Hearing Baby's Unspoken Story INTERWEAVING EMDR, EGO STATE AND SOMATIC THERAPIES IN THE REPAIR OF VERY EARLY TRAUMA

Hearing Baby's Unspoken Story INTERWEAVING EMDR, EGO STATE AND SOMATIC THERAPIES IN THE REPAIR OF VERY EARLY TRAUMA SANDRA PAULSEN PH.D.

Why Important?  Trauma in attachment period disrupts  affect regulation  attachment and relationship expectancies  state switching capacity  These disruptions are the basis of many:  dissociative disorders  somatoform disorders  personality disorders  mood disorders  anxiety disorders

Repair is possible by interweaving  Ego state therapy to  deconflictualize the self system and  reduce loyalty to the aggressor  Somatic therapy to  resource the client  increase capacity for moment to moment tracking  decrease phobic avoidance of somatic and affective experience  enhance capacity to stay in window of tolerance  EMDR to  catalyze sequestered trauma and process it to an adaptive resolution  modified for working in attachment period in implicit memory using Early Trauma approach  special procedures for increasing affect regulation  Therapist attention to non-verbal communication to discern unspoken story i

Ego State Therapy  Deconflictualize the system by  Using Dissociative Table (Fraser) to give a voice to forsaken parts of self, and access internal dynamics, stabilize relationships between states  orienting alters to present circumstances (person, place, time)  softening the perpetrator introject to reduce loyalty to the aggressor (Paulsen, 2009)  orienting to same body, status of external perpetrator  appreciating survival function  reassure not getting rid of but updating, new way of functioning  repeated reminders  welcome into self system  experiment with loyalty to self instead of perpetrator  experiment with decrease self harm

Somatic Therapy  Somatic empathy - therapist's attunement to client's felt sense  Somatic resourcing - first without reference to body in dissociatives, share in experience of anything life enhancing  Somatic tracking  moment to moment awareness, similar to mindfulness  decrease phobic avoidance of sensation and affective experience  Somatic evoked oscillation  pendulating between trauma vortex and resource state, "nibbling around the edges," never going deeply  enhance capacity to stay in window of tolerance  Somatic micromovements to release thwarted sympathetic arousal once introjects allow it  other special procedures

EMDR Modified- Early Trauma  sufficient containment, stabilization, preparation  self system deconflictualized  fractionated by time frame, beginning from the beginning (O'Shea & Paulsen, 2007; Lanius, Paulsen & Corrigan, 2014)  not postulating its all memory, but some of it appears implicit memory  normal developmentall milestones  how would that have gone in your family  not narrative or verbal as much as somatic, affective nuance  special procedures - resetting affective circuits  repair in imagination "what would you have needed" (see Paulsen, O'Shea & Lanius, 2014, on alexythymic, imagination and affective circuits in Lanius, Paulsen Corrigan 2014)

EMDR - Resetting Affective Circuits  Based on:  Jaak Panksepp's seminal experimental discovery of mammalian hardwired affective circuits, present from birth, needs no learning RAGE, FEAR, PANIC, CARE, LUST, SEEKING, PLAY  Object cathexis not ego cathexis as reprocess each hardwired affect or defensive subsystem (Porges polyvagal systems)  need special procedures for dissociatives  Bringing neocortical resources to bear on subcortical affective circuits wtihout an affective load on the circuits by processing with objectivity  appears to repair intersubjectivity  decreases affective reactivity  decreases dissociative avoidance of affect  adjusts baseline of arousal downward, uniformly report "calmer"

Temporal Integration  Contrasts with Strategic Integration and Tactical Integration  Integration bottom up by time period  Still needs subsequent trauma repair done  Ego state therapy is most commonly used intervention  Once soma and affect tolerance is improved  Described in Lanius, Paulsen & Corrigan (2014).

Story Tells Itself - Therapist Attunement  Listening to the verbal of the narrative as revealed by alters  Listening to the verbals attributed to present time incorrectly (transference material)  Listening to the non-verbals in projective identification  Observing non-verbal behavior (facial flushing, fidgeting of extremities, tearfulness, switching)  Observing therapist mirror neuronal responses  Observing therapist intuition, what's emerging in energy field  Hypothesis testing how the pieces come together

Summary  Skillful interweaving therapeutic elements old and new  resourcing in diverse ways until readiness  deconflictualizing the self system, bringing it up to present circumstances  hearing story in the verbals and nonverbals  processing trauma by time period for temporal integration  repair in imagination to meet developmental milestones

Lanius, U., Paulsen, S.L., & Corrigan, F. (2014). The Neurobiology & Treatment of Traumatic Dissociation: Toward an Embodied Self. N.Y. Springer. Levine, P. A., & Gabor, M. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley: North Atlantic Books. Panksepp, J., & Biven, L. (2012). The archaeology of mind: Neuroevolutionary origins of human emotions. New York: W. W. Norton. Paulsen, S.L. & Watkins, J.G. (November, 2005). Best Techniques from the armamentarium of hypnoanalytic, EMDR, somatic psychotherapy and cognitive behavioral methods. International Society for the Study of Dissociation. Fall Conference, Toronto Paulsen, S. L. (2009a). Looking through the eyes of trauma and dissociation: An illustrated guide for EMDR clinicians and clients. Charleston, NC