This chapter provides information useful not only to therapists who are working with individuals with the Connection Survival Style but also to anyone struggling with this survival style or elements of this survival style. It provides guidelines for understanding the sometimes complex process of coming back into connection.
Connection with self and others, the deepest human longing, represents for individuals with the Connection Survival Style the most profound fear and greatest challenge. The organizing principle for healing this adaptive survival style relates to increasing the capacity for connection with self and others, feeling the “right to be,” and the intrinsic right to one’s meaningful place in life and in the world. Connection with self includes the capacity to know what we are feeling emotionally and bodily. Connection with others means having the capacity for consistent relationship and intimacy. An essential part of the NARM therapeutic process is to bring to awareness a person’s relationship to the primary principle of connection, difficulties with which underlie many symptoms. Since the majority of us have elements of this survival style, individuals who struggle most with this theme have something important to teach all of us.
How to help individuals with the Connection Survival Style come out of dissociation and back into connection is the overarching theme of this chapter. Therapeutically, there is an important distinction between a person who has had limited experience with connection with self and others because of early shock or attachment trauma versus someone who, as a means of coping with trauma later in life, has dissociated and disconnected. When individuals have had early experiences of positive attachment, they have more resources available and more capacity for reconnection than those who have had limited lifelong access to their emotions, body, and positive relationships. Shame, disconnection, attachment difficulties, and unintegrated anger are greater for someone with the Connection Survival Style. Dissociation is more profound if a person has never had the experience of connection in their body. In such cases, therapy is more complex and must proceed more slowly.
Over the past thirty years, I (Larry) have supervised and provided consultations to thousands of experienced therapists with a wide variety of training and backgrounds. I have noticed common patterns in the work of these talented and experienced clinicians that limit the effectiveness of the therapy they provide to clients with this survival style. Without a full understanding of the primary organizing principles of this adaptive survival style, success in treatment is inconsistent, and in some cases, therapy can even be re-traumatizing. Therapeutic problems arise when a therapist places too much focus on the symptoms of despair, loneliness, and fearfulness that are characteristic of this survival style: focusing on symptoms does not address the root causes of this survival style, which, at its core, revolve around issues of disconnection, identity distortions, pathological shame, nervous system dysregulation, distortions of aggression, and the loss of the full capacity for aliveness.
More highly symptomatic individuals with the Connection Survival Style show psychological conditions such as borderline personality disorder; obsessive-compulsive disorder (OCD); dissociative, depressive and anxiety disorders; low self-esteem; and attachment and relational difficulties. The roots of dysregulated conditions such as profound despair, phobias, and addictions, to name only a few, begin in this first developmental stage. Physiological syndromes such as irritable bowel syndrome (IBS), chronic fatigue syndrome, fibromyalgia, and environmental sensitivities also can be the result of the profound systemic dysregulation caused by early trauma. At the less symptomatic end of the spectrum of this survival style, we find people who are shy and uncomfortable socially, individuals who do not have access to their emotions, compulsive loners, seekers, and dreamers.
This chapter presents the organizing principles of NARM therapy and applies them to the Connection Survival Style. In the NARM approach we work simultaneously with the physiology and the psychology of individuals who have experienced developmental trauma, focusing on the interplay between issues of identity and the capacity for connection and regulation. NARM uses four primary organizing principles:
1. Support connection and organization
2. Explore identity
3. Work in present time
4. Regulate the nervous system
Although presented sequentially in the above list and in Table 10.1, in reality the primary principles, tools, and techniques weave together organically in the process of therapy. In NARM we track several themes at the same time in a figure-ground process: for example, at any given point we might primarily focus on the theme of identity, while the issues of connection-disconnection and safety are in the background. At other times, the process of connection-disconnection might be in the foreground, while other themes remain in the background.
Connection to self and others is the compromised core capacity that must be addressed with individuals with the Connection Survival Style. There are two parallel and complementary organizing aspects to the process of connection: (1) connection with self, the body, and emotions, and (2) learning to experience connection with others as an enriching reciprocal experience rather than as a source of threat.
| PRIMARY NARM PRINCIPLES | TOOLS AND TECHNIQUES |
| 1. Support Connection and Organization | Inquiry |
| • Tracking Connection-Disconnection | Curiosity |
| • Tracking Organization–Disorganization | Resourcing |
| • Developing Positive Resources | Grounding |
| • Encouraging Somatic Mindfulness | Orienting |
| • Engaging the Eyes | Focusing on Here and Now |
| • Understanding the Challenges of Reconnection | Tracking |
| • Tending to the Therapeutic Relationship | Mirroring |
| 2. Explore Identity | Containment |
| • Supporting Expansion and Aliveness | Titration |
| • Working with Identifications and Counter-Identifications | Pendulation |
| • Teaching Disidentification | Somatic Mindfulness |
| 3. Work in Present Time | Psychoeducation |
| • Fostering Agency and Empowerment | Learning to Listen |
| 4. Regulate the Nervous System | Capacity for Self-Reference |
| • Containment | Grounding | Orienting | Titration | Pendulation | NeuroAffective Touch* |
*NeuroAffective Touch is addressed in Chapter 11 and should only be used by therapists trained in the use of touch.
TABLE 10.1: Primary Principles, Tools, and Techniques Used in the NARM Approach
Exploring both the conscious and unconscious ambivalence about the desire for connection is a core orientation informing the therapy for individuals with this survival style. Regardless of the symptoms and surface issues, holding in mind the overarching principle of connection makes the therapeutic process richer and more efficient for those who struggle with the pain of disconnection. For individuals with the Connection Survival Style, whose deepest longing for connection is also their deepest fear, the key is to work with the conflict around connection as it is expressed in their symptoms, in their current lives, and in the relationship with their therapist. To effectively support the possibility of connection, NARM therapy uses a mindful, process-oriented approach that tracks how a client moves in and out of connection-disconnection and organization-disorganization in present time: in the body, in the nervous system, in a client’s capacity for relationship, and in the therapeutic relationship itself.
From the beginning, NARM pays attention to the client’s process on three levels of experience: cognitive, emotional, and physical. To support clients’ mindful awareness of connection-disconnection while articulating their experience, a NARM therapist might ask:
“As you are talking about this issue in your life, what you are experiencing right now?”
The word experiencing is used purposefully to keep the initial question as open as possible. Clients are invited to pay attention to their own experience at whatever level they can access it. Questions that reference the body, and even the emotions, too quickly, can be overly distressing for people with this survival style. We will see why approaching emotions and sensations slowly is a particularly important aspect of working with the Connection Survival Style. NARM therapists mindfully track and reflect a client’s tendency to disconnect and isolate. Challenging habitual patterns of disconnection and finding the correct pace to support reconnection is like lifting weights: too much too quickly can cause injury, whereas with too little, no growth takes place. As the therapy progresses and we learn more about clients’ capacity to be in touch with their body and emotions, we attune our interventions and pacing accordingly. Finding the optimal way to track and at times gently challenge survival style patterns supports the growth process.
The capacity for connection is the fundamental resource; it is important to attune to and build from existing capacities for healthy connection, whatever those might be for a given individual. Some people have been so injured that they have no conscious awareness of any internal movement toward connection. In fact, their conscious awareness is the opposite: their impulse is to move away from connection. Whatever my clients’ painful personal history, I always help them remain aware of any internal or external resources that have supported connection in their lives. I may ask what or who in the here and now or in their past has been or is a positive source of connection:
“I’m getting a sense from what you tell me, how hard this has been for you. So before you continue with the story, I’m curious as to whether or not there has been somebody who has been helpful to you in dealing with all this.”
This simple question is usually the first step in orienting a client toward positive resources. Shifting clients’ attention to positive experiences of connection, as opposed to pushing for the re-experiencing of distressing states of disconnection, supports self-soothing and brings more organization to the nervous system. It is necessary to help clients slowly shift their attention from what is not working in their lives and encourage them to focus on any area of experience, external or internal, where there is or has been, positive connection. Whatever positive connection an individual has experienced provides an important resource to draw upon in supporting the journey back to increased contact and connection.
Experiencing the psychological and nervous system impact of positive memories, images, and associations in the present moment is useful with all clients, but it is particularly helpful with those with the Connection Survival Style who are the most disconnected from their ongoing present experience. As a client is able to find either an external resource such as an important person, or an internal resource such as the will to survive, I track how identifying the resource impacts his or her current state. When I see softening or relaxation—both indicators of increasing organization—I communicate this observation and invite the client to notice how the relaxation feels.
LARRY: I notice as you talk about your grandmother who was so helpful to you, you seem to be relaxing. Does that fit with your experience?
CLIENT: Yeah … it does feel like I’m relaxing.
LARRY: Can you say anything more about how you’re experiencing that?
CLIENT: I’m feeling lighter all over.
In the NARM healing cycle, increasing relaxation and nervous system organization indicate a developing sense of connection with the body, and as connection with the body develops, there is in turn increasing nervous system regulation.
Primary emotions lead toward integration while default emotions keep individuals stuck in a groove that does not lead to increased integration, coherence, or greater connection to their core life force. Most people have a tendency toward a particular default emotion. The more habitual and automatic the emotion, the more likely it is to be a default emotion. It is not that default emotions are “bad,” but when they are part of a well-worn groove of automatic responses, these emotions keep the survival style in place and do not facilitate reconnection and growth.
We all know individuals who, regardless of what they may actually be feeling, turn to anger. Their primary emotion may be sadness, hurt, vulnerability, or even a more primary unresolved anger, but what they are aware of in themselves and what they show the world is an ungrounded, disconnected anger, which they tend to act out. For them, anger has become a default emotion. For others, anger may be the primary emotion, but regardless of what they are feeling, they default to sadness.
Holding a broad understanding of primary and default emotions is an essential tool in helping individuals experience more depth and connection within themselves. Many clients do not know that they have alternatives when dealing with difficult emotions other than automatically turning to their default emotion and acting out on others or acting in against themselves. In NARM, we present a middle ground where emotions are experienced and contained, leading to increased connection with the life force and the strength, independence, and capacity for intimate relationship that accompany that increased connection.
Organization is experienced as a sense of safety, ease, curiosity, productivity, and creativity. Organization provides an implicit sense of continuity and realistic confidence that are available even in the face of life’s challenges. Ultimately, organization is reflected in the capacity to live in the present, whereas disorganization occurs when a person experiences life through the distorted and limiting lens of unfinished past experience. Organization is reflected in a person’s resiliency; capacity for emotional depth and connection to self and others; physical health; and in the coherence of his or her life narrative. Chaotic lives and disjointed, fragmented narratives reflect internal disorganization. Organization expresses as coherency at every level of experience: cognitive, emotional, behavioral, and physiological. Clients with early trauma who are highly symptomatic tend to focus primarily on the things that are going wrong or have gone wrong in their lives. This tendency, although understandable, is disorganizing to the nervous system. Focusing on a traumatizing narrative without referencing how the body and nervous system are managing, or failing to manage, the arousal that comes with that narrative can cause more disorganization and even be re-traumatizing. In NARM, when discussing life difficulties or trauma, we track disorganization moment to moment and help clients move their attention away from the trauma narrative when it becomes too activating. For example, the NARM therapist might say:
“As hard as things have been for you, is there some area of your life that feels like it’s working or that brings you pleasure or satisfaction?”
As clients discuss painful experiences, a NARM therapist keeps in mind the importance of the capacity for regulation. Bringing clients’ awareness to their experience in the present moment, while they are talking about the past, is an important first step in supporting the re-regulation process. By finding and working with areas of organization in the client’s nervous system, body, relationships, and life, NARM supports the development of an increasing capacity for regulation. Instead of focusing primarily on stories of trauma and difficult symptoms, an important organizing principle is to find and work with areas of pleasure, satisfaction, or better functioning. Certainly there are times when naming and sharing distress can bring more organization, and therapists must be available to hear a client’s distressful narrative. However, at the same time, NARM therapists ask questions that bring clients’ awareness to the state of their nervous system, continually supporting possibilities for improved regulation. For example, as a client shares difficulties, I might say:
LARRY: I’m going to interrupt you for a moment and invite you to notice what you’re experiencing right now as you are talking about your difficulties.
CLIENT: I’m getting tighter and tighter all over, particularly in my stomach.
LARRY: I interrupted you because I could see that you were getting increasingly tense and not paying attention to that tension. Eventually, I want to hear the whole story, but I encourage you to talk about it in such a way that you don’t get overwhelmed or disconnected.
CLIENT: I’m relieved that you’re slowing me down.
LARRY: Pause.… Tell me more about the sense of relief you’re feeling.
CLIENT: I’m not feeling so tight, and my stomach is starting to settle.
Because clients are often unable to notice or identify their own increasing arousal before it progresses into disorganization and dysregulation, it is important to bring their awareness to it. Many clients, as in the dialogue above, express relief at being slowed down. Therapists can track increasing or decreasing organization by paying attention to clients’ physiological markers: muscular bracing or relaxation, breathing patterns, facial expressions, skin color, and movement. It is key to pace clients by monitoring and supporting their capacity for regulation and by paying attention to whether or not what is unfolding overall is bringing increasing organization or more disorganization.
Overview of the Basic Steps to Reconnection
1. Explore how clients experience disconnection and what the symptoms of that disconnection are in their current lives. It may be helpful to bring into awareness of where and how the patterns of disconnection first developed, but the purpose is not to focus primarily on the past.
2. Recognize and understand the survival value of the coping mechanisms and adaptive survival styles clients developed and still use that currently create disconnection.
3. Identify how these survival patterns are expressed in the body and held in place by identifications and behavior.
4. Bring mindful awareness to and help disidentify from shame- and pride-based identifications. Challenge unhealthy behavioral patterns that limit clients’ lives and keep them re-enacting the past.
5. Work through the distortions of the life force, reconnect with the missing internal resources, and original core self-expression.
TABLE 10.2: Overview of the Basic Steps to Reconnection
Therapeutically, positive resources tap into those elements of a person’s life, psyche, and nervous system that are functional, organized, and coherent. Positive resources tap into either positive states in the moment or the memory of positive life experiences as they are brought to awareness. Positive resources support stability in the body, in the nervous system, and in social relations by promoting self-soothing, relaxation, and increased organization. Pain, emptiness, anxiety, and myriad fears are symptoms of the real problems—the lack of internal organization and the missing capacity for connection.
A hierarchy of resources supports connection and reorganization. Human resources are the most helpful; any person, such as a loving grandparent, an involved teacher, or a mentor, may have been a positive resource whose image can be called upon in the therapeutic process to support re-regulation and reconnection. The more chronic the early trauma, the harder it often is to find human resources, since humans are often experienced as sources of threat. It is not unusual for clients with the Connection Survival Style to feel safer connecting to animals, nature, or God, any of which can function as a positive resource.
Most of us have access to more resources than we realize. It is important for clinicians to remember that if clients are functioning in the world, they are drawing on resources, internal and external. Even in the most chaotic of lives, there are healthy capacities and resources from which to draw. We have all heard about individuals who came from dysfunctional or abusive families who went on to have successful, meaningful lives as adults. When we read their stories, we often see that they remember one or more significant persons in their lives—a grandmother, teacher, aunt—who taught them that, despite their traumatic home life, there was still love and kindness in the world.
We can understand the therapeutic impact of resourcing in relation to three different domains: cognitive, emotional, and physiological. One of the first questions I ask clients who talks about a traumatic childhood is who or what helped them get through those difficulties. This question is helpful on several levels:
• Cognitively, recognizing positive internal resources helps clients not blame themselves for, and feel shame about, their difficulties. When therapists identify and mirror positive capacities in their clients, they help them shift their thinking away from trauma-based cognitive distortions and negative self-judgments to become more self-accepting.
• On the emotional level, it may never have occurred to clients that there has been, and often still is, support for them. They often do not realize the degree to which they have shown tenacity and courage in managing what have been lifelong difficulties. It is helpful to recognize and appreciate both the external support they might not have realized was there as well as the internal strengths they have not acknowledged in themselves.
• On the level of the nervous system, getting in touch with internal and external resources reinforces and enhances the capacity for regulation. Recognizing and acknowledging resources has a further calming and regulating effect on the nervous system.
• Resources in the here and now interrupt the brain’s predictive process and support the important dynamic of disidentification. Body-based resources are even more powerful than cognitive awareness in disrupting the predictive processes of the brain, helping clients not to identify so strongly with the content of their fears.
When we view ourselves and our world through the lens of developmental trauma, our perspective is blurred by split-off anger, pain, disorientation, and shock. A therapeutic orientation focused on internal and external resources is an antidote that shifts clients’ attention to a larger, less distorted picture of themselves and their lives. It brings to the forefront of their awareness the capacities they do have and reminds them that there is love and support in the world.
Focusing on positive resources and the associated experience of safety establishes and reinforces oases of organization in the nervous system. It cannot be repeated often enough that focusing primarily on dysfunction reinforces dysfunction and that, step by step, it is necessary to help clients shift their attention away from focusing exclusively on what is not working in their lives and encourage them to pay attention to areas of experience where they do feel connected and organized.
It is often easier to find and utilize positive resources when working with shock trauma as opposed to developmental trauma. When clients begin a narrative about a shock trauma event, such as a rape or a car accident, they become visibly anxious or disconnected. I interrupt the escalating arousal and explain that, although I eventually want to hear the whole story, I propose that we begin with a different question:
“Tell me the first moment when you felt safe after the event.”
If they have an experience of safety after the event that they can access, they exhale and relax. With developmental trauma, however, when the experience of lack of safety has been chronic, the process is more complex. It is necessary to look for any life experience in which clients felt at least a sense of relative safety. The exercise in Figure 10.1 can be useful in identifying positive internal and external resources.
EXERCISE
Identifying Positive Resources
External Resources
Take some time to write down all the external resources you have had in your life. Notice what you feel emotionally and physically as you remember the people, places, activities, pets, or organizations that have supported and helped you. It is not unusual for this exercise to continue over several weeks as you remember more resources and add them to your list.
Internal Resources
Make a list of all your internal resources (tenacity, capacity for friendship, curiosity, openness, etc.). Track your emotional and physiological responses as you recognize the positive aspects of who you are. Notice how you feel as you acknowledge your strengths.
FIGURE 10.1: Exercise to Help Identify Positive Resources
The following is a simplified protocol for working with positive resources with individuals who have developmental trauma.
• Inquire about positive supportive relationships or life situations that functioned as resources in their life.
LARRY: With parents as chaotic and abusive as you describe, I’m wondering how you made it.
CLIENT: For me, school [church, Scouts, a neighbor, relatives] was the only place I felt safe.
• Encourage clients to elaborate on the resource.
LARRY: Tell me about how it was for you at school.
As clients go into details about the resource experience, reflect any increasing organization. After this client describes his school experience in general, I evoke awareness of the specific needs that were met in the situation.
LARRY: What in particular stands out that was so helpful?
CLIENT: My fifth-grade teacher, Mr. Martin, really liked me and cared about me. He saw a potential in me that no one had ever seen before. Looking back now, I realize that it was because of him that I started to see that I was smart. He was so different from my dad, who always put me down and called me stupid.
• Track how clients respond as they talk about those positive areas of their lives. Look for any indication of relaxation or discharge of arousal, such as a smile or softening in the body, and reflect this change. When a movement toward organization and regulation is noticeable, reflect it and help the client track the relaxation.
LARRY: As you talk about Mr. Martin, I notice you’re smiling. I’m wondering what you’re experiencing right now?
CLIENT: I’m feeling some emotion, but it feels good.
LARRY: See what happens if you give that feeling a little time.
Obviously, interventions are often more nuanced than the bare-bones outline presented above. Nonetheless, in order to support autonomic regulation, simple language that evokes particularly positive relationships is useful in accessing the affective core that has become frozen in trauma.
Therapists often struggle with how to help clients who are shut down and dissociated. When a client identifies a positive resource, there is discharge of activation or arousal reflecting an increase in nervous system regulation. As clients talk about their positive resources, I track to see what impact the awareness of the resources is having: increased expressiveness, softening in the body, deepening of the voice, smiling, positive shift in the breathing, increased skin color.
As the work with the oases of organization continues, clients experience increasing affect regulation and expansion. In a natural movement of pendulation, areas of disorganization—including painful affects, negative beliefs, shame-based identifications, and other symptoms—inevitably surface. Only when clients are stabilized should the therapist redirect their attention to the original painful narrative. The therapist helps clients learn to manage difficult affects as they surface, teaching them to hold the dual awareness of their emotional pain while helping them see that these painful affects are often relics of the past. It is important not to push painful affects away, but at the same time, it is equally important not to reinforce identification with them or get submerged in them. This mindful dual-awareness process supports increasing organization, and the increasing organization in turn supports a greater capacity for mindfulness.
Some clients with particularly difficult histories may have a harder time than others identifying resources. If they cannot find any positive human connection, I encourage them to look for areas of positive connection in other parts of their lives. For example, if they mention they have a dog that is the love of their life, I may say:
“I notice that as you are talking about your dog, something seems to change for you. What are you aware of?”
When a resource is identified, I encourage them to report associated sensory details, such as colors, smells, and sounds. The sensory details of a positive resource have a powerful organizing and regulating impact on the nervous system. I might continue:
“Give yourself some time to notice what it’s like for you as you talk about your dog. Tell me some of the things you like to do with your dog.”
When remembering or imagining positive resources of any kind, past or present, it is important to direct the client’s experience to the present moment:
“As you tell me about playing with your dog, what are you noticing right now?”
Eventually, as the therapy progresses, clients will develop more capacity to experience other humans as possible sources of support rather than as sources of threat, but in the beginning the therapist works with whatever resources are available.
NARM adds somatic mindfulness to the traditional practice of mindfulness to help individuals increase their capacity for self-regulation and connection. In NARM, somatic mindfulness is a primary principle and is used as a technique to both regulate the nervous system and to support clients’ efforts to free themselves from the restrictions of distorted identifications, including pathological shame and guilt. Because of early trauma, clients with the Connection Survival Style have the deepest disorganization in the nervous system and the most distorted identifications. As a result, somatic mindfulness is more difficult for them than for the other survival styles but, as their somatic awareness develops, they experience significant growth.
A core value in NARM is to support clients as they learn to listen on every level of experience. The more we learn to listen to our thoughts, feelings, and sensations, the more we experience an internal flow. When we chronically do not pay attention—do not listen—to our body, it finds ways to get our attention, even if it needs to “scream” at us in the form of symptoms. When we learn to listen to our internal states, it is easier to regulate ourselves, and we become less symptomatic.
In NARM the development of a grounded and stable connection to the body is the physiological base for nervous system reorganization and re-regulation as well as a primary source of support for the process of disidentification. The dissociation commonly experienced by individuals with the Connection Survival Style reflects their disconnection from their physical and emotional core. Since every cognition and every emotion has a physiological substrate, it is important to track the somatic connection that underlies thoughts and feelings. In the following dialogue, I help the client develop a deepened awareness of her emerging emotions using mindful emotional tracking:
LARRY: As you’re talking about your situation, I notice some tearfulness. What are you aware of on an emotional level right now?
CLIENT: I feel some sadness.
LARRY: Is it okay to allow that sadness to be there?
CLIENT: It’s okay, but it scares me.
LARRY: Take your time with it. Take a moment to ground yourself again, and we’ll explore the feelings that are coming up at a pace that feels manageable.
CLIENT: Takes time to ground.… I’ve always been afraid that if I let myself feel the sadness, it would never end.
LARRY: Are you feeling the sadness right now?
CLIENT: A little bit.
LARRY: Notice what happens in your body if you just allow that little bit of sadness.
CLIENT: Strangely, when I allow it, I start to relax a bit.
LARRY: When you don’t struggle against the emotion, you start to relax. We’ve seen many times before that emotions come and go.
Notice that this is a non-goal-oriented process. It is not focused on getting a person into the feeling. The implicit understanding is that as clients feels safe to allow their emotions, whatever emotions need to be addressed will surface. In the comment that emotions come and go, I am reminding this client to be mindful of, but not identified with, her emotions—to be open to her emotions and at the same time not to take them as ultimate truth.
Here is an example of mindful sensate tracking:
LARRY: What are you feeling in general right now?
CLIENT: Concerned look.… I thought I was getting more relaxed, but I just started trembling.
LARRY: Trembling often happens when the nervous system is re-regulating. Take a moment and see how it is for you to allow it to happen.… Pause.… Is the trembling pleasant or unpleasant?
CLIENT: It feels weird, but it’s really not unpleasant.
LARRY: Okay, then see what happens if you give it time.
Trembling is often an indication of discharge of high arousal, and we support the client to allow it as long as it does not become overwhelming.
Many somatically oriented psychotherapists are confused when they work with clients who are unable to talk about their bodily experience. Individuals with the Connection Survival Style are estranged from their bodies, find bodily experience threatening, and have difficulty sensing their bodies. These clients feel anxious and disorganized when asked to focus on sensations too early in the therapeutic process; even if they look affectless and shut down, their bodies and nervous systems carry such a high sympathetic charge that until they are able to discharge some of this high arousal, they cannot access their internal states. It is not advisable to push them to feel their bodies or emotions prematurely because it can be disorganizing to do so. In the long term, however, it is essential to help these clients develop access to their emotions and bodily sensations. Individuals with the Connection Survival Style discover, slowly and over time, that grounding in their biological and emotional selves can become a source of pleasure and comfort.
Individuals who are dealing with significant fragmentation tend to focus on discrete and distressing internal experience even when overall, there is organization and increasing coherency taking place. In such cases the NARM therapist references the overall experience rather than focusing on discrete bodily sensations. Addressing a client who is clearly settling and relaxing, I might say:
“I’m wondering what you are experiencing right now.…”
Individuals with the Connection Survival Style tend to focus their attention on what feels wrong even when overall, they are actually becoming more regulated. Such a client might say:
“I feel tension in my throat, and my belly feels tight.”
This tendency to focus on distress has a disorganizing result and needs gentle redirection.
LARRY: It’s fine to notice the tension in your throat, but see if you can bring your attention to your overall experience right now.
CLIENT: Overall, I’m actually feeling better.
As the painful levels of arousal and unresolved emotions that keep clients out of their body diminish, they naturally begin to have access to awareness of their body.
In NARM, we explore clients’ internal states as well as their relationship to their internal states—what they are feeling and how they relate to what they are feeling. Are the emotions and sensations they are experiencing manageable, or do they have judgments or fears about allowing them to surface? If they are aware of fears or judgments about their internal state, those are explored. We never push clients to feel an emotion; we want to help them notice internal states as they arise and expose any internal conflict they have about experiencing them. Because Connection clients often present with little affect, some therapies and some therapists may prematurely push them to feel emotions and sensations in the body. It is a failure of attunement to push clients to feel before they are ready. This lack of attunement is experienced as rejection and can reinforce these clients’ shame about their difficulty connecting with their internal experience.
Trauma, and particularly early trauma, has a profound impact on the eyes. Hans Selye’s research confirmed what Wilhelm Reich knew fifty years earlier: that under stress there is a narrowing of the visual field and other visual distortions. The unbearable, acute stress of early developmental and shock trauma is managed by chronic contraction, tension, and freeze in the musculature around the eyes. This contraction in the eye segment is part of a larger dynamic of tension and immobilization in the face, neck, and shoulders, all elements of an incomplete defensive-orienting response.
For individuals with the Connection Survival Style, who have had early shock, attachment, and/or developmental trauma, the early environment has been experienced as dangerous or threatening. This experience of early threat is held as high levels of arousal, freeze, and an incomplete defensive-orienting response that expresses as hyper- or hypovigilance. For most clinicians, the darting eyes of the hypervigilant client are more familiar and easier to recognize; the hypotonic responses can be subtler and harder to track but have an even greater disconnective impact on the client.
Individuals with the Connection Survival Style have difficulty making eye contact. Typically, there are two ways in which therapists encounter this difficulty. Some clients find it uncomfortable or frightening to engage visually, and in therapy they avert their gaze, looking anywhere but at the therapist. Others, as we saw with Carla in Chapter 9, lock on with a fixed, contactless gaze, trying to hold on to a sense of connection. Encouraging clients to engage their eyes by finding non-threatening objects or colors to explore visually functions as an antidote to projection; successfully engaging the eyes can disrupt panic attacks and support reregulation. Table 10.3 summarizes the characteristics of hypertonic and hypotonic eyes.
When I teach NARM’s psychobiological approach to attachment dynamics, I give participants in my training groups the exercise described in Figure 10.2.
This exercise gives participants an insight into their own early attachment dynamics. As is well known, the gaze interaction is part of the larger attachment dynamic that functions as a template for later relationships. Attachment researchers have explored how a mother’s gaze, particularly when it conveys chronic anger, depression, or dissociation, impacts the developing child. Some participants, in reporting their experience, mention that they were unable to bring up any image of their mother’s eyes, which in itself is telling. Other participants, for whom the mother’s eyes were a source of trauma, report strong emotional and physical reactions, including fear, sadness, dissociation, and tightness in the chest or belly, to mention but a few. Finally, for others, the exercise is a positive experience and brings up a sense of closeness and appreciation.
| HYPERTONIC EYES | HYPOTONIC EYES |
| Chronically angry eyes | Contactlessness |
| Chronic squinting | Each eye tracking in a different direction |
| Whites of eyes visible all around | Lights on but no one home: indication of dissociation |
| Darting eyes | Looking without seeing |
| Exophthalmic “bug” eyes | The “long distance” gaze; diffuse focus |
| Frightened eyes | Disengaged |
| Frightening eyes | Impaired capacity to orient |
| Excessive blinking | Waxy, frozen quality to the eyes and face |
| Tics | Fixed gaze |
| Hypervigilant eyes | Sleepy eyes |
| Predatory eyes | Difficulty making eye contact |
TABLE 10.3: Impact of Trauma on the Eyes
Your Mother’s Eyes
Ideally, this exercise is done with a partner with whom you can share your experience, but it can also be done alone or with a therapist. It can be quite evocative, so if at any point, it becomes too challenging or painful, please do not continue with it alone.
• Take a moment to center and ground yourself.
• From this centered, grounded place, bring up an image of your mother’s face and eyes.
• Take a few minutes to be with the image and at the same time track both your emotional and physical experience.
• Share your experience with a partner, or if you are doing this alone, write it down.
FIGURE 10.2: Exercise to Explore Early Gaze Dynamics
The eyes are a good diagnostic marker to gauge a client’s coherency, connection, and organization. As we saw with Carla, paying attention to a client’s gaze is an extremely useful way of tracking the connection-disconnection process. The first step in working with the eyes is to bring mindful awareness to the gaze and gaze-aversion process. Therapists reflect to their clients what they observe while encouraging clients not to force contact. In NARM the overall orientation is to help clients stay in contact with their internal experience and make eye contact only when they feel able to maintain internal connection with themselves.
Therapists need to modulate their own gaze with clients who have this survival style. Very direct gaze is threatening. It is helpful if the therapist looks away periodically to give these clients sufficient space. The challenge is to be present for the contact when the client wants it but not to push for it, holding the space without coming too strongly into the client’s field. For these clients, too direct a gaze on the part of the therapist can be experienced as judgment and attack.
Eye contact should not be forced. When clients attempt to force themselves to make more contact than they can manage, other areas in their body will tighten up or shut down. It is relieving for most clients to track their gaze and gaze-aversion process with a clear understanding of not forcing contact, uncoupling shame responses that surface when they are not able to tolerate much eye contact, and simply bringing curiosity and inquiry into the dynamic. In this non-pathologizing atmosphere, in which clients become mindful of their process of connection and disconnection, possibilities for connection become increasingly available. After NARM sessions clients often report sharper vision, brighter colors, and a broader visual field.
Individuals with the Connection Survival Style have retreated into frozen and dissociated states, a certain kind of non-being that has helped them survive. These clients know, at a deep level, that their survival strategy is no longer serving them, but it is frightening for them to live without it. In the beginning of treatment, many of these clients have little capacity to tolerate either positive or negative affects and sensations. Since too much feeling of any kind threatens to overwhelm them, therapists must be able to anticipate the challenges that these clients face as they slowly confront the vulnerability of moving beyond their survival strategy.
Despite their dissociated, depleted, and undercharged appearance, clients with the Connection Survival Style are energetically highly overcharged at the core; their entire nervous system has been flooded with shock energy. Their dissociation and disconnected lifestyle are attempts to manage this intense activation. Their ability to sense their body can be slow and initially difficult, because feeling the body initially brings a greater sense of threat than the non-feeling state.
Even a gradually titrated process of reconnection presents distinct challenges. As clients increasingly feel their bodily sensations and emotions, every increase in connection brings with it an upsurge of bodily sensations and emotion. As self-awareness increases, awareness of distress states also increases. Clients need to be educated about how this upsurge is part of a natural growth process, otherwise they can become frightened by the welling up of feeling and will tend to retreat into the non-feeling state. Since freeze and dissociation are driven by unmanageable levels of high arousal, the focus of the therapy is to find ways to help the client discharge these unbearably high levels of arousal. Some body-centered therapies, and even relaxation exercises that encourage deep breathing or use techniques that increase charge in the body, are often destabilizing for individuals with this survival style. Since they are already in a hyper-aroused state, adding more charge to their system is harmful. Because it is frightening to come out of dissociation and to feel again, the process of returning to feeling and to the body must be carefully titrated.
The following techniques are useful in managing the challenges of reconnection. Several of the techniques discussed here are explained in more detail in the section on regulating the nervous system later in this chapter.
In guiding clients to connect to their experience, the NARM therapist is careful not to ask too many questions. Rather than asking questions, it is useful to mirror or reflect. When there is settling in a client, the therapist reflects it. When positive reorganization is occurring, it is useful to reflect it in a general way, to point out any positive shifts, such as relaxation, softening, and increased connection or regulation. It is important to observe and note visible behaviors, being careful not to interpret. The therapist might say:
“I notice when you’re talking about your grandmother, you are smiling. What are you feeling right now?”
It is more helpful to be descriptive than prescriptive, to reflect the client’s internal conflicts rather than try to resolve them. The therapist might say:
“From what you are saying, there seems to be both anger and fear of your anger coming up right now.
At the beginning of the process, questions are as open as possible:
“What are you aware of?”
Or:
Only after the therapy has progressed and a client is ready would the NARM therapist ask:
“What do you notice in your body?”
Early in the therapeutic process, we reference the body when:
• The reference is to a positive, not a painful, state.
• The client is in touch with a resource or is in the process of discharging shock energy.
• There is sufficient capacity for containment.
Once clients begin to experience their body sensations again, the NARM therapist:
• Pendulates between negative and positive states, emphasizing positive states.
• Anchors positive states in the felt sense.
As reconnection occurs, negative affects will, of necessity, emerge, and the NARM therapist is careful to support mindful awareness of negative states while encouraging clients not to let themselves get overwhelmed by these painful states.
For individuals with the Connection Survival Style any shift in arousal can feel like too much. At first we work with the subtlest shifts, helping clients stay at the edge of what they can tolerate without being overwhelmed.
In NARM, we encourage containment of affects, not catharsis. Over time we help clients develop the capacity for depth in feeling both positive and negative emotions. We encourage clients not to act emotions out against others nor in against the self.
There is a seeming paradox between having a clear understanding of the organizing principles specific to this and other survival styles and, at the same time, coming to each moment of the therapeutic encounter with curiosity and without preconceived ideas. Organizing principles only constitute a working hypothesis which is always subject to change based on what unfolds, moment by moment, in therapy. Open curiosity informs the NARM process; this means coming to each moment fresh and supporting clients to be curious about their own situation and difficulties. Curiosity is an openness and a “not knowing” that functions as an antidote to our judgments, fixed ideas, and rigid, distorted identifications.
The NARM therapist educates clients to know what powerful emotions and tremendous charge they hold inside without pushing for too much expression. It is as important to work with a client’s fear of feeling as it is to get to the feelings themselves. When an individual is finally able to track his or her experience in the body, it indicates that a major milestone has been reached in the therapy; the client has developed enough organization to feel the sensations in his or her body.
LARRY: It seems that you’re recognizing there’s anger there, and at the same time it’s frightening to you.
CLIENT: That’s right.… It scares me, and I don’t like it.
LARRY: Do you feel in a place to explore the fear and the judgments you have about anger?
The therapist is the representative of attachment and social engagement. The role of the therapeutic relationship is particularly important in working with early shock trauma, attachment wounds, and themes of abuse that are present with individuals who have the Connection Survival Style. Since these individuals tend to see other human beings as a threat, there are specific difficulties, challenges, and complications that surface in the dynamics of the transference. The following describes some of the key issues that arise in the therapeutic relationship with Connection Style individuals.
Managing the Therapeutic Process of Connection
• Pointing out and reflecting positive shifts
• Being invitational, not directive
• Not focusing solely on what has gone wrong
• Titrating small oscillations in sensation and emotion
• Offering unconditional kindness, compassion, and acceptance
• Pendulating between distress states and positive resources
• Not pushing for trust or connection before the client is ready
• Not pushing for sensation or emotion before the client is ready
• Mindful awareness of negative states without becoming identified with them
• Keeping one foot in the here-and-now, discouraging regression
TABLE 10.4: Techniques Useful in Managing the Therapeutic Process of Connection
These highly sensitive clients are extremely attuned to the therapist in both positive and negative ways. They are particularly attuned to inauthenticity. The quality of therapists’ presence and their ability to authentically be with these clients is of greater importance than any technique. If the therapist’s approach is “techniquey,” these clients will experience it as a misattunement. Since Connection Survival Style individuals tend to believe that no one will understand them, they do not respond well when the therapist does to them rather than is with them.
The NARM approach to working with this survival style offers mindful, nonjudgmental ways of being that can help therapists avoid approaching these clients in a mechanical manner. It is important to let these clients decide how much of themselves they are ready to reveal and at what pace. Individuals with the Connection Survival Style already see their lives as problems to be solved, so that if a therapist holds a primarily problem-solving focus, these clients’ vulnerable inner world can be missed.
It is important to attune to the natural connection-disconnection cycles of the Connection Survival Style. Because of their frozenness, individuals with this survival style are challenged by human warmth. When these individuals allow themselves to feel connected, the feeling is quickly followed by fears and suspicions. For them, small oscillations in feelings, positive or negative, represent a major risk, and the therapist should be prepared for powerful positive and negative transference reactions.
In NARM we:
• Explore clients’ attachment dynamics and the various ways they turn away from connection. A NARM therapist keeps in mind how much contact clients can tolerate before becoming disorganized and how much expansion is possible before contraction is triggered.
• Support both autonomic and affective regulation by carefully titrating and working with clients’ rhythm of connection and withdrawal.
• Support clients’ slow but progressive mindful attunement to their emotional and somatic states.
Clients with the Connection Survival Style will, at some point, be disappointed because their therapist cannot always live up to their expectations. It is important to communicate to these clients that they have a right to their needs even if their needs cannot be met. With these clients in particular, the process of rupture and repair in the therapeutic relationship is ongoing. Underneath the surface disconnection are needy, angry, and demanding parts, which of necessity must emerge and be explored. Therapists should not work with these clients unless they are willing to address the disappointments, suspicions, anger, and resentments that will inevitably surface toward them.
The importance of understanding attachment dynamics and the need for affective attunement between therapist and client has been addressed by many researchers and clinicians, but the critical role of somatic attunement—knowing how to clinically address the functional unity between disorganized attachment and a disorganized physiology and how to work with the disorganized physiology—is less well understood. Understanding regulation on a somatic level is key to implementing effective clinical interventions that can help clients in the process of moving from what Attachment Theory calls disorganized and avoidant attachment to what is called earned secure attachment.
Being mindful of the moment-to-moment process of contact and contact rupture is extremely important in working with individuals with the Connection Survival Style. For these clients, sharing distress in a compassionate relationship is in itself a new form of connection. While the therapist’s warmth and acceptance are absolutely necessary for these individuals, these qualities can, at the same time, evoke high arousal along with fear and suspicion. This high arousal can quickly lead to a freeze response, leaving the therapist confused as to what happened. Moment by moment in the therapeutic process, NARM therapists work with the experience of contact and contact interruption. As the therapeutic alliance develops, the NARM therapist tracks and reflects the client’s coming in and out of connection without pushing for more connection than the client is able to manage. For example, a NARM therapist might say:
“I notice that as you’re talking right now, you seem distracted and are going away. What are you noticing right now?”
The mindful inquiry into the process of contact and contact rupture is gently repeated many times over the course of therapy. With these clients, it is important not only to point out when they go away but also to reflect moments when they are more present. It is important to reflect any increase in a capacity for connection as it becomes evident in a session or in the client’s life. The therapist might say:
“I notice that today, even though we’re dealing with some difficult material, you seem to be staying more connected. Does that fit with your experience?”
If it fits with the client’s experience, the therapist might then offer the following invitation:
“See what it’s like if you take a moment to notice how it feels to be more present here today.”
In the long term, experiencing the presence of a caring other has a calming effect. For some, a caring therapist may be the first truly kind person in their lives. The therapist’s quality of contact offers a corrective experience of connection that allows clients to feel heard, understood, and appreciated, giving them the opportunity to feel received and valued.
Individuals with the Connection Survival Style tend to be harsh with themselves and are filled with self-hatred. Their self-hatred and self-judgment can be so automatic and reflexive (ego syntonic) that they are not aware of how harsh they are with themselves. It is important to consistently point out to clients when they are directing their anger and rage against themselves and to encourage them not to be so harsh with themselves. In psychodynamic terms, the therapist’s consistent, kind presence allows the client the opportunity, sometimes for the first time, to introject an empathic other. A client who has begun the therapeutic process of introjection might report:
“The other day at work I was struggling and getting really upset with myself. Then I thought about you and how you encourage me to be kinder with myself.… I just let go of it [the judgments]. It was really helpful.”
It is important for clients to know that they are in charge of how fast or slow the therapeutic process will unfold. Many clients have been pathologized as “resistant” when they are simply trying to keep their internal experience manageable. We explain to clients the importance of proceeding slowly and at their own pace. The therapist’s pacing and rhythm are as important as the quality of his or her presence; a therapist can be generally empathic yet not be sensitive to clients’ need to move at their own pace.
In order to make sense of early trauma and distress states, individuals with the Connection Survival Style have taken their experience of environmental failure to be their own personal failure. This often implicit sense of personal failure shapes and distorts their developing sense of self. In addition to creating dysregulation, contraction, and freeze responses, trauma-based identifications also distort an individual’s identity.
Individuals with the Connection Survival Style learned to shut down their aliveness by withdrawing from their own bodies and emotions as well as from engagement with others. As a result, aliveness and expansion are threatening to both the vulnerable physiology and to the identity of a person who has adapted to a dangerous environment early in life. It is important to track how both the fear of and desire for connection and aliveness compete with each other and are expressed in the moment-by-moment process of a session and in everyday life.
It is essential to help clients understand that there is a natural process of expansion and contraction in life that becomes even more evident in the therapeutic process. As psychological difficulties are resolved, increased regulation and embodiment are experienced as a sense of expansion. Toward the end of a session during which important experiences of resolution occurred, a client may say:
CLIENT: Wow! Everything seems brighter.
LARRY: Take a moment and explore that.
CLIENT: All the colors in your room seem more intense.
LARRY: And what do you notice in your body as you look around?
CLIENT: I feel lighter and bigger.
In the nervous system and elsewhere in the body, every expansion and uptick in aliveness will naturally be followed by contraction. NARM has specific interventions to help clients manage the contraction phase. There is a tendency for clients to assume that when they experience the contraction phase, something is wrong. At this point a cycle of self-judgment is often triggered. It is important to let clients know that this expansion-contraction dynamic is a normal part of the therapeutic process and help them release any fears and judgments they have about it.
Sometimes psychological material that emerges in the contraction phase needs to be explored, but at other times, it is sufficient merely to be present to, and mindful of, the expansion-contraction dynamic. After a powerful session the previous week during which the client reported feeling more in his body that ever before, this interaction took place:
LARRY: I’m wondering how it was for you after our last session.
CLIENT: I had two days where I felt really good, and then my boss pointed out a mistake I made, and I got really tense and anxious.
LARRY: How are you feeling right now?
CLIENT: I’m not feeling so anxious right now.
LARRY: As you look back on those first two days when you felt really good, what do you see?
CLIENT: Pause.… It felt nice, but as I look back, I see it was also a little vulnerable and scary.
LARRY: So feeling good was scary and vulnerable, and then your boss said something to you.
CLIENT: He said I was late on my project. I felt really criticized, even though I sort of knew I was overreacting.
LARRY: Take a moment and ground yourself.
CLIENT: Takes a deeper breath and sighs.
LARRY: And from this perspective now, where you’re feeling more grounded, what do you see about your reaction to your boss?
CLIENT: Chuckling to himself.… Feeling so good those first two days seemed too good to be true.
LARRY: It sounds like you were expecting something bad to happen.
CLIENT: It’s true.… In a way, I was.
LARRY: What do you see about your reaction to your boss from your perspective right now?
CLIENT: I see that I really was overreacting. He just pointed out that I was late with the project—he wasn’t being critical.
LARRY: And what are you experiencing right now as you see your reactions to what you took to be your boss’s criticism.
CLIENT: My body is relaxing again. I’m starting to feel better.
LARRY: After giving the client time to re-regulate.… This seems to fit with the expansion-contraction dynamic we’ve been exploring.
CLIENT: It does.
This client was in an expanded state after the previous session; it was only a matter of time before contraction set in. In the contraction phase old shame-based identifications and sensitivities inevitably surface; sometimes they need to be explored, but at other times they are simply a way to make sense of the contraction; in either case, the trap is that when clients attach content to the contraction and identify with that content, they lose sight of the overarching dynamic of expansion-contraction and get stuck in the contraction phase.
Individuals with the Connection Survival Style often come into therapy with fears and even obsessions about death and disease. For example, one client, a young man, came in wanting to talk about his continual fear of dying, which had been a central subject in three previous therapies that were, according to him, “not very helpful.” My comment to him was:
“I think we may get more mileage out of exploring your fear of living than your fear of dying.”
For such clients, expansion and aliveness are more frightening than the half-alive state in which they live. For every uptick in aliveness, the therapist should be prepared to help the client manage the corresponding contraction and increase in symptoms that often follow the expansion. Table 10.5 provides a summary of the therapeutic themes pertinent to clients with a Connection Survival Style.
NARM therapists explore the psychological and physiological patterns that limit expansion and aliveness. Helping clients understand their fear of aliveness as well as exploring the ways they disconnect from themselves and others helps them learn to mindfully tolerate the increasing aliveness they experience as they learn to reconnect. Intellectual insights alone are rarely enough to alter the deep-seated psychological and physiological patterns that foreclose aliveness. Key to successful personal development for Connection Survival Style individuals is supporting the feelings of expansion that arise as their conflicts about connection move toward resolution. It is necessary to help them tolerate and manage the upsurge of energy that comes when they move into greater organization. For example, the therapist might say:
“We’ve seen, time and again, that when you start feeling more alive, these symptoms come up. Let’s see today if you can notice them and let them move through without focusing all your attention on them.”
As with all the adaptive survival styles, the Connection Survival Style has underlying shame-based identifications that develop in order to make sense of the distress of early environmental failure. Later in life, in reaction to the underlying distress and shame, these clients develop pride-based counter-identifications. A large part of what we take to be our identity consists of these shame-based identifications as well as the pride-based counter-identifications. Shame-based identifications, which we often believe to be the truth about ourselves, can be conscious or unconscious. The more energy individuals invest in the pride-based counter-identifications, the more strongly the underlying shame-based identifications are reinforced. Table 10.6 provides examples of both types of identifications.
NARM therapists keep the following therapeutic themes in mind when working with clients with the Connection Survival Style:
• What is their capacity for connection?
• How do they disrupt the connection?
• What is their emotional range?
• Can they feel their body?
• Can they ground?
• Can they find and utilize resources?
• What is their relationship to anger and aggression?
• Do they tend to act their aggression in or out?
• What is their capacity for self-soothing and self-regulation?
• What is incomplete on both emotional and physiological levels?
• How do they manage the expansion-contraction dynamics?
• Is the overall trajectory of the therapy over time toward more regulation?
TABLE 10.5: Therapeutic Themes to Keep in Mind When Working with the Connection Survival Style
| SHAME-BASED IDENTIFICATIONS | PRIDE-BASED COUNTER-IDENTIFICATIONS |
| Shame at existing | Disdain for humanity |
| Feeling like a burden | Pride in not needing others |
| Feeling of not belonging | Pride in being a loner |
| Shame at not being able to feel | Pride in being rational / disdain for emotions |
| Undeserving | Demanding neediness and entitlement |
| Feeling unlovable | Spiritual superiority (spiritualizing subtype) Intellectual superiority (thinking subtype) |
TABLE 10.6: Shame-Based Identifications and Pride-Based Counter-Identifications (partial list)
In NARM, regardless of how a client presents, we keep in mind that both identifications and counter-identifications are always present. It is particularly important when working with Connection types not to expose the fiction of the pride-based counter-identifications without, at the same time, addressing the equally false, shame-based identifications. Therapies that focus on dismantling the pride-based identifications—the so-called defenses—can leave Connection clients feeling more identified with their shame. NARM emphasizes, in many different ways, that the shame-based identifications result from the attempt to come to terms with early environmental failures, being careful not to leave clients more identified with feeling like a helpless child, a burden, undeserving, or unlovable. A dialogue on this topic might go as follows:
LARRY: As you’re seeing through this image of yourself as superior for not feeling, it’s also important to understand how life-saving it was to be able to turn off your feelings the way you did.
CLIENT: I’ve always felt so out of step … it’s always seemed weird that other people had so many emotions about things and I never did.
LARRY: From your perspective right now [adult consciousness], what are you able to see about these patterns of shame with which you’ve struggled your whole life?
In this example, the client is seeing through the pride-based image he has tried to maintain in not feeling and in not needing anyone. As his feelings and needs surface, they are accompanied by shame that he was not as self-sufficient as he wanted to believe. It is important when working with the Connection Survival Style, not to focus solely on working through the pride-based counter-identifications. Though on the surface this client presents as a prideful loner who is without feelings, underneath he feels shame, seeing himself as an outsider and wondering why he does not feel emotions like other people. As I challenge this client’s pride-based counter-identifications, I also help him see that the shame he feels about himself is just as unreal as the prideful self-image he has tried to maintain.
With clients who present as more identified with the shame-based elements of their personality, there is usually a hidden and unconscious grandiosity that surfaces in the course of therapy: “My suffering is greater than anyone else’s” or “I’m so wounded—my needs are much more important than anyone else’s. I need more attention than everyone else.” In the course of therapy these clients can swing from the pride-based “I have no needs” to “I have so many needs, and I need them met now, and I need you to take care of them.” Rejecting their needs and feelings would constitute a repetition of the early environmental failure, but the demand that all needs be met merely acts out the needy “inner child” without leading to resolution. It is important that these clients have the corrective experience in which their needs are validated; at the same time, the therapist must avoid the trap of infantalizing them by attempting to meet all their needs. It is important to attune to, but over time to gently challenge, the demanding neediness. As the neediness surfaces, the NARM therapist communicates acceptance of the infantile needs while at the same time, supporting the development of an “inner adult” who can understand and manage the tension that comes with not having needs immediately met. In the NARM healing cycle, we find that as the nervous system regulates bottom-up, there is increasing physiological support for the development of the executive functions; as executive functions develop, there is top-down support for increasing self-regulation.
The principle of disidentification is a core element of the NARM approach. Disidentification helps clients see through the fiction of both the shame- and pride-based identifications of their survival style. As they progressively disidentify from the limiting elements of what they have come to believe is their identity, clients consistently report feeling more at ease and more connected. Since every distorted identification is reflected in the body in the form of tension and collapse, when identifications dissolve, clients consistently describe themselves as feeling lighter, as having a sense of more internal space.
One component of the disidentification process involves developing mindful awareness of the fixed and rigid beliefs we hold about ourselves and about the world. As part of the disidentification process, NARM encourages clients to hold lightly, and to be curious about, the fixed beliefs they have about themselves or the world. Curiosity and inquiry are part of the disidentification process. Curiosity implies a not knowing; through a mindful disidentification process NARM helps clients move from the frozenness of fixed beliefs to flow, from narrowness and contraction to expansion. We challenge fixed beliefs and identifications by encouraging clients to look at themselves from a fresh perspective.
The following are typical fixed beliefs about self and the world found in individuals with the Connection Survival Style:
• “Life is meaningless.”
• “I’m a failure.”
• “Everybody has love but me.”
• “The world is a cold, empty place.”
• “People are dangerous.”
• “I’m better off being by myself.”
• “Emotions are weak and stupid.”
• “I can work everything out rationally.”
• “As long as I stay in my head, I’m safe.”
• “I’m a horrible person.”
• “Other people are angry. Not me, I’m gentle and nice.”
To the degree that clients label themselves, or put themselves in rigid categories—“I am a person who always …” or “I am a person who never …”—they narrow their life and block their capacity for open inquiry.
Clients are often not aware of the element of judgment that is implicit in their shame, so it is important to identify patterns of self-judgment. It is also true that as the nervous system regulates and internal distress diminishes, shame will also diminish. But to work effectively with pathological shame, therapists need to work both top-down and bottom-up.
In NARM, we address these clients’ identifications with shame and badness without trying to convince them that they are good; they “know” they are not.
CLIENT: I’m a loner. I’ve never been good at relationships. I’ve always felt that there is something basically wrong with me.
LARRY: I understand that you have various explanations for why relationships are so hard for you and that you blame yourself for what you see as your failures. But maybe the reality of why relationships have been difficult for you is more complicated than that.
NARM therapists explore the broad patterns of self-judgment by identifying toxic self-criticism and sometimes even using paradox to highlight the foolishness of toxic self-judgments. After listening to a client’s monologue for several minutes on how bad they are, we might say:
LARRY: You’ve convinced me—you really are bad!
CLIENT: Laughs.
This client’s laughing at herself is part of the process of disidentification, not taking her self-judgments so seriously.
Because early trauma is held implicitly in the body, causing significant systemic disorganization, identity distortion, and shame, it is often impossible for clients with the Connection Survival Style to identify the actual source of their distress. What these individuals identify as primary issues often can only serve as general landmarks for the therapy. Their narrative often centers around what in NARM is called the designated issue—what they believe to be the source of their pain. Although their pain is real, the narrative with which they explain their pain may not be accurate. As described more fully on this page–this page, the designated issue involves a real or perceived personal or physical deficiency or defect, such as a dissatisfaction about the body, shyness, not feeling smart enough, not feeling tall enough, or a persistent health problem. Individuals with the Connection Survival Style believe that if their particular designated issue were resolved, their life would then be great. The therapeutic challenge is that although there may be a real problem, these clients do not realize that the designated issue is a symptom of deeper difficulties.
Therapeutically, it is important not to fall into the trap of problem solving or over-focusing on the designated issue without addressing the fundamental theme of disconnection. For example, we might say to a client who is focusing on the pain she feels about a perceived personal shortcoming:
“I know that you believe that you understand what your pain is about … but let’s see if we can stay open to the possibility that it may more involved than that.”
Here we are introducing a bit of space between the client and her explanation for her difficulties. This is part of the disidentification process.
Self-acceptance is an important part of the healing process. We invite the possibility of including or even embracing those parts of the self that have been condemned, expelled, and rejected. We might say:
“You’ve said several times during the course of our therapy how much you hate this scared part of yourself, but maybe you could be curious about this scared part rather than hating or rejecting it.”
We support clients to accept themselves even when they have a problem. We want to help clients separate their self-esteem from whatever has become their designated issue. In the case of a client who is truly overweight and has hated herself her whole life for her weight problem, we would say:
“I wonder if it’s possible for you to see yourself as a good person who at the same time has a weight problem.”
This pattern of self-rejection will not change overnight, but we are planting a seed of possibility, a different way for this client to relate to herself. When real-life problems such as difficulty with weight are approached from a perspective of self-rejection rather than self-acceptance, self-hatred can be reinforced.
NARM moves a person’s attention away from past history to the moment-by-moment process of therapy. As we saw in the session with Carla in Chapter 9, attending to the process in the present moment is fundamental when working with early shock and developmental trauma. The following clinical vignette illustrates NARM’s orientation toward process rather than content and to the here and now rather than personal history.
Linda came to my office following the breakup of a relationship. Feeling betrayed by her ex-partner, she was bitter and cynical about ever finding love with men she described as “commitment phobic.” From previous therapies, she was aware of her dysfunctional personal patterns and she explained how she picked men who were like her father. She berated herself for “doing it again,” for perpetuating her “dysfunctional relationship patterns” by choosing a man who was intellectual, emotionally cold, and who, in the course of the relationship, became increasingly withdrawn. She was concerned that since the breakup, she was overeating, not sleeping well, and fighting the impulse to smoke, although she had given up the habit ten years earlier. When I asked her at different times during the session, “What are you experiencing right now as you’re talking about this?” she answered by telling me what she was thinking: “I think this has to do with my father. He could never be there for me either.” Although I could see that she was visibly upset, when I asked her directly what she was experiencing emotionally, she drew a blank.
As Linda sat with her arms tightly wrapped around her thin torso, I noticed that her voice sounded strained, that she avoided eye contact, and that she seemed quite disconnected. The content of her narrative revealed consistent difficulties with relationship, and I noticed that these same difficulties were present in the therapeutic relationship with me. Her insights about her difficult relationship with her father did not address the here-and-now difficulty she was having in knowing her current emotional and sensate experience and being present with me.
Linda’s cognitive understanding of the sources of her problems did not address her ambivalent and compromised capacity for connection. From a NARM perspective, it is less important to focus on the theme of her father than on her own current ambivalence with contact. As much as Linda longed for connection, she did not realize until later in therapy how frightened she was of it. She also did not learn until later that choosing men who were unavailable was her way of limiting connection in her current life.
Developmental and shock trauma trap our consciousness and our life force, effectively keeping part of us stuck in past time. In cases of developmental trauma, we continue to see the world through the eyes of a child. When we filter the present moment through past experience, we live through our memories, identifications, and old object relations.
Because of their early trauma, individuals with the Connection Survival Style are the most stuck in past time and most identified with their trauma. Bringing clients’ attention to what is happening in the here and now starts in the first session and is ongoing throughout therapy. NARM explores, on the level of both body and identity, how individuals have incorporated the environmental failures that they have experienced, and over time, helps them to see how they continue to recreate their history in the here and now. The focus is less on why clients are the way they are and more on what they are experiencing in the moment and how they disconnect from themselves in present time. Exploring personal history is part of the therapeutic process to the degree that it helps clients see the bigger picture of their survival style. Seeing the survival value of old patterns that are now dysfunctional as adults helps them be less critical of themselves.
It is possible to come home to oneself only in the present moment. In our minds we can anticipate the future or remember the past, but the body exists only in the present moment. Even when working with personal history, NARM maintains a present-moment focus, always supporting the dual awareness of what was then and what is now. A NARM therapist might say:
“As you’re talking about your relationship with your father, what are you noticing in your body right now?”
Over time, as therapy continued with Linda, I repeatedly brought her awareness back to her experience in the present moment; by separating how things were for her as a child from who she was in the moment, her beliefs that there were no good men out there and that she herself was a failure greatly diminished. By learning to listen to what she was feeling, both on an emotional and on a sensate level in the present moment, she reconnected to her emotions and her body.
As clients learn to listen to themselves, their nervous systems become more regulated. As their nervous systems become more regulated, it is easier to listen to themselves. As the nervous system regulates and as painful identifications resolve, clients move progressively into the here and now. The reverse is also true: as clients move progressively into the here and now, the nervous system re-regulates and old identifications become more obvious and resolve. In this process, Linda’s impulse to overeat diminished, her sleeping returned to normal, and she no longer experienced the impulse to smoke. As she shifted her focus away from what had happened to her in the past, blaming her father and blaming herself, and as she was able to identify and own her current fears about intimacy, her agency and sense of empowerment increased, and she came to see herself less as a victim of circumstances.
In NARM, it is maintained that the more we try to change ourselves, the more we prevent change from occurring. On the other hand, the more we allow ourselves to fully experience who we are, the greater the possibility of change. This understanding is core to NARM. The orientation is one of working with what is, rather than with how we want things to be. This perspective is consistent with a present-moment focus because it is only in the present moment that we are able to fully experience ourselves.
NARM uses the term agency rather than the term responsibility, which is commonly used in other therapies, because for many people, responsibility carries overtones of blame. Agency comes from the Latin to act and conveys more neutrality. As human beings, we are constantly organizing and reorganizing our experience. It is the agency inherent in this organizing capacity that the NARM approach addresses and supports. For example, a client who responds fearfully to other people’s anger might say:
“Anger is really frightening to me because my dad was such a rageaholic.”
The fact that this client’s father was a “rageaholic” is only part of the picture. This client’s fear of anger is more complex than this statement implies. Based on the belief that the past determines the present, many therapists would take this statement at face value and accept the premise that what happened in childhood determines this client’s fear of anger as an adult. This paradigm of the past, however, may lead a person to feel like a victim of childhood experiences and can reinforce a sense of helplessness.
Usually, it is clients’ disowned and unrecognized anger that is more germane to their fear of anger. After exploring what it was like for this client to be around a rageaholic, I would inquire into his current relationship to anger:
LARRY: I wonder what your relationship to your own anger is.
CLIENT: Anger.… I don’t have any anger … except maybe at myself.
Consistent with the Distortions of the Life Force model (Figure I.2), working through the splitting, judgments, and fears about their own anger is usually a multilayered process: “Only bad people like my father have anger. I’m a good person; I don’t have anger.” As clients work through the internal fears and identifications that have foreclosed for them the experience of anger, they progressively integrate their own anger and aggression. As they experience how they have split off and turned their anger against themselves in the form of self-rejection, self-loathing, and self-judgment, the energies that have been turned against the self become available for life. It is tremendously empowering to integrate the survival energies inherent in anger and aggression. In every case, when clients can integrate their own aggression, they feel stronger, less afraid, and more connected.
As part of our survival patterns, we have all adapted to, aligned ourselves with, and literally incorporated the life-denying elements of our early environment. Unless we can identify and own our adaptations to early childhood experience, including how we have adapted to and internalized the life-denying elements of our early environment, we continue to suffer. It is, of course, a given that many of the patterns addressed in therapy began in early childhood. However, NARM makes a critical distinction: clients perpetuate dysfunctional patterns because they do not know how to do it differently. A NARM therapist might comment:
“It’s clear that you didn’t start this process, but it’s important that you see how you continue it.”
Agency is seeing what we do to ourselves as adults, how we have internalized and continue to re-create the environmental failures we have experienced. We choose people in our lives who resonate with our dysfunctional survival patterns. Unless we can see how we turn against and abandon ourselves by rejecting our core needs and emotions, we have a tendency to feel like victims. Addressing the issue of agency with a client who had been in a series of abusive relationships, I might say:
“If you, on some level, think you are bad and deserve to be punished, it’s not hard to find people in the world who will agree with you and find ways to punish you.”
Helping clients experience how they maintain dysfunctional patterns requires tact and sensitivity to each individual’s vulnerability as well as, when necessary, an element of confrontation. It is important that clients do not feel blamed or shamed for perpetuating patterns that were once life-saving; at the same time it is important for them to see that they are “actors” re-creating and acting out old survival patterns. It is implicit in this understanding that until clients develop a sense of agency in regard to their survival patterns, they will feel like helpless victims of others or of circumstances. There are, of course, times when a person truly is a victim, but here we are addressing the effects of adaptive survival styles on adult life. Agency involves owning the split-off aspects of oneself and is a here-and-now process. The dynamic of progressively experiencing more agency feels liberating and empowering.
In summary, to reestablish agency, a NARM therapist explores with clients how they are contributing to their own suffering—how they may be consciously or unconsciously instrumental in creating their own distress as adults. Individuals with the Connection Survival Style are certainly not responsible for the early trauma or attachment difficulties they have experienced. Over time these clients come to see that although in early life they were victims of circumstance—family patterns, parental abuse, neglect, etc.—as adults it is important that they come to see how they continue to perpetuate their victimization.
In the NARM healing cycle, nervous system regulation can be addressed from both top-down and bottom-up vantage points. From a top-down perspective, nervous system regulation increases as the distorted identifications of adaptive survival styles are resolved and as disavowed emotions become integrated. From a bottom-up perspective, which is the focus of this section, the principle techniques used to support nervous system regulation are containment, grounding, orienting, titration, and pendulation.
Working within a client’s range of resiliency supports containment. It is essential that clients be able to work with their difficulties while, at the same time, remaining grounded in their bodies and in the present moment. We regularly ask clients questions whose answers clarify for us how they relate to their various internal states. For example:
CLIENT: Now I’m starting to feel upset.
LARRY: Is it okay for you to allow that upset to come up, or does it feel like it is too much?
It is important not to push painful affects away but rather, over time, to learn how to become less submerged and less identified with them. As long as difficult emotions feel manageable to clients, we continue to explore them. If the emotions feel overpowering or if clients start to dissociate, then we have them slow down (titrate), ground, pendulate to a resource, or focus on their experience in the present moment (ground and orient).
Focusing on positive resources and the experience of safety that comes with them establishes and reinforces oases of organization in the body and in the psyche. As the work with these oases of organization continues, areas of disorganization, which include painful responses such as shame, self-judgments, and identity distortions, as well as painful affects such as grief and loss, will likely surface and temporarily increase the disorganization. In a contained therapeutic process, therapy overall brings increasing systemic organization. This mindful process of containment supports increasing organization, which in turn supports a greater capacity for connection (see Figure 12.1).
Working with painful experiences from childhood becomes overwhelming when a client loses the capacity to hold a dual awareness and is no longer mindful of what was then and what is now. In abreaction, the traumatic memories become more real than present reality. In such cases, we ask questions designed to reinforce the distinction between past and present. It is useful to explore the past only as long as the client is able to remain anchored in the present. When clients act as though a past situation is still in the present, such as with powerful intrusive imagery about an abusive father who is long dead, we may intervene:
LARRY: How long ago did these beatings take place?
CLIENT: A long time ago.
LARRY: How long has your father has been dead?
LARRY: What are you experiencing as you remind yourself that he’s been dead for fifteen years?
CLIENT: I’m starting to calm down.
LARRY: Take your time. Notice how you experience that calming.
CLIENT: Long pause.… The client is visibly settling and his breathing is becoming more regular.
LARRY: From this calmer place right now, what do you see about this situation that you weren’t able to see as a child?
CLIENT: I can see that part of me really wanted to fight back, maybe even kill him.
LARRY: And what do you notice in your body as you acknowledge those impulses?
CLIENT: It actually feels good. Stronger.
LARRY: Give yourself some time to feel that “good, stronger” feeling.
Grounding is a basic technique widely used in body-centered psychotherapies. In NARM, grounding is used to support an increasing capacity for somatic mindfulness, connection, and nervous system regulation. Grounding functions as an antidote to disconnection, helping to literally bring awareness back into the body, supporting reconnection on all levels of experience. To the degree that clients can feel their feet on the floor and their body in the chair, they are mindfully present in the here and now. Like all therapeutic processes, grounding should not be pushed; it needs to be done slowly, in a way that is manageable and does not overwhelm. In the initial stages of therapy some dissociated clients find it difficult, if not impossible, to ground themselves. Therapists support the processes of connection and organization by bringing their clients’ attention to the process of grounding:
“As you are talking about the challenges you are facing, take a moment to see if you can get a sense of yourself in the chair. Can you feel your feet on the floor … your seat in the chair … the support of the backrest?
As we attend to clients’ capacity for self-awareness, we support their awareness not just cognitively and emotionally, but also in their physiological experience. Many clients will find grounding to be organizing and settling, whereas some will find it anxiety provoking. When clients become more anxious when attempting to ground, or when they are unable to do it, it is an indication that there is too much activation in their body to allow them to ground at that moment. When grounding is not possible, facilitating discharge of activation can be supported by other regulating techniques such as pendulating, resourcing, and orienting. As activation is discharged, grounding becomes more possible. From a NARM perspective, grounding in the body provides an anchor to reality. From an increasingly more grounded and embodied place, the truths and fictions of our shame- and pride-based identifications become clearer. Attuning to the body gives us a stable platform on which to work with the adaptive survival styles that are often mistaken for our true self.
Grounding and orienting are seemingly simple but valuable tools. As clients ground and orient to their surroundings, they come into the present moment and simultaneously begin to emerge from dissociation. Orienting techniques are useful with all clients, but they are particularly useful for clients with the Connection Survival Style for whom dissociation is the primary coping mechanism. Clinically, NARM therapists encourage orienting as a simple yet powerful technique to help clients “come down” into their bodies, out of their fantasies, and be more present in the here and now. Consider this orienting exchange:
LARRY: Check out the room and see if there’s anything that attracts your attention.
CLIENT: That painting on your wall is interesting.
LARRY: Tell me what you find interesting in the painting.
CLIENT: THE colors, for one thing.
LARRY: What colors in particular attract your attention?
CLIENT: The blues and the reds.
LARRY: As you’re paying attention to the colors, what’s happening in your body right now?
CLIENT: I feel a little more here, a little more relaxed.
LARRY: Notice how you experience physically being “a little more here” and “a little more relaxed.”
As seen in this dialogue, when clients are panicky or begin to dissociate, it is useful to encourage them to orient to an object or a color in the room. As soon as clients engage their eyes, both panic and dissociation diminish.
NARM does not focus on painful or traumatizing experiences until there is a capacity to settle, ground, and regulate. Over time, NARM uses grounding and containment to support an increasingly organized and organizing adult consciousness. It is only when some capacity to self-regulate is possible that we can begin to focus on a client’s trauma narrative. By approaching traumatic experiences slowly and obliquely, we are using a technique from Somatic Experiencing called titration.
Titration is a word borrowed from chemistry. In chemistry, when two containers, one with an acid and one with a base, are poured one into the other all at once, it produces an explosion. But if the two substances are combined drop by drop, the discharge is very small and gradually, the two substances neutralize each other. This analogy communicates the importance of taking highly charged emotional material one manageable piece at a time. This measured approach helps avoid catharsis—the explosion—and facilitates the integration of the highly charged affect.
It is important to carefully titrate disorganizing experiences such as extreme fear. In developmental work, extreme fear is often an indication that disowned and disavowed anger and rage are moving toward awareness. Trauma narratives that are not titrated effectively can be overwhelming and disorganizing. Knowing when and how to titrate effectively—going fast enough but not too fast—is an art that requires continually adjusting the pacing to the client’s developing capacity. To titrate effectively, we track observable cues, pay attention to our own resonant responses, and ask clients directly how the pace is working for them, remembering that traumatized clients do not always know when they are becoming overwhelmed and dissociated. We often have to use various techniques to manage the pace of the session, particularly at first, because clients are often unable to do so. The following examples highlight some important points:
• Slowing the process down and shifting focus.
“I notice that as you’re talking about your father, you start to get agitated and go away. So let’s slow things down a bit … take a moment and give yourself time to settle.”
• Psychoeducation.
“It’s important that you don’t go into the painful memories all at once.”
• Reinforcing clients’ capacity to pay attention to and titrate their own pace.
“It’s important for you to listen to your own capacity to manage the feelings that are coming up and find the pace that is right for you.”
• Freeze frame.
“When you talk about your father’s abusiveness, the memories come rushing back. See what happens if you bring up a static, single-frame image of him and put it at any distance that feels right for you.”
• Finding a pace where the client remains connected.
“In our work together, control isn’t a bad word. It’s important to go at a pace where you are able to stay connected and in control.”
Pendulation is a natural pulsatory phenomenon of expansion and contraction. It is also a clinical intervention that can be consciously utilized by the therapist as part of the overall containment process.
As clients experience more aliveness, there is an accompanying expansion. At some point, this expansion will be followed by contraction. It is important for therapists to explain to their clients that growth is a process of expansion and contraction and that the contraction phase is natural and inevitable. This understanding of the natural pendulation process helps clients navigate the contraction phase without becoming overly concerned that something is wrong.
In NARM, we attend to the natural pendulation process within a session and between sessions. Particularly following a session in which clients have a strong experience of expansion, it is important to inquire into how they managed the inevitable contraction that can be expected to follow. If a client responds with unmanageable contraction, evidenced by regression, strong anxiety, depression, or increased physical symptoms, this indicates what in NARM is called a boomerang effect and is an indication to the therapist to titrate more carefully and go forward at a slower pace.
In clinical pendulation, the therapist consciously shifts the focus from difficult memories to resources that bring soothing and settling. Observing that a client is beginning to dissociate while addressing a new element of their abuse history, this exchange took place:
LARRY: Let me interrupt you for just a moment. I notice that you’re starting to go away. I want to direct your attention back to feeling your body in the chair and your feet on the floor. Long pause.… How is that for you?
CLIENT: Deep exhale. That feels better.
In slowing down the process, we are titrating. In consciously encouraging clients to shift attention back to the body and away from the narrative, we are pendulating. Pendulation is used simultaneously with titration to support the nervous system’s capacity to integrate highly charged affects in a way that brings increasing self-regulation.
When addressing painful elements of personal history, NARM therapists pay mindful attention to their clients’ changing states. When a client is becoming overly activated, it is useful to pendulate to resource-oriented questions. For example:
“I’m wondering what or who helped you get through all this?”
Both shock and developmental trauma trap our consciousness in the past. The question above reinforces the fact that the client is here, in the present moment, and safe; it is intended to evoke an external resource such as a loving grandmother or an internal resource such as the will to live. The ultimate resource that clients have when working with any trauma is that they have survived. Working in the present moment helps clients progressively integrate the reality that they survived. In this way, we pendulate between the reality of the present moment wherein the client is safe and the painful, frightening memories while reminding the client of resources that have been and are available.
In teaching therapists how to address the issue of safety with clients who have the Connection Survival Style, I use the analogy of befriending a feral animal that has been living on its own as best it can. We see that the animal both wants to come in out of the cold—meaning, wants to connect—but, at the same time, is fearful. If we attempt to approach the feral cat or dog, it will run away, but if we hold an invitational space, over time the animal will increasingly trust and approach us.
It is similar with clients who have experienced early trauma. They want to trust but are scared and angry. As with a feral animal, the therapist communicates that it is safe to come in out of the cold. At the same time, the therapist respects their fearfulness and does not push them to trust prematurely or try to force connection. These clients desire closeness but are not always aware of how frightened they are of it. Pushing them to trust before they are ready ignores how frightened they are of connection. As with the feral animal, the therapist addresses the ambivalence of clients with the Connection Survival Style by holding a space in which they can slowly experience and take in that there is no threat and that the situation could actually be safe. Initially, therapists will find that when they move toward clients with the Connection Survival Style, these clients will freeze or run away. Over time, as the therapeutic alliance strengthens, these clients will discover that not only will the therapist not hurt them, but that the therapy can be a haven of safety.
Even though many readers have not experienced such extreme ambivalence about connection, most of us know the feeling of both wanting and fearing closeness in relationship. Many individuals have reached a certain comfort level with their own tendency toward disconnection, not consciously aware of how frightened they are of feeling close connection. For those clients who identify with wanting close connection in relationship but feel like they can’t find partners with whom to connect, the road to growth and healing lies in owning their own ambivalence about closeness and seeing how they pick partners who act out their own need for distance in the relationship.
The dance between connection and disconnection is a core organizing theme for all five adaptive survival styles. For individuals with the Connection Survival Style, however, who have experienced early shock and developmental trauma, the resulting dissociation, nervous system dysregulation, and identity distortions are the most severe. It is easy to become confused by the complex and painful symptomatology that these clients present, losing sight of what drives their painful symptoms.
In this chapter we have presented principles, tools, and techniques that address the major issues that weave together in self-reinforcing loops and drive this survival style.
• We have presented how to work with the global high-arousal states as well and the frozen and dissociative states that are associated with the nervous system dysregulation and the lack of social engagement that clients with the Connection Survival Style experience.
• We have detailed how to work with identity distortions such as low self-esteem and self- hatred that result from early trauma.
• We have illustrated how to work with the continuous interplay and self-reinforcing loops between nervous system dysregulation and identity distortions.
Being available to clients’ inner world without pushing for connection
Tracking and reflecting the connection-disconnection process
Tracking organization-disorganization
Helping clients navigate the challenges of reconnection
Understanding and tracking the dynamics of expansion-contraction
Working with the fear of aliveness and supporting increasing aliveness
Exploring clients’ relationship to anger and aggression
Helping clients to disidentify from shame and pride-based identifications
Understanding the function of the designated issue
Encouraging self acceptance
Supporting clients’ capacity for self-reference, self-reflection, and mindfulness
Using somatic mindfulness to work with the nervous system and identity
Supporting increasing self-regulation
Tracking and supporting somatic connection
Helping clients resolve identity distortions including shame and self-hatred
Tools and Techniques
Creating safety and containment
Working in the here-and-now even with personal history
Establishing resources
Evoking positive experiences of connection
Tracking clients’ range of resiliency
Titrating to help clients come out of dissociation in a manageable way
Working with the difficulties that emerge with increasing connection and expansion
Working with clients who cannot feel their bodies
Working with the eyes, the gaze, and projective processes
Compassionate feedback and confrontation of clients’ acting in of aggression
Maintaining a dual awareness of past and present
Avoiding regression
TABLE 10.7: Summary of Principles and Techniques that Inform the NARM Therapeutic Process with the Connection Survival Style
• We have discussed how to work with clients’ simultaneous desire for and deep fear of connection and how to create an environment that supports increasing connection while also exploring how clients disrupt their connection with self and others.
• We have explained the functional unity that exists between being in the body and being in the present moment and how to help clients become more embodied and more present. We have offered therapists and clients tools for working with difficult early survival patterns as they express in the therapeutic process and in a client’s life.