Category: Trauma therapy

In our lives, and in our clinical practice, we have all encountered the inner critic, and it can be a true impediment to connecting deeply with ourselves from the inside. Although everyone has a different version, the basic experience is the same: that of a repetitive and demeaning refrain that knows our particularly sensitive spots and sends critical messages right to that target. Often just as we (or our clients) start to feel good and strong, an inner voice enters that deflates us, telling us we are not [smart/successful/good/good-looking/talented…] enough.

In my 20 years of clinical practice, I have encountered many versions of the inner critic and find that the more trauma someone has suffered, the more intense this inner voice becomes. I think it’s in part because as children, we rely so much on our caregivers that if something is wrong with the relationship, it is too scary to blame those we rely on for our very survival. So the badness must be inside of us. It is a protective idea that helps at the time but that outlives its usefulness. However, because it was acquired at a young age, it often feels ‘true’ and is accepted without question. It is a revelation to some to simply say, you don’t have to believe your inner critic. You might want to consider its origin and question its message.

The inner critic is an ancient survival mechanism

Neuroscience expert Dan Siegel says the inner critic originates in our internal ‘checker,’ the vigilant part of ourselves that enabled our ancestors to survive. Those who were most alert to danger, and to something being wrong were more likely to survive and to pass on their genetic heritage. However, unchecked, it can manifest in many unhelpful ways: OCD, anxiety and also as the inner critic. This idea normalizes the voice, and also gives us a bit of objective distance from it. The inner critic is not something to believe without question, especially as we now live in a world where physical survival is rarely at stake.

Siegel’s suggestions for working with the inner critic are: to get curious about the nature of that voice, notice what brings it up and what it wants for you. Or more often, what it doesn’t want for you. Then thank it for doing that and mutually try to figure out a better way to work together.

Thoughts are not the same as facts. Just because something enters our mind doesn’t mean we have to believe it’s true. This may seem obvious, but very often people in the grip of an internal attack do not stop to question the veracity of their thoughts. In depressed clients, I have often seen them make up a whole story that makes themselves wrong or bad, maybe involving other people they imagine are thinking disparaging things about them – and then react as though this entire fantasy is real.  I like to label these thought trails as fantasy. Then I invite them to use inner focusingto inquire into the origin of this felt sense, and to tend to it from there. When the source of the self-criticism is tended to, the critic tends to shift and soften too.

The critic often has its roots in childhood, and from that vantage point, the message might make more sense, because it actually was or felt like it was true at the time. Or it somehow offered necessary protection. I suggest my clients give the critic a new job. Update the critic on the current situation, enlist their constructive help. The critic can become an ally.

Reassign the ‘Loyal Soldier’

I like to use the story of the loyal soldier here. This is the story of Hiroo Onoda, a Japanese soldier who refused to surrender after World War Two ended. He spent 29 years in the jungle on an island in the Philippines, engaged in his military duties (and killing 30 people!). He remained there until 1974, because he truly did not believe that the war had ended.

During his time on the island, he ignored search parties and leaflets sent from Japan to get him to surrender, dismissing them as ploys. He was finally persuaded to emerge after his ageing former commanding officer was flown in to personally relieve him of his duties. Still dressed in a tattered uniform, he handed over his Samurai sword and went home to Japan where he was greeted. He became a rancher and survival training teacher. He died in 2014 at age 91.

This story suggests many things I think are true of the inner critic: that the critic has good intentions and is protective in some way, that it is operating on an outdated set of orders that it will not easily give up, and that in order to shift its energy to something more constructive, it needs to be acknowledged, thanked, relieved of its duties and reassigned. It needs to know the war is over and it can put its sword down.

Because the inner critical voice is thought-based, sometimes cognitive techniques (in addition to focusing) can be helpful. Therapist and author Rick Hanson suggests thought-labelling: “Oh – anxiety. Oh – self-criticism. Oh – alarmist thinking.” This has been shown in research to do two good things in the brain:  it increases activity in prefrontal regions that are involved with executive control, and it lowers the activity in the amygdala, reducing the sense of alarm.

Hanson refers to an idea that originated with Jung: the concept of the self as a committee of various parts. “If the brain is a committee, the chair of the committee, roughly, tends to live right behind the forehead. So when you increase activation of the chair of the committee, who in effect is then able to say to the self-critical member of the committee, “Oh, we hear you already. We got it. Enough already. Hand the microphone to somebody else.”

Recruit your inner cheerleader

To combat our natural tendency toward the negative, I suggest finding the cheerleader or support person to sit on your ‘inner committee’ – and if you don’t have one, recruit one. Just as the inner critic is often a composite of all of the authoritative and judgmental aspects of important people in your life, you can find or create a composite of those who supported you most, or simply evoke a person or character that can be that for you. Then, when you notice the inner critic speaking, you could turn to the inner support person and ask for their opinion. It’s also like asking, what would the person who supports and loves you most say to that critical statement or idea? Let this sink in and be a counterweight to the critic. Over time, you will find that the inner world will become a more benign and supportive place.

The following is a brief review of some key concepts from Clinical Applications of the Polyvagal Theory (Stephen Porges & Deb Dana, Eds., Norton, 2018).

It is now well understood that until our trauma clients genuinely feel safe, no healing will take place. “Cues of safety are the treatment,” according to Dr. Stephen Porges. His Polyvagal Theory that has transformed how we understand the nervous system and now treat trauma emphasizes that “safety is defined by feeling safe and not simply by the removal of threat” (p. 61). It is not good enough to point out to a frightened client that there is nothing to fear in the therapy room with you, they must actually feel it to be so. And this is a moving target.

In the context of providing therapy to those who suffer from the effects of complex trauma, safety may need to be established again and again as younger parts of the self emerge to establish relationship. You may have established a great rapport with the person who shows up to therapy, the part of them that presents a brave and competent face to the world.  However, trauma survivors, and this represents all of us to some degree, can be exceptionally resilient and successful in some areas of their lives, while being chaotic and vulnerable in others. They can experience profound splits. The presenting self, the persona, is often very well put together, as this person may have had to put on a brave face over and over again and become very good at seeming reasonable and fine even when they were breaking inside.

The rapport you so carefully establish with your client is critical, but then when the relationship deepens, there will often be a whole new process of creating safety. As van der Kolk states in his chapter on Safety and Reciprocity, “Our most painful injuries are inflicted by people we love and depend on. That is the source of the deepest human grief, as well as of most psychiatric disturbances… [When] the very sources of comfort simultaneously are the sources of danger, this creates complex disturbances” (p. 31).

I have found that early establishing of safety with the presenting self in a complex trauma case can be relatively easy, but that as soon as the relationship deepens, we enter an entirely new and challenging terrain. Once we enter the client’s inner circle, we can suddenly be perceived as a threat because it was in the context of these very close relationships that the deepest trauma occurred. In session, the client can move from a sense of safety to one of threat in a heartbeat. The trigger can be something you can’t even see, perhaps something as seemingly-benign as an increased sense of closeness to you.

Van der Kolk said these problems will show up in two ways in our clients, both externally and internally, and the Polyvagal Theory makes sense of how this happens. Under real or perceived threat, the body will mount the series of defenses we are familiar with: fight/flight which can lead to “various degrees of unmanageable behavior”, and/or “withdrawn self-isolation” which moves the system into parasympathetic (dorsal-vagal) shutdown. According to van der Kolk, “Both adaptations interfere with play, formation of friendships, social awareness, emotional responsiveness and language development” (p. 31).

Pat Ogden explains, in her chapter on integrating Polyvagal Theory with her Sensorimotor Psychotherapy, that people can experience sympathetic arousal or parasympathetic slowdown in vastly different ways depending on whether or not fear is present. Arousal without fear is excitement (sport, dance, performance) and slowdown without fear is deep relaxation (meditation, yoga, daydreaming). Ogden said stimulating these states without fear may have inherent healing properties. “Perhaps their nervous system recalibrates as they learn to tolerate extremes of arousal… This recalibration leads to better social engagement because “when safety and choice are paramount, the evolutionarily newer ventral vagal branch of the parasympathetic system that regulates the heart, calms the viscera and governs the muscles of the face is activated, [this enables] positive social behavior” (p. 40).

Ogden wrote of her early days as a therapist, and how she moved clients through powerful, cathartic experiences of early trauma experiences, only to find that they became more dysregulated as a result. She tried various body-based exercises like grounding, centering and use of breath, and found attention on helping the body remain calm and present as the client made contact with early memories was slower going, but ultimately more effective. This attention the ‘window of tolerance’ is now standard practice in trauma therapy. Polyvagal theory gives us a clear sense of why such an approach is effective.

The concept of neuroception is key

Porges coined the phrase neuroception as our innate and automatic ability to detect threat or safety in our environment. Neuroception could also be seen as the internal communication system we come into direct contact with when we are focusing, an elegant practice that enables us to connect safely with our inner felt sense. Ogden notes that teaching clients about neuroception and how it can automatically trigger nervous system responses helps clients feel less shame and self-judgment about their behaviours. Cues of threat that go unnoticed consciously, can still trigger fight/flight and/or shutdown, and an understanding of how this works can clear confusion for the client about some of their challenging and automatic behaviours.

In therapy, the work then becomes in part learning to identify triggers, and in part learning to notice and manage the sensations and impulses that come up in response to these triggers. When a past trauma is “touched and awakened” (to use Bonnie Badenoch’s lovely phrase), the body will initiate defensive responses that are rarely under the person’s control. Focusing, the ability to pause and notice, ask inside with compassion and then assess whether the current environment is truly as unsafe as the body seems to think, is something that brings the client back a sense of self-control, understanding and relief.

Love as the key to creating a therapeutic presence

Ron Kurtz, who developed the Hakomi method and was Ogden’s teacher, suggested a beautiful practice to help create the loving, therapeutic presence so necessary to our work as therapists. He suggests we simply discover and hold what we love about each client. “My first impulse is to find something to love, something to be inspired by, something heroic, something recognizable as the gift and the burden of the human condition, the pain and grace that’s there to find in everyone you meet” (Kurtz, 2010, from Readings in the Hakomi method, Hakomi.com).

Ogden concluded that “The felt sense comes to life in the science of the Polyvagal Theory which teaches us that the wisdom that we need is in our bodies and nervous systems and is deeper than cognitive explanations or mental assessments of danger and safety. Polyvagal Theory describes the drive for connection and intimacy as a nonconscious biological imperative situating any relationship, including the therapeutic relationship, in a new realm… At its core, Polyvagal Theory is about love and identifies the physiology behind it” (p. 48).

Embodying love to stay on target

This is a beautiful conclusion – that love is the key to providing safety in the therapy room. Badenoch underscores that this loving attention must come with “the ability to be present without agenda” (p. 79), something our culture does not teach us very well. In the challenge of doing deep trauma work, where the client’s neuroception of safety can be ephemeral, what the Polyvagal Theory tells us is to hold steady, and remain connected to the feelings of love, admiration and respect you hold for the client. This creates the environment they need to return to safety, social connection and the ability to heal due to the combined presence of your sustained loving support and their natural resilience.

Dr. Leslie Ellis teaches dreamwork, focusing and trauma treatment, and is author of A Clinician’s Guide to Dream Therapy.