way, try to save energy and numb so as to not feel the pain. Deb teaches clients to regulate the ANS.
Maybe read Deb’s book, which is very accessible and provides many practical suggestions. it starts with a simply explained theoritical background, before she goes into the different therapeutic approaches. I used the exercises with myself to start with and found them very helpful.
I got so much out of today’s session. The practical applications are greatly appreciated as it is wonderful to understand the “theories” and “methodologies”, but having hands-on approaches discussed, such as recognizing when the response state is dorsal/sympathetic/ventral and how to work with them, was very helpful.
I also appreciate the reflection pieces on the therapists’ regulation and monitoring in response to these presentations from the client. Very informative and useful. Thank you!
I’ve been reflecting on the work I do with traumatized children and teens. Paying more attention to the interplay between sympathetic and dorsal vagal responses, especially with teens who can sometimes vacillate between the two very quickly. I’m also going to be utilizing more of those somatic strategies to help with the teens who are in collapse. I struggle the most with clients who are hypo-aroused and often can feel it in my own nervous system. When this happens I begin to feel stuck in session. But the somatic approaches seem like something I can lean into more, for myself and my clients. The attach/cry and appease responses show in many of my younger clients who fear getting in trouble or may appear clingy to the adults in their lives. I can use some of what I’ve learned to work with caregivers, explaining the underlying nervous system engagement and teaching responses that will help move the children to ventral vagal states.
Not a practitioner, a writer. I use this info to better understand my own responses to experience and those of people I care enough about to share info with them, when possible (they have enough background to take it in), and to try to improve relationships, with myself and them. The basics of the nervous system and its responses to danger, now that we know of them, should be taught from childhood, and to all adults who missed this knowledge growing up — i.e, most people, not forgetting heads of militaries. Familiar with the bare basics of the polyvagal theory, I esp. appreciate hearing from Deb Dana and understanding behavior through this perspective in particular. It’s all quite simple in theory, very complex in the living of it.
Outstanding session. I am wondering where we can find more information on how to distinguish between attach/cry and borderline personality disorder.
Also, how can we distinguish between ongoing collapse submit symptoms and the task paralysis associated with inattentive type ADHD?
great questions! also curious about the anwsers!
There is no need to ‘distinguish’ between attach/cry for help and BPD. All cases of BPD (unless it is a misdiagnosis) are trauma related, BPD is in and of itself a trauma-related disorder, all of it’s symptoms can be understood through the lens of trauma, and the disorder is tragically sitting in the wrong section of the DSM. There is no such thing as trauma survivors vs. ‘true’ BPD, that is a myth that was sadly upheld by her poor choice of wording…
I agree. BD is a trauma adaptation. It always amazes me that the DBT techniques are specifically supposed to be for clients with BPD, yet DBT therapists do not permit their clients to talk about trauma, and they terminate them abruptly if clients do NOT please and appease. I hear this time and time again.
As a pastoral counselor myself, I noticed you are a clergy person. I take these psychology courses on trauma to.more deeply understand the people served in homeless shelters and services. The volunteer or non-clinical staff work in shelters for homeless women, female teens, some with small children. Most are victims of various types of exploitation and have symptoms of PTSD, but no diagnosis is given. I have found that most untrained volunteers lack knowledge and clinical training to be effective. They often resort to rejecting the “clients” but dismissing them or refusing to provide care. Your points are exactly true and well-taken. Education is needed but I find that pastoral services are often regarded as incompatible with public Social Services. This is a misconception. There are many gaps to be bridged. These mini-courses valiantly help to bridge gaps. It is a vocation or “calling” to be a clinician
@ BPD & Attach/Cry, those were my thoughts. All clients with BPD have trsuma in their usually early years. Wonderful training.
Thank you for this very good session. It has opened up new insights for me. Especially the parts of setting bounderies as a therapist instead of pacing with (and plaesing) the client. I ‘m also inspired by how playful Pat Ogden works with the body in the here and now.
Our nervous system is like a book and if we can read it thoroughly through the client’s narrative we will learn so much more than the words they use. Powerful for us as Practioners but more importantly, an excellent tool for the client to utilize at any time in their life.
I really appreciated hearing the differences between attach/cry for help and Borderline Personality Dis. I am working with a few clients where BPD didn’t fit and this is such a lightbulb moment for me! Will definitely be more attuned for all three of these states!
Hi,
I’m so taken with the fact that, as a client myself in therapy, NONE of these obviously important elements in therapy are not discussed or seemingly any part of my own therapy sessions. I believe that my therapist isn’t aware of these ideas. She isn’t an LCSW or a Psychologist or psychiatrist. I work with my therapist through Zoom, so how would I find a truly knowledgable therapist in terms of the material discussed over these 3 days and onword, perhaps referred by your organization, to truly dig as deeply as is necessary for a deep therapeutic experience? I’m JoAnne Leff in NYC with email: jleff41@gmail.com and phone: 212 874 2835. Thank you for your informative broadcasts!!
Lots of very useful tips! Thank you. I value the polyvagal approach, specially adapting it to work with autistic adults, in order to recognize their own “collapse”, “pease/appease”,”cry for help” responses. I will start using pictures or other sensory inputs to acknowledge this mechanisms, and develop ways to engage and learn from their own nervous systems (build their own “dictionary”). Being different often comes with trauma, and this session was very helpful for me. As a therapist, I will be more aware of my own ways of setting boundaries & using “righ brain to right brian communication” when my clients shutdown.
Helpful to have concrete concepts for nervous system state – this was my second intro to the polyvagal theory, but now with application examples. Also appreciate the idea of both the client and therapist saying no and saying yes in all three states.
Thank you so very much for the last 3 Days. I have enjoyed, and learnt soo much. Sadly, at the current South African exchange rate, as much as i would love to own the package, it is just not viable, given our Economy. But thank u for the ability to share it and hear all the advice. Good luck and Good Therapy to you All.
Looking forward to the next 2 sessions. i will look for you all on Utube, and hope to find more bits of Gold there.