Clients who have experienced serious trauma in their lives may reenact their trauma during therapy sessions. Because nothing therapeutic can happen whilst clients are reexperiencing trauma, it is important to be able to get them to separate themselves from the extreme response. Although neuroscience isn’t a therapeutic method in itself, it can help us understand which interventions need to be used in a clients reaction, dependant on the pathway in the brain the reaction has originated from.
When a reaction is triggered by a traumatic experience, the response will either be sympathetic hyperarousal or parasympathetic blunting. A client experiencing sympathetic hyperarousal will be highly emotional, have a lot of physical energy and they will struggle to self regulate or calm themselves down. On the other end of the spectrum is parasympathetic blunting – when a client will have little access to cognitive function, their physical energy will be very low as will their emotional levels. Understanding what happens in the nervous system helps us react appropriately to clients in either of these states.
Whatever your client may be going through, whether they have serious suicidal ideations, are extremely agitated, fully dissociated and numb or switching between states, in order for them to properly engage in therapy, you need to be able to help them separate from the extreme state that they are in. The ultimate goal for our clients who are experiencing either sympathetic hyperarousal or shut down is to get them to a place where they can observe what is happening internally for them. The way to do this is guide them to shift states, become mindfully present and feel safe enough to follow your guidance.
During sympathetic hyperarousal, the areas of our brains that can usually help calm things down aren’t accessible. They are offline. The therapist’s job is to help the client bring that part of their brain back online. This involves making sure you stay present and neutral throughout your client’s experience. In doing this, you will become the “shared rational brain” whilst your client is unable to access their own. As the rational brain you will need to greet their reaction with confidence and clarity and not allow yourself to react or become overwhelmed.
When clients are in any form of hyper aroused state it is important that you separate them from the feeling. If you try to focus on the emotion or sensations within the body, it is likely that you will increase the intensity of those feelings. If a client is highly aroused, you may want to ask them to take a moment to do something else – read something, check their emails or try to meditate. Anything that enables them to step away from their emotional state and eventually observe their reaction.
On the other end of the scale is treating a client who is experiencing parasympathetic blunting which ‘activates the dorsal branch of the parasympathetic nervous system.((Anderson, F. Responding to Extreme Trauma Symptoms retrieved from https://www.psychotherapynetworker.org/blog/details/1079/using-neuroscience-in-therapy accessed on 7th August 2019))’ When this is activated it will cause different parts of the brain to disconnect, or go offline, including the amygdala – which is the emotional part or the brain, the insula – which is the part of the brain which connects to the body and to our awareness and lastly the hippocampus, anterior cingulate, and prefrontal cortex all of which process the information we receive and allow us to respond appropriately to it. When all of these areas of the body are switched off we become totally disconnected from our own bodies, our feelings and our rational mind. As you can see a client who is experiencing parasympathetic blunting, they will appear completely different to a client who is in a state of hyperarousal. Because of this, the way you treat the client will also be very different.
‘Hypoarousal originates from lower, more primitive brain structures and works its way up to higher, more evolved structures, so bottom-up interventions make sense here, compared to top-down strategies with hyperarousal.((Anderson, F. Responding to Extreme Trauma Symptoms retrieved from https://www.psychotherapynetworker.org/blog/details/1079/using-neuroscience-in-therapy accessed on 7th August 2019))’ This basically means that with clients who are totally shut down, you will need to start working with the body and bodily sensations before you will be able to work on any sort of emotional experience or thought. Generally it will take a client who is in a state of shut down much longer to feel safe and engage with the therapy than a client in an aroused state. Knowing this, allow yourself to take your time, give the client control of the situation and go at the the speed that they dictate. Always remember that clients in an extreme state of emotional shut down will be responding to an internal sense of very serious danger.
It is often hard to remain neutral if a client is very overwhelmed, or sit with the client and allow them to control their session. It is natural to want to relate to empathise with a client if they are in an extreme hyperaroused state, but this may increase their emotional state. The same goes for trying to cognitively engage with a client in shut down. This is not something they will be ready or able to do and may actually just exacerbate their feeling of disconnection. Instead of resorting to our natural impulse to intellectualise what they are experiencing, encourage them to sense it deep in their body.
Using these interventions, guided by the knowledge neuroscience gives us as to the origins of the reactions, eventually your client should be able to move to a place they feel safe enough to engage with the therapeutic process.
