Praise for

Transforming The Living Legacy of Trauma

“Reading Janina Fisher’s wonderful, generous, and

beautifully written Transforming The Living Legacy of
Trauma reminds me of how much we, as a profession, have
learned in only three short decades. This book beautifully
articulates how mind and body adapt to intolerable feelings
of terror, self-loathing, and fear of abandonment with a
range of ingenious solutions to create some semblance of
safety and control. These adaptations endure over time, and
eventually tend to interfere with having satisfying
relationships with one’s self and others. Janina shows us
that healing traumatic wounds consists of learning new
habits of observation and self-discovery. The goal of
treatment is not so much digging up the past but the repair
of the injuries suffered as a result of traumatizing
experiences. It’s a marvelous and easily accessible work
that should be part of every therapist’s skill set.”
— Bessel van der Kolk, MD, President, Trauma Research
Foundation Professor of psychiatry, Boston University
School of Medicine author of New York Times bestseller
The Body Keeps the Score

“Written with her characteristic hopefulness and clarity, this outstanding

workbook showcases Janina Fisher’s unique gift of getting to the essence of
things. Complex theories are transformed into simple, easily understood, useful
concepts that teach clients to make sense of their symptoms, to befriend their
coping strategies, and to practice effective skills to relieve their suffering.
Perhaps even more noteworthy, this remarkable book will inspire the confidence
that healing is possible for even the most traumatized survivor.”
— Pat Ogden, PhD, author of Sensorimotor Psychotherapy: Interventions for
 Trauma and Attachment and The Pocket Guide to Sensorimotor Psychotherapy
“Fisher brings the most important concepts of trauma recovery to life—in both
words and diagrams—with simultaneous simplicity and sophistication. She has a
knack for communicating complex trauma-related ideas and information in an
economical and easy-to-understand way. And, as always, she offers her readers
hope and invaluable practical guidance.
With its easy-to-understand diagrams, powerful case examples, and crystal-clear
explanations of complex concepts, this book belongs on every therapist’s (and
not just trauma therapists) and survivor’s bookshelf. Fisher reaches out to her
readers with compassion and encouragement, offering a unique guide to
comprehensive healing.
Fisher’s diagrams and worksheets are being used all over the world by therapists
and survivors. They are a valued part of my personal trauma treatment toolbox.
In this book, she effectively couples these materials with user-friendly
explanations and case examples, bringing them fully to life for the reader. All I
can say is wow!”
— Deborah Korn, PsyD, The EMDR Institute, author of Every Memory
Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal

“In this succinct and well-organized volume, Janina Fisher distills the essence of
modern trauma theory and the deep wisdom of her decades of clinical
experience. The result is a welcome, reader-friendly primer for personal use or to
support professional work with trauma survivors.”
— Gabor Maté, MD, author of In The Realm of Hungry Ghosts: Close
Encounters With Addiction

“Renowned trauma recovery pioneer, Janina Fisher offers a superb, user friendly,
and comprehensive guide to healing for all trauma survivors and for therapists as
well. Grounded in expert knowledge of neurobiological, Transforming the
Legacy of Trauma walks readers step-by-step through an effective process of
deep, lasting change, looking both at childhood injuries and at lifelong
adaptations to them. Practical, smart, and wise, this book has the power to
change your life.”
— Terry Real, author of The New Rules of Marriage and founder of the
Relational Life Institute
“This workbook is an extraordinary gift for therapists and clients alike. With her
trademark compassion, Dr. Fisher succeeds in de-pathologizing and simplifying
the complexities of the cognitive, somatic, emotional, and behavioral residue of
trauma. Clients will be tremendously enlightened as they learn about the brain’s
ability to process, store, and remember trauma, how to identify and navigate
triggers and destructive coping strategies, the impact of disorganized attachment
and dissociation, and how to distinguish an unsafe past from an empowered
present. The visual aids make essential information readily accessible while the
worksheets and “parts” perspective replace self-blame and shame with newfound
insight, curiosity, self-compassion, and genuine healing. An absolute must-read
for every therapist who wants to be trauma informed, and a life-changing
workbook for trauma survivors!”
— Lisa Ferentz, author of Letting Go of Self-Destructive Behaviors: A
Workbook of Hope and Healing

“Janina Fisher has contributed meaningfully to trauma recovery in this

wonderful workbook. With her up-to-date approaches, practical techniques and
worksheets to help guide healing, this book is a must have for resolving deeply-
held trauma responses. I highly recommend it.”
— Nancy J. Napier, LMFT, author of Getting Through the Day, Recreating
Your Self, and Sacred Practices for Conscious Living

“Janina Fisher and I have long followed parallel paths promoting greater
attention to stabilization in trauma therapy. Here she furthers her careful,
educational, common sense, and resource-rich approach, filling a much-
neglected niche in the trauma self-help literature. Fisher successfully balances
illuminating commonalities of post traumatic conditions while encouraging
readers to select, portion, and pace individualized healing paths. This book
provides an excellent adjunct to any course of trauma therapy or personal self-
help.”
— Babette Rothschild, author of The Body Remembers, Vols. 1 & 2 (2000 &
2017) & 8 Keys to Safe Trauma Recovery (2010)
 Transforming the
Living
Legacy of
Trauma
A Workbook For
Survivors and Therapists

Janina Fisher, PhD

Copyright © 2021 Janina Fisher
Published by
PESI Publishing & Media
PESI, Inc.
3839 White Ave
Eau Claire, WI 54703

Cover: Amy Rubenzer

Editing: Miriam Ramos
Layout: Amy Rubenzer & Bookmasters

ISBN: 9781683733485
All rights reserved.
Printed in the United States of America
pesipublishing.com
 ABOUT THE AUTHOR

Janina Fisher, PhD, is the assistant educational director of the Sensorimotor

Psychotherapy Institute and a former instructor at Harvard Medical School. An
international expert on the treatment of trauma, she is the author of Healing the
Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation and is co-
author with Pat Ogden of Sensorimotor Psychotherapy: Interventions for
Attachment and Trauma. She is known for her work on integrating neuroscience
research and newer body-centered interventions into traditional psychotherapy
approaches. More information can be found on her website:
www.janinafisher.com.
 TABLE OF CONTENTS

Acknowledgments
Trauma Survivors: How to Use this Book
Therapists: How You and Your Client Can Use this Book

Chapter

1 The Living Legacy of Trauma

2 Understanding the Traumatized Brain
3 How the Brain Helps Us Survive
4 The Challenge of Post-Traumatic Coping
5 Recovering from Self-Destructive Patterns of Coping
6 Trauma and Attachment
7 Trauma-Related Fragmentation and Dissociation
8 Healing and Resolution

References
 WORKSHEETS
Chapter 1
1: The Living Legacy of Trauma
2: How Did Your Symptoms Help You Survive?

Chapter 2
3: Getting to Know Your Brain
4: How Your Brain Remembers the Trauma
5: Recognizing Triggers and Triggering
6: How Can You Tell You Are Triggered?

Chapter 3
7: Differentiating Past and Present
8: How Our Nervous System Defends Us
9: Trauma and the Window of Tolerance

Chapter 4
10: How Do You Try to Regulate Your Traumatized Nervous System?

Chapter 5
11: Tracking Your Abstinence/Relapse Cycle
12: Breaking the Cycle
13: How Working Memory Interprets Our Experience
14: Getting Help from the Noticing Brain
15: 10% Solutions

Chapter 6
16: Noticing Your Reactions to Closeness and Distance
17: Traumatic Attachment Patterns
18: Changing Our Attachment Patterns

Chapter 7
19: The Structural Dissociation Model
20: Identifying the Traumatized Parts
21: Signs of Structural Dissociation
22: Speaking the Language of Parts
23: Strengthening Your “C” Qualities

Chapter 8
24: The Four Steps to Freedom
25: In Which Phase of Recovery Are You?
26: Welcoming Your Younger Selves
 ACKNOWLEDGMENTS

It takes a village to write a book, and I am grateful to all the villagers whose
work has made mine possible. First, I want to thank the leaders of the trauma
treatment village, Bessel van der Kolk and Judith Herman. Without their
inspiration, determination, and unrelenting commitment, we would not have a
trauma treatment field or a worldwide community of trauma specialists today. I
first was inspired to devote my professional life to trauma when I heard Judith
Herman speak in 1989, and I still remember the words that changed the course
of my career aspirations. She said, “Doesn’t it make more sense that people
suffer because of real things that have happened to them than that they suffer
because of their infantile fantasies or their mental ‘illness?’” It did make sense
that real things had happened to my clients—real and terrible things.
The other words that changed the course of my life and work came from
Bessel van der Kolk: “The body keeps the score,” he asserted in 1994. Had he
not had the courage to say something that, at the time, was considered crazy, the
field would never have discovered the neurobiological source of what I call “the
living legacy of trauma.” Without his encouragement and mentorship, I would
never have become a voice for integrating these new ideas into trauma treatment.
Bessel, thank you from the bottom of my heart for making possible the privilege
of doing what I do.
Had it not been for Pat Ogden and Sensorimotor Psychotherapy, I would not
have known how to work with the body as well as the mind; would not have had
the opportunity to learn such a gentle, nonviolent treatment for trauma; and I
would not have had the incredible opportunities that Pat has generously made
possible.
But, most of all, if it had not been for the clients who have been my teachers
since the 1990s, I would never have come to understand trauma as I do. I would
not be able to speak for trauma survivors without having had such gifted and
generous teachers. I wish I could name you all by name, but I hope you know
who you are. Each one of you has taught me something reflected in this book.
I want to acknowledge my fellow “villagers” scattered all over the world.
Their support for me personally and for the mission we share has been
invaluable. In Italy, Giovanni Tagliavini and Paola Boldrini, beloved friends and
fellow travelers in this field, have worked tirelessly to improve the
understanding of trauma and dissociation and to create a community for Italian
trauma therapists. Trine Anstorp and Kirsten Benum, my wonderful Norwegian
family of friends, have devoted their entire professional lives to improving the
understanding of trauma in Norway. In Australia, my good friend Naomi
Halpern has worked tirelessly for over 20 years to bring cutting edge trauma
training to Australian therapists.
Writers also need friends and colleagues who are willing to nag, coax,
encourage, and then nag us some more until we finally get the book done. Dear
friends Stephanie Ross and Deborah Spragg are always my best naggers,
reminding me frequently that I have something to say and that it is about time I
said it. Deirdre Fay always had the vision for what I could do long before I could
see it, and I am deeply grateful that she finally convinced me to believe her! Lisa
Ferentz has always been my book-writing maven and role model. My thanks to
her and to our power women, Denise Tordella and Robyn Brickel. Thank you to
Terry Trotter, Sally LoGrasso, Phyllis Lorenz, Ellen Odza, Marilynne Chophel,
and the rest of my Bay Area Sensorimotor Psychotherapy community for being
such very vocal encouragers. And then there is the younger generation: My
thanks to Maren Masino for making my work better and always reminding me
that I have something to say that needs saying.
An author invariably needs other eyes and ears to help communicate on
paper what is so clear in her mind. My thanks to Audrey Fortin for reading
portions of this manuscript and giving me such very helpful feedback and to
Linda Jackson, my publisher, for her unwavering support over many years. I am
also deeply grateful to John Braman for his wise, mindfully-informed guidance
in all things.
A very, very special note of gratitude to my amazing and gifted editor,
Miriam Ramos, whose attention to detail helped to make this book far better than
the one I first wrote. Her therapist mind always saw what needed to be said more
clearly, while her editorial eye caught every error and repetition.
And then, last but hardly least, I want to thank my family: Jadu and Wendy,
Jason and Kelli, and my amazing granddaughters Ruby and Nika. Thank you for
always being there, for taking such good care of your aging mama and
grandmother, and for putting up with this book! Writing a book is always a
family sacrifice. My love and my heartfelt thanks to all of you.
 TRAUMA SURVIVORS
HOW TO USE THIS BOOK

This book was written for you.

Even though you are not responsible for the traumatic events you endured,
you have been left to manage all the challenges of recovering from those
experiences. Worse yet, there is no road map for understanding how you are
affected by what happened or to guide you in recovering. That is the purpose of
this book—to provide you with a map and detailed directions for the journey
ahead based on the latest understanding of trauma and its effects.
Thirty years ago, it was thought that traumatic experiences could be healed
when the secrets were finally revealed and the story of what happened was told
to a safe, validating witness. However, contrary to what we believed then, that
process often made the traumatic effects worse instead of better. I remember
thinking at the time how unfair that was. Why should it take more suffering to
heal from what someone had already suffered? No one else seemed to question it
because it was the only map we possessed in the 1990s, even if it was not getting
survivors any closer to the destination they wished to reach.
My first teacher in the field of trauma, Judith Herman, believed something
different: She was adamant that what survivors needed was information. They
needed to be educated about trauma and all its ramifications and manifestations.
They needed to know enough to make intelligent choices about their lives and
treatment. It was important, she said, for survivors to be full collaborators with
the therapist rather than passive recipients of therapy. As victims of trauma, they
had been disempowered and deprived of choice. The antidote, said Judith
Herman, was the power of knowledge, some way to understand the baffling and
intense reactions that had plagued them, often for years, so they did not feel so
crazy and abnormal. However, there was one problem. As you will read in
Chapter One, threat and danger automatically shut down the part of the brain that
has the ability to think, plan, and remember. Thinking takes too long; instinctive
survival responses are quicker. The body operates on the principle that it is better
to start running now than to stand around wondering how to get out of danger.
You might have noticed that new information, even if reassuring, is difficult
for you to process. That is because a traumatized brain, conditioned by years of
abuse, shuts down each time you are triggered, every time you feel vulnerable,
threatened, or even hear someone say the word trauma. In trying to find ways to
get around this problem, I discovered that it helped to draw pictures of what I
was trying to explain. These simple images seemed to wake up the thinking
brain and, suddenly, it would become possible to focus more easily. Even
adolescents found it easy to understand information about the brain and nervous
system when it was communicated by way of these simple diagrams.
This workbook was written to support you, with or without the help of a
therapist, and to educate therapists and survivors together about the latest
understanding of trauma and its effects on the body and brain. Although I would
recommend using this book with a trauma-informed therapist, it can also be used
entirely on your own. Not all survivors have access to specialized trauma
treatment or sometimes to any treatment at all. Either way, having a guidebook
that you can use on your own has many benefits, too, even when you have the
availability of a skilled therapist.
One of the many consequences of trauma is a loss of trust in human beings.
Fear of vulnerability, a phobia of dependence, fear of self-disclosure, and careful
avoidance of sadness and anger are also common symptoms. Each of these fears
is adaptive in a world in which even a child’s caretakers are not to be trusted,
where tears or anger are punished, emotional needs are exploited, and
dependence is dangerous. But having had these experiences makes trauma
therapy very challenging. We cannot avoid all vulnerability in therapy; we
cannot prevent perfectly normal feelings of dependency or the wish to depend
from spontaneously coming up; we cannot outlaw tears or anger.
Therapists understandably want their clients to trust without always realizing
how difficult it is to trust anyone when every instinct in your body is saying,
“Danger, danger—do not believe this person—do not trust.” I found that
education about trauma helped my clients because it gave them factual
information coming from research and writing. I was not asking them to trust me
or my opinions. I was asking them to trust facts. Trusting information was much
easier for most of them than trusting me as a person. They felt validated by the
diagrams and relieved to learn that their actions and reactions were normal ones.
And the more often I gave my clients copies of these diagrams as homework, the
more it seemed to help them stay centered and stable between weekly therapy
sessions.
This is the threefold intention of the workbook: to help you make sense of
your most confusing, puzzling, and even shameful symptoms; to support your
recovery by providing you with ways to recognize the living legacy of traumatic
experience as it affects your day-to-day life; and to practice new habits of
response.

SOME SUGGESTIONS FOR HOW TO USE THIS BOOK

This book is not a book about dealing with traumatic memories. It is intended to
help you recover from the effects of trauma: the physical effects, the emotional
effects, and the changes in belief it creates. You may not yet know all the ways
in which you have been affected by your trauma, but I encourage you to assume
that any highly distressing or overwhelming emotion that you do not understand
might be a trauma symptom. Consider the possibility that self-destructive
impulses, critical or fearful thoughts, or feelings of numbness or disconnection
might also be the effects of trauma. I have found that trauma survivors suffer
from too much emotion, even if they cannot feel it. Having no emotion at all is
the reaction of the body to feelings that exceed our ability to tolerate. If you are
alive, then you are feeling—even if you are numb and cut off from your
emotions or your body.
Take your time with this book. It will not be helpful if it overwhelms you
or shuts you down. Do not feel that you have to read the whole thing, and do
assume that feeling pressure to rush through it is probably trauma-related. I
would advise reading a chapter at a time, taking some days or weeks to make
sense of that section, doing one worksheet, seeing how that feels, then trying
another one. If a worksheet is helpful, make several copies and keep filling them
out, especially when times are challenging for you. The right ones can be a way
to keep your head on straight, to help you stay centered and know where you are.
If a worksheet is too triggering or makes it hard to think, just put it aside and
leave it for another time, or skip it completely.
You do not have to get an A in this course! This book was designed to be
your ally in healing—not another pressure or burden or goal.
 Do more of what speaks to you, and give yourself permission to do less
with sections that are more difficult or less relevant. A workbook inevitably
includes information that is very timely and relevant to you, as well as
information that seems too obvious or simply unrelated to what you are
experiencing. Instead of trying to go through the book section by section, in the
order in which it is written, give yourself permission to pick and choose.
Learning to pay attention to what you need in the moment is an important skill in
recovery.
But also, be curious if you have strong negative reactions to certain sections
in this book. Without putting yourself under pressure to figure out why, assume
that a strong negative reaction means that some fear or trauma-related resistance
has been triggered. Resistance should never be considered a negative reaction—
it simply means that we feel threatened, and being curious about any feelings of
threat or danger is always illuminating. It does not mean that you have to address
those sections—just be curious about your mistrust or aversion. If you can, try
out worksheets even if you do not like them. Give them a “test drive” to see if
they are as bad as you think. Try out things you do not like and see if they help.
If they do not, or if they are overwhelming, give yourself permission to go on to
something else. You can always return to skipped sections or worksheets later
and see if they have gotten any more relevant or less difficult.
Remember that traumatic effects and symptoms are not something you asked
for or something you can control. However, understanding them will help you
live more comfortably in your own skin.
Trauma impacts human beings in very specific ways because we have a brain
and body designed to prioritize survival. Our bodies and brains adapt to trauma
by instinctively developing anticipatory patterns meant to protect us against the
same dangers repeating themselves again. If you are feeling overwhelmed or
tortured by the symptoms (depression, hopelessness, flashbacks, fears and
phobias, fears of abandonment and/or closeness), remind yourself that each of
these reactions represents a survival strategy. Flashbacks keep us on guard;
depression and hopelessness shut us down so we are better at being seen but not
heard; fear restricts our relationships and our freedom to act; shame makes us
retreat into invisibility. Each symptom represents a way your brain and body
adapted to a chronic condition of threat. When you are frustrated by the living
legacy of trauma, blame your brain and your nervous system, not yourself!
 Never push yourself or try too hard—but do not give up either. Because
survival is an effort, because it includes being pushed to the limits and having to
“keep on keeping on,” healing should be as easy as possible. Giving up is not
healing. Neither is self-judgment. But making a choice to go slowly and easily,
to never force anything, to challenge yourself without pressure or judgment, are
important principles in healing work. There is no right or wrong way to use this
workbook. Faced with something you long to avoid, take your time to be curious
about the impulse to avoid, wonder about it, and then make a thoughtful choice
about tackling it versus following your impulse to ignore it. You might decide to
ignore it for now, tackle it to see what is so threatening, or just pass over that
section.
Last but not least, I wish you well on your journey toward healing and
recovery. My professional mission for almost 40 years has been to increase
international awareness and understanding of trauma and to support treatments
that resolve the post-traumatic living legacy with which trauma survivors are
burdened long after they have survived.
I am glad you survived, and now it is time to heal. I hope this workbook will
help you on the way.
 THERAPISTS
HOW YOU AND YOUR CLIENTS CAN USE THIS BOOK

Transforming the Living Legacy of Trauma was inspired by the ideas of the two
most influential pioneers in the trauma field: Judith Herman and Bessel van der
Kolk. I was fortunate enough to have Judy Herman as a teacher in the early
1990s and even more fortunate to have Bessel as a long-time colleague/mentor
beginning in 1995, just at the start of the neurobiological revolution that
transformed our ideas about what it means to treat a trauma. Research on
traumatic memory, inspired by Bessel van der Kolk’s theory that “the body keeps
the score,” helped to change the direction of the field from event-centered to
experience-centered, from emotion-centered to brain-centered. As the goals of
trauma therapy transformed and as we better understood the long-term impact of
traumatic experiences, it became increasingly clear that new approaches were
needed—approaches that felt less overwhelming and more empowering for those
we were trying to help.
But it was not just the leaders and pioneers who changed the direction of the
trauma treatment field—it was also the survivors.
Focused on retrieving memories of events and sharing these stories with a
non-judgmental witness, the early treatments for trauma never had the effect
therapists and clients initially hoped. Traumatized clients taught us that telling
their stories was not the relief they were led to expect. The overwhelming
emotions evoked were not consistently of therapeutic value because they
exceeded most individuals’ capacity to feel. Telling the story and feeling their
emotional responses was often experienced as re-traumatizing and disturbing
rather than healing. Many individuals did not recall the stories they told because
they could not speak of the events and stay present at the same time. Many more
could not feel or remember being witnessed. Judith Herman was very alarmed
by what she observed in her clients as they told their stories. Some became more
self-destructive and suicidal, began using drugs and alcohol to manage their
overwhelming feelings, or could no longer function. She was adamant that
treatment for trauma should not cause more suffering or further disrupt the lives
of those who had suffered so much.
So, like many of the early leaders in the field, she turned to an idea first
proposed by Dr. Pierre Janet in the late 1800s: a phase-oriented treatment model
in which client and therapist concentrated first on stabilizing the symptoms and
emotions, developing a foundation for clients that would allow them to address
the traumatic past from a position of strength (Herman, 1992). As a feminist, she
was particularly attentive to issues of power and privilege, and, concerned about
the inherent inequality of the therapeutic relationship, she developed an
approach that began with educating the survivor to become an expert on trauma.
The goal was to equalize the balance of power by equalizing knowledge: If the
survivors knew what the therapist knew, then they could be more like equals in
trauma work. In 1990, this was a radical idea. In that era, psychoeducation had
no place in the psychotherapy world. It was considered too intellectual—it was
not therapy.
Nonetheless, as a postdoctoral fellow in Judith Herman’s clinic, I was
expected to learn how to provide psychoeducation that would normalize the
feelings and symptoms that tormented my clients. Normalizing their suicidality,
their self-harm, their hopelessness, their tendency to isolate, their mistrust, and
their fear of abandonment would lessen the shame, she believed, and help them
to experience themselves as ingenious survivors instead of humiliated victims. It
was not always easy, but I rarely encountered clients who objected to this
education as long as it was embedded in empathy—not so much empathy for
their vulnerability but empathy for how they had survived. Psychoeducation
made it easier to tolerate acknowledging what they had been through without
having to explore all the details and reexperience the overwhelming emotions. It
made it easier to hope, made it easier to believe they could recover. After all,
they had survived!
The next important lesson I learned was in Bessel van der Kolk’s clinic. The
focus at his clinic was not so much on specific events but on the cumulative
impact on young children of separation and attachment failure, neglect, abuse,
and domestic violence. It was rare for our clients to have had one single
traumatic event. Most had endured multiple events at the hands of several
different perpetrators in a context of neglect and attachment failure. As a
supervisor sitting in on Bessel’s clinical team meetings, I was privy each week to
the new information about the nature of trauma that emerged as a result of the
first brain scan research studies. His first study on the nature of traumatic
memory demonstrated that, when subjects recalled a traumatic event, the
prefrontal cortex (especially the areas in the left hemisphere responsible for
verbal memory and expression) became inactive, while nonverbal areas of the
brain (the limbic system, specifically the amygdala) become highly active. In
other words, these individuals lost their ability to remember in words and began
remembering physically and emotionally. The research finally made sense as to
why so many of our clients had traumatic amnesia for the events they had
experienced and why, at the same time, they were so symptomatic. They were
experiencing their trauma as sensory fragments without words (van der Kolk &
Fisler, 1995, p. 516), divorced from any chronological memory of the event.
These nonverbal, sensory elements of the traumatic experiences were
sometimes the only record left of what had happened, constituting a living
legacy that could not be resolved because the feelings and physical reactions did
not feel past—they felt very present, here and now. Even the client’s symptoms,
the very reasons for seeking treatment, were usually evidence of traumatic
memory at work. Mary Harvey, Judith Herman’s colleague, used to say, “Trauma
survivors have symptoms instead of memories” (personal communication,
September 23, 1990). Bessel van der Kolk’s research was proving her correct,
but most clients did not know they were remembering when they felt afraid,
ashamed, enraged, or frightened. And most therapists did not know either.
In this context, it became even more important to educate my clients about
their symptoms and reactions. But now psychoeducation meant trying to explain
how their brains worked. And we would have to try to explain these complex
concepts even though the research showed that working memory and capacity
for verbal expression were impaired by the trauma responses. In order to
simplify this complicated information and make it accessible to my clients, I
discovered through trial and error that it helped to draw simple diagrams so that
there were fewer words to process.
To my surprise, most clients could understand my “Brain Science for
Dummies” approach, and they were also able to focus more easily when I
depicted the concepts through the drawings than when I put them into words. In
fact, the fewer words I used, the better it was for them! And then, thanks to a
colleague who asked me to publish the diagrams so that she and others could use
them, I created the first flip chart and named it “Psychoeducational Aids for
Treating Psychological Trauma.” It had to be a flip chart because
psychoeducation is a collaborative task. It requires that both client and therapist
be able to see the diagrams together. It had to stand up on an easel or stand so
that it did not require physical closeness to see the same page, and it had to be
big enough to be visible to both parties.
Ten years later, this workbook is being written to accompany the flip chart,
explain the diagrams more fully, and provide some strategies for addressing
trauma responses that can be used in therapy sessions or at home.

USING THE WORKBOOK WITH YOUR CLIENTS

My first and most important recommendation to the therapist is: Slower is
faster.
Evoke the client’s interest in these ideas before recommending or
assigning the workbook. Psychoeducation does not have to be academic—it can
be very relational. And that includes attunement to the client’s state and interests.
If I recommend the workbook before creating a rationale for its use, the client is
less likely to actually use it. If I ignite clients’ curiosity or interest, they will be
motivated to explore its contents. And the easiest way to evoke curiosity is by
showing the client the first flip chart diagram: “The Living Legacy of Trauma.”
When I introduce the flip chart, I usually start by saying, “Can I show you
something that might help you understand why things have been so difficult for
you? Why you have been feeling crazy? Why it has been so overwhelming?”
Then I show them the first diagram, Figure 1.1 on page 14, because it tends to be
relevant to most clients’ troubling issues and symptoms. Neither the flip chart
nor the workbook, however, have to be used sequentially. In fact, this work has
much greater therapeutic impact if it is employed as an empathic response in the
moment to something troubling or baffling to the client. Luckily, the first
diagram is easy to use in that way.
Because it is important that the flip chart and workbook feel relevant and
relational, I suggest that therapists read the workbook first (or at least the first
few chapters) so that they are familiar with the topics it addresses. That makes it
easier to react spontaneously to clients’ needs in the moment and to convey
genuine interest or excitement about how a concept or chapter might speak to
them.
 The relational value of the therapist’s being able to connect the client’s
immediate need to some relevant information in the flip chart or workbook is
very powerful. Traumatized individuals have generally not had the experience of
a spontaneous, attuned reaction to their feelings and needs. When we are able to
make a connection between the distress clients are experiencing now and a larger
context that validates or normalizes what they feel, it is very reassuring.

Carla came to her first appointment in a highly dysregulated

state. She sat on the edge of her chair, agitated, trembling,
speaking so fast she could barely get the words out. Confused and
overwhelmed by the trauma-related responses that had suddenly
begun flooding her mind and body, this high-functioning
professional sought help from several different therapists, but
talking about her traumatic childhood had only increased the
intensity of her symptoms and emotions.
First, I had to validate and normalize her experience. I had to
meet Carla where she was and educate her about what was going
on. “You are flooded—that’s what’s wrong,” I told her. “Your
body and nervous system are so highly activated you cannot think
straight.” She agreed, “The only time I feel any relief is at work
—for a few hours at least.”
“Yes, that makes perfect sense,” I said, validating her again.
“The traumatic activation is shutting down your prefrontal
cortex. You get relief at work because your job stimulates your
prefrontal cortex. Can I show you?” She nodded, and I opened
the flip chart to the corresponding figure and turned it to face her.
Immediately, I could see her begin to focus and her body calm a
bit as she did so. “The brain remembers overwhelming
experiences primarily as feeling and body memories, not so much
as events—that is what has been overwhelming you. You must
have thought you were going crazy!” I spoke the deepest fear
most trauma survivors have and then used the flip chart to
reassure her. “But this is normal—because as you see here,
traumatic experiences are recorded in this little area called the
‘amygdala,’ and that is why the symptoms are so intense. You are
not getting pictures or flashbacks—you are getting these
 emotional and physical reactions that overwhelm you because
they are traumatic memories. And then your frontal lobes shut
down! So, you have all this anxiety in your body and no way to
make sense of it.” I could see Carla’s agitation decreasing bit by
bit as she listened and looked at the diagram. “You will feel
better if we can keep your frontal lobes online—like they are at
your job.” Carla answered, “I am interested in anything that will
help me stop feeling this way!”

Always wait for the client to show interest before suggesting any
intervention. Traumatized individuals like Carla are very sensitive to how they
are met by others, and prematurely recommending this workbook or any other
intervention may actually discourage their interest. Try to find a reason coming
from the client’s expressed concerns that necessitates its use: “If this way of
understanding trauma makes sense to you, you might be interested in the
workbook that goes with this diagram…” or “If this feels validating, you might
also like the workbook…” Notice that I do not directly recommend the
workbook. Instead, I mention that it is a resource and leave it to the client to
express some curiosity about it. Or I could just have it sitting on my coffee table
so the client sees it each week and becomes curious about it. I could also refer to
it as we go along: “This reminds me of something in this workbook… Can I
show you?” Or I share with the client, “I have been reading this workbook and
thinking that you might find it helpful—could I show you something from it?”
Remember that trauma is the experience of being forced to do what
others want. It is therefore very important in trauma treatment for the therapist
to offer choices, even when we feel certain in our own minds about what would
help the client. Some clients will only want to read the text, whereas others will
love the worksheets and be eager to use them. Some will have a negative
reaction to the word homework, especially if they have had learning disabilities
or painful educational experiences. If they fear failure or shame, you might
suggest that the two of you experiment to see if a worksheet is useful. You might
read a paragraph that speaks to what the client is experiencing, and then you and
your client could fill out a worksheet collaboratively and see if the client finds
either of any value. The less pressure we put on the client, the more collaborative
the treatment will feel. The more easily we can laugh at ourselves if a diagram or
worksheet is not useful and blame ourselves for guessing wrongly, the more
willing most clients will be to try the material another time. And if they feel
validated by the flip chart, the more willing they will be to see if the workbook is
also validating.
“Bite-sizing” information is crucial. Remember the effects of traumatic
activation on the thinking brain, as Carla attests. Our clients cannot process too
much information at a time, so we have to give them small pieces to absorb
before introducing the next piece. Each diagram presents a different concept and,
in most cases, it is better to introduce only one concept per session or, at most,
two related flip chart pages. “Slower is faster” is the expression I learned about
trauma work early in my career, and it is a reassuring expression even for clients
who are in a hurry. If I bite-size new material, the client can really take it in or
get interested in it, and we will progress more quickly in the end. If I present too
much information and it overwhelms the client, it will slow us down. The client
may become averse to more new information or have a harder time trusting me
when I want to present even more psychoeducation.
Do not be task-oriented in the use of this book. It will be of more value to
the client if it is used as a resource rather than an end in itself. It is meant to
support the effectiveness of any trauma treatment using any method, so it is
crucial that the client experience it as a resource and an ally. The workbook can
be used in the preparation phase for Eye Movement Desensitization and
Reprocessing (EMDR; Shapiro, 2001) or for body-centered methods, such as
Sensorimotor Psychotherapy (Ogden & Fisher, 2015) and Somatic Experiencing
(Levine, 2015). It can be helpful in stabilizing clients prior to any type of trauma
processing or simply in helping them regain their ability to function. If you are a
therapist working with a limited number of sessions and feeling the pressure to
get a lot of work done in a short time, you might introduce the book as a way of
maximizing the time you have or carrying on what you and the client have
started even after the ending of this phase of treatment. Stabilization and
education are of even greater importance when therapists are working under
short-term therapy constraints. But just keep in mind that too much information
at one time will discourage, rather than inspire, the client. The goal is to equip
survivors with psychoeducation that helps them manage their symptoms and
triggered responses, supports their emerging life after trauma, and validates their
experience without requiring that they remember all of its horrifying details.

ENGAGE THE CLIENT IN MUTUAL EXPLORATION

The workbook will have greater impact if it is connected to the therapeutic
relationship. Rather than assigning the book as reading material for therapy,
which can feel distancing, use it together as a shared resource or guidebook for
therapy.
Remember that, as the therapist, you are more likely to have a prefrontal
cortex that is not inhibited by traumatic activation. Your ability to absorb new
information and generalize or apply it will be greater than the client’s. Do not be
afraid to help clients think about these ideas. You will not be doing the thinking
for them. You will be stimulating their own brain activity. Make use of the flip
chart and workbook as a shared experience. Do not hesitate to offer your
personal perspective: “This is what I get from this page. You actually do not
have poor judgment. Triggers shut your thinking brain down, and the feelings
and impulses just take over. Does that make sense?” Or ask clients about their
perspective: “Can you relate to this page? Do you notice this in your own life?
How does this apply to you?” Or even: “I was thinking about how much this
applies to your experience. Do you get that same feeling?”
To the extent possible, reference the ideas throughout therapy sessions. “As
you talk about this, how is your nervous system doing?” or “Is this too triggering
for your frontal lobes? Are they getting a little overwhelmed?” or “It sounds as if
your amygdala really freaks out around people who are very loud—especially
men. And then does your thinking brain shut down?” One of the difficulties
experienced by trauma survivors is the failure of the traumatized brain to
integrate past and present, safe now versus dangerous then, regular feelings
versus triggered trauma-related emotions. The more the workbook materials
become part of the conversation in psychotherapy, the more easily clients will
integrate what they learn.

MANAGING NEGATIVE REACTIONS TO THE FLIP CHART OR

WORKBOOK
Invariably, some clients will be triggered by the flip chart, the workbook, or
both. Some might see the word trauma in a title and immediately feel triggered.
Some will associate psychoeducation with negative school experiences of being
humiliated as “stupid” or shamed about their “lack of education.” Some
experience psychoeducation as “being lectured to” or “being in school.” Longing
for relief and a feeling of unconditional acceptance in therapy, some clients can
be irritated by what feels academic instead of caring. Expect that some clients
will refuse to use the chart, the book, or both—or be unable to use either because
they are too triggered and dysregulated. On the other hand, some clients will find
these two tools indispensable: The visual images of the flip chart will enable
them to focus even when spacey or overwhelmed, and they are more likely to
feel validated by the information and better understood. Survivors of trauma
email me constantly to thank me for the flip chart and to tell me how much it
means to them. But do not be surprised when other clients ask you to put one or
the other away so they do not have to see them!
There is no need to struggle with any client over the use of these tools. It is
best to validate clients’ negative responses but to ask them to be curious as well:
“Wow, so this is really triggering, huh? What gets triggered when I show you the
flip chart (or the worksheet)?” or “Thank you for telling me why it is so
triggering—I get it now” or “What a shame that it reminds you of school and the
torture of having dyslexia back at a time when no one recognized it! It is too bad
because the book does help a lot of people—if it is not too triggering.”
With some clients, I might tell the story of how Judy Herman discovered the
importance of educating trauma survivors to be full collaborators and to ask their
opinion about her ideas. With other clients, I may try to offer the same
psychoeducation but without the use of the flip chart or the workbook: “Your
nervous system really reacted, huh?” or “I bet your thinking brain just shut down
—you probably did not have a chance to think before it just went off like a light
bulb—that is what happens to trauma survivors.” As the therapist, you can still
familiarize yourself with the flip chart and workbook and use the same concepts
in talking to the client: “Of course, you do not remember many of the events of
your childhood, but you remember a lot: the fear of the dark is most likely a
memory; the shame must be a memory—and the hopelessness and the feeling of
being inferior or at fault. You have a lot of feeling and body memories even if
your brain does not remember many events.”
Last but not least, when the client is not ready for a particular intervention,
the therapist can do what wise parents learn to do: Wait for a more opportune
moment or find another way to introduce the same concept. I can put the flip
chart or workbook away, then bring it out a few weeks or months later, or I can
reference it periodically: “It is a shame the workbook is so triggering…” or “It is
too bad that the flip chart reminds you of school and those mean teachers…” or
“If I did not know how triggering it is, I would bring out the flip chart right
now… but is it okay if I tell you about trauma and the brain?” And if the client
says no, then I have to accept that decision. I can be transparent and say, “I
would rather you know what is happening inside you so it is not just me that
knows, but you are in charge of these decisions about your own treatment, and I
can respect that.”

USING TRIGGERS AS AN OPPORTUNITY TO PRACTICE THE

SKILLS
Some clients will want to use the flip chart and/or workbook but then find
themselves triggered by certain words, ideas, diagrams, or worksheets. Or the
client may come to sessions chronically triggered or triggered by some specific
experience earlier in the day. If either occurs, you have an opportune moment to
use the book to help the client manage and learn from the experience of being
triggered. A workbook is not a textbook. Finishing it is less important for clients
than is gaining practice in using its concepts and skills to help themselves when
triggered or flooded. For example, if the client is obviously triggered in a session
(e.g., highly anxious, reactive, angry, defensive or spacy, numb, and shut down),
Worksheet 6 can be very useful because it focuses on the client’s ability to
identify being triggered. Worksheet 5 is very appropriate if the client is
chronically triggered. As therapist, I might point out, “You [or your body] are
really triggered today, huh? Have you been triggered all day? Did you wake up
triggered this morning? Or did something trigger you in the course of the
morning?” Then I might suggest, “Let us work on a trigger log together—that
will help you anticipate a lot of the triggers so they do not catch you by
surprise.” We can start to fill out the worksheet in the session, and then I can
suggest that the client take it home and keep working on it.
Because the ability to recognize triggered responses and to differentiate real
and present danger from a triggered sense of threat is so crucial to trauma
recovery, time spent on these issues in therapy is always valuable. There is no
rush to go on to other chapters and topics if the client’s primary challenge is
sensitivity to triggers and difficulty managing triggered responses. In trauma
recovery, certain issues (and thus certain sections of the flip chart or workbook)
may take center stage for months and months, and then other issues and chapters
might become relevant—but not necessarily in the same order as a table of
contents. Always go where the client’s needs and difficulties take you, for better
and for worse, and use the book accordingly.
 The psychotherapeutic skill of attuning to the client and using your presence
to help clients stay present and tolerate their distressing emotions is at the heart
of all therapy. Using the workbook in an attuned, flexible, responsive way is key
to its success and to its meaning in the client’s life. For me as a therapist and
author, the client’s connection to the book, the felt sense of it as a support or ally
in the battle to overcome the traumatic past, is even more important than its
completion. I want survivors to feel my presence, as well as yours, urging them
on and holding the conviction that they can do it—they can heal. We are on their
side.
 1
The Living Legacy of Trauma

Once thought to be a rare event, we now know that traumatic experiences

happen to millions of human beings every year. Whether the trauma is long-term
exposure to a traumatic environment (e.g., child abuse, domestic violence, war)
or a single catastrophic event (e.g., terrorist attack or car accident), all human
beings are vulnerable to trauma or impacted by the trauma experienced by those
they love. What most individuals do not know, however, is that a traumatic
event is not over when it is over—even if we have successfully survived.

RECOGNIZING THE LIVING LEGACY OF TRAUMA

The effects of trauma often endure for weeks, months, years, even decades
afterward. It is a living legacy.
Unlike the feelings we have about relics of the past, such as a grandmother’s
vase, a father’s watch, or a mother’s ring, a living legacy is not recognizable as
an antique. The living legacy of trauma manifests in intense physical, perceptual,
and emotional reactions to everyday things—rarely recognizable as past
experience. These emotional and physical responses, called “implicit memories,”
keep bringing the trauma alive in our bodies and emotions again and again, often
many times a day. Reactivated in day-to-day life by apparently harmless
reminders related to the original situation or situations, our bodies tense up, our
hearts pound, we see horrifying images, and we feel fear, pain, or rage. We
startle as if facing Godzilla even in the safety of our own homes, or we feel a
sudden wave of painful shame and lose the capacity to speak. We feel loneliness
and heartache even when surrounded by people who care about us, or we
experience the desperate impulse to run away and hide from them. If past
traumatic events occurred in the context of family, home, neighborhood, and
close attachment relationships, those arenas will become a land mine field of
potential triggers that can be tripped by the simplest daily routines—even
waking up, eating breakfast, taking a shower, brushing one’s teeth, or going to
work or school.
Worse yet, there may be no event or picture to which we can connect these
nonverbal memories. Decades of research on the effects of trauma confirm that
overwhelming experiences are less likely to be recalled in a clear, coherent
narrative or a series of pictures that we can describe. Trauma is more likely to be
remembered in the form of sensory elements without words (Ogden, Minton, &
Pain, 2006)—emotions, body sensations, changes in breathing or heart rate,
tensing, bracing, collapsing, or just feeling overwhelmed. When implicit
memories are evoked by triggers or “landmines,” we reexperience the sense of
threat, danger, humiliation, or impulses to flee that we experienced at the
moment of threat—even if we have no conscious verbal memory of what
happened.
However, trying to think of a particular event to which these reactions might
be connected is unlikely to bring much relief. Often, making the connection to a
single event in the past intensifies the painful physical and emotional responses
and sense of feeling overwhelmed. Without understanding their meaning, most
individuals assume that something is wrong with them or with the current here-
and-now environment: “He scared me” or “She shamed me,” they conclude,
“This is not a safe place.” Or they interpret the intense, baffling responses as
meaning, “Something is wrong with me” or “I am losing my mind.”
Trauma does not just leave behind terrible memories that disrupt the sleep
and waking lives of survivors. The living legacy of trauma consists of a gamut of
symptoms and difficulties, most of which are unrecognizable as trauma-related,
as Figure 1.1 illustrates.
 Figure 1.1: The Living Legacy of Trauma

This diagram is meant to remind you and your therapist that a traumatic
event is just an event. The living legacy of one overwhelming event or a lifetime
of such events is an array of symptoms and difficulties common to individuals
who have been traumatized. As you take in all the different effects caused by
traumatic experiences, see which ones are most familiar to you. Each represents
a way that your mind and body adapted to threat and danger, to being trapped, to
being too young or too powerless—or a way that your mind and body adapted to
manage all the other feelings and body responses.
 At this point, you can turn to the end of this chapter and use Worksheet
1: The Living Legacy of Trauma to explore your own living legacy of
trauma. Be curious. If you did not know these symptoms were caused by
trauma, what do you think caused them?

Most trauma survivors tend to either blame themselves for their symptoms or
blame the immediate environment. They do not experience feelings of relief that
“it” is over or any sense of “I made it—I am still alive.” Their bodies and
emotions still respond to the people and situations around them as if the danger
had never ended. When asked, “How long ago was the last traumatic event you
experienced?” most trauma survivors are surprised at how much time has gone
by because they are still “there,” wherever “there” was.

SURVIVING TRAUMA
Why do we not experience trauma as a past event? The answers lie in our brains
and bodies.
Human beings do not survive horrific experiences through thoughtful
decision making or deliberate planning. In the face of threat, we are too young or
too overwhelmed to think and plan. We “make it” because our bodies have the
instinct to survive built into them and because we have a brain that prioritizes
survival above all else. At the moment our brains perceive a potential life threat,
our survival responses are automatically set in motion.
Certain areas of the brain are specialized to help us survive danger (van der
Kolk, 2014). A set of related structures in the limbic system hold our capacity for
emotional, sensory, and relational experience, as well as the nonverbal memories
connected to traumatic events. The limbic system includes the thalamus (a relay
station for sensory information), the hippocampus (an area specialized to process
memory), and the amygdala (the brain’s fire alarm and smoke detector). When
our senses pick up the signs of imminent danger, that information is
automatically transmitted to the thalamus, where, in a manner of nanoseconds, it
is evaluated by threat receptors in the amygdala and in the prefrontal cortex
(LeDoux, 2002) to determine if it is a true or false alarm.
The prefrontal cortex, our thinking and perceiving brain, is theoretically
designed to hold the “veto power.” If the stimulus is recognized as benign, the
amygdala is not supposed to respond. But when something might be threatening,
the amygdala stimulates the brain to turn on the sympathetic nervous system,
initiating an adrenaline stress response that prepares the body to fight or flee.
Adrenaline causes an increase in heart rate and respiration, maximizing oxygen
flow to our muscles and turning off other non-essential systems, including the
prefrontal cortex. We are now in survival mode, where pausing to think might
waste precious seconds of response time. But the price we pay for the automatic
engagement of our instinctive defenses is a high one. We lose the ability for
conscious decision making, and we lose the ability to bear witness to the entirety
of the experience. We act and react automatically by crying for help, freezing in
fear, fleeing, fighting, or giving in when there is no other way out.
Following a traumatic event, the hippocampus, another tiny structure in the
limbic system, is responsible for putting the nonverbal experience into
chronological order and perspective preparatory to it becoming a memory that
we can put into words. However, the hippocampus is one of the non-essential
parts of the mind and body that are suppressed under threat. So, for the very
worst of human experiences, the hippocampus is unable to complete its task of
memory processing, interfering with our ability to make meaning of what has
happened. Having survived the trauma, we are left with an inadequate or
fragmented memory record that fails to reflect exactly what has happened and
how we endured it.
Some survivors have a clear chronological memory of what happened, but
even if they do, they still often lack a sense of having survived it. Worse yet, if
the environment is chronically traumatic, as in child abuse and neglect or in
domestic violence, an individual’s survival response system may become
chronically sensitized to anticipate threat, resulting in ongoing physical
reactivity to the environment as if it were still dangerous and menacing. Without
a clear, coherent verbal memory of what happened, there are only two
conclusions that traumatized individuals can draw: either “I am in danger” or “I
am defective—something is very wrong with me.” Either or both of those
conclusions exacerbate the painfulness of having survived only to carry the
burden of the living legacy of the trauma for days, weeks, and even years
afterward.

If you have carried the blame or shame for what happened or still live in
a state of threat, you might want to turn to the end of this chapter and
 complete Worksheet 2: How Did Your Symptoms Help You Survive?
Beginning to understand how these symptoms have helped you survive
is the first step to changing your relationship to them.

TRIGGERS AND TRIGGERING

Think back to the days of the cavemen and cavewomen, our forebears. They
lived in a very dangerous world, vulnerable to disease, harsh climates, the
challenge of providing food for the tribe, and potential attacks by animal and
human predators. Survival in that harsh environment was enhanced by the ability
to sense danger and to react protectively but also by the ability to keep on going,
no matter what happened to their loved ones or themselves. It takes precious
seconds or minutes to think about potential danger: “Is it safe to go out looking
for food?” or “What are those rustling sounds I hear?” It was most likely
advantageous to sense danger rather than having to remember or analyze the
level of threat.
Centuries later, human beings still have heightened stress and survival
responses. Following experiences of danger, the brain and body become biased
to cues indicating potential threat. Cues or stimuli connected even very indirectly
to specific traumatic events are called triggers and have the potential of evoking
strong physical and emotional responses, a phenomenon known as triggering.
Here is one example:

Brianna reported to her therapist that the depression had been

much worse in the past two weeks “because the weather has been
so cold.” Curious, her therapist asked, “What did cold weather
mean to you when you were a child?” She recalled, “Where I
grew up, cold weather meant snow and ice—it meant we were
trapped in the house with my mother. We couldn’t go out—there
was no way to get away from her. Oh! Is that why I get so
depressed in the winter?” Brianna’s mother was an abusive
alcoholic, and it was not safe for any of the children to be
trapped in the house with her. Years later, the coming of winter
weather each year triggered hopelessness and depression, the
feeling memories connected to Brianna’s childhood experience.

Here is another example:

 Anita longed for signs that she was important to those in her life,
and she was easily hurt when they did not reach out to her—but
she was also “spooked” when they did. The failure to invite her
or to remember her birthday was triggering, but their invitations
or gifts also triggered her. She felt hurt, unimportant, and
invisible when her family members were distant, and she felt
angry and mistrustful when they reached out. “What do they want
from me now?” she would wonder. Her relational life was
flooded with emotional memories of being either overlooked or
manipulated by her abusive family, feeling memories that
prevented her from taking in how much she was loved and valued
in her adult life by her family of choice.

Without a reliable, chronological memory of what happened and tormented

by the constant reactivation of nonverbal emotional and body memories,
survivors of trauma are apt to find themselves acting and reacting in ways that
complicate their situations even more—as we have seen in Figure 1.1. Knowing
something about the brain can help them make more sense of their actions and
reactions. Let us move on to the next chapter and learn a little bit more about
how our brains work.
 Worksheet 1
The Living Legacy of Trauma
Circle those symptoms and difficulties you recognize in yourself or have
had in the past. Then put a check mark or asterisk next to those you never
knew were the result of your trauma.

How do your feelings about yourself change when you see that these
problems or symptoms are all part of the living legacy of the trauma?
____________________________________________________________
 Worksheet 2
How Did Your Symptoms Help You Survive?
Choose four of your most troubling or difficult trauma symptoms and then
ask yourself: “How did the shame help me survive?” “How did the
depression help me get through?” “How did losing interest in things help
me?” “How did not sleeping help?” “How did using drugs help me
survive?” “How did it help to want to die?”
Write in whatever you discover below.
If you are unsure of an answer, just ask yourself, “What would it have been
like if I had not been depressed [or irritable or ashamed or wanted to die]?”
1.
____________________________________________________________
2.
____________________________________________________________
3.
____________________________________________________________
4.
____________________________________________________________
 2
Understanding the
Traumatized Brain

The brain is the most complex organ in the body, and it affects everything we
feel and do, not just what we think. Divided into different structures, each with a
different purpose, our brains rely on instantaneous coordination of multiple areas
to accomplish most things. If we have lost the car keys, for example, we might
try to visualize where we last saw them and then reconstruct, frame by frame,
what we did after that. This process requires coordination of two different brain
areas: the part of the brain that stores visual memories and the part of the brain in
charge of “working memory” (the ability to retrieve past information, compare it
to present data, plan, or problem solve). Every day, we rely on the brain to get us
through all of our usual routines—but without really understanding how it
works.

THE TRIUNE BRAIN MODEL AND THE DEVELOPING BRAIN

The brain model most often used in trauma treatment, called the triune brain,
comes from the neuroscientist Paul MacLean (1967) and is now considered out
of date by scientists. However, it works for trauma survivors and their therapists
because it simplifies the brain into just three areas and therefore is easy to
remember and use.
As you can see from Figure 2.1, MacLean divided the brain into three areas:
the prefrontal cortex or thinking brain, the animal or mammalian brain, and the
reptilian brain. The reptilian brain is essential to staying alive because it controls
basic functions like heart rate and breathing, as well as our reflexes and
instinctive responses. Thinking of a lizard makes it easy to see how the reptilian
brain works: The lizard does not stop to think—it just responds quickly,
automatically, and instinctively. Newborn babies are born with a fairly well-
developed reptilian brain and only the beginnings of a mammalian brain and a
thinking brain. Their first life challenges are breathing, heart rate, digestion, and
regulation of the nervous system. Parents might say, “My baby just sleeps, cries,
eats, and poops,” not knowing that means the reptilian brain is doing its work of
ensuring life.

Figure 2.1: Understanding the Brain

Then, around three months of age, most babies become more social. They
smile when they see a beloved figure appear, wiggle and squeal with excitement,
and make little faces and sounds. Their smiles are often so contagious that even
weary, sleep-deprived parents cannot help smiling back. This milestone means
that the limbic system or mammalian brain is growing rapidly, laying down the
foundation for the baby’s future emotional and social development. The fact that
small children tend to be very emotionally reactive creatures attests to the
dominance of the limbic system or mammalian brain during early childhood.
Their ability to be rational and organized in their behavioral responses grows
very slowly through the childhood years as the thinking brain or prefrontal
cortex slowly develops.
By 11 or 12 years of age, most children can use reason instead of emotion to
communicate their needs, but, even then, the prefrontal cortex has not yet
finished developing. Estimates are that the prefrontal cortex continues to grow
and become more elaborated until young people reach the age of approximately
25—in other words, until they are well past the age of adolescence. No wonder
adolescents often do not mature until their early 20s! Their brains do not support
maturation until the prefrontal cortex has finished its growth and then its
reorganization process. If you sometimes feel shame or guilt over how you acted
as an adolescent, give the responsibility for your actions to your brain. The rapid
growth of the brain at ages 12 to 13 disrupts its maturation. Children suddenly
have intense feelings and impulses, as well as a disorganized prefrontal cortex
that has suddenly grown bigger but has not yet matured into an organized, wiser
brain. Adolescents make decisions based on impulse or emotion, not reason,
because their brains have not caught up yet.

To apply this material to your experience, turn to the end of the chapter to
Worksheet 3: Getting to Know Your Brain, which will help you identify
how each part of your brain contributes to your being you. Be curious.
The goal of this worksheet is to help you notice how your brain works.

HOW WE REMEMBER TRAUMA

As we discussed in Chapter One, both single traumatic events and enduring
traumatic conditions affect the developing brains of children (Perry et al., 1995).
Because danger causes overstimulation of the reptilian and mammalian brains
and also shuts down the prefrontal cortex, certain mental processes, such as
learning, are often more difficult for traumatized individuals. In children, for
example, impulsivity and reactivity can be heightened, leading to a diagnosis of
Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant
Disorder, or the child can appear unmotivated. In abusive environments, lower
levels of the brain are subject to constant stimulation by threats and/or reminders
of past threat and therefore cannot support maturation of the prefrontal cortex.
Neuroscience research has also demonstrated that trauma-related emotional
and body memories are stored in the amygdala and are easily activated by
triggers or by remembering traumatic events. The research also shows that
verbal memory areas (which allow us to tell a story from start to finish) shut
down when the amygdala is triggered and reactive. After a traumatic event or a
traumatic life, survivors might have only a very fragmented narrative of what
happened or no clear story at all. Many survivors say, “I don’t remember
anything,” without realizing that they are remembering when they suddenly
startle, feel afraid, tighten up, pull back, feel shame or self-hatred, or start to
tremble. Because trauma is remembered emotionally and somatically more than
it is remembered in a narrative form that can be expressed verbally, survivors
often feel confused, overwhelmed, or crazy. Without a memory in words or
pictures, they do not recognize what they are feeling as memory.
What they also do not realize is that human beings do not just remember
events. We remember in many different ways. As you can see in Figure 2.2, each
brain area stores memory in a different way and form. With the thinking brain,
we might remember the story of what happened but without a lot of emotion
connected to it. With our sensory systems, we might spontaneously see the
images or hear the sounds connected to the event. Our emotions might remember
how something felt. Our bodies might remember the impulses and movements
and the physical sensations (tightening, trembling, sinking feelings, fluttering,
quivering) experienced at the time.
 Figure 2.2: The Traumatized Brain: How We Remember Trauma

Most people are unaware of all these different ways of remembering, even
though they are all too familiar with the experience of suddenly getting anxious
or angry for no apparent reason. When they are triggered, they do not realize that
what they are experiencing is a memory. They know the warm feeling that is
connected to thinking about loved ones or the pulling back or bracing that occurs
when they encounter someone who feels threatening. Many individuals describe
déjà vu experiences, like “I feel like I’ve been here before” or “This seems
familiar, but I don’t know why.” Those too are memories without words.

At this point, you might find it helpful to use Worksheet 4: How Your
Brain Remembers the Trauma to look at how you might be
remembering without words—above and beyond whatever events you
recall. Do not focus on memories you can put into words. Instead, be
curious about every thought, feeling, or physical reaction that could
possibly be a nonverbal memory. One tip to guide you: If the feeling or
reaction is painful or confusing or overwhelming, it is likely to be a feeling
memory or body memory!

Many trauma survivors feel uncomfortable when they do not remember

whole events or when the memories are fragmented or unclear or consist of just
a few images, not a whole mental video of the events. Sometimes they doubt
themselves and think, “It can’t be true because I don’t remember exactly what
happened” or “I must be making this up or I would remember more clearly.”
They are expecting to have a clear-cut narrative that can be described in words—
like the memory of what they did last weekend.
It is important to know that trauma cannot be remembered the same way
other events are recalled because of its effects on the brain. When you feel the
impulse to doubt your memory or intuition that something happened to you,
remind yourself that recalling events as a story or narrative is not the only way
of remembering. You may be remembering a lot more than you think you do!

STARTING TO RECOGNIZE TRIGGERS AND TRIGGERING

Are you surprised at how much you remember when you include distressing
feelings, negative thoughts, and physical reactions as memory? Beginning to
recognize when we are triggered or when we are remembering with our feelings
and our bodies helps all of us to know who and where we are. You might not be
a “scaredy-cat”—you might just be experiencing a lot of fear memories. You
may not be an “angry person,” but you might have feeling memories of anger
that get triggered by unfairness or rejection.

To help you begin to see the relationship between what triggers you and
what gets triggered in you—namely, feeling or body memories—start
keeping a list each time you might be triggered using Worksheet 5:
Recognizing Triggers and Triggering. This is a worksheet that many
people keep on hand and keep filling out as they unexpectedly encounter
triggers in future situations. Remember, you never choose to be
triggered. It happens to you.

As time goes on, you will start to see patterns. You might notice that certain
kinds of things are frequently triggering—for example, authority figures,
separation from someone you love, sudden noises, unfairness or rudeness, the
dark, or being alone. Assume that whenever you feel overwhelmed, desperate, or
numb, something has triggered you. If we assume that what we feel has
meaning, even if we do not understand it, we are more likely to see the trigger
than if we doubt ourselves or discount what we are feeling as “crazy.” Look for
very subtle cues that might have triggered what you are feeling. For example,
disappointment can be a very huge trigger for trauma survivors, as can being told
“No!” or not being understood, having to wait, being ignored or being noticed,
or not being believed or taken seriously. Many triggers are paradoxical. Being
alone might be a trigger, but being with other people might be also. Change,
whether good or bad, is often a trigger, especially if unexpected. As you begin to
see patterns of triggers emerging, you will understand more of your story—even
when you do not know why something is triggering.
Avoid the temptation to connect triggered feelings to specific events in
your life. A feeling memory might be the memory of many experiences, not just
a single event. Remembering specific events is likely to be even more triggering
and therefore increase the intensity. It is more helpful to just acknowledge that
you are triggered and to know that being triggered means you are experiencing
trauma-related feeling and body memories.
Using the Recognizing Triggers and Triggering Worksheet, you can now
start to anticipate triggers: If authority figures are triggering, you can begin to
prepare yourself in advance for encountering certain kinds of authority figures. If
leaving or having someone leave even for a few hours or days is triggering, you
can anticipate the leave-taking and build in some ways to support yourself in the
moment. Later chapters will offer you some ideas for how to calm, comfort,
energize, or support yourself.

DEALING WITH TRIGGERS AND TRIGGERING

The most difficult aspect about triggering is how it affects our perception of our
present lives:

Annie felt herself flushing with shame and feeling slightly sick to
the stomach each time she drove up to the home she shared with
her husband and grown son. If a friend or acquaintance
suggested meeting at her house, she would blurt out a hasty
“No!” The very thought of someone seeing her home was
humiliating to her. She had no idea she was remembering a very
different home. Her home as a child was dilapidated and
obviously untended, reflecting the chaos inside it. Her alcoholic
mother was a respected professional, but the family home
revealed dark secrets to anyone passing by. Inside was even
worse: unwashed dishes, dirty clothes, and four disheveled
children dressed in mismatched, ill-fitting outfits donated by the
local church. Thirty years later, the feelings of shame and alarm
at the thought of anyone seeing her home persisted as an
emotional memory that she assumed was a realistic response to
her current home now. She did not see how warm, welcoming,
and charming or how carefully kept up it was. Seeing it through
the feeling memories led her to conclude, “I have failed—nothing
has really changed—I am still ‘less than’ other people.”

This is a powerful example of why it is crucial for trauma survivors to learn

to notice the signs of being triggered. In order to know where we are and who
we have become despite the trauma, we have to learn how to discriminate
between a here-and-now emotional reaction and a feeling or body memory. To
know we or those around us are safe, we have to make those discriminations.
Otherwise we will automatically trust those who do not trigger us and distrust all
those who do. We will believe the shame is a truth about ourselves rather than
understand it as a memory. We will interpret fear as a sign that we are not safe. It
took Annie more than 30 years to see her home in present time, to know and feel
it was a safe place, and to appreciate how it reflected her journey from trauma to
recovery.

To practice differentiating triggered feelings and perceptions, you might

want to fill out Worksheet 6: How Can You Tell You Are Triggered?
Recognizing the signs of being triggered helps us to know our reality: Am
I triggered, or am I really in danger? Am I triggered, or does the shame
mean that I am unworthy? Recognizing that we are triggered does not
mean that our feelings are unimportant—it means that our feelings are
remembering something far worse than what triggers them.

Sometimes, the trigger is something that would bother anyone, such as being
startled, yelled at, embarrassed, criticized, ignored, or rejected. All human beings
experience some level of distress when such things happen, but if these kinds of
events are also triggering, you might experience a “double whammy” effect.
Like anyone, you might feel understandably upset and distressed by what has
happened but also be triggered by it, multiplying the effect. A feeling of being
humiliated might become overwhelming, incapacitating shame if the humiliating
event was also triggering.
To make it worse, many traumatized individuals are triggered just by feeling
their emotions—any emotion. Because it is usually unsafe for children in
traumatic environments to exhibit distress, feeling upset or tearful or angry (or
all three combined) can also be triggering.
What is difficult for most trauma survivors is that feeling and body memories
do not feel like memories. The shame feels real right now. The fear or terror
make us feel unsafe right now. There is nothing that says, “Don’t worry—you
are just remembering.” Bessel van der Kolk, one of the pioneers in the trauma
field, reminds therapists that “we must most of all help our patients to live fully
and securely in the present” (van der Kolk, 2014, p. 73). It is easy to access the
past; all that is needed is a trigger. What is difficult for trauma survivors is to be
here, now. Think of this step in your recovery as taking on a project to help your
body learn that you are here, not there. And your brain can help you do that, as
you will see in the next chapter.
 Worksheet 3
Getting to Know Your Brain
Write on the diagram what each part of your brain contributes to your
everyday life. Perhaps your thinking brain is a resource, or maybe it goes in
circles or never turns off. Maybe your emotions are a strength, or maybe
they are overwhelming. Maybe your reptilian brain overreacts, or it freezes
and cannot allow you to take action when you want to do so.
Write down whatever you notice.

What parts of your brain are a resource for you?

What parts give you the most difficulty or cause the biggest problems?
The “triune brain” model (McLean, 1967)
 Worksheet 4
How Your Brain Remembers the Trauma
Write in what each part of your brain remembers. There is no need to
write in all the details. Just a few words or sentences is fine—such as “I
remember what happened” or “I don’t remember my childhood” or “I can
talk about it without any feelings” or “I only have overwhelming feelings
and reactions.”
 Worksheet 5
Recognizing Triggers and Triggering
Each time you think you might be triggered, write in your reaction
(feelings, thoughts, physical responses), its intensity, what was happening
just before, and how you coped. Did you try to ignore it or suppress it? Did
you judge yourself or the trigger? Do not judge, just notice.

Feelings,
thoughts, and Trigger: What Coping: What
Date, time,
physical Intensity: 0–10 was happening did you do to
situation
sensations that just before? cope?
got triggered
 Worksheet 6
How Can You Tell You Are Triggered?
Recognizing the signs of being triggered helps us to know our reality: Am I
triggered, or am I really in danger? Do I need to leave my job, or am I just
experiencing being triggered? Recognizing that we are triggered does not
mean our feelings are unimportant. It means that our feelings are
remembering something far worse than what triggers them.
Check the signs of being triggered that you recognize:
Shaking, quivering
Overwhelming emotions
Difficulty breathing
Body wants to collapse
Feeling “possessed”
Wanting to give up or die
Wanting to hurt myself
Wanting to drink or use drugs
Knees knocking
Going numb all over
Sudden intense physical or emotional reactions
Wanting to run away
Teeth clenching
Feels unbearable
Terrified, panicky
Hating myself
 Hating others
Feeling rage
Feeling overwhelming shame
Emotions do not fit the situation
Actions do not fit the situation
Clenching or churning or pit in stomach

When you recognize the signs of being triggered, just keep reminding
yourself that “it’s just triggering—I am triggered—that’s all that is
happening.”
 3
How the Brain
Helps Us Survive

Some unexpected and unnoticed trigger evokes alarm, and our bodies suddenly
brace or startle. Our hearts begin to pound. Simultaneously, the thinking brain or
prefrontal cortex goes offline, making it difficult to think but easier to respond
quickly and instinctively if we really are in danger. Without a thinking brain, we
cannot step back and assess the situation or ponder the best alternative. There is
no time to think in an emergency situation. Instinct is always better and faster
when immediate survival is at stake, but once the threat is over, we need mindful
awareness and the ability to think in order to heal from the traumatic past.
That, however, is made difficult by the fact that the brain and body continue
to respond to everyday life as if we were in danger. Years later, even when our
worlds are safe, the same emergency responses are activated whenever some
trigger sets off this internal alarm system. When such experiences happen daily,
trauma survivors feel overwhelmed and confused. They wonder, “Why am I so
angry? So fearful? So ashamed?” And the most common conclusions they reach
are either “There is something wrong with me,” which makes them feel more
ashamed, fearful of being found out, or defensive, or “There is something wrong
with my home/job/ friends/partner/way of life,” which usually increases anxiety,
anger, shame, or hopelessness. And the worse we feel, of course, the more
impulsive we become.
The triggers, as well as the automatic conclusions we reach, deactivate the
thinking brain, leaving the reptilian brain free to act on instinct. And what does
the reptilian brain instinctively seek? Relief and a sense of safety. The desperate
impulse to find quick relief, coupled with the loss of ability to judge the
consequences of our behavior, invariably exposes individuals to further danger
or becomes an increasingly vicious circle.
No one is to blame. The brain and body are simply responding to perceived
threat. We do not consciously choose to lose our ability to think and plan—it is
automatic.

HEALING AND THE THINKING BRAIN

The thinking brain does more for us, however, than simply allowing us to think
clearly and make good decisions. To heal—to feel safe now and to know we are
safe—requires restoring activity to the prefrontal cortex so that we can observe,
reflect, see ourselves and others in perspective, and have access to curiosity and
compassion. Wisdom requires this part of the brain. When we use the expression
wise mind, we are actually referring to the medial prefrontal cortex, located right
behind the middle of the forehead. Its job is to help us observe the environment,
ourselves, and those around us, to literally see the big picture. We use that part of
the brain when we meditate, notice, or focus on something specific, and mentally
sit back and look at things from a distance. It also helps us to integrate
information from other parts of the brain. We might think, “I’m nervous,” and
then notice that our knees are trembling and hearts beating faster.
Most of all, the medial prefrontal cortex or wise mind has a calming effect
on the amygdala, the structure believed to be an emotional memory center where
trauma-related feeling and body memories are stored or encoded. The amygdala
also serves a sentry function, scanning the environment for potential threats.
When we activate our wise minds, we send a signal to the body and the nervous
system that it is safe here now, and the amygdala automatically decreases its
activity. Think of it like the smoke detector in your home that is usually set off
when the toast is burning: When we activate the medial prefrontal cortex, we can
discriminate better, and when we recognize the smell as the toast burning, the
brain’s smoke detector stops beeping.
If you take a look at Figure 3.1, you will see how the thinking brain can help
you to change automatic traumatic responses. Even though we cannot reason
with the reptilian brain or with our emotions, we can use the thinking brain to
help calm the body and the nervous system by taking advantage of its ability to
observe and to differentiate the past from the present.
 Figure 3.1: Using Our Brains to Heal the Effects of Trauma

HOW DO WE KNOW WHEN A TRAUMATIC EVENT IS OVER?

In a traumatic situation, things happen quickly and are overwhelming in their
intensity. When the thinking brain shuts down, we cannot make any sense of
what is happening—and that is why most survivors lack the felt awareness that
the event has finally ended. It is done and over, but it does not feel finished. The
only way to know that we are safe is either to feel relief and a physical sense of
safety in the body or to assess intellectually whether we are safe or still in
danger. But if the brain’s internal alarm system is activated and responding as if
the threat exists now, we will continue to feel unsafe.
You can easily see how this system helped primitive man and woman
survive: having a brain and body biased in favor of perceiving threat meant over-
responding to danger, not under-responding. As you learned in Chapter One, the
cavemen and cavewomen who under-responded to the myriad threats facing
them were less likely to survive, and those who over-responded were more likely
to be on the alert and ready to defend. The brain’s negativity bias (Hanson, 2013)
keeps us on guard against danger, but its effects haunt survivors of trauma for
years and even decades after the events have ended.
Perhaps because it was not adaptive in the days of primitive man to relax
into a sense of safety, the body’s emergency stress response only knows how to
go to extremes. It has just two speeds: “Don’t just sit there—do something!” and
“Don’t move—it’s not safe.” Each one is driven by a different branch of the
autonomic nervous system, the brain system that controls our emotions, physical
reactions, and impulses. Both branches of the nervous system are specialized to
respond differently, giving us more options for survival.
When we are in danger, as you will see in Figure 3.2, first, the sympathetic
nervous system is immediately mobilized. Heart rate speeds up to increase
oxygen flow to muscle tissue. We feel a surge of energy, and all non-essential
systems in the body shut down, including the thinking brain, so that all our
energy is focused on fighting, fleeing, ducking, or getting out of sight.
 Figure 3.2: How the Nervous System Helps Us Defend Against Threat

Two conditions then activate the parasympathetic system. If defending

ourselves is more dangerous than complying, or if we are trapped, the
parasympathetic nervous system acts as a brake on our defensive impulses, and
we become passive and compliant. We “play dead.” If we survive the danger and
the threat is over, then the parasympathetic system helps us rest, lick our
wounds, and repair.

You can use Worksheet 7: Differentiating Past and Present to help

you notice whether your mind and body are in the past or if they are in
the present. Experiencing a past moment in the here and now feels
unpleasant but not unsafe once we know we are remembering rather
than in danger.

Children, for example, are almost entirely dependent on freezing and

“playing dead” responses, as are battered wives, prisoners of war, and hostages.
It is not safe for the less powerful to flee or fight—it would simply increase the
risk of harm—and the human body and brain are organized to instinctively
choose the most adaptive survival response in the moment.
Perhaps you have wondered, “Why didn’t I fight back?” The answer is that
“you” did not make that decision. Your body and brain determined that it was
not safe to fight. Your thinking brain turned off, and your body instinctively
decided what to do next.

Use Worksheet 8: How Our Nervous System Defends Us to observe

how your nervous system works. Whatever you notice will not just help
you understand your actions and reactions now. These patterns will also
help to tell you more about how you survived.

HOW POST-TRAUMATIC SYMPTOMS REFLECT OUR TRAUMA

HISTORY
The ingredients of post-traumatic stress disorder (PTSD) are found in the ways
our nervous system still keeps trying to save our lives long after the danger is
over. When we are triggered, high sympathetic activation communicates an
alarm to the body and mind: “Red alert! Watch out for danger!” It provides a
surge of physical energy, strong instinctive impulses, and the icy calm that gives
us a sense of superhuman power. But if action was dangerous then, the body may
have come to perceive sympathetic arousal as a threat, automatically triggering
the parasympathetic system to slam on the brakes, bringing our movements to a
grinding halt. Years later, the parasympathetic system may still be dominant,
robbing individuals of energy, drive, and confidence.
Not knowing that their brains and bodies are causing these feelings and
reactions, not knowing that traumatic events have conditioned their nervous
systems to react in these ways, trauma survivors blame themselves and think,
“I’m depressed—even though I have nothing to be depressed about” or “I’m just
an angry person” or “I don’t know why I’m afraid of everything—I’m just a
chicken.” But blaming ourselves is triggering, and it can also propel many
individuals to try to fix these problems in ways that further worsen the situation.
We have a nervous system adapted to threat even if we now live in a world that
is rarely dangerous, and that adaptation keeps the living legacy of trauma
actively mobilized in our bodies even when we do not need it anymore.
Figure 3.3 depicts the most common patterns of autonomic activation that
develop as a response to chronic or repeated threat. As you look at the diagram,
notice which patterns of arousal are most familiar to you. The pattern of nervous
system responses to the environment and to ordinary stress that you notice in
your life today tells the story of your survival, reflecting how it adapted to the
traumatic conditions you once faced. Did you survive by being constantly on
guard, tense, fearful, and reactive? Or did you survive by shutting down, going
numb, and spacing out? Was it better for you to run or fight? Or was it better to
collapse and go passive? Your body is actually telling you what was safest then,
even if it is not helpful now. This diagram can also serve as a way to notice when
you are outside of the window of tolerance and as a reminder to slow down or
speed up.
Figure 3.3: A Nervous System Adapted to a Dangerous and Threatening World

Worksheet 9: Trauma and the Window of Tolerance can help you

become aware of how your sympathetic and parasympathetic nervous
systems still react after the trauma has passed, how they still affect your
feelings and behavior, and how much you may need a wider window of
tolerance. Often, our sympathetic and parasympathetic responses occur
predictably. Certain situations trigger one response or the other, and
certain situations are positive triggers that help widen the window of
tolerance. Include that information on the worksheet, too, to help yourself
 anticipate trauma-related triggers and seek out positive triggers.

Remember you had no control over how your nervous system responded at
the time. The brain reacts long before we have conscious awareness of the
situation, and we cannot control our instinctive reactions any more than a lizard
can. Increasing awareness of these reactions as nervous system memories or
survival responses often helps them to feel more tolerable. When we do not
understand why we are going numb or jumping out of our skins, we feel more
alarmed and ashamed of our reactions.
Without awareness of why they are having these reactions, desperate to stop
them from happening, and unable to think clearly, many survivors of trauma find
themselves acting impulsively. Caring about the consequences of our actions
requires a thinking brain and some sense of having the time to think. The
desperate measures to which trauma survivors resort when triggered can range
from workaholism and perfectionism to over-use of food and alcohol to severe
substance abuse disorders, compulsive self-harm, life-threatening eating
disorders, or suicidal impulses and actions. In the next chapter, we will examine
how to understand and work with these patterns of behavior that initially induce
feelings of greater safety in the body but eventually become a threat to life and
stability.
 Worksheet 7
Differentiating Past and Present
Learning to recognize when we are reacting to the past helps us to know
when we are safe (but triggered) versus when we are in real danger. It helps
us to feel less hopeless, less afraid, less angry, less depressed, and less
crazy. It helps to know when we are remembering. Any time you feel
distress, study what is going on by filling out this worksheet.

Do these
What feelings What belief thoughts/
What are you and sensations seems to explain feelings make
Time of day
doing? are you aware why you are more sense in
of? feeling this way? the present or in
the past?

What happens when you identify a feeling as making more sense in the past
than now?
 Worksheet 8
How Our Nervous System Defends Us
Describe how your nervous system works. When you get triggered, what
does your sympathetic nervous system do? What are your fight-or-flight
responses like? What does your parasympathetic system do? Which is more
familiar?
 Worksheet 9
Trauma and the Window of Tolerance
Circle the signs of autonomic hyper- and hypoarousal that you notice in
yourself, and add any other signs not listed here. Write in the situations that
seem to stimulate these different states. For example, are you more
hyperaroused when alone or when around people? Are you more in the
window of tolerance at work?
 4
The Challenge of
Post-Traumatic Coping

In a threatening world, with no support, protection, or comfort, children have to

rely upon the limited resources of their own bodies to manage overwhelming
circumstances and unbearable feelings. Infants have the fewest resources
because the body and nervous system are still immature at birth, yet even a baby
can dissociate or go into a limp, numb parasympathetic state. Toddlers and
preschoolers have a few more options. They can use food to soothe themselves
and masturbate to stimulate pleasurable feelings. They can also stimulate
adrenaline production through hyperactive or risky behavior. As children reach
latency and early puberty, even more options become available: They can restrict
food, binge and purge, develop obsessive-compulsive patterns of behavior, act
out sexually, pinch or scratch themselves, and even fantasize about suicide. Less
self-destructive coping can also develop: getting lost in books or fantasy,
parentified behavior, or over-achievement.
In adolescence, the growing physical strength and capability of the body
facilitates a new array of options for self-regulation. Running away is now a
choice. Teenagers also have greater access to cigarettes and drugs, or they can
act out sexually, engage in more severe eating-disordered behavior, and have the
strength to act on suicidal impulses. The physical body is now capable of
violence, whether aggressive behavior toward others or self-inflicted violence,
unchecked by an inhibited or immature prefrontal cortex. As the saying goes,
“Desperate times call for desperate measures,” and often desperate self-
destructive measures are a well-conditioned pattern of response by the time
traumatized children reach adulthood. Ask yourself, “How old was I when I first
started to _____________________ as a way to manage my feelings?”

DESPERATE EFFORTS TO REGULATE A TRAUMATIZED NERVOUS

SYSTEM
Every type of addictive, eating-disordered, and self-destructive behavior
produces a neurochemical reaction in the human body. Let us take a closer look
at some of the common ways in which trauma survivors attempt to regulate their
trauma responses.
Self-injury (cutting, head banging, punching walls, or even hitting ourselves)
brings quick relief to the body by stimulating the production of adrenaline and
endorphins, two neurochemicals that decrease pain. As discussed in the previous
chapter, adrenaline produces a surge of energy and a physical sense of strength,
and it also induces a state best described as “calm, cool, and collected.” Doctors,
nurses, and EMTs all rely on adrenaline to do their jobs well, as do most peak
performers. Endorphins are the neurochemicals associated with relaxation,
pleasure, and pain relief; they are the body’s “happy” chemicals. The
combination of these two chemical responses triggered by self-harm is
responsible for the very immediate and complete physical and emotional relief
felt by those who self-injure.
Restricting food intake puts the body into a neurochemical state called
ketosis, creating a numbing effect but also a boost of increased energy. No
wonder individuals with anorexia can eat so little and still work out at the gym
for hours. Binging and overeating, on the other hand, both have a numbing and
relaxing effect.
Drugs (whether illicit substances or prescription drugs) cause many different
effects, from sedation and numbing to stimulation and increased feelings of
power and control. Alcohol is a mild stimulant in small doses and a relaxant in
larger doses, bringing some relief to trauma survivors who experience both
anxiety and depression. Marijuana serves the purpose of inducing a steady state
of hypoarousal and numbing, especially when taken at intervals throughout the
day.
Compulsive hyperactivity, workaholism, and high-risk behavior of all kinds
also tend to stimulate adrenaline production, whereas retreating to one’s bed and
curtailing activity tends to increase feelings of spaciness and numbing.
Long before substance use becomes abuse or self-harm becomes active
suicidality, trauma survivors initially learn that they can successfully control
their symptoms and function in the world by using their drugs and behaviors of
choice. I use the term successfully because, to the extent that substance use,
eating disorders, or self-harm bring symptom relief to the survivor, it may
prevent suicidality, loss of functioning, social withdrawal, and a host of other
problems common to those who have been traumatized.
Figure 4.1 illustrates the ways in which people instinctively try to cope with
their hyper-or hypoarousal in order to get relief. These behaviors provide a
temporary false window of tolerance, offering a sense of “I can handle this” that
is time-limited and illusory.

Figure 4.1: How Trauma Survivors Cope with Traumatized Nervous System

Turn to Worksheet 10: How Do You Try to Regulate Your

Traumatized Nervous System? to explore how you have learned to
regulate yourself. How do you try to manage your nervous system and
distressing emotions? What is your “go-to” way of feeling better? Your
second most familiar way of trying to manage traumatic activation? Do
not judge yourself—just be curious about how these behaviors help!
Whatever you notice will not only help you understand your actions and
reactions as ways you are trying to help yourself, but it will also tell you
more about how you survived. Was survival dependent upon staying
frightened and on guard? Ashamed and people-pleasing? Or shut down
and numb? Or being constantly on the run?
THE VICIOUS CIRCLE OF ADDICTIVE AND SELF-DESTRUCTIVE
BEHAVIOR
Any addictive or self-destructive behavior begins as a survival strategy: as a way
to numb, wall off intrusive memories, self-soothe, increase hypervigilance,
combat depression, or facilitate dissociating. But compulsive behaviors also
have a “drug effect” that wears off after a few minutes or hours, increasing the
sense of need or urgency to repeat the action or substance to prevent losing that
positive effect. With repeated use, the body develops tolerance, meaning that
these psychoactive substances (whether alcohol, heroin, or the body’s own
chemicals like adrenaline) require continual increases in dosage to maintain the
original degree of relief and eventually are needed just to ward off physical and
emotional withdrawal effects.
Were it not for the body’s increasing tolerance, trauma survivors could use
these means of obtaining relief in a moderate, low-risk way for years. Instead,
over time, eating disorders become increasingly worse, substance use becomes
abuse, self-harm becomes more dangerous, and suicidal thoughts and wishes
become more actively life-threatening. Thus, the substance use or self-
destructive behavior may begin as an effective approach to managing post-
traumatic reactions, but then it gradually acquires a life of its own, becoming
increasingly disruptive to the survivor’s functioning until it is a greater threat
than the symptoms it attempts to keep at bay.
Once the thinking brain matures in our 20s, we have more capacity to
appreciate the consequences of unsafe behavior and more ability to think before
we act, but that increased awareness often results in shame: “Why am I doing
this? If anyone knew, they would judge me. I need to stop, but I can’t!”
Survivors may hate themselves for using these ways of coping, but the
alternative is worse. The emotions and implicit memories that were dangerous to
feel or acknowledge long ago still trigger the same sense of threat—and the
same desperate need to stop them at all cost.
Without understanding the method to their madness, the logical conclusion
most trauma survivors reach is: “There must be something wrong with me—I
must be defective.” Their shame and self-blame of course trigger more intense,
intolerable feelings—further increasing the need to do something to make the
feelings stop. They are now literally, as the saying goes, “between a rock and a
hard place.” If they stop the behaviors that stem the tide of overwhelming
feelings, then the feelings will be even more intolerable. If they do not stop, the
shame worsens into self-hatred. Few trauma survivors realize that their self-
destructive behavior represents an ingenious attempt to regulate their nervous
systems and their unbearable physical and emotional reactions.
When you are a trauma survivor who has learned to manage overwhelming
feelings using addictive, eating-disordered, or unsafe behavior, it takes more
than this book alone to address both the trauma and the ways you are coping
with it. This way of thinking about how you have learned to survive and adapt,
however, is an important first step. In the next chapter, we address how to
observe and begin to change high-risk patterns for managing traumatic
responses.
 Worksheet 10
How Do You Try to Regulate
Your Traumatized Nervous System?

Hyperarousal
How do you try to regulate your hyperarousal? Without judging yourself,
list all the things you do to bring your activation down or to stop emotions
from becoming overwhelming.
____________________________________________________________

Narrow Window of Tolerance:*

Even a little bit of emotion feels intolerable

Hypoarousal
How do you try to regulate your hypoarousal? Does it regulate you, or do
you regulate it? Without judging yourself, list all the ways you try to bring
your activation up or keep yourself numb and detached.
____________________________________________________________

*Siegel (1999)
 5
Recovering from
Self-Destructive
Patterns of Coping

Willpower never works when the prefrontal cortex or thinking brain is shut
down. Worse yet, safety, sobriety, or abstinence may initially result in increased
hyper- or hypoarousal and a shutting down of the prefrontal cortex. Treatment
programs are often essential for stabilization of eating disorders, addictions, or
suicidality and self-harm, but long-term change in these patterns is impossible in
just a few weeks or even months. Traditional psychiatric hospitalizations for
unsafe behavior contain the risk of harm but rarely offer trauma treatment or
result in helping survivors develop new, more adaptive coping patterns. As
necessary as these programs are when individuals are at risk, a longer-term
approach is needed beyond the hospital or treatment center.

AN INTEGRATED MODEL FOR TREATING TRAUMA AND ADDICTIVE

BEHAVIOR
The mental health world has always been divided, treating substance abuse as a
public health or medical issue and treating trauma, eating disorders, and
suicidality as psychiatric disorders. The tendency toward specialization can
make it even more difficult to find help for both. Many trauma survivors
complain that eating disorder professionals do not understand the role of the
trauma in driving their symptoms; those who are suicidal or self-harming feel
misunderstood when their trauma histories are ignored or, worse yet, when they
are treated as attention seeking and manipulative. The addictions recovery world
is increasingly aware of the role of trauma in addictive disorders but still tends to
prefer a “treat the addiction first” approach. I would agree that severe addictive
and eating disorders do need to be brought under control first so that you can
begin to recover the use of your thinking brain. Without it, long-term recovery
from either the trauma or the addictive disorder is not possible. However, when
professionals acknowledge the survivor’s traumatic past and help them to see
how the trauma and compulsive behavior complicate each other, it is often easier
to engage in the recovery program.
Treatment programs for eating disorders or substance abuse are especially
effective when the survivor is participating in them on a daily basis because they
stimulate the thinking brain by providing education and structure. In addictions
programs, the newly sober individual is challenged to face the phobia of emotion
and to develop new ways of coping. However, once outside of these programs, it
is much harder to anticipate triggering and regulate what is triggered—which
accounts for the high rate of relapse among trauma survivors who graduate from
addiction or eating disorder programs. It is not surprising that many trauma
survivors find themselves cycling in and out of hospitals and addiction/eating
disorder programs without long-lasting benefit, increasing their sense of shame
and defectiveness. Even though 12-Step programs—such as Alcoholics
Anonymous, Narcotics Anonymous, Overeaters Anonymous, or Sex Addicts and
Sex and Love Addicts Anonymous—can be very triggering, their benefits can
far outweigh their side effects and I highly recommend them.
In addition, I also recommend that survivors try to find a therapist who
understands the complex relationship between trauma and suicidality, trauma
and addiction, trauma and eating disorders, or trauma and other kinds of
compulsive behavior. The job of the therapist is to remember to look for the
adaptive intent and to reframe the disorder or addiction as a valiant attempt to
manage overwhelming feelings and memories. Understanding that the individual
was desperate and overwhelmed and that these behaviors, in small doses,
initially worked is crucial for recovery.
Understanding this process becomes even more crucial when individuals
stop using substances or harming the body and begin to experience a profound
sense of shame about how self-destructive they have been. But remember that
shame and self-blame shut down the prefrontal cortex and diminish the capacity
to learn. Curiosity, instead, increases activity in the thinking brain and therefore
promotes new learning. So, start by being curious and ask yourself:
How did ________________ (e.g., the drug use, cutting, eating disorder) help
me to cope at the time it started? What was different as a result?
 Given that I did not know why I was doing these things, how did I respond when
life challenged me to cope more or to cope differently?

Did I have to use substances, cut, or binge and purge more often? Or did I
change my substances of choice? Or did I find new ways to manage my nervous
system and my feelings?

Did I begin to act out in other ways when under the influence (e.g., by engaging
in compulsive sexual behavior or being preoccupied with suicide)?

When did the addiction begin to negatively affect my ability to cope?

What did I do then?

You may believe that the anorexia helped because it resulted in weight loss
or that the cutting worked because you wanted to punish yourself. However, the
physiological results of these behaviors do not support such beliefs. Restricting
food intake and self-harm both work because they induce numbing and a
positive change in bodily state, and that is what we have to be curious about. At
each step of the way, it is important to validate that every choice of behavior is
and was an attempt you made to stay in control of these powerful forces inside
you, even if the attempts were not entirely successful and even if the end result is
not a pretty sight. Then, it makes sense that for sobriety and stability to feel safe,
individuals must learn new ways of feeling a sense of control—through the
acquisition of the skills and inner resources necessary to expand the window of
tolerance.
What is different about developing and expanding a resilient window of
tolerance versus creating a “false” window of tolerance is that self-destructive
and addictive behavior provides immediate relief. Expanding the window of
tolerance without self-harm or addictive behavior requires practice—it is
anything but immediate! On the other hand, the immediate relief is usually long
gone by the time these issues become a family or therapeutic concern.
Immediate relief may have occurred when the individual first discovered these
ways of controlling the symptoms and emotions. But as he or she continues to
cut, restrict, drink, or attempt suicide, relief becomes more and more difficult to
achieve as the addiction progresses. Worse yet, the self-destructive, addictive, or
eating-disordered behavior gets increasingly dangerous.
THE ABSTINENCE/RELAPSE CYCLE
Once trauma survivors fully grasp the contribution of the addiction or self-
destructive behavior at different points in their lives, the next most important
idea they need to know about is the Abstinence/Relapse Cycle (Fisher, 1999). As
the diagram in Figure 5.1 describes, sobriety or abstinence in the context of
trauma can precipitate a whole series of new crises and symptoms because the
individual is now totally without the neurochemical barrier and false window of
tolerance created by the substance use, eating-disordered behavior, suicidality, or
self-injury. What happens to most trauma survivors very early and repeatedly is
that, each time they achieve safety, the PTSD symptoms tend to worsen within a
matter of weeks, months, or even days, becoming more intrusive and intense.
 Figure 5.1: The Abstinence/Relapse Cycle

If the symptoms worsened in recognizable ways, that might be easier.

Although some survivors start to experience flashbacks and nightmares that
validate their traumatic experience, more often what comes up for the newly safe
or newly sober individual is a deluge of implicit memories that create
overwhelming feelings of irritability, anxiety, reactivity, and vulnerability. Not
knowing why they feel these things (and disappointed or frustrated that they do
not feel better, as they have been told they would), the addictive craving and
self-destructive impulses increase—not always in recognizable ways either.
Some individuals might feel resentment or entitlement to drink or hurt
themselves; others might feel a desperate sense of needing to do something,
anything, to stop the feelings. Relapses (in self-harming, eating disorders or
addictions) frequently occur as acts of desperation to stem the tide of
overwhelm. As one trauma survivor told me to explain the degree of her
desperation, “Why do therapists keep asking me to sit with my feelings? They
don’t understand. I don’t have feelings, I have tsunamis!”

Worksheet 11: Tracking Your Abstinence/Relapse Cycle can be very

helpful if you find yourself in these dilemmas. Try to avoid the tendency
to shame and self-blame and instead be curious about how impulses to
stop overwhelming or distressing feelings can lead you back to less
healthy ways of coping despite your best efforts.

Using the Abstinence/Relapse Cycle diagram, it is usually easy for most

people to see where they are in the cycle: “I’m definitely feeling overwhelmed
and irritable, so I guess I’m at the ‘increased PTSD symptoms’ stage—and pretty
soon I’ll be hoarding razor blades… tempting but maybe not a good idea” or
“I’m starting to feel more resentful and burdened by everyone and everything. I
feel like I deserve a drink for what I’m putting up with.” Or “I can’t stand how
big I am—I’m as big as a house—I can’t keep eating all this food they tell me to
eat.” Wherever you are in the cycle at the moment, you can learn to track the
signs that anticipate what is likely to happen next.
Once you are safe, sober, or abstinent, it is crucial to anticipate an increase in
trauma-related responses. Without the neurochemical buffer provided by drugs,
eating disorders, or self-harm, you will find yourself more vulnerable to being
triggered and more reactive and emotional. The trauma symptoms complicate
recovery because trauma-related triggers tend to reactivate impulses to self-
harm, restrict, binge and purge, or use drugs very quickly. For example, many
trauma survivors encounter triggers in the workplace: authority figures, arbitrary
rules and regulations, pressure to do more and more, low salaries for long hours,
and competitive colleagues. Being triggered by a critical boss can quickly lead to
the triggering of addictive or self-destructive impulses. Having been triggered,
you might skip lunch to induce numbing (rationalizing that you need to work or
that you do not want to be seen). Or you might give in to the temptation to go
out with the boys for a drink after work to manage the anger or anxiety.

In the meantime, you can use Worksheet 12: Breaking the Cycle to
become more aware of these patterns in your life and to practice new
alternatives for interrupting and changing them.

The key principle guiding most addiction and psychiatric recovery models is
learning to ask for help. However, relying on others is very triggering for most
trauma survivors since being vulnerable was so dangerous in a neglectful,
abusive world. Even Alcoholics Anonymous and other 12-Step programs can be
highly triggering, leading either to avoidance or to impulses to relapse. A trauma
therapist can work with you to help you manage the triggered reactions
stimulated by learning to ask for help and can assist you in expanding your
window of tolerance. However, the good news is that the first and most
accessible source of help can be found in your own brain!

GETTING HELP FROM THE “NOTICING BRAIN”

Thinking and noticing are very different ways of relating to the world. We might
think, “I really should finish this project today” without noticing that, before the
thought is even complete, our bodies feel tired and heavy. We might think, “I
shouldn’t have done that—I put my foot right in my mouth,” not noticing that
the self-blame evokes shame and the impulse not to think about it. We might be
so preoccupied with anxiety about something that happened yesterday or
something that might happen tomorrow that our senses do not register something
positive (a flower, the sun, a puppy, someone’s smile). The capacity of the
human mind to remember the past in chronological detail or to envision a future
that is not here yet is both a blessing and a curse. Our thinking brain can spend
weeks and months worrying about the past or dreading the future—distracting us
from moment-to-moment experiences in our lives that are safe or even
satisfying.
The left hemisphere of the brain is in charge of thinking sequentially and in
words; the right hemisphere is intuitive and reacts nonverbally. Both of these
functions are important. We have to be able to think and plan, learn from
experience, link cause and effect, and anticipate how to deal with the future. And
we have to be able to sense our gut reactions and our intuition when logic is not
enough. Trauma disrupts both. It inhibits the thinking brain, and it makes us fear
and doubt our intuitive reactions.
Noticing is a very different kind of brain function; it is the activity of being
aware in this present moment. We cannot notice the past because it already
happened, and we cannot notice the future because it is not here yet. All we can
notice is our reaction to thinking about the past or the future in this present
moment. But to notice with awareness requires the medial prefrontal cortex, the
part of your brain described in the last chapter, located right behind the center of
your forehead. Brain scan technology shows that the medial prefrontal cortex has
connections to both the left and right sides of the brain, as well as to the lower
levels associated with emotion, gut reaction, and impulse. Most importantly,
researchers have shown that when individuals meditate, activity in the medial
prefrontal cortex increases and, along with that, activity in the amygdala
decreases. You may remember from earlier chapters that the amygdala functions
to achieve two goals: to detect threat and to store emotional memories. The more
stimulated the amygdala is, the more nervous and on guard we will feel. In
addition, an activated amygdala increases sensitivity to triggers and stimulates
impulsive urges. We are also more likely to experience increased flooding of
trauma-related emotional and body memories. When flooding occurs, we might
suddenly feel overwhelmed by anxiety, hopelessness, dread, or sadness without
knowing why—a state that can last for hours and days at a time. When the
amygdala is calmer, our nervous system is more regulated, and we can more
easily tolerate stress and emotion. Flooding decreases when the amygdala is less
stimulated and the window of tolerance expands.
The diagram in Figure 5.2 shows how different areas in the frontal cortex
help us function throughout the day. Working memory is a function of the left
brain, as are abilities such as long-term memory (memory for facts and other
verbal information) and autobiographical memory (memory for what has
happened in our lives). The working memory area of the left brain allows us to
hold new information in mind and to connect it to other related ideas, words, or
experiences. When we ask ourselves, “What should I do?” our working memory
centers are stimulated to think of all the pros and cons, to consider information
about similar decisions we have made before, and even to anticipate
consequences based on what we have experienced in the past. Insight is another
ability provided by the working memory areas of the brain, and so are activities
like remembering a phone number or where we last put the car keys. These
structures have no direct connection to the amygdala, so insight does not reduce
activity in a traumatized amygdala. At times, insights may have a calming effect
if they are compassionate or comforting, or if they reassure us that we are not
crazy or defective, but they do not diminish traumatic responses.

Figure 5.2: Getting Help from the Mindful Brain

 Worksheet 13: How Working Memory Interprets Our Experience will
help you study the relationship between your negative thoughts and
interpretations and your feelings and impulses. What types of
interpretations and judgments do you usually make? And how does each
affect your feeling and bodily state?

The noticing brain or medial prefrontal cortex, however, does connect

directly to the amygdala, facilitating a calming effect when we are more mindful
and when we notice rather than commenting on what we notice. For trauma
survivors, free-floating meditation is not always the right approach to increasing
activity in the medial prefrontal cortex. Internal awareness can sometimes be
very triggering, so it is usually more helpful to start using the noticing brain to
notice very specific things. For example, when a feeling of anxiety comes up,
noticing it as just anxiety or as just a body sensation (increased heartbeat or
tightening in the chest or stomach) or as “just triggering” usually helps to
regulate the anxiety. When feelings of shame get triggered, remembering to
notice the physical sensations of the shame and the thoughts that go with it as
separate components is usually calming or regulating. In mindful noticing, we do
not get flooded with the feeling—we notice it at a very slight distance, even as
something interesting or curious.
It requires practice to notice a feeling instead of reacting to it by drawing
conclusions or assigning blame. Most of us interpret our feelings as quickly as
we have them. We might feel embarrassed and then interpret that as a sign of
having done something stupid. We feel sadness, and then we interpret it as either
weakness or a sign of how much we have lost or how terribly we have been
treated. These interpretations very rarely make us feel better!
Noticing the shame, sadness, anxiety, or anger without judgment or
interpretation has a very different effect. Noticing sadness means bringing our
attention to the choked-up feeling in the throat, the wetness or tears in the eyes,
and the emotional pain in the chest. When we notice the sensations of pain rather
than recall all the experiences that have caused the pain, it has a slightly calming
effect. If we notice the tears instead of interpreting them as weakness, they will
subside much more easily than if we try to choke them back. Whenever we
notice a feeling as just a feeling or a thought as just a thought, it is generally less
overwhelming.
In the mindfulness world, meditators are taught to observe with interest and
“without attachment or aversion.” These words speak to the very human
tendency we all have to agree with certain thoughts and feelings and to push
other feelings away or reject them. We might agree with the thought “Your
opinion doesn’t matter” and reject the thought “Whatever I think or feel does
matter,” judging it as too grandiose or narcissistic. Mindful noticing disciplines
us to be aware of each thought with equal curiosity: “I’m having the thought that
I should shut up—my opinion doesn’t matter anyway—and now I’m having
another thought that everyone’s opinion matters.” With the noticing brain, we
might then observe that the thought “My opinion doesn’t matter” is followed by
a slump in the shoulders and a sigh, then a feeling of heaviness and defeat. Or
we might notice that thinking, “My feelings and opinions do matter” is
accompanied by spontaneously sitting up straight and holding the head higher or
by a feeling of confidence or solidness. The noticing brain does not judge either
thought—it just notices that the negative thought feels more familiar and the
positive thought more unfamiliar or even unpleasant. It can be used to notice
which feels better or lightens our sense of carrying a load.

USING THE NOTICING BRAIN TO CHANGE HABITUAL PATTERNS

Because activating the medial prefrontal cortex reduces activity in the amygdala
and therefore calms and regulates the nervous system, the noticing brain is a
game-changer in the struggle with addictive or unsafe behavior. It allows us to
study compulsive impulses without judgment or shame. Noticing what happens
when we act on unsafe impulses is also crucial to interrupting the
Abstinence/Relapse Cycle. Even better, noticing the negative consequences of a
relapse without attachment or aversion also helps stabilize unsafe behavior and
addictive patterns.

Use Worksheet 14: Getting Help from the Noticing Brain to observe
the differences between what happens when you notice and what
happens when you analyze or judge your thoughts and feelings. Does
noticing an impulse without judging it or trying to control it make it easier
to avoid acting on it? Does noticing make intense emotions easier to
tolerate?

The key is increasing your ability to notice your thoughts, feelings, and
impulses as signals about how the nervous system is doing, rather than a sign of
how you are measuring up to old expectations. Are you activated or shut down?
Overwhelmed or numb? Or is your window of tolerance expansive enough to
tolerate whatever you are feeling? What do the thoughts, feelings, and impulses
tell you about where you are on the Abstinence/Relapse Cycle?
Keep in mind that the goal is to regulate your nervous system so that you can
tolerate your moment-to-moment feelings and thoughts. All human beings will
experience unpleasant, overwhelming emotions and impulses at points in their
lives, and we all need to have the bandwidth to tolerate these ups and downs.
Trauma makes that challenge much harder because the body responses and
feeling memories are so easily triggered on a daily basis, disrupting the sense of
present time. Although the eating disorder, self-harm, or suicidal thoughts and
feelings may have been ways of managing triggered response, you are reading
this chapter because they no longer work so well or are causing new difficulties
and risks.
No treatment approach, skill, or intervention can make the feelings just go
away, and even the eating disorder, addiction, or self-destructive actions
eventually stop having that instantaneous effect. All we human beings are left
with are “10% solutions”: things that help us 5%, 10%, or 15% of the time or
that help for a few minutes while we are doing them. Most ways of healthy
coping are 10% solutions: taking a moment to breathe, focusing on something
that feels better, reading a book or watching television, filling out a worksheet,
going for a walk, knitting, crocheting, doing crossword puzzles, gardening,
taking a hot bath, reciting the Serenity Prayer, or playing with a pet or with
children. Even psychotherapy is a 10% solution, and so are most psychiatric
medications and coping skills. Very few coping habits are immediately and
completely effective. To feel better at bad times, we might have to use five or ten
different solutions until we begin to feel a little relief.

Use Worksheet 15: 10% Solutions to develop an ongoing list of what

helps to give you 5% or 10% relief. You will begin to see patterns. For
example, you might notice that you get a 10% solution from physical
activities that involve working with your hands, activities that require
concentration and focus without a lot of thinking (like jigsaw puzzles or
knitting), or activities that involve contact with other human beings or with
pets. You can cultivate more solutions in any category that seems to be a
good fit for you as an individual, or you can integrate skills that you have
learned to add to your list of solutions. And keep this worksheet handy
during hard days so you can remind yourself of things you can do to get
 through the day—10% at a time.

In an ideal world, you would have grown up in a safe, supportive

environment where your needs for reassurance and soothing were met by parents
who felt your distress and were relieved when you felt better. Your nervous
system would have learned how to recover from ups and downs, and your
“emotional muscles” would have had a chance to grow stronger. But a traumatic
environment, as we will see in the next chapter, robs children of what they need
in order to develop a resilient nervous system and a wide, flexible window of
tolerance, making the trauma-related feeling and body memories even harder to
manage and tolerate. Sadly, one very unfair aspect of recovering from trauma is
the fact that now, as an adult, you have to work so hard to develop the capacities
that should have been facilitated or taught to you as a small child. As unjust as it
is, however, it is more unfair to continue feeling numb, overwhelmed, or
constantly frightened, angry, and ashamed. Working your emotional muscles by
practicing 10% solutions will help to give you the window of tolerance you need
for a life after trauma.
The next chapter will help you to understand more about traumatic
attachment and its “living legacy.”
 Worksheet 11
Tracking Your Abstinence/Relapse Cycle
Write in what you notice at each stage of the cycle. How do you feel when
you first get sober or abstain from unsafe actions? Then, what are the signs
that your PTSD symptoms are worsening? What tells you that you are
having unsafe impulses again? How do relapses usually happen? And then
what? Do not judge yourself! Be curious and interested in the cycle that has
driven you so many times.
 Worksheet 12
Breaking the Cycle
Because the brain and body tend to default to old patterns under stress, you
may notice the same cycle occurring each time you try to use new healthier
coping strategies. Write in what you notice when you try to change trauma-
related patterns.
 Worksheet 13
How Working Memory
Interprets Our Experience
Write in the kinds of interpretations that your working memory usually
makes when you feel distress. Then notice. Do the feelings get better or
worse? Do your sensations and impulses increase or decrease?
 Worksheet 14
Getting Help from the Noticing Brain
What is different when you use your noticing brain? What happens when
you use your noticing brain to observe your feelings, thoughts, and body
sensations without judgment?
 Worksheet 15
10% Solutions
Any activity that gives me even a
What kinds of feelings, thoughts,
little bit of relief or pleasure or What % does it
situations, and impulses does it
takes my mind off negative help?
help with?
thoughts
 6
Trauma and Attachment

Unlike other animals, human babies begin life with a very immature brain and
body, sometimes struggling to keep up a steady heartbeat and breathing. Because
their nervous systems are so underdeveloped, they lack the capacity to eat, sleep,
change positions, and regulate their emotional and physical states without round-
the-clock help from their caretakers. Ideally, during this stage of development,
loving, attuned parents do more than help children by feeding them and keeping
them physically comfortable. They also help babies recover from distress,
expand their capacity to sustain positive feelings, and teach them how to
communicate their physical and interpersonal needs. Good attachment teaches us
that it is safe to be soothed by others and that it is safe to soothe ourselves when
loved ones are not available. Even the child’s ability to acquire new information,
problem solve, and verbally communicate is dependent upon the quality of
parental attachment.
Early attachment is not a single event or even a series of particular events. It
is the result of hundreds of physical and emotional experiences: being held,
rocked, fed, stroked, or soothed, and experiencing the loving gaze of our
caretakers. Rather than using words, loving parents communicate to infants
using coos, mmmm’s, and terms of endearment that evoke a lilt in the voice of
the speaker. Young children take in the warm eyes, the smile, and the
playfulness, and they respond with sounds and smiles of their own. But, just as
easily, they can take in the caregiver’s bodily tension, stony face, rough
movements, and the irritable tone of voice. Their immature nervous systems are
alarmed by bright lights, loud sounds, or physical discomfort, so it is not
surprising that sudden movements, intense emotional reactions, loud voices, and
anger or anxiety are all frightening for babies.

Use Worksheet 16: Noticing Your Reactions to Closeness and

 Distance at this point to notice your own reactions to closeness and
distance. Write in the key things you learned about closeness and
distance as a child, such as “It was not safe to be close,” “Mother
couldn’t tolerate my distance,” “I had to be seen and not heard,” “We got
punished,” or “My parents couldn’t tolerate closeness to anyone, even
their children.” Then write in the key things you notice in your
relationships. Do you feel comfortable being close? To whom does it feel
comfortable to be close? (Some individuals feel comfortable being close
to their children but not to a spouse—or to friends or a spouse but not
their siblings.) How do you do with distance? Is that easier or harder?

HOW WE REMEMBER ATTACHMENT

Whether our parents promote a sense of safety or they frighten us, no child
remembers these experiences of attachment in words or as individual events. In
the first three years of life, attachment is primarily remembered in the form of
nonverbal body memories: emotional, physical, autonomic, tactile, visual, or
auditory memories—memories without words. Our attachment or relationship
styles are also memories of how we adapted to the relational environment of our
childhoods. If we were held lovingly and safely, we feel comfortable hugging
others or being hugged by them. If we were held in a frightening or abusive way,
our bodies might tighten up when people come close to us or tense and pull
away even when we are touched in a perfectly safe way. Closeness or physical
contact may trigger a surge of fear. Whether we like to snuggle or prefer less
physical contact, whether we smile or have no expression, look away rather than
at people, like we-time more than me-time or vice versa, our relational habits
were formed very early in life.

EYE-TO-EYE COMMUNICATION
Babies are born with the instinct to seek the eyes of the person caring for them.
Their heads turn until they see the attachment figure looking at them, and then
their eyes lock on to that gaze. Research shows that infants even prefer to look at
pictures of eyes when there are no human faces or eyes at which to gaze.
But what if the eyes of the baby’s caregivers are scary eyes? What if they
frighten the child? The majority of adults gaze at babies with warm, loving,
interested eyes—but what if the parent is high or sedated on drugs? What if the
attachment figure has a mental illness and is preoccupied with voices, images, or
fears in his or her head? What if the parent’s eyes reflect rage at having to take
care of a baby twenty-four hours a day? Despite their innate preference for
gazing, most babies have the same instinctive response to things that startle or
disturb them: They close their eyes and turn their heads away. Years later,
looking into the eyes of a partner, a loved one, or even a therapist may still evoke
fear and gaze aversion.
This is well illustrated through Cathy’s experience:

Cathy said to me one day, “I notice that I can’t look at you—it’s

weird. You’re looking at me, and I’m looking off to the side of
you. It’s not that I don’t like you or trust you because I do, but it’s
just hard to look into your eyes.”

Kaitlin’s example also illustrates how can attachment trauma can elicit gaze
aversion:

Kaitlin consistently turned her head to look out the office window
while we were talking. Curious about this pattern, I voiced it one
day, “I notice your eyes are focused on the window—even when
we’re talking—and I’m curious about that.” She looked at me as
if I were stupid, “Of course—because that’s the window I’m
going to jump out of when they come for me.”

Their habits of eye contact were trauma-related, not personal to me or anyone

else in their lives. Kaitlin was always looking for an escape route, and Cathy had
grown up looking into the eyes of the depressed mother she loved so much and
seeing a far-away, hopeless expression. Years later, their brains and their bodies
were still remembering what was safe then and what was not.

TOLERATING CLOSENESS AND DISTANCE

If we feel safety in closeness to our attachment figures when we are very young
and then we later learn to feel safe when they are in another room or at work or
preoccupied, the capacity to tolerate being close to others expands and so does
the ability to tolerate being separated or out of contact. We grow up to become
adults who might prefer more contact or more distance, but we can tolerate less
of either when necessary.
 In a traumatic environment, there is no safe place. Closeness is rarely safe,
but neither is being alone because a child is unprotected when no safe adult is
present. Showing emotion is rarely safe either because a child’s sadness or anger
usually triggers abusive and neglectful parents to lash out. Needs are not safe
because normal needs for care and closeness can be exploited. It is not safe to
trust reassurance, and it is certainly not safe to allow abusive parents to comfort
us. It is not safe when abusive parents show affection either—nor is it safe to
demonstrate loving feelings toward them. Every single aspect of close
relationships can become dangerous in a traumatic environment. Figure 6.1
depicts the way in which safe attachment builds the capacity for both closeness
and autonomy while unsafe attachments create a sense that either is dangerous.
 Figure 6.1: What Trauma Teaches Us about Relationships

If the abuser is a parent, then the home is not safe, and the only safe place is
at school or at a grandparent’s house. In that situation, children learn to fear or
avoid family relationships and feel safe only at a distance from others. Equally
frightening is the experience of the home and attachment figures offering a safe
place while the child encounters danger outside of the family (e.g., when abused
or exploited by neighbors, babysitters, teachers, coaches, or extended family
members). That teaches children that it is safe to be close but not safe to be away
from home or in the company of other people. Because we were too young to
remember why and how we developed the habits and reactions we have, it can
be very confusing when these traumatic attachment patterns follow us into
adulthood.

FRIGHTENED AND FRIGHTENING PARENTING

Research shows that children can be traumatized even when there is no abuse in
the family. Having parents who are frightening or appear frightened (who are
anxious, withdrawn, phobic, depressed, or shut down) creates a sense of danger
for the young child. It is scary to have a frightened parent and, of course, scary
to have a frightening parent. But for children, it can be even more confusing and
distressing because a child’s natural biological response to feeling scared is to
seek the attachment figure, to move closer. The problem is that moving closer to
a frightening or frightened parent is scary too, and the body’s other natural
response is to move away from something frightening.
When the person to whom the traumatized child is drawn to find safety is
also the danger from which he or she is seeking refuge, the child is literally
caught between a rock and a hard place. The instinct to cling to the attachment
figure when alarmed also triggers the child’s instinct to pull back, but then the
pulling back triggers the instinct to move closer, which then increases the
instinct to pull back. Sometimes children have a “fight” response to a neglectful,
abusive parent and feel the impulse to push away angrily. Whenever either
parent is frightened or frightening, the instinct to cling or move closer is
activated, and as the child gets close enough to get hurt, the fight-or-flight
instinct is evoked.
Because the children of frightening and frightened parents are chronically
afraid of being hurt, they are sensitive to many things that can be better tolerated
by children who feel safe. Any small or large rejection, being misunderstood,
being told no, being disappointed, failures of empathy, or being “on the outside
looking in” can trigger intense emotional and physical alarm reactions: fear,
shame, emotional pain, anger. The closer the relationship, the more intense these
triggered responses, a phenomenon that is often misunderstood by teachers,
adoptive parents, and other adults in the child’s life. The teacher or adoptive
parent might hope that with increasing closeness will come increasing trust, only
to find that the opposite occurs. Many survivors with these traumatic attachment
patterns have very good, stable friendships but get triggered in their intimate
partner relationships. Others also get triggered in friendships or in family
relationships with non-offending parents and siblings.
Trauma survivors frequently find themselves fleeing from those who are
kindest to them and attaching to partners who are distant or even abusive. They
blame themselves for these patterns (“Why do I always choose abusive men?”)
without understanding their origin in early traumatic attachment. But the
dynamics make perfect sense in a trauma context: A distant or abusive partner
triggers the instinct to seek closeness, while the caring, safe partner, who wants
to be close, automatically triggers the impulse to flee or fight.
If this is a pattern that is familiar to you, it is important to reassure yourself
that these are very natural trauma-related reactions, not a sign that you make bad
choices. The most important thing you can do to transform these patterns is to
observe them. Be curious: Notice when you feel strong needs for closeness or
when closeness is triggering for you, observe impulses to distance or push others
away, and become aware of what gets triggered in you when others respond by
distancing or defending themselves or getting angry.

Annie’s parents were frightening, and they were abusive: Her

father was superficially charming but sexually abusive, and her
mother was physically and emotionally abusive. In addition, her
alcoholic mother often appeared frightened: passed out on the
couch and unresponsive or nervous and irritable, or at other
times in a violent rage. Annie had to adapt to this complex and
very unsafe environment, care for her younger siblings, and keep
them out of danger as much as she could. Her “go-to” pattern
was caretaking: soothing her irritable mother and caring for her
when she passed out, charming her teachers at school because
they were the only adults who seemed to like her, and working
hard to earn acceptance from her peers. But, internally, she
instinctively pulled back and disconnected when around other
people. She learned to hide from her parents—in the closet,
outside in nature, or in the world of books.
As an adult, she could not make sense of her tendency to caretake
everyone around her other than to assume that she was being
pressured by others to meet their needs. She explained her
tendency to isolate (especially when other people approached her
for friendship) as a way of avoiding exploitation, and she
 assumed that her husband of thirty years did not really love her
because he was not very emotionally expressive. She believed
that, in fact, no one cared about her and, as a result, she could
not recognize all the ways her husband, sons, and extended
family demonstrated how much they loved her. She could not
believe that she was the glue that held her family of choice
together and attributed their seeking her out as a bid for
caretaking. Stuck in the relational patterns dictated by her
childhood situation, she felt alone, hurt, unloved, and unlovable.

Remember: A pattern always reflects memory. We learned that pattern

somewhere, and if it is very familiar, we learned it when we were young. Do not
put pressure on yourself to figure out where the pattern came from. Just assume
that it was a necessary adaptation to the limitations of your attachment figures or
that it was a survival strategy, just as it was for Annie.

Use Worksheet 17: Traumatic Attachment Patterns to observe your

patterns in relationships. Try not to be distracted by thoughts and
feelings about the people to whom you have these reactions. It is more
important to be curious about how the trauma has affected your capacity
to be in relationships and to become aware of these patterns. Do your
fight-or-flight responses get triggered by nice people or abusive people?
Do you flee when people do not treat you well, or do you put up with it?
Do you feel compelled to stay close to them because you are afraid to be
alone?

CHANGING TRAUMATIC PATTERNS IN RELATIONSHIPS

Having seen some of your own patterns on Worksheet 17, you now have a
chance to decide what changes you want to make. For example, you might see
that the biggest problem you encounter in relationships is not being able to set
boundaries, not being able to say no, tolerating abusive or inconsiderate
behavior, and fearing abandonment or being left alone. Or you might notice a
pattern of having walls up, feeling suffocated by too much closeness or niceness,
not letting your partner in, and not sharing your thoughts and feelings other than
in anger. Or you might see a pattern of seeking closeness when the other person
is distant and seeking distance when they want to be close. You might notice that
you have very high standards or needs in relationships and very little tolerance
when your partner does not meet them. Are you quick to anger? Or quick to
hurt? Or quick to hurt followed by anger?

Worksheet 18: Changing Our Attachment Patterns will give you a

chance to look at some of your patterns in close relationships, whether
with friends, family, or romantic partners. Some of these patterns might
be okay with you, and some may not. Do not judge them. Just note which
ones are most problematic in your life. If there are many, then prioritize
just two or three related ones. Next, assume that these patterns are
triggered reactions. You might even want to start a Trigger Log so you
can see the triggers in advance. Assume that you do not have a window
of tolerance in relationships even if you have developed a window in
other areas of your life. It is understandable: Relationships can feel like a
safe haven or like the most dangerous undertaking of our lives.

Go back to some of your earlier worksheets. Do you need to expand your

window of tolerance for closeness? Or for not being understood? Or for being
disappointed or hurt? Or do you need to increase your ability to tolerate setting
boundaries with your partner? Or work at tolerating your partner’s quirks and
bad habits? Remember that the abuse was not just ethically and morally wrong.
It was also the abuser’s bad habit, and therefore even harmless bad habits could
be a very big trigger for you.

Yvonne was ready to give up family dinnertimes because she was

so irritated by her husband’s behavior. “My husband is so
immature and irresponsible—how could he behave the way he
does? How could he teach my son such terrible habits?”
I asked, “What exactly happens at the dinner table that makes
you so angry?”
“They play with their food! They have little food fights! My
husband puts some of his mashed potatoes on my son’s plate, then
my son puts his broccoli on my husband’s plate, and then my
husband puts more mashed potato on, and they think it’s so funny,
but it isn’t!”
“And what would have happened to you,” I said, “if you and
your siblings had done that at the dinner table?”
 “We would have been beaten within an inch of our lives—that
would have been stupid and dangerous!”
Then I understood. “No wonder you’re triggered by their food
fights! It feels like they are doing something really unsafe, and
they’re not aware of it, and they are not stopping.” Yvonne was
alarmed by what would have been dangerous to her years ago,
rather than amused to see her husband and son bonding in such
an annoying but harmless way.
What helped Yvonne to change her pattern was to keep reminding
herself that she was just triggered. Nothing bad was happening—
no one was getting hurt or punished. When she just kept saying to
herself, “I’m triggered—that’s all that’s happening,” over and
over again, she could feel her heart rate going down and the
anger subsiding.
As she anticipated another stressful dinner time, she realized that
she could simply explain to them that the food fighting was
making her nervous. She did not have to criticize them and make
them both feel defensive. Her husband’s pattern was to be passive
and conflict avoidant in relationships, so he rarely protested her
criticisms, but he would withdraw and become very quiet. That
felt safer to her, but she knew that the result was more distance
between them. They were both keeping things safe the way they
knew safety as children, but that was not keeping them close.

Without seeing the patterns, most people keep blaming themselves or their
partners. Yvonne could have blamed the failure of closeness on her husband, but
seeing the whole pattern helped her to see that he was triggered by her alarm and
her judgments of him, just as she was triggered by both his playfulness and his
withdrawal. She still felt some alarm when he and her son got silly at the dinner
table as her body remembered how violent her stepfather used to get when he
was irritated by her brothers, but she no longer interpreted the alarm as a clear
and present danger.
Remember: It takes practice to change our habits of surviving! Insight is not
enough to create lasting change.
Practice noticing and naming when something is triggering for you—over
and over and over again: “I’m triggered—this is very triggering—I’m really
triggered.” Consider the possibility that what you find offensive (unless illegal or
immoral) is related to triggers more than to the actual degree of badness inherent
in the action. For example, many individuals find themselves wanting to flee
relationships or even threatening to leave their mates when they are triggered. Is
that “mean”? Or is it an automatic reaction triggered by the relational dynamics?
Many individuals get quiet when they are hurt or angry—or get loud and
accusatory—or walk away. Or they try to “improve” their partners by critiquing
behavior that triggers them. These patterns reflect what our bodies and emotions
learned about relationships long ago. They do not usually reflect conscious,
thoughtful choices.
Assume that unless your partner has beaten you, publicly humiliated you,
kept you confined to your home, controlled your ability to come and go, or
harmed you or your children, you are probably triggered by his or her behavior.
Be curious. How am I triggering my partner? Are we both triggering each other?
Awareness of triggering is another important ingredient in healthy relationships.
We cannot always prevent our partners and spouses from getting triggered, but
we can make an effort to avoid triggering them when there is a choice to say or
do something a little differently. Learning how to be sensitive to the other
person’s triggers without feeling like you are walking on eggshells or
automatically complying is very healthy in relationships. We tend to do that
naturally with children, friends, or someone more vulnerable than ourselves, but
we often forget to do that with our partners.

HOW MUCH SHOULD I TOLERATE?

It is hard for all human beings to know the limits of what they should accept or
tolerate. There is no absolute standard other than a legal one. We have a legal
right not to accept physically or sexually violent treatment, the use of weapons to
enforce control, physical restraint, threatening behavior, drug use, or other self-
destructive actions that threaten our safety or that of our children. Beyond that, it
becomes hard, especially for trauma survivors, to discern what is unacceptable
or unsafe and what is just insensitive and rude behavior. (If you question whether
or not you are being abused, there are many checklists available online that can
guide you in assessing what feels like abuse in your relationship.) Often,
financial dependence on one’s partner can bias us into accepting inappropriate
behavior as something we have to tolerate. Or if we are triggered by rude,
uncaring, or insensitive behavior, we may not be able to access a sense of
deserving or having a right to set boundaries or even walk away.
One standard to determine how much to put up with is to ask, “Are the
negatives I get worth whatever positives I get?” If you are with someone flawed
but non-abusive whom you deeply love, it might be worth learning to manage all
the triggering in the relationship. If you are in the job of your dreams, it might be
worth the effort to work with all the triggering that comes with it. All human
beings have the right to determine how much they choose to tolerate and when—
they do not have to justify their choices.

Jennifer was married to a man who adored her and supported

her as a mother and professional, but he was also controlling and
critical. In his prestigious job, he was respected as an expert and
obeyed as a leader. Unfortunately, he brought those expectations
home with him. He was always sure he was right and, if irritated
or anxious, he would talk over her. He could not take Jennifer’s
opinions or feelings seriously unless they agreed with his. When
friends asked her, “How can you put up with him?” she would
always smile and say, “He adores me—he would do anything for
me. I know he’s just being a grumpy grump—it doesn’t hurt me.”

Jennifer made a choice that was not dictated by fear or shame. She did not
feel smaller because, even though her husband sometimes belittled her, she did
not feel belittled. That is the key.
Trauma survivors need to feel safe in order to heal; they need to feel some
sense of control over their lives now; and they do not need to feel small or less
than others or ashamed. At the same time, feeling memories of being small and
ashamed, unloved and unwanted, or afraid and unsafe are inevitably going to be
triggered even in good relationships, as Annie’s example illustrates:

Annie described her husband as uncaring and exploitive: “Why

do I always have to make dinner? Why doesn’t he ever make
dinner for me? Why am I the one who always has to bring up
issues? Why am I the only one who cares about this
relationship?” She could not take in that he showed his caring in
other ways: by supporting the family through all the years that
she was disabled by her PTSD symptoms, by never criticizing or
 questioning her triggered reactions, by helping her to do things
that she was afraid to do alone, and by never touching her in any
way without her permission first. He accepted her working when
she could, not working when she could not, never tried to control
her, and almost never got angry even when she would threaten to
leave him. Not a very demonstrative man, he did not know how to
express his feelings, and that failure of expression triggered
Annie’s feeling memories of a childhood in which no adult
showed any genuine interest in or affection for her. His failure to
cook for her or take care of her in more nurturing ways evoked
feeling memories of the neglect she had also suffered. Her mother
fed the children only when she was in the mood to do so, and
often they went hungry. “I feel ashamed when I always have to
cook for myself,” she said. “It’s like I’m not good enough—
there’s no one who cares if I eat or not.”
It was liberating and comforting for Annie when she was able to
see that she had been so triggered that she could not see the
healthiness and caring in her marriage for many years. “I still
wish he was a more emotional person,” she would say, “but I
know now it’s not about me. He’s just limited.” Appreciating her
marriage also helped her appreciate herself. “I was a mess when
I met him, and I could have picked a monster, but I didn’t.”

TAKING CARE OF THE LITTLE “YOU” INSIDE

Being neglected and abused in childhood means that no one took care of that
tiny child we all once were. In relationships, those young parts of all of us will
get activated. We will feel uncomfortably vulnerable at times, and because our
partners also feel vulnerable, they cannot always help us with the feelings they
evoke in us. When Annie was triggered and felt the shame of the young Annie
whose mother did not bother to feed her unless she was in the mood to do so, she
instinctively looked to her husband to comfort and ease those feelings. When
Yvonne was triggered by playfulness at the dinner table, the little Yvonne felt
alarm and looked to her husband to keep things safe. We all instinctively turn to
our partners for the things we did not get as children without recognition that we
are reacting to the past. Although it was important for Yvonne to tell her husband
that it made her nervous when he and their son were “horsing around” at the
dinner table, and important for Annie to communicate that she was not
criticizing her husband but just letting him know she was triggered, it was also
important that they accept and welcome their own young traumatized selves.
Even though both husbands were sensitive to what their partners had gone
through as children, the child parts could not take in that information. Years of
abuse, neglect, rejection, and abandonment had left their mark. Even though
each woman had married a very safe, accepting man, each still experienced the
feeling memories on a daily basis. Each needed to welcome and make room for
that wounded child inside, rather than trying to make the feeling memories go
away by recruiting their husbands as caretakers.
In the next chapter, we will talk about how traumatic experiences leave
individuals fragmented and their wounded child selves disowned and
unwelcome.
 Worksheet 16
Noticing Your Reactions
to Closeness and Distance
 Worksheet 17
Traumatic Attachment Patterns
Recognizing the signs of traumatic attachment can help us in adult
relationships. Am I putting up with too much? Or am I not willing to put up
with anything? Am I confusing my partner with my reactions to distance
and closeness? Do I need to leave this relationship, or am I just triggered?
Check the signs of traumatic attachment that you recognize:
Difficulty with not being listened to
Difficulty when people don’t understand me
Worrying that he or she doesn’t love me
Fear of being abandoned
Fear of being cheated on
Not wanting to be touched
Wanting to be held all the time; only feeling safe when someone is
there
Worrying I’m not good enough
Worrying the other person isn't good enough for me
Wanting to leave bad relationships but I can't
Wanting to run away when we get close
Can't bear being alone/apart
Feeling suffocated
Putting up with abusive behavior
Unable to put up with rude behavior
Not letting my partner in; unable to share feelings
 Feeling rage when feelings are hurt
Feeling unlovable
Unable to tolerate partner's anger
Unable to tolerate partner's silence
Unable to set boundaries or say, "This is not okay"

Remember that these patterns developed as a way to survive when you

were very young. They were the best you could do in a bad situation.
 Worksheet 18
Changing Our Attachment Patterns
Not every survival pattern has to be changed. Check those that, if changed,
would help you to have easier or better relationships.
Preference for Distance:
Wanting to run away when we get close
Feeling suffocated
Not trusting my partner
Believing I'm being cheated on
Not wanting to be touched
Feeling rage when feelings are hurt
Worrying the other person is not good enough for me
Unable to tolerate neediness, sadness, or insecurity in my partner
Not putting up with rude or insensitive behavior
Getting angry, pushing my partner away
Stop talking when I'm upset

Preference for Closeness:

Unable to bear being alone/apart
Difficulty with not being listened to
Putting up with abusive behavior
Difficulty when people don't understand me or aren't concerned
Worrying that he or she doesn't love me or that I'm going to be
betrayed
 Fear of being abandoned
Wanting to be held all the time; only feeling safe when someone is
there
Feeling unlovable when my feelings are hurt
Unable to tolerate anger or silence
Unable to set boundaries or say, "This is not okay"

Assume that these are triggered reactions. What happens when you notice
them as just signs that you are triggered? What changes?
 7
Trauma-Related
Fragmentation and Dissociation

Without caretakers who are capable of creating safety, soothing distress, and
caring for their physical well-being, small children must depend on their brains
and bodies to manage the overwhelming reactions provoked by a threatening
world. Many individuals recall, “There was never a day that I wasn’t afraid or
ashamed” or “My most vivid memory of childhood is the feeling of hunger—I
was always hungry” or “I was always alone—always lonely and scared.”
How does a very young child cope?
Luckily, the human brain and body have resources upon which even a baby
can draw. We can dissociate, go numb and limp, or disconnect from our bodies.
And our minds can split or fragment. With brains that are compartmentalized
already, fragmenting is not difficult (Fisher, 2017).

HOW THE STRUCTURE OF THE BRAIN FACILITATES

FRAGMENTATION
The brain as a whole is divided structurally into two major regions: the right
hemisphere and the left hemisphere, each with very different functions and
abilities. Though babies are born with both sides of the brain intact, they are
right-brain dominant for most of childhood and rely on subcortical structures
that drive action and emotion. The slower developing left brain has spurts of
growth around age two and again at adolescence, but the development of left-
brain dominance is only achieved very gradually over the course of childhood.
For the two sides of the brain to talk to each other, a third area is required called
the corpus callosum, a long narrow structure located between them. In
childhood, right-brain experience is relatively independent of left-brain
experience and vice versa, making fragmentation easy should the need for it
arise. From research comparing the brains of traumatized children and teens with
those of non-traumatized young people, we know that trauma seems to be
associated with a smaller-than-average corpus callosum—meaning that it is
underdeveloped, interfering with the ability of the left and right brains to
communicate or collaborate with each other. The result is that trauma survivors
often find themselves with a left hemisphere that does not coordinate well with
the right hemisphere and vice versa.
As Figure 7.1 illustrates, the early developing right hemisphere is a
nonverbal area of the brain, while the slower-to-develop left hemisphere has the
ability for language and the capacity to remember experience chronologically
and in words. The right brain is better at reading body language and facial
expression, whereas the left brain is better at interpreting verbal language. The
right brain remembers how things felt; the left brain remembers what happened.
When we are triggered, the right hemisphere is more active; when we are
planning and problem solving, the left hemisphere is more active. The result is a
bit like having two different personalities: one logical, rational, and verbal but
not in touch with emotion, and the other very emotional and reactive but not
accessible to reason because it does not have words. All of us have had the
experience of these two sides: We might be about to make an impulsive decision
when the left brain stops us with its rationality. It reminds us that we might get
caught or get hurt or that we might want to be a better person. Or we may be ill,
grieving a loss, or undergoing a stressful time in our lives, and we question
whether we can get through the day without breaking down, but somehow our
ability to keep going instinctively kicks in, and we find ourselves able to think
and function despite our distress.
 Figure 7.1: How the Two Sides of the Brain Function

UNDERSTANDING DISSOCIATED PARTS OF THE PERSONALITY

This biological situation is the foundation for a theory known as the Structural
Dissociation Model developed by Onno van der Hart, Ellert Nijenhuis, and
Kathy Steele (2006). It is a trauma model designed to make sense of individuals
who have been chronically traumatized (e.g., have suffered multiple types of
abuse and neglect at the hands of more than one perpetrator) or who have
experienced familial abuse followed by other traumatic events.
The model theorizes that, in a traumatic environment, the more instinctive
right brain is stimulated to anticipate danger by maintaining hypervigilance or
readiness for action, while the left brain side of the personality “keeps on
keeping on,” getting through the day, keeping life going no matter what. This
allows an abused child to be on guard and ready to hide but still able to walk to
school, play with other children, and do homework. While the right-brain side
might be afraid and ashamed, the left-brain side could be confidently developing
skills as a student, athlete, artist, or scientist.
The diagram in Figure 7.2 represents this model of survival-related splitting.
Under stress, the left- and right-brain sides of the personality begin to operate
more independently to allow the individual to do two things at once: to carry on
as if nothing has happened and to prepare for the next threat—and the next and
the next. Both are necessary for survival. The authors of the Structural
Dissociation theory named the left-brain self the “Apparently Normal Part of the
Personality,” suggesting that it pretends to be normal, but I quickly found that
my clients could not appreciate the important role of this part of the personality
when it was called “apparently normal.” So, for their sakes, I re-named it the
“Going On with Normal Life” self to emphasize that our left-brain selves reflect
an instinctive survival-related drive to “keep on keeping on,” not a false or
pretend self. I wanted to emphasize the positive evolutionary function of this
part and challenge the tendency to see the ability to function as a false self, as if
the trauma-related responses were the only “true self.”
 Figure 7.2: The Structural Dissociation Model

In addition, emphasizing the positive aims and goals of the Going On with
Normal Life self encourages survivors to strengthen their ability to manage the
tumultuous emotions of the defense-related parts, rather than simply trying to
ignore them. We could think of the right-brain part of the personality as the
Emotional Part, as do the authors of the theory, or we could think of it as the
traumatized part of the personality. It can be very confusing and crazy-making to
be logical, rational, and functional one minute and then be overwhelmed by
emotion and impulse five minutes later. This model helps to reassure survivors
that they are not crazy or faking it. They can learn to identify triggered reactions
and overwhelming emotions as the traumatized part(s) and understand their
Going On with Normal Life part as a resource, not a pseudo-self.

Tammy always struggled during her birthday month of July,

alternately yearning for someone to care about her and then
developing elaborate plans to commit suicide on the day itself.
Some years, she was hospitalized because of her suicide risk or
would miss many days of work because she could not get out of
bed in the morning. One year, she was shocked to find out at the
end of the month that she had won the Employee of the Month
Award! Even though she had called in sick many times, she
apparently had been extremely productive when she was there,
more so than other workers who never missed a day of work.
That was the first sign she ever had to indicate that she was more
than her loneliness and suicidality.

Use Worksheet 19: The Structural Dissociation Model to explore the

two sides of you. Avoid labeling characteristics of either side as bad,
shameful, or false. Just be curious about your inner struggles and which
sides of your brain are in conflict.

MORE DANGER MEANS GREATER NEED FOR SPECIALIZED

SURVIVAL-RELATED PARTS
The Structural Dissociation Model goes on to say that with repeated and chronic
experiences of trauma, more complex splitting and fragmentation is often
adaptive and necessary. But it too follows the logic of the body and brain.
Because children have to depend upon their instinctive animal defense survival
responses (fight and flight, cry for help, freeze in fear, or collapse and submit) in
the absence of parental protection, the theory states that with chronic trauma,
subparts of the personality spontaneously develop representing these very
different forms of self-protection (see Figure 7.3). The model is clear that
fragmentation or structural dissociation is a normal instinctive reaction to
repeated trauma, not necessarily evidence of a dissociative disorder. You will be
able to sense if these ideas resonate for you.

Figure 7.3: Understanding the Traumatized Parts as Protectors

For example, in some families, it is not safe for children to fight back or
show anger, but having a fragmented, split-off fight part means that the anger
does not have to be felt by the child and therefore is not perceived by the adults.
In other families, it is even more dangerous for the child to cry or to cry for help
(e.g., to tell other adults what is happening). Having a fragmented cry for help
part allows the child to cry or show distress in some situations (e.g., with a
grandparent or teacher) while never looking sad in the presence of the abusive
parent. The cry for help part also seeks closeness and protection—both of which
are dangerous with abusive parents. Fragmenting in this way allows for very
complex and sophisticated adaptations to traumatic environments. The submit
part might carry the sense of hopelessness and helplessness necessary in an
environment where being seen and not heard is most adaptive and hope is risky,
while the Going On with Normal Life part goes to school, plans ahead for
college and then a life beyond trauma. And, as the Going On with Normal Life
self is planning a future, the suicidal fight part might be plotting a way out if
things get worse, and the flight part might be drinking too much to manage the
hopelessness of the submit part and the flashbacks of the freeze or fear part.

Carly had hopes and dreams for her future beginning when she
was quite young. Then she met her partner in college at age 19
and began to imagine someday having a home and family and a
career as a therapist. But these hopes and dreams were
complicated by the daily nightmares and flashbacks she still
experienced. These symptoms overwhelmed her and triggered a
hopeless part that just wanted to give up. Unfortunately, that was
usually a signal to her suicidal part to begin a new round of
planning how to die rather than live with being constantly
overwhelmed. “I don’t think I want to die,” she said. “I have a lot
to live for. I don’t understand why I keep trying to kill myself.”

For children raised in unsafe environments, all of these subparts may be

necessary in response to changing demands. For example, going to school
requires a part of the personality that can pay attention in class, learn, and
socially engage with peers and teachers. At home, with parents who may be
withdrawn and neglectful sometimes and violent at others, different parts
dedicated to different ways of surviving could be essential. For example, the
sound of the abuser’s voice or footsteps might trigger the panic of a fearful part
(freeze), alerting the body to danger; a playful part might try to lift the parent’s
irritable mood and facilitate a positive connection by making him laugh (social
engagement); a caretaker part (submission) might try to protect herself or her
younger siblings in the face of the violent behavior; and a hypervigilant fight
part would be carefully observing the parents’ mood to anticipate how to best
defend against them.

Use Worksheet 20: Identifying the Traumatized Parts to connect the

 parts model to your own particular symptoms and struggles. You do not
have to be certain—just begin to be curious about which part of you is
shy, which part is ashamed, which part is mistrustful, etc. See if this
model intuitively makes sense to you, even if it is a very new idea.

Usually, the Going On with Normal Life part of any individual tries to carry
on with daily priorities (e.g., functioning at a job, raising the children, caring for
pets, organizing home life, even taking on meaningful personal and professional
goals). But those activities are often complicated when traumatized parts are
triggered in the context of everyday life, resulting in overwhelming emotions,
incapacitating depression or anxiety, hypervigilance and mistrust, self-
destructive behavior, and fear or hopelessness about the future. Many survivors
come for treatment after being flooded or highjacked by the feelings and
physiological reactions of the trauma-related parts; others come when their
attempts to disconnect from or deny these responses lead to chronic depression
or depersonalization.

Geraldine considered herself a successful survivor of her

childhood. By the age of 38, she had left home, married her
childhood sweetheart, established herself professionally, had a
baby, and bought the house of her dreams. She felt that she had
made it. She finally had everything she had ever wanted, and now
she could finally relax. And then she woke up one day trembling
with inexplicable and overwhelming fear, hopelessness, dread,
and a feeling of desperation. The tsunami of trauma had hit, and
the parts had highjacked her body. Not knowing what these
feelings meant, she went to see a therapist who encouraged her to
talk about her painful childhood past—which left her feeling
more panicky and overwhelmed. By now, the feelings had gripped
her body: She could not sleep, eat, or sit still. When she was not
shaking, she was vomiting—which made it harder to eat because
she could not keep food down. She tried another therapist who
said she was too anxious for treatment and another who
complained that she was resisting treatment. Because she was so
accomplished professionally, it did not occur to anyone that she
might be suffering from trauma or from trauma-related
dissociation.
UNDERSTANDING YOUR DIAGNOSIS
Because the theory of Structural Dissociation describes a way of understanding
personality in chronically traumatized individuals, it is consistent with a number
of diagnoses given by mental health professionals, including Complex PTSD (C-
PTSD), Borderline Personality Disorder (BPD), Dissociative Identity Disorder
(DID), and Dissociative Disorder Not Otherwise Specified (DDNOS). If you
have ever been given any of these diagnoses, just remember that they are all
diagnostic labels commonly given to trauma survivors who survived by
fragmenting. They do not mean that you have a mental illness. Here is how to
understand these diagnoses as manifestations of the parts.
If you have been given a diagnosis of BPD (the most common diagnosis for
fragmented individuals), it simply means that you have a very strong cry for help
part and a very strong fight part, making it difficult for you to tolerate separation,
isolation, disappointment, and loneliness (the cry for help part)—and also
making it difficult for you to tolerate anger and impulses to hurt yourself (the
fight part) when someone has upset the cry for help part. You might function
well at work or as a parent, or you might find these parts getting triggered even
in those domains, making your job even harder.
If you have been given the diagnosis of a dissociative disorder, it means that
you have more clearly observable compartmentalization and more experiences
of being possessed by the emotions and impulses of the parts (e.g., the intense
anger of the fight part or the hopelessness and shame of the submit part). But
even if you do not understand why these strong feelings take hold so quickly and
either blame yourself or the other person, you are conscious of what you have
said or done.
If you have been given a diagnosis of DID, not only is the number of trauma-
related parts likely to be greater, but you are more likely to have resource parts
serving the Going On with Normal Life self or its priorities, for example, a
professional part, a parenting part, or a part with special talents or social skills
(see Figure 7.4).
 Figure 7.4: Getting Help From the “Normal Life” Self

Use Worksheet 21: Signs of Structural Dissociation to explore your

own experience of fragmentation. Notice if it is helpful to think of the
different reactions you commonly experience as reflective of different
parts. Especially when you notice internal struggles or paradoxical
reactions, be curious about a possible conflict between parts of you.
 In addition, the parts of an individual with DID have a life of their own:
They can take over the body and act outside of conscious awareness. The key
indicator of DID is evidence that you have done or said things you do not recall.
That is, you are not able to remember hours or days or particular activities in
which you clearly have been engaged.

While updating her curriculum vitae, Celia, a successful

organizational consultant, was surprised to discover that she had
won an award in 1990 for which she had no memory. Not only
could she not recall winning it, she could not recall what she had
done to deserve it! She had long suspected she might have DID,
but this discovery seemed to corroborate that idea. Annie also
discovered disturbing evidence of her DID diagnosis when she
received a letter from her oldest friend asking her never to
contact him again under any circumstances. “I will never forgive
you for what you said to me last week—it was cruel, and I don’t
want to be hurt anymore.” Lacking a memory of having spoken to
him recently, she could not imagine why she had been angry at
him or what she could have said.

RECOGNIZING SIGNS AND SYMPTOMS OF STRUCTURAL

DISSOCIATION
The Structural Dissociation Model predicts that symptoms of fragmentation,
depersonalization, out-of-body experiences, failures of integration, and internal
conflict between parts of the personality are all to be expected as a legacy of
traumatic experience, in addition to the more common symptoms of PTSD like
flashbacks or numbing.
If you are not sure whether structural dissociation applies to you, start by
seeing if the following more general points are issues or challenges in your life:
Limited benefit from therapy. You have sought help from therapists, but
therapy has not resulted in much progress or clarity. Or, worse yet, the therapies
have been rocky, tumultuous, or overwhelming rather than supportive and
helpful, or your symptoms have gotten more severe rather than lessening.

Somatic symptoms. You have unusual pain tolerance or unusual sensitivity to

 pain, get migraine headaches, or have an unusual need for sleep but never feel
rested. You have suffered at times from dizziness, nausea, and/or vomiting, and
psychiatric medications have never worked well for you (either the side effects
were too difficult or the drugs simply did not work).

Memory symptoms. You have difficulty remembering how time was spent in a
day or find that you have engaged in conversations or activities that other people
recall but you do not. Perhaps you have suffered from blackouts, even when you
were not drinking or taking drugs, or you often get lost even while driving
somewhere familiar, such as going home from work. You might find yourself
suddenly forgetting how to do something very simple and familiar.

Subtle manifestations of fragmentation. You function well at work or as a

parent while often or occasionally feeling overwhelmed, abandoned, depressed,
ashamed, or suicidal and self-destructive.

If any of these points apply to you, it is quite possible that you may be
dealing with structural dissociation. The core challenge for structurally
dissociated individuals is the effect of trauma-related triggers on their
fragmented parts. Triggers lead to trauma-related hijacking of the Going On with
Normal Life part by other parts, resulting in internal struggles between the
trauma-related parts and the Going On with Normal Life part. For example,
accomplishing your "To-Do" list for the day is limited by a part’s fear of leaving
the house, or your wishes for more closeness and friendship are countered by the
fight part’s mistrust of anyone with whom you have a relationship. These inner
struggles will be reflected in a series of difficulties thinking, making decisions,
and managing your symptoms and impulses. The following is a more specific
list detailing the different ways in which the presence of structurally dissociated
parts can manifest in your life:
Evidence of child parts. At times, you feel small and your body language
young, whatever your chronological age. Sometimes you suddenly lose the
ability to speak, worry a lot about being rejected and abandoned, have difficulty
being alone, or need help in accomplishing basic activities (e.g., shopping,
cooking, driving, turning on the computer).

Patterns of indecision. You find it difficult to make even small, everyday

decisions and to commit to activities, relationships, or jobs. You may have
noticed a pattern of committing and then changing your mind or starting out a
new job or relationship very easily, then having things fall apart. You are
sometimes very responsible, especially to others, and at other times very
irresponsible, usually to yourself.

Patterns of self-destructive and addictive behavior. Despite your commitment

to your family or job or to living, you find yourself engaging in behavior that
you would never choose. For example, your Going On with Normal Life self
might swear not to do any more binge-eating at night—and then, hours later, you
might find yourself halfway through a pint of ice cream.

Difficulty “being here, now—in the present moment.” While your Going On
with Normal Life self tries to avoid thinking about the past, the trauma-related
parts are chronically preoccupied with danger, fearful, angry, sad, or lonely.

Difficulty soothing or even managing the overwhelming emotions and

impulses of the parts. Even when your normal life is a very safe and stable one,
trauma-related parts may interpret traumatic triggers as signs that they are in the
same danger of being annihilated, humiliated, or abandoned as they were in
childhood.

Had Geraldine been given this information about structural

dissociation, she would have resonated with the model. The fear
and vulnerability she was experiencing did not feel like the
person she knew herself to be. But no therapist seemed to be able
to help her understand it or remedy what was happening. In the
midst of what she termed her “nervous breakdown,” Geraldine
discovered something that helped: pain medication. After a tooth
extraction, she was given an opioid pain medication that not only
relieved her physical pain but also calmed her body and made the
emotions bearable. Soon, she was using the pain medication daily
and then multiple times a day. She was addicted but without
knowing it because it was a behavior driven by her flight part
and, although she was conscious of doing it, the thought that the
pills would harm her never crossed the mind of her Going On
with Normal Life self. Had her daughter been taking the same
drugs, she would have known it was risky behavior, but because
the drug-taking was the impulse of her flight part, she was not
 fully connected to it.

When trauma-related parts are triggered, each one responds with

characteristic behaviors reflecting the different animal defenses, as you can see
in Figure 7.5. The freeze part might become agoraphobic; the submit part may
retreat to bed in shame, depression, and hopelessness; and the hypervigilant fight
part might push people away with irritability, mistrust, or guardedness. Suicidal
or self-harming parts that once increased the child’s sense of having some
control (“If it gets too bad, I can die. I can go to sleep and never wake up”) may
continue to have strong self-destructive impulses when triggered by threat, loss,
or vulnerability—even tolerating the vulnerability of other parts may be difficult
for fight parts. The flight response might drive addictive behavior, eating
disorders, sexual addiction, and other sources of relief (or “flight”) from the
overwhelming trauma-related feelings and sensations. And then, in response to
the acting out of fight-or-flight parts, submissive and needy parts might become
ashamed, depressed, and filled with self-loathing, while the cry for help parts
beg not to be abandoned. Often, survivors are left feeling confused, helpless, and
even overwhelmed by all these different feelings and responses. Life feels more
out of control, not less.
 Figure 7.5: Figuring Out Who I Am

Use Worksheet 22: Speaking the Language of Parts to practice

speaking the language of parts and unblending from the parts’ feelings
and impulses. Use the left-hand column to identify the feelings or
reactions you notice in yourself and the right-hand column to translate
those feelings into the language of parts.
PREPARING TO WORK WITH TRAUMA-RELATED DISSOCIATION
AND FRAGMENTED PARTS
As we have learned in the previous chapters, scientific research on traumatic
remembering tells us that both spontaneous triggering and deliberate recollecting
result in activation of the autonomic nervous system and deactivation of the
prefrontal cortex or thinking brain (van der Kolk, 2014). We feel endangered but
have lost the ability to discriminate the actual degree of threat. Repeated
reactivation of our survival responses (fear, shame, loss of breath, body tension,
pulling back, collapsing, rage, the impulse to hide, even feelings of
worthlessness and fault) increasingly sensitize the brain and body to respond to
traumatic reminders even more automatically. It can become a vicious circle—
one made worse when not only the body but also the trauma-related parts are
triggered.
To address the challenges of fragmentation and break this vicious circle, we
must first be able to “turn on” the prefrontal cortex. Without the noticing brain, it
becomes impossible to do the work of trauma recovery. Use the diagrams and
worksheets in this book to keep reminding yourself about triggers and triggering,
the window of tolerance, and the Structural Dissociation Model. Keeping in
mind and practicing the following suggestions can help you make use of your
prefrontal cortex to observe trauma-related parts rather than getting swept away
by their emotions or impulses:
1. Assume that your intense and intrusive emotions, thoughts, and impulses
are communications from parts, as are numbing and loss of energy. That
might be an oversimplification, but it is safer than assuming that all distress
reflects your entire self feeling hurt, angry, ashamed, or afraid. Children and
adults deal differently with distress. As adults, we have more ways to soothe
or manage our emotions and more self-control over how we express
ourselves. The traumatized child parts have no way to deal with distress other
than to act or react, and they have no ability to reality test their actual level of
safety.
If the parts interpret traumatic activation as danger and so do you, it will keep
reinforcing their sense of threat. However, when we identify distress as
communication from a younger part of ourselves, we can change our
relationship to the feelings or impulses or to the lack of feeling. We can be
more curious and interested instead of overwhelmed and, as we know,
curiosity helps to increase activity in the prefrontal cortex. Recognizing that
your mind and body are being influenced moment by moment by emotional
 and physiological input from these trauma-related parts also stimulates the
thinking brain. Once you can recognize the signs that parts are being
triggered, your thinking brain begins to work better, your nervous system
calms, and you can begin to soothe and bring hope to the parts.
2. Practice differentiating your Going On with Normal Life self from your
traumatized parts. If we are now chronologically of adult age, every one of
us has an adult self, no matter how depleted, demoralized, or unable to
function we may feel. You might have little consciousness of your Going On
with Normal Life self because your attention has been drawn to the
overwhelming emotions or incomprehensible behavior of the parts, over
which you feel no control. Or you may be aware of certain skills associated
with being an adult, such as the ability to think, acquire knowledge and skills,
or care for others or accomplish tasks, but experience these states as a false
self rather than as a more stable, thoughtful, functioning self.
Often it helps to simply identify what roles the Going On with Normal Life
part plays in your life now—for example, going to work, taking care of a
child, interfacing with the external world, doing things with friends, and
participating in hobbies. Even if you feel incompetent and fraudulent, take it
on faith that any of these activities are evidence that your Going On with
Normal Life self is alive and well.
Then start to notice what is not that self—for example, when you feel small
and overwhelmed at work or hopeless and depressed when out for a
celebratory dinner with a friend or partner. Learn to assume that vulnerable
feelings must logically belong to a part that feels much younger and more
overwhelmed, such as a traumatized child part. When you feel angry and get
sarcastic with your boss, is that your Going On with Normal Life self? What
part would feel angry at an authority figure and not care about the
consequences? At what age and stage of life would that be a characteristic
behavior or way of thinking? At what age would we be worried about
abandonment or not being loved? As you begin to differentiate what actions
and reactions go with your Going On with Normal Life self and which go
with different ages and stages of childhood, you will begin to better
understand your traumatized selves. They have not been complicating your
life intentionally. They get triggered, and their emotions, actions, and
reactions are driven by fear, not maliciousness. Like any adult, the Going On
with Normal Life part’s job is to keep the younger generation feeling safe,
stable, and protected—a job that always begins with understanding. When
children or child parts feel heard and understood, they feel safer.
3. Speak the language of parts. Practicing the language of parts and
interpreting symptoms, conflicts, intrusive emotions, impulsive behavior, or
an inability to act as communications from parts simplifies the task of
noticing the moment-to-moment responses of the parts and being curious. In
addition, it aids in developing another important skill called “unblending”
(Schwartz & Sweezy, 2020). As human beings get flooded by the emotional
reactions of their parts, most of us “blend” with them. We tend to use “I”
language, which strengthens the parts’ reactions and our identification with
them and increases the likelihood that we will act on their feelings and
impulses. We feel the anxiety, anger, or shame and name it as my feeling—
for example, “I feel very anxious today” or “I feel very depressed.” Then we
attempt to interpret the feeling based on the present context: “I think it’s
because I have this job interview coming up.” Often, we base our actions on
how we have interpreted the communications from the parts: “Maybe I
should cancel the job interview—but I really need a job.”

Guiliana repeatedly found herself attracted to unavailable men

(her “attach for survival” part) and repulsed (the fight and flight
parts) by men who were clearly attracted to her, especially those
who were kind and wanted closeness. Although Guiliana was
generally very tactful in her Going On with Normal Life self, she
found herself pushing away the available men with an air of
boredom or disgust (the fight part) while always finding reasons
to excuse the unavailable men (the attach part). At other times,
she felt alone and lonely. At age 45, she longed for a partner and
home. However, because she automatically blended with
whatever part was reacting in a given moment, she could not
resolve the endless internal conflict about relationships until she
began to name each different response as a part: “A part of me
appreciates how patient and loving Dennis is with me, something
I’ve always wanted. Another part of me finds him boring, and
there’s also a part who complains that she’s not attracted to him
at all. And how can I be with a man to whom I’m not attracted? I
tend to believe that, so then I have to remember how attracted to
him I was when we first met—and most of all to remember what I
want in a relationship, which is love and respect.”

If we use parts language, it will be easier to notice that it is the parts that are
struggling. Saying, “I am depressed” seems to confirm that the whole body and
mind are depressed, whereas saying, “A part of me is depressed” expresses
empathy for the part while also conveying that there are other parts that are not
depressed. Parts language also facilitates increased self-compassion: If an angry,
lonely, or ashamed feeling is reframed as a communication from a young part,
we can feel more empathy for those feelings.
In order to teach clients about blending and unblending, it is necessary to
take on a very different role as a therapist. Instead of empathizing with trauma-
related emotions and helping clients to sit with them, we need to help
traumatized individuals first learn to mindfully distance from emotions; become
curious about them as implicit, nonverbal memories held by a part; and then use
parts language to be curious about distressing emotions: “She is anxious because
it’s getting dark so early in the day now.” By learning to recognize that you are
blended and then unblending, you can begin to make more sense of your internal
struggles and avoid decisions or conclusions based on the input of a single part
or group of parts.
Sometimes clients are told by professionals not to use the language of parts
because it will make the dissociation or fragmentation worse. That concern
would be understandable if it were true, but when we notice thoughts, feelings,
and physical reactions, and name them as manifestations of parts, we are actually
promoting what is called integrative activity in the brain. We cannot integrate
aspects of ourselves if we have not observed and differentiated them as parts of
our whole.

LEARNING TO HELP YOUR PARTS

The next step is to become more skilled at helping or soothing your parts. These
are just a few of many ways of helping your nervous system and your parts to
feel less overwhelmed, less reactive, or less numb. As traumatic reactions
become less intense, your reactions to triggers (and theirs!) will slowly lessen:
Use your 10% solutions from Worksheet 15. See which ones seem to be most
helpful to the parts, not just to you.

Learn to use somatic resources from Sensorimotor Psychotherapy (Ogden &

Fisher, 2015) to regulate your nervous system and help all the parts. For
example, feeling your feet on the floor can communicate to the parts that you are
grounded even though they are freaking out. Placing a hand over your heart
might signal to frightened or lonely parts that someone supportive is there.
Lengthening your spine and slightly raising your chin might help to
communicate hope to hopeless parts or decrease the shame of a part that feels
worthless.

Practice the eight “C” qualities from Internal Family Systems (Schwartz,
2001) illustrated in Figure 7.6. No matter how much trauma we have
experienced, all human beings have the capacity to be curious, calm, clear,
compassionate, creative, courageous, connected, and confident. The “C”
qualities are never lost. Often, simply asking a part to step back or to sit back
mobilizes the “C” qualities spontaneously, but it is also helpful to simply try to
be more curious, more compassionate toward the parts, and more creative or
calm in dealing with them.

Learn how to foster internal communication and cooperation. Traumatized

parts have no reason to trust any human being, and they will not trust your Going
On with Normal Life self without some relationship building and a sense that
you are there with them and for them. Practice talking to yourself (e.g., to them)
by asking them simple questions, “What are you worried about if
____________________? How will it help to die? How will feeling hopeless
help me?” Assume that the parts always have good intentions and that they are
just trying to help you survive in a world they perceive as dangerous. Do not try
to connect the parts to particular events. They developed to help you survive
those events, but it is important to remember that the parts are survival-related,
not event-related.
Figure 7.6: The Eight “C” Qualities
 Use Worksheet 23: Strengthening Your “C” Qualities to explore,
recognize, and strengthen your “C” qualities. If you think you do not have
a certain quality, ask yourself, “Have I ever been curious [or
compassionate or courageous] for even one minute in my whole life?”
We do not have to use these qualities to possess them, and the
worksheet is meant to help grow your “C” qualities so they are resources
for you.

For trauma to feel like a past experience, we need to have gained the ability
to stay conscious and present even in the face of triggers, to tolerate the ups and
downs of a normal life, and to help all parts feel safe in the body. This takes time
and practice, but once you can be here now and help the parts join you, the
trauma will feel over and you will be able to experience it as something that
happened long ago.
Each time you notice how a feeling is linked to a particular part—each time
you attach an age or state of mind to that part, feel curious about it, or connect it
to current triggers—you are helping yourself to see all the aspects of your whole.
You are not rejecting or ignoring some parts and feeling proud of other parts—
you are welcoming every side and aspect of yourself. You are setting the stage
for healing and resolution to take place, as we will see in the next chapter.
 Worksheet 19
The Structural Dissociation Model
 Worksheet 20
Identifying the Traumatized Parts
When many traumatic events happen, more splitting is required to allow
parts who can defend in different ways against the dangers the individual
faces.
 Worksheet 21
Signs of Structural Dissociation
You might notice different sides of you in the descriptions below. Check
any that apply and, in the column to the right, note to which part the feeling
or behavior might belong.

Able to function in some situations but not in ____________________

others
Overwhelming emotions ____________________
Sudden intense physical or emotional reactions____________________
Often feeling out of control of what I do and ____________________
say
Anxiety rules my life ____________________
Feeling “possessed” ____________________
Can’t stop hurting myself ____________________
Can’t stop drinking or using drugs ____________________
Having plans for the future but not wanting to ____________________
live
Feeling out of control of my body ____________________
Can never make a decision ____________________
Insecure about acceptance by others ____________________
Can’t trust anyone or trust too easily ____________________
Fears of abandonment ____________________
“All over the place” ____________________
Depression rules my life ____________________
Hating myself ____________________
Anger rules my life ____________________
Shame rules my life ____________________
Pushing other people away ____________________
Too dependent, too needy ____________________
Not knowing who I am anymore ____________________
Having trouble with my memory ____________________

What is it like when you think of these different reactions as

communications from different parts of you?
____________________________________________________________
 Worksheet 22
Speaking the Language of Parts
Use the left-hand column to identify feelings or reactions you might be
having and the right-hand column to translate the feelings into parts
language.

Feeling or Reaction Translation

“I’m depressed.”
_________________________
“I am a failure.”
_________________________
“I want to die.”
_________________________
“It’s hopeless.”
_________________________
“I’m worthless.”
_________________________
“No one loves me.”
_________________________
“I want to hurt myself.”
_________________________
“I’m fine.”
_________________________
“I just need a stiff drink.”
_________________________
“I just want all this to be over.”
_________________________
“I don’t trust anyone.”
_________________________
“I am so angry I feel like I could
explode.” _________________________

Notice if it feels different when you express the feeling or thought in parts
language:
____________________________________________________________
 Worksheet 23
Strengthening Your “C” Qualities
Use this worksheet to write down the “C” qualities you have and where you
have them in your life. Think of some ways you can strengthen these
qualities.

Self
Curious, Compassionate,
Calm, Clear, Creative,
Courageous, Confident,
Connected

Curiosity: ____________________________________________
Compassion: _________________________________________
Calm: _______________________________________________
Clarity/Perspective: ___________________________________
Creativity: ___________________________________________
Courage: ____________________________________________
Confidence: __________________________________________
Connection: __________________________________________

Remember: Any thought, feeling, impulse, or physical reaction that does

not possess any of the “C” qualities is always a communication from a part!
 8
Healing and Resolution

Post-traumatic stress represents our biological inheritance as human mammals.

After trauma, our survival instincts keep the mind and body riveted on the past.
The visual images play and replay. Our senses become heightened to detect
potential danger, and we react to sounds, sights, and other human beings in
anticipation that they will be threatening. All our emotional and physical
reactions become heightened as well; we might find ourselves reacting more
intensely or, conversely, not reacting at all. Suddenly, we feel excruciating
shame, lose the capacity for speech, or comply when every fiber of our being
wants to say, “No!” Often, we either become overwhelmed by what we sense or
feel, or we are inexplicably numb and everything is an effort. Sometimes, there
is no predicting how we will react to anything.
Trauma leaves behind little to no sense that an event occurred and that it had
a beginning, a middle, and then an end. There is no visceral feeling of relief at
having survived. The past has not been resolved or integrated with a clear felt
sense that “the traumatic event is over—it is behind me—and I survived it.”
Even decades afterward, traumatized individuals can still be frozen in time
midway through the traumatic experience—afraid, overwhelmed, numb,
ashamed, or helplessly furious—without any awareness that they have long ago
made it safely to the other side. You might know intellectually that it is over but
still not feel safe or feel normal because the trauma is still alive in your body and
nervous system. Given that the story has had no ending, how do survivors
achieve a sense of completion or resolution?

ACKNOWLEDGING THE PAST WHILE STAYING CONNECTED TO

THE PRESENT
For decades, experts believed that the experience of resolution could only be
gained by remembering the traumatic events and reexperiencing the unresolved
emotions until they felt over. A logical belief to be sure, but it was a treatment
approach that often produced the opposite effect on trauma survivors: shame
instead of relief, an increase in overwhelming feelings and self-hatred, and
impulses to attack their bodies or end their lives. In the 40 years since the
inception of the trauma field, experts in the field and survivors have learned the
hard way that reexperiencing the past is equally or more likely to contribute to a
failure of resolution.
Now we know that, for trauma treatment to be effective, no matter what
methods we employ, survivors do not have to reexperience or even remember the
past. However, they do have to be able to experience some kind of clear physical
and emotional sense that “it” is over and that they are still here. We must be able
to acknowledge the past and reflect on its legacy without reexperiencing it. Even
when trauma responses keep demanding our attention, we have to learn how to
access other places in our minds and to use the resources of our bodies and
minds to change the physical responses that keep us traumatized.
If the goal of trauma treatment is “to be here instead of there,” as Bessel van
der Kolk tells us, any therapeutic approach must directly or indirectly keep the
emphasis on the present. Although this book is not a substitute for trauma-
informed treatment, it is intended to provide the building blocks to help you
connect to a felt sense of safety in the present moment. This may seem like a
simple task, but it is not. The difficulty is that, as you now know, the implicit or
nonverbal aspects of memory keep reactivating the sense of immediate danger.
When we remember a traumatic event, or when we are triggered by some small
cue in the here and now, our bodies automatically begin to mobilize for danger,
not knowing that we are remembering threat rather than being threatened now.
And when the prefrontal cortex shuts down and our bodies go into survival
mode, we cannot rationally analyze what we are feeling.

Week after week, Annie reported, “It’s bad—everything is falling

apart. There is too much stress in my life. Nothing has changed.”
But when I inquired about what was happening, she reported, “I
thought I was going to have a quiet afternoon, but my
goddaughter called and wanted a ride to her job … It’s almost
autumn—and I’m not ready for winter … We haven’t had a single
party or cookout all summer—no one comes to our house
anymore.” With further discussion, it emerged that her
 goddaughter’s need for rides triggered an anticipatory wariness
that she was being used; the tasks of putting away garden hoses,
getting ready to rake leaves, and cleaning out gutters on her
house felt like emergencies that had to be addressed immediately;
and the slowing of family social occasions as her children moved
into their 30s triggered feelings of being unwanted and
unimportant. These normal life stresses had triggered
disconnected feeling memories of being used, on the brink of
disaster, and painfully alone.

Resolution of the past requires transforming our relationship to what

happened, and this is achieved through the development of the following skills,
all of which have been covered throughout the previous chapters:
Expanding the window of tolerance until both the implicit memories and the
day-to-day stresses of a life after trauma can be experienced as within our
capacity. We do not have to like trauma-related feelings, past or present, but we
do need to feel a sense of being able to tolerate them. If we have the bandwidth
to stay present, manage our impulses and emotions, and keep our thinking brains
online, we do not have to reexperience overwhelming feelings or go numb.

Recognizing as implicit memory the feeling and bodily states that can still be
triggered even after successful treatment, whether or not we have the images or
the narrative of an event.

Learning to recognize triggering stimuli and to accurately label triggered states

as responses to the past (“This is a feeling memory or a body memory,” “This is
triggering”), refraining from searching for proof beyond a reasonable doubt
about what happened, and not trying to remember every detail of what you know
at your core has happened.

Identifying distressing feelings or symptoms as survival strategies rather than as

problems or defects to be eliminated.

For all of these reasons, I have focused attention in this book on helping you
notice when your body and brain are remembering dangers from the past. And
when we can finally appreciate what it took to adapt to that dangerous
environment and to parents who were incapable of safe attachment, then it
becomes possible to live fully in the present despite traumatic triggering and
trauma-related conditioning. It becomes possible to have a healing story, a story
that makes meaning of what happened and that attests to how we have survived
it.

Annie’s sense of emergency about household and yard tasks was a

body memory of the danger she and her siblings faced if they did
not complete their chores on time. The anticipatory prediction
that she was being used was the feeling memory of a child who,
over and over again, was used sexually, physically, and
emotionally by the adults in her life. And her inability to say
“no” reflected the conditioned learning that it was safer to help
her alcoholic mother manage her life than to wait until her
mother felt stressed. The traumatic past had been over for over
40 years, but it did not feel over.

OVERCOMING THE CHALLENGES TO RESOLUTION

Bessel van der Kolk (2014) gives us a simple prescription for trauma treatment:
Recovery is a process of “re-establishing ownership of one’s mind and body” (p.
203). And he lists four steps to that goal:
1. “Finding a way to become calm and focused;

2. Learning to maintain that calm [despite triggers] that remind you of the past;

3. Finding a way to be fully alive in the present and engaged with the people
around you;

4. Not having to keep secrets from yourself, including secrets about the ways that
you have managed to survive.” (pp. 203-204)

“Finding a way to become calm and focused” is another way of saying that
resolving trauma requires expanding the window of tolerance, just as we
discussed in Chapter Three. Increasing the number of 10% solutions in your
repertoire and learning to use them when triggers activate the nervous system,
emotions, and body gradually increases the sense of being okay in the present.
When you are in the present, even just noticing “I’m triggered” over and over
again, you are more available to focus on work, play, rest, relationships, and
enjoyment. And as the window of tolerance expands, most individuals gradually
feel less triggered in their daily lives and relationships, or they are more easily
able to recover from having been triggered.
A life after trauma is not a life in which we will never ever be triggered
again. It is a life in which being triggered is a nuisance, not a catastrophe or an
experience of shame. A nuisance just requires patience and perspective, the
ability to “maintain that calm [despite triggers] that remind you of the past,”
which becomes a less effortful step as we have more capacity or bandwidth.

Annie was reflecting on how far she had come in her recovery but
often still experienced her life as unsatisfying, grim, lonely, and
meaningless. I asked her to be curious for a moment about this
pattern. “How might this have helped you survive? What if your
body learned to block any good feelings or sense of pride to
protect you?”
She pondered this question, “Well, I do remember my mother
seemed to be triggered when we were happy and definitely when
we accomplished anything—it’s like she was jealous of her
children’s successes—and she would become more abusive.”
Then she recalled, “And we couldn’t let down our guards—we
couldn’t afford to relax. There were so many people in our lives
who might do something to us at any moment. We couldn’t afford
to feel safe, calm, or loved.” It felt right, and it felt true. “So,
even though there are people in my life who love me,” she
reflected, “I can’t enjoy it… And even when I have a good day or
I do something good, I can’t feel good about it. That’s amazing!
So, it’s not my life that’s the problem; it’s how my body helped me
to survive!”

If we can identify when we are triggered, it becomes possible to “be fully

alive in the present and engaged with the people around [us]” (van der Kolk,
2014, p. 204). If we can keep noticing the signs of triggering—the triggers, the
body sensations, and the emotions—as just memory or just sensations, their
effects do not linger. Most of all, the ability to just notice the experience of being
triggered, rather than react to it, is an act of self-acceptance. “I’m triggered
because I experienced trauma, not because I am a bad or flawed human being.”
By accepting the experiences of being triggered as normal, we accept ourselves
as normal, recognize that we are doing the best we can, and increase our
awareness that being triggered is a badge of courage—a testament to being
survivors of trauma.
However, self-acceptance is not easy. Perhaps the most difficult hurdle for
many trauma survivors is overcoming the self-hatred and self-alienation often
necessitated by abuse and neglect. Small children with no way to explain what is
happening to them blame, shame, silence, and reject themselves—all of which
help to lessen the danger. A child (or adult) who blames herself and then feels
shame has no trouble being seen and not heard, finds it easier to comply and
collapse, and less difficult to have no needs or opinions. But that ingenious
adaptation when we are young becomes a hurdle in recovery. Once the danger is
over, self-acceptance and self-compassion are necessary to help us do the work
of recovery and allow the wounds to heal. That may be the inspiration for Bessel
van der Kolk’s final ingredient in the recipe for recovery: “Not having to keep
secrets from yourself, including secrets about the ways that you have managed to
survive” (van der Kolk, 2014, p. 204). By accepting that all living creatures are
instinctively driven to survive by any means necessary, we can forgive ourselves
for whatever we did to stay alive or to maintain some semblance of control.
Acknowledging that it can require extreme measures to cope, adapt, and survive
threatening conditions when we are young and without financial or emotional
support is a way of saying, “That’s how I survived; that is why I’m here now.”

Justin endured years of abuse and abandonment by his mentally

ill, substance-abusing parents until he was kicked out for
“disobedience” and became a homeless adolescent. Out on the
streets, he soon found that the only way to survive was by
prostituting himself, but tolerating prostitution required being
high. He quickly became addicted to heroin, thanks to a drug-
dealing boyfriend, and even sold it at times of desperation.
Deeply ashamed of this period in his life, he hid the secret from
his friends and family even after he had fought his way back to
sobriety and eventually to college. Thanks to his choice of
psychology as a major, it slowly became easier to view this
period in his life as just a way of surviving and to begin to feel
some pride in himself for fighting his way back from the brink to
a healthy, normal life. He now had a healing story: “How I
survived wasn’t pretty, but I did survive, and now I’m going to
 pay it forward.”

LEARNING TO ORIENT TO THE PRESENT MOMENT

It is tragic that the very defensive responses that once helped to save our lives
later prevent us from appreciating that we did survive. Many survivors of trauma
long for relief, long for a sense of pride and confidence, long to feel unafraid and
unashamed. But because the brain and body seem designed to prioritize
anticipation of danger over the enjoyment that it is over, relief is often absent or
short-lived. Our senses still orient to potential threat. Our bodies still mobilize
defensive responses even with the subtlest of triggers. Resolution of trauma
depends on the individual’s ability to change those patterns. In Chapters Two
through Five, we discussed and practiced many different ways of changing
trauma-related responses. Go back to those chapters if you are feeling at a loss as
to how to manage the incessant triggering and its disruptive effect.
One of the most important skills that will help at this stage of your recovery
is what is known as orienting (Ogden & Fisher, 2015). The orienting reflex is
familiar to all of us, so familiar that we rarely notice ourselves orienting even
though we all do it constantly. We turn at the sound of our name or if we hear an
unfamiliar or alarming sound. We pause when we go into a store, airport, or new
building, and look around to see where to go. As parents, we are always
orienting toward our children to make sure they are safe. “Where is he [or she]?”
is a familiar parental question. We do the same with our pets. We instinctively
orient toward potential danger first but also toward sources of nourishment, such
as the produce section of the grocery store, or a friendly-looking stranger at a
social gathering.
The instinctive trauma response of hypervigilance is a form of orienting: Our
brains and bodies are constantly scanning for threat or danger. The feeling of
mistrust is similar, as it mobilizes us to be attentive to any sign that a situation or
individual cannot be trusted. Trust, on the other hand, requires us to focus our
attention toward information that confirms the belief that we can trust. To
resolve trauma requires that we learn to orient differently and more realistically.
As long as hypervigilant orienting keeps us focused on threat, it is physically
impossible to feel a sense that the past is over and things are safe now.

Annie hated her home, felt ashamed of it, and often expressed
dread about returning home after therapy. She described it as a
hovel, but I knew that description could not possibly be accurate
given how many hours each week she and her husband spent
maintaining their house and property. I asked her to imagine
driving home after the therapy session and to pause as she
visualized parking in the driveway and to then look around.
“What do you see as you get out if the car?” I asked.
“I see a white farmhouse with a fence around it. And I can feel
my body relaxing when I see the fence. It looks safe.”
“Notice that fence and then notice what else your eyes are drawn
to.”
“I can see that everything is newly painted, and the back door is
bright red. I painted it red to make it more inviting.”
“How do you feel when you see the red door?”
“I feel warm, and it makes me want to go inside.”
Room by room, I asked Annie to imagine walking through her
home and to just notice whatever she saw. Finally, we came to
her study. The study held deep meaning for her: Two years ago,
she and her husband had decided that she needed a sanctuary in
the home, a place where she could read, sew, or rest and where
she would not be disturbed. But it had been triggering to actually
convert the guest room into her study because it triggered beliefs
that she was undeserving, that it would be taken away, and that
she should not inconvenience others by allocating a whole room
to herself. Nonetheless, she had done it.
As she imagined looking around her study and fully orienting to
it, she could feel a strong somatic sense of being in the here and
now. “This is my room—with the colors I like, with the quilt I
made up on the wall, and with my desk by the window.” She had
a sense of awe and pleasure, along with an awareness of how
different this room was than the rooms of her childhood home; it
was orderly, colorful, and homey. In the weeks that followed, she
practiced orienting to her study each time she was triggered. She
might feel anxious, ashamed, or overwhelmed, but when she
 looked around the study (or even visualized looking around), she
felt her body calming and an awareness that here, in her new
home, she was safe—so safe she even had a room of her very
own.

It can be very challenging to learn to orient to what is positive when your

body instinctively responds to the environment as a threat. It does not happen all
by itself unfortunately. It takes repeated practice: orienting to non-threatening or
positive stimuli, expanding the window of tolerance, deliberately choosing to
focus on what feels good, and working with the fear and shame connected to the
experience of positive feelings.

APPRECIATING SURVIVAL: THE FOUR STEPS TO FREEDOM

Annie once said, “I’m glad I became who I am… I’m not glad about all that
trauma, and I wish it had never happened, but I would not be the person I am
without it.”
A life after trauma has to include some sense of pride, respect, or just awe
that we have survived. We might have to thank those parts of us that contributed
to our survival, even if how they (or we) survived is not pretty. The sense that we
have been through a dark time but now have made it out of the darkness is
important for recovery. There is no conclusion to the story of trauma without
knowing that we survived. But because post-traumatic responses seem to have
developed to increase the odds of survival for early mankind, knowing that we
have survived takes work!
Claudia Black’s “Four Steps to Freedom” (1999, p. 47) provides simple steps
for helping survivors work their way to freedom from the past. I have adapted
these steps slightly for trauma survivors who might be triggered by
remembrance of the past:
Step One. Assume that whatever distress you might be experiencing has been
triggered and is related to the childhood past. [This is a leap of faith that is
crucial to trauma recovery.]

Step Two. Connect that distress to its roots in the traumatic past by fast-
forwarding through your childhood history and noticing where the feelings and
body sensations you notice right now best fit. [“Fast-forward” means no more
than 20–30 seconds! Focusing on or thinking about the past for more than that
short time risks activating the trauma responses.]

Step Three. Identify the internalized old belief that developed as a result of that
experience. [Ask yourself: “What would any human being come to believe about
themselves in that situation?” Or think about the negative beliefs that most
trouble you day to day and identify them as related to the past, not to you
personally.]

Step Four. Find a way to challenge that old belief so that you can begin to
develop new beliefs that better fit your life today. [You are already challenging
those beliefs the moment you label them as “old.” That is the first sub-step. The
next sub-step is to create a new possible belief, such as “I had to believe this in
order to survive” or “This belief helped me to survive because it made me more
________.”] It is not necessary to come up with a new positive belief or to
expect yourself to believe it. It is only necessary to challenge the old beliefs.
 Figure 8.1: The Four Steps to Freedom

Without repeated practice of new reactions and new beliefs, the same
responses that helped you survive will continue to be triggered over and over
again. It appears that the brain and body are slower to let go of responses
associated with survival under threat, and the only way to combat that
phenomenon is to keep practicing the new responses until they become
increasingly automatic. No wonder survivors and therapists alike held on so long
to the belief that all it took to resolve trauma was to tell the story! It would have
been far easier if the burden of traumatic experience were lifted just by sharing
the secrets of the past.

Use Worksheet 24: The Four Steps to Freedom whenever you find
yourself being triggered.

However, practicing the Four Steps to Freedom is empowering. I recommend

making several copies of the worksheets in this book so you can repeat them
again and again—and that includes repeating the Four Steps whenever you are
triggered. After practicing with the worksheets, you will find yourself
increasingly able to recognize that you have been triggered, to trust that there is
a connection to the past, and to assume that you are still carrying some conscious
or unconscious belief as a result of that experience. Once we become aware of
how these old beliefs are constricting our lives, it becomes easier and easier to
challenge them.
But any time you find it difficult to challenge an old belief, be especially
curious. If you find yourself saying, “But it’s true!,” assume that this automatic
“no” reaction means that the belief once played an important role in your
survival and, for that reason, your mind is not giving it up without a fight.

PHASES OF TRAUMA TREATMENT

Judith Herman has been the most vocal advocate of what is called phase-
oriented trauma treatment—meaning that addressing overwhelming, terrifying,
and sickening memories cannot safely be the focus of treatment without first
ensuring the individual’s safety and stability. Because post-traumatic responses
challenge even a wide, resilient window of tolerance, it is often unsafe to dive
into traumatic memories without providing a solid foundation. In fact, it can
become a repetition of having to face danger as a small child without the
emotional and physical resources to manage an overwhelming experience.
Once understood as “you have to be stable to face the trauma,” we now
understand the prioritization of safety and stability in a different way. It means
the discovery that “you have to be here now and you have to be safe now in
order for the trauma to feel over.” It cannot feel over and done if you are in an
abusive relationship, are harming yourself, are trying to die, or are addicted to
“sex, drugs and rock ‘n’ roll.” It cannot feel over if you are still taking care of
those who harmed you or if you are dependent on them financially.
The following are the stages of trauma treatment, adapted from Judy Herman
(1992), that you can see summarized in Figure 8.2.

Figure 8.2: Phase-Oriented Trauma Treatment

STAGE 1: SAFETY AND STABILIZATION: OVERCOMING
DYSREGULATION
As a first step, survivors must be taught to understand the effects of trauma, to
recognize common symptoms, and to interpret the meaning of overwhelming
body sensations, intrusive emotions, and distorted cognitive schemas. The
achievement of safety and stability rests on the following tasks:
Establishment of bodily safety (e.g., abstinence from self-injury, sobriety)

Establishment of a safe environment (e.g., a secure living situation, non-abusive

relationships, a job and/or regular income, adequate supports)

Establishment of emotional stability (e.g., ability to calm the body, regulate

impulses, self-soothe, and manage post-traumatic symptoms triggered by
mundane events)

The goal of this stage is to create a safe and stable life in the here and now,
allowing individuals to safely address the traumatic past, not relive it.

STAGE 2: COMING TO TERMS WITH TRAUMATIC MEMORIES

At this stage, the survivor works to overcome the fear of the traumatic events
and body/emotional memories so they can be integrated, allowing appreciation
for the person he or she has become as a result of the trauma. In order to
metabolize the nonverbal memories, make use of EMDR (Shapiro, 2001); body-
oriented therapies, like Sensorimotor Psychotherapy (Ogden & Fisher, 2015) and
Somatic Experiencing (Levine, 2015); or Internal Family Systems therapy
(Schwartz, 2001). Pacing ensures that individuals do not become stuck in
avoidance or overwhelmed by memories and flashbacks. Since “remembering is
not recovering,” the goal is only to come to terms with the traumatic past, not to
remember its details.

STAGE 3: INTEGRATION AND MOVING ON

The survivor can now begin to work on decreasing shame and self-alienation,
developing a greater capacity for healthy attachment, and taking up personal and
professional goals that reflect post-traumatic meaning-making. Overcoming
fears of a normal life, healthy challenge and change, and intimacy become the
focus of the work. As the survivor’s life becomes reconsolidated around a
healthy present and healed self, the trauma feels further away, part of an
integrated understanding of the self, but no longer a daily focus.

Use Worksheet 25: In Which Phase of Recovery Are You? to look at

where you are in the phases of recovery.

Very important warning: Wherever you are in the stages of recovery, do

not judge yourself! There are many reasons the process of recovery is slow, and
none of them is about you. There is a huge international shortage of trauma
specialists in the mental health and medical worlds. Perhaps you have not had
specialized treatment or a trauma-trained therapist. Perhaps the therapist has
been using the old “tell your story and it will be over” model. Perhaps you
needed to fragment or dissociate to survive—an ingenious way of surviving that
requires more time to resolve. Perhaps you have been afraid of treatment
because you thought it meant having to remember and having to feel the
emotions all over again. Maybe you wanted to believe it had never happened.
All these are normal problems that slow the process of recovery, but they
do not prevent it. Even if you are afraid that you are not ready to even
acknowledge what happened to you, do not give up! Look for a specialized
trauma therapist and tell them in advance that you are looking for a therapist
familiar with the work of Bessel van der Kolk, Pat Ogden, or myself. Make sure
to be honest about how hard it is to even imagine addressing what happened.
Recovering from trauma is a complex and very slow process. Keep
reminding yourself that the symptoms represent survival responses! Even trying
to kill yourself is an attempt to take back control of your feelings and your
future. Most likely, it is a memory of wanting to stop the violence and to end
your suffering. Self-harm or drug use are not evidence of your defectiveness.
Both bring immediate relief and, despite their harmful long-term effects, these
may have been the only ways you knew to manage the overwhelming feelings.
Try to admire your ingenuity, even if these ways of surviving have also led to
shame and hopelessness.
Try not to judge yourself or worry about where you are in the process.
Just focus on the next step, whether it be the establishment of a safe environment
or the ability to acknowledge the past and experience triggering as remembering.
We all find our way to healing step by step, and most of us will not recognize
that we are there until well after our own personal legacy of trauma has been
resolved and we have forgiven ourselves.

HEALING AND FORGIVENESS

Healing or feeling healed begins to happen the moment when we accept and
forgive ourselves—the moment when we see that small child who we once were
through the eyes of the compassionate adult we have become. That little boy or
girl believed the feeling of shame was evidence that he or she was at fault,
defective, or unworthy. Children are too young to know that shame is simply a
survival response that helps us submit when we are trapped. Children do not
know that it is safer to blame themselves than to blame the adults on whom they
depend for a roof over their heads and something to eat. They do not know that,
had they fought back, the violence would only have been worse. Be curious
when hopelessness, shame, or anger continue to dominate your mind and body
despite your hard work to transform the effects of the trauma. Ask yourself,
“Why might my young self be afraid to believe that it’s not his or her fault?” and
“Why would a little boy or girl be afraid to hope?”

Use Worksheet 26: Welcoming Your Younger Selves to begin the

process of getting to know your child selves, which is the first step in
making them welcome rather than trying to ignore, control, or reject their
vulnerability.

When we can finally see how young we were, how magical our thinking
was, and how ingeniously we survived, it is easier to open our hearts to that
child we used to be.
And when we feel warmth, pride, or compassion for that little one inside,
something important changes. We experience our grown-up selves in present
time while simultaneously connecting to that wounded child who carries the
emotional and somatic legacy of the past. In those moments, past and present
come together, and the warmth of our compassion heals a little more of that
child’s fear, hurt, and loneliness—until the day we wake up and feel healed or
normal at last. Be patient with the child parts who are afraid to believe they are
not to blame, afraid to believe that they were ingenious and creative, afraid to
believe that it will be safe now. Keep extending the same compassion you would
offer to any vulnerable being until you feel that child inside relaxing, softening,
or sitting up a little straighter. Know that when the young child inside you begins
to feel the warmth and kindness of your acceptance and welcome, you are finally
healing the legacy of the traumatic past.
 Worksheet 24
The Four Steps to Freedom
Assume that the distress you are experiencing has been
triggered and is related to the childhood past.
Describe that distress (tears, hurt, anger, shame, hopelessness), and see what happens
when you assume it is triggered and related to the past:
____________________________________________________________

Connect that distress to its roots in the traumatic past by fast-

forwarding through your childhood history for 20–30 seconds
and noticing where the feelings and body sensations best fit.
Describe in just 1–2 sentences where the distress fits. Try to acknowledge where it might
fit rather than trying to be sure:
____________________________________________________________

Identify the internalized old beliefs that developed as a result

of that experience.
Describe a belief or beliefs about yourself that resulted from how you were treated:
____________________________________________________________

Find a way to challenge that old belief so that you can begin to
develop new beliefs that better fit your life today.
Describe what happens when you label the belief as old. What would you like to believe
now? What would you want a child in that situation to believe?
____________________________________________________________
 Worksheet 25
In Which Phase of Recovery Are You?
STAGE 1: Safety and Stabilization
Ask yourself: Have I established bodily safety? (e.g., “I am sober, no
longer hurt my body, I go to the doctor” vs. “I still self-injure, do drugs,
and let my body be abused”)
____________________________________________________________

Have I established a safe environment? (e.g., a secure living situation,

nonabusive relationships, I can earn enough to take care of myself )
____________________________________________________________

Have I established emotional stability? (e.g., ability to calm the body,

regulate impulses, self-soothe, manage triggering)
____________________________________________________________

Do I have a safe and stable life in the here and now?

____________________________________________________________

STAGE 2: Coming to Terms with Traumatic Memories

Ask yourself: Do I try to avoid the word trauma? Can I acknowledge the
past? Or am I always focused on the past? Can I recognize when I am
triggered? Or do I just go into the past without knowing I’m triggered?
What triggers me most often? Do I know and appreciate how I survived?
____________________________________________________________

STAGE 3: Integration and Moving On

Ask yourself: Does the trauma feel more finished? Am I less often
triggered or quicker to recognize triggering? How has my relationship to
other people changed? Has my relationship to myself changed? Do I still
believe it was my fault? Or do I have more perspective? What good
qualities or skills do I have as a result of what I went through? Has the
trauma changed my goals in life?
____________________________________________________________
 Worksheet 26
Welcoming Your Younger Selves
Use this worksheet to develop a clearer picture of the child you were at
different ages and stages. He or she does not have to be connected to any
specific event—just to the environment as a whole at that age.

Younger
Self
How old is this child?
What is his or her face and
body language telling you?
What is this child thinking
and feeling still?

When you see your younger self, notice how you feel toward him or
her.
_______________________________________________________

If you notice a judgment or negative reaction, assume that the

hostility comes from a different part. What do you notice about this
part?
_______________________________________________________

What happens if you welcome this younger self as you would any
child?
_______________________________________________________
 Younger
Self
How old is this child?
What is his or her face and
body language telling you?
What is this child thinking
and feeling still?

What happens when you imagine and welcome your

very youngest self?
_______________________________________________________

What happens if you welcome that part too?

_______________________________________________________
 REFERENCES

For your convenience, you may download a pdf version of the worksheets
in this book from our dedicated website: pesi.com/legacyoftrauma

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