Introduction to the
NeuroAffective Relational Model™

The price of freedom is eternal mindfulness.

This is a book about restoring connection. It is the experience of being in connection that fulfills the longing we have to feel fully alive. An impaired capacity for connection to self and others, and the ensuing diminished aliveness, are the hidden dimensions that underlie most psychological and many physiological problems. Unfortunately, we are often unaware of the internal roadblocks that keep us from experiencing the connection and aliveness we yearn for. These roadblocks develop in reaction to developmental and shock trauma and the related nervous system dysregulation, disruptions in attachment, and distortions of identity. The goal of the NeuroAffective Relational Model (NARM) is to work with these dysregulations, disruptions, and distortions while never losing sight of supporting the development of a healthy capacity for connection and aliveness. In this book we address conflicts around the capacity for connection and explore how deeper connection and aliveness can be supported in the process of healing developmental trauma.

Although the original intention was to write a book for clinicians, it soon became clear that NARM’s understanding of the profound ambivalence human beings have about connection could be helpful to anyone on a path of self-discovery seeking new tools for self-awareness, growth, and healing. This book will be useful to clinicians who are looking to add a new dimension to their clinical practice, but it also stands alone as a guide for those interested in developing a greater capacity for connection and well-being.

Many systems of psychotherapy are based on the medical model of disease, and as a result they focus on psychopathology; commonly, psychotherapy investigates a person’s past and seeks to identify the dysfunctional cognitive and emotional patterns that underlie psychological problems. However, as new information emerges on how the brain and nervous system function, traditional psychological methods have come into question and the need for new clinical approaches has become increasingly clear. It now appears that it is a misguided assumption to think that if we know what has gone wrong in a person’s life, we will also know how to help that person resolve their difficulties. For example, we now know that when we focus on dysfunction, we risk reinforcing that dysfunction: if we focus on deficiency and pain, we are likely to get better at feeling deficiency and pain. Similarly, when we focus primarily on an individual’s past, we build skills at reflecting on the past, sometimes making personal history seem more important than present experience.

Healing Developmental Trauma introduces the NeuroAffective Relational Model, a somatically based psychotherapy that focuses on supporting an individual’s capacity for increasing connection and aliveness. It is a model for human growth, therapy, and healing that, while not ignoring a person’s past, more strongly emphasizes a person’s strengths, capacities, resources, and resiliency. NARM explores personal history to the degree that coping patterns learned early in life interfere with our capacity to feel connected and alive in the present moment. NARM helps build and expand upon our current capacity for connection to our body and emotions as well as to our capacity for interpersonal connection—capacities that are, as we will see, intimately related.

Five Biologically Based Core Needs

NARM recognizes five biologically based core needs that are essential to our physical and emotional well-being: the need for connection, attunement, trust, autonomy, and love-sexuality. When a biologically based core need is not met, predictable psychological and physiological symptoms result: self-regulation, sense of self, and self-esteem become compromised. To the degree that our biologically based core needs are met early in life, we develop core capacities that allow us to recognize and meet these needs as adults (Table I.1). Being attuned to these five basic needs and capacities means that we are connected to our deepest resources and vitality.

Although it may seem that humans suffer from an endless number of emotional problems and challenges, most of these can be traced to early developmental and shock trauma that compromise the development of one or more of the five core capacities. For example, when children do not get the connection they need, they grow up both seeking and fearing connection. When children do not get their needs met, they do not learn to recognize what they need, are unable to express their needs, and often feel undeserving of having their needs met.

To the degree that the internal capacity to attend to our own core needs develops, we experience self-regulation, internal organization, expansion, connection, and aliveness, all attributes of physiological and psychological well-being. Supporting the healthy development of the core capacities is central to the NARM approach.

CORE NEED	CORE CAPACITIES ESSENTIAL TO WELL-BEING
Connection	Capacity to be in touch with our body and our emotions Capacity to be in connection with others
Attunement	Capacity to attune to our needs and emotions Capacity to recognize, reach out for, and take in physical and emotional nourishment
Trust	Capacity for healthy dependence and interdependence
Autonomy	Capacity to set appropriate boundaries Capacity to say no and set limits Capacity to speak our mind without guilt or fear
Love-Sexuality	Capacity to live with an open heart Capacity to integrate a loving relationship with a vital sexuality

TABLE I.1 NARM’s Five Core Needs and Their Associated Core Capacities

Five Adaptive Survival Styles

Five adaptive survival styles are set in motion depending on how well the five biologically based core needs are met—or not met—in early life. These adaptive strategies, or survival styles, are ways of coping with the disconnection, dysregulation, disorganization, and isolation that a child experiences when core needs are not met. Each of the five adaptive survival styles is named for the core need and missing or compromised core capacity: the Connection Survival Style, the Attunement Survival Style, the Trust Survival Style, the Autonomy Survival Style, and the Love-Sexuality Survival Style (Table I.2).

As adults, the more the five adaptive survival styles dominate our lives, the more disconnected we are from our bodies, the more distorted our sense of identity becomes, and the less we are able to regulate ourselves. Though we may feel constrained by a survival style and the physiological patterns that are part of it, we are often afraid to move beyond it. When we identify with a survival style, we stay within the confines of learned and subsequently self-imposed limitations, foreclosing our capacity for connection and aliveness.

All of us, clinicians included, are often overwhelmed by the wide range and seeming complexity of psychological and physiological problems that human beings experience. Understanding adaptive survival styles provides five basic organizing principles that offer a clear focus for therapy and personal development. NARM works with each core capacity to support the process of personal development (Table I.3).

Part A of this book introduces the five adaptive survival styles. Part B presents an in-depth understanding of how the earliest survival style—what in NARM is called the Connection Survival Style—develops as an adaptation to early shock and developmental/relational trauma. This first stage of development is presented in depth because from a psychobiological perspective, difficulties in this stage are not well understood yet have a foundational impact on our vitality, the resiliency of our nervous system, the formation of our sense of self, and our capacity for relationship.

ADAPTIVE SURVIVAL STYLE	CORE DIFFICULTIES
The Connection Survival Style	Disconnected from physical and emotional self Difficulty relating to others
The Attunement Survival Style	Difficulty knowing what we need Feeling our needs do not deserve to be met
The Trust Survival Style	Feeling we cannot depend on anyone but ourselves Feeling we have to always be in control
The Autonomy Survival Style	Feeling burdened and pressured Difficulty setting limits and saying no directly
The Love-Sexuality Survival Style	Difficulty integrating heart and sexuality Self-esteem based on looks and performance

TABLE I.2: The Five Adaptive Survival Styles and Their Core Difficulties

DEVELOPMENT OF CORE CAPACITIES

Core Needs→Attuned Caregivers→Core Capacities for Connection, Aliveness, and Creativity

FORMATION OF ADAPTIVE SURVIVAL STYLES

Core Needs→Caregiver Failures→Disconnection→Compromised Core Capacity→Adaptive Survival Style

TABLE I.3: Development of Core Capacities and the Formation of Adaptive Survival Styles

CORE NARM PRINCIPLES

The NeuroAffective Relational Model focuses on the interconnection of biological and psychological development. The NARM model:

• Clarifies the role of connection difficulties as they affect a person on all levels of experience: physiological, psychological, and relational.

• Develops the use of somatic mindfulness and an orientation toward personal strengths to increase the capacity for self-regulation and the freedom from the limitations of the fixed identities of the adaptive survival styles.

Self and Affect Regulation

In recent years, the importance of self-regulation has been extensively researched in the field of neuroscience and has become a prominent construct in psychological thinking. It is now understood that one of the most significant consequences of early relational and shock trauma is the resulting lack of capacity for emotional and autonomic self-regulation. Shock and developmental trauma compromise our ability to regulate our emotions and disrupt autonomic functions such as breathing, heart rate, blood pressure, digestion, and sleep.

Stated simply, self-regulation means that when we are tired we can sleep, and when we are stressed we have healthy ways to release that stress. Affect regulation involves how we manage our emotions: how we handle sadness, joy, anger, excitement, challenge, fear—the gamut of human emotions. Symptoms of emotional dysregulation develop when we are unable to feel our emotions, when they overwhelm us, or when they remain unresolved. It is essential to our well-being to be able to manage the intensity of both our positive and negative emotions. When we are unable to manage powerful or difficult emotions, or when we are anxious or depressed, we are in a state of dysregulation. Disrupted sleep or eating patterns, anxiety, panic attacks, compulsive behaviors, depression, and addiction are some of the more common symptoms of dysregulation.

In the beginning of life, connection with the mother or primary caregiver functions as the regulator of the baby’s nervous system; the capacity for self-regulation is first learned by the infant through the relationship with the mother or a close caregiver. In Attachment Theory, it is well documented that a healthy connection between caregiver and infant is of essential importance in shaping the development of the infant’s capacity for regulation. Each time a mother successfully soothes her baby, she is effectively regulating her baby’s nervous system—although, of course, she does not usually think of the mothering process in these terms. Attachment Theory documents how chronically depressed, anxious, angry, or dissociated mothers impact their developing infant; the disruption of the connection between infant and mother is traumatic. If, for whatever reason, the regulation process between mother and infant is disrupted, the infant does not develop the core capacity for regulation. If a mother’s capacity for self-regulation is compromised, she cannot soothe herself and therefore cannot adequately regulate her baby’s nervous system. The stability of this early connection is particularly important in shaping an individual’s patterns of relationship to body, self, and others. A compromised capacity for self-regulation can negatively impact a person for a lifetime. If a healthy capacity for self-regulation does not become an integral part of our development, we become destabilized, and without this essential foundational element, life is a struggle. Affect dysregulation is believed to be at the core of an individual’s increased vulnerability to stress and trauma and is seen to be a foundational element of psychological and physical problems.

The need to feel regulated, at ease in our body and in our life, is so important that when we are in a state of dysregulation, we attempt to find the regulation we need, often at any cost. For example, the need to feel regulated is so strong that people smoke despite the fact that they know it is damaging to their health. Smoking seemingly functions as an emotional regulator because nicotine reduces anxiety and, for a short while, can relieve depression. Dysregulated individuals smoke to gain a sense of relief even though they know smoking can kill them. Attempts to stop smoking or give up any sort of self-destructive addictive substance or behavior, such as drugs, alcohol, hypersexuality, overeating, or overworking, often fail because it is very difficult to give up a means of self-regulation even when it is unhealthy until it can be replaced with a better form of self-regulation.

Bringing Self-Regulation into Clinical Practice

NARM brings the current understanding of nervous system regulation into clinical practice. It is a key NARM concept to support healthy ways of regulating the nervous system by emphasizing connection to the parts of self that are organized, coherent, and functional. Analyzing problems and focusing primarily on what has gone wrong in a person’s life does not necessarily support self-regulation, and in some cases, increases dysregulation. As we will see, NARM promotes an individual’s potential for health by using specific techniques that support the autonomic and emotional self-regulation that underpin the capacity for connection and aliveness.

Experiencing Expansion and Aliveness

Take a moment to think about a time in your life when you felt particularly alive. Choose an event that ended well (or at least did not end badly). It could be an event when you were with someone, in a group, or by yourself. It could be anything from a time in nature to the birth of your child to making love.

Let yourself remember as many of the sensory details of that experience as you can: colors, sounds, temperature, smells, etc. As you bring up these sensory details, notice how you are affected. Notice your physical experience if possible. For those who have difficulty sensing in the body, let yourself notice the overall impact of the memory.

Take your time with this exercise, and pay attention to any thoughts, judgments, or emotions that get in the way of sensing your aliveness and expansion. Even if you are successful in feeling increased well-being, don’t be surprised if some sadness surfaces with the expansion, because the happy time you are remembering may be over. If you feel any sadness, notice it, but do not make it the primary focus of your attention.

There is no correct reaction to this exercise, but one response that many people have is that simply remembering such a time may activate a sense of flow, warmth, and pleasure, a sense of aliveness and expansion.

FIGURE I.1 Exercise to Help Identify Experiences of Expansion and Aliveness

Supporting an Increasing Capacity for Aliveness

Our greatest desire is to feel alive. Meaninglessness, depression, and many other symptoms are reflections of our disconnection from our core vitality. When we feel alive, we feel connected, and when we feel connected, we feel alive. Although it brings mental clarity, aliveness is not primarily a mental state; nor is it only sensory pleasure. It is a state of energetic flow and coherency in all systems of the body, brain, and mind. Human beings respond to shock and developmental/relational trauma by dissociating and disconnecting. The result is a dimming down of the life force that leaves a person, to varying degrees, exiled from life. In NARM, working with the roadblocks that are in the way of reconnecting with aliveness is a key organizing principle.

In our many years as a clinicians, teachers, and supervisors, we have noticed a need for a more comprehensive and unified understanding of emotional regulation. NARM presents a clear understanding of how to work with emotions; learning how to be in touch with our emotions and appropriately express them is a fundamental part of this approach. By tracking the physical, sensate, and energetic experience of emotion in the body, NARM emphasizes somatic mindfulness—the containment, deepening, and support for the biological completion of affective states. Tracking and containing emotions in this way puts us progressively more in touch with our core aliveness.

The Life Force, Aliveness, and Emotions

We have created two charts to understand and work with emotions in the context of increasing the capacity for aliveness. Figure I.2 tracks how the life force becomes diminished and distorted in reaction to the adaptations a child makes to environmental failure. It also shows the similarities and differences between developmental and shock trauma. Figure 6.1 specifically tracks the distortions of the life force in each adaptive survival style. Both figures clarify emotional and autonomic regulation as they relate to the sympathetic and parasympathetic functions of the nervous system and integrate an understanding of how the distortions of the life force impact our psychology and physiology.

Distortions of the Life Force

The following section explains how to use the chart in Figure I.2 from the bottom up to track distortions of the life force as a person experiences and then adapts to developmental and shock trauma.

• Core Energy/Life Force: The first level of the chart represents undifferentiated core energy or life force. It is what the French call élan vital and what other cultures call prana, reiki, chi, and essence, to mention but a few of its more commonly known names.

FIGURE I.2: Distortions of the Life Force. To understand how the life force becomes distorted, read the chart from the bottom up. To understand the therapeutic or growth process, read the chart from the top down.

• Healthy Differentiation of the Life Force: The second level maps the various expressions of core needs and healthy aliveness. The life force is the energy that fuels healthy aggression, strength, self-expression, separation/individuation, fight-flight, passion, and sexuality. When the core expressions of the life force are not supported, when they are inadequately responded to or blocked from expression, sympathetic activation in the nervous system increases.

• Sympathetically Dominant Symptoms: When core needs are not met, movement toward the sympathetically driven distortions of the life force begin. The response is initially one of protest that, when not responded to, develops into anger. Anger is a life-supportive response intended to impact an unsupportive environment. For example, infants express their need for touch, nourishment, love, and connection at first by fussing and crying, which is simply an expression of healthy aggression. Attuned mothers recognize their child’s need and respond appropriately. If the infant’s need is not appropriately responded to, the infant escalates the demand, ramping up the sympathetic branch of the autonomic nervous system, protesting the lack of response, and finally erupting into anger. In neglectful and abusive environments, when lack of adequate response is chronic, anger and aggression cannot be resolved. When infants feel chronic anger toward their caregiver, it is instinctively experienced as a threat to the attachment relationship and therefore as dangerous to survival. Symptoms of undischarged sympathetic activation develop, leaving children, and later adults in states of high arousal, anxiety, and irritability, prone to temper outbursts, fearfulness, and even panic attacks. We will see that all of the survival styles develop as an attempt to protect the attachment relationship by foreclosing core expression, anger, aggression, and, ultimately, authenticity.

• Parasympathetically Dominant Symptoms: When aggression, anger, and other forms of protest are ineffective, not possible, or dangerous, children adapt. At a certain point, if the lack of attunement persists, the chronic sympathetic arousal overloads the nervous system; children adapt through resignation, shutting down the angry protest as well as the need itself, and move into the parasympathetically dominant freeze response. This shut-down does not resolve the basic problem but effectively numbs children to their needs and emotions. The unfulfilled needs and unresolved feelings are bound in the body and nervous system in the form of undischarged arousal, which is held as physical tension or as collapsed and frozen states.

Working Therapeutically with Distortions of the Life Force

It is central to the NARM approach to keep in mind the underlying theme of supporting aliveness and connection when working with symptoms, remembering that symptoms reflect disconnection—a diminishment of the connection to the life force. Working from the top of Figure I.2 (most symptomatic) to the bottom (most alive), we present in Chapter 12 therapeutic strategies for working with the acting in and acting out of unintegrated aggression. As rage, anger, and then healthy aggression are progressively integrated, anxiety, depression, and other symptoms recede. As the developmentally unmet core needs are recognized, connection to the life force is progressively strengthened.

The work of integrating all emotions plays a significant role in supporting reconnection to the life force. When working with emotions, NARM therapists keep the following question in mind: what is the implicit intention of the emotion? Helping clients understand and integrate the core intention of their emotions leads to greater biological and emotional completion, which in turn leads to more connection to the life force. By supporting a process of containment and deepening of affects, greater emotional range and increasing self-regulation become possible.

Somatic Mindfulness

The practice of mindfulness comes to us from Eastern traditions and is becoming an increasingly popular psychotherapeutic tool. Mindfulness, in the most general of terms, means paying attention to our experience: listening to ourselves, to our thoughts, to our emotions, and to our bodily sensations. Ultimately, we learn to listen in such a way that we don’t push elements of our experience away but come to see that thoughts, emotions, and sensations come and go. The appeal of mindfulness is the freedom that we experience and the sense of flow and fluidity that comes when we are present to but not identified with our thoughts, feelings, and sensations.

The NARM process adds two new refinements to the traditional practice of mindfulness:

• Somatic mindfulness

• Mindful awareness of the organizing principles of our adaptive survival styles

In traditional mindfulness practice, an individual is generally taught to hold an open awareness to all experience. Traditional mindfulness is most effective when a person has experienced little trauma. When there has been major trauma, maintaining an open awareness is extremely difficult and may even lead to overwhelming emotional reactions. The more trauma a person has experienced, the more difficult the practice of open awareness.

Trauma, because of the associated nervous system hyperarousal and the resulting systemic dysregulation, keeps us from being present in our bodies. The tendency for traumatized individuals is to disconnect from the body by becoming overly cognitive or by numbing bodily experience, or both. When there is high arousal and dysregulation, it is painful to be in our bodies. This is why the NARM approach has added somatic mindfulness to the practice of traditional mindfulness. The purpose of somatic mindfulness is to progressively support nervous system re-regulation by adapting techniques from Somatic Experiencing^® such as grounding, orienting, titration, pendulation, and discharge that are designed to address the high arousal, collapse, and shock states that traumatized individuals experience. In NARM the practice of somatic mindfulness integrates the established ancient understanding of mindfulness with twenty-first-century knowledge of nervous system regulation.

Mindfulness of the Adaptive Survival Styles

The second aspect of mindfulness used in NARM involves bringing our adaptive survival styles and the organizing principle of each style into mindful awareness. Awareness of survival styles usually begins after a certain capacity for self-regulation has been established. As a person becomes more regulated and embodied and as internal distress states diminish, the capacity for self-awareness becomes stronger. Integrating somatic mindfulness with the mindful awareness of survival styles allows us to work with a person’s life story from a perspective that is deeper and broader than the narrative itself. The two processes of somatic mindfulness and mindful awareness of our survival styles reinforce each other and enhance the effectiveness of psychological and physiological healing work.

Shame-Based Identifications and Pride-Based Counter-Identifications

Each adaptive survival style has underlying shame-based identifications that develop to make sense of early environmental failure. In addition, in reaction to underlying shame, most people also develop pride-based counter-identifications, an ego ideal that reflects how they would like to see themselves or want others to see them. The pride-based counter-identifications, traditionally thought of as defenses, are an attempt to turn shame into virtue, but paradoxically, the more energy a person invests in the pride-based counter-identifications, the stronger the shame-based identifications become. These are briefly presented in Table I.4.

NARM holds that both the shame-based identifications and the pride-based counter-identifications, while often feeling quite real, are illusions. The pride-based counter-identifications, sometimes dismissed as defensiveness, resistance, and denial, function to protect against the painful shame-based identifications that result from developmental trauma and represent their own kind of illusion. There is a danger in challenging only the protective pride-based counter-identifications, the so-called defenses, without simultaneously working through the shame-based deeper identifications, which otherwise might be reinforced. Without this understanding of the nature of these two levels of identifications, the therapeutic process can become needlessly painful and sometimes even harmful.

SURVIVAL STYLE	SHAME-BASED IDENTIFICATIONS	PRIDE-BASED COUNTER-IDENTIFICATIONS
Connection	Shame at existing Feeling like a burden Feeling of not belonging	Pride in being a loner Pride in not needing others Pride in not being emotional
Attunement	Needy Unfulfilled Empty Undeserving	Caretaker Pride in being the shoulder everyone cries on Make themselves indispensable and needed Pride in not having needs
Trust	Small Powerless Used Betrayed	Strong and in control Successful Larger than life User, betrayer
Autonomy	Angry Resentful of authority Rebellious Enjoys disappointing others	Nice Sweet Compliant Good boy/girl Fear of disappointing others
Love-Sexuality	Hurt Rejected Physically flawed Unloved and unlovable	Rejects first Perfect Does not allow for mistakes “Seamless,” having everything together

TABLE I.4: Shame-Based Identifications and Pride-Based Counter-Identifications for Each Adaptive Survival Style

The Distress Cycle

NARM supports the development of the capacity for connection, aliveness, and creativity. Disrupted attachment, as well as early developmental and shock trauma, interfere with healthy self-regulation, cause disconnection from self and others, distort identity, and undermine self-esteem. Indeed, developmental trauma is a major contributor to the dysregulation and associated disturbances that lead to countless psychological and physiological problems, as well as to compulsive, addictive, and self-destructive behaviors. Survival styles begin as adaptive, life-saving strategies that help us in early life to manage and survive painful traumatic experiences. Paradoxically, as we become adults, these same survival strategies become the cause of ongoing nervous system dysregulation, dissociation, and self-esteem difficulties. The once-adaptive survival styles, when continued beyond their usefulness, create a distress cycle (Figure I.4).

To understand how a distress cycle is set in motion, it is important first to comprehend how information flows both top-down and bottom-up in the nervous system. The term top-down refers to how cognitive structures of the brain impact the emotional and instinctive systems of the body. The term bottom-up refers to how regulation in the nervous system impacts cognitions. Top-down, our thoughts, judgments, and identifications affect how we feel and impact the nervous system’s capacity for regulation. Bottom-up, regulation/dysregulation in our nervous system affects our emotions and thoughts.

Bottom-up mechanisms are involuntary, most often unconscious, and related to the physical effects of environmental stimuli upon the body. In contrast, top-down mechanisms can be voluntary, conscious, and pertain to how memory, motivational relevance, emotion, attention, and imagery shape perception. Top-down therapeutic approaches focus on the cortical functions of cognition. Bottom-up therapeutic approaches focus on the body, the felt-sense, and the instinctive responses as they are mediated through the brain stem and move upward to impact the limbic and cortical areas of the brain. Continuous loops of information travel from the body to the brain and from the brain to the body. Similar loops of information move among cognitive, emotional, and instinctive structures within the brain (Figure I.3).

FIGURE I.3: Top-Down and Bottom-Up Information Flow

It can be argued that babies mostly rely on bottom-up perceptual mechanisms. When a child experiences early trauma, a distress cycle is set in motion that initially moves bottom-up and later top-down in continuous self-reinforcing loops. Bottom-up, trauma creates nervous system dysregulation. When people experience trauma, they feel bad; children, in particular think they are bad when they feel bad. Chronic bottom-up dysregulation and distress lead to negative identifications, beliefs, and judgments about ourselves. These negative identifications, beliefs, and judgments in turn trigger more nervous system dysregulation, and a distress cycle is created.

FIGURE I.4: The Distress Cycle

The NARM Healing Cycle

Most therapeutic and personal growth traditions tend to focus on either top-down or bottom-up aspects of the circular flow of information, working either from the body to the brain or from the brain to the body; as a result, they do not address the self-perpetuating aspects of the information loop and, by not doing so, often miss the pernicious links that keep the distress cycle in operation. NARM integrates both top-down and bottom-up orientations, explicitly working with the information flow in both directions. This disrupts the self-perpetuating closed loops of distress and supports the shift to a healing cycle.

NARM views the mindful bottom-up experience of the body as the foundation of the healing process. The body is our connection to reality, the platform from which NARM works. By paying attention to the body, we are more easily able to recognize the truths and fictions of our personal narrative. As shock states held in the nervous system are discharged, we come into more contact with our body. A positive cycle is established in which the more self-regulated we become, the more we are in touch with our body, and the more in touch with our body we are, the greater our capacity for self-regulation.

At the same time that NARM is grounded, bottom-up, in somatic mindfulness, it uses the mindful awareness of survival styles to bring a process of top-down inquiry to our sense of self which includes our fixed beliefs (identifications and counter-identifications), our self-hatred, self-rejection, and judgments. NARM also uses inquiry to help dissolve the fixed, narrow ideas about others and the world that limit our life. Since many of our identifications develop in the first five years of life, distortions in identity keep us seeing ourselves and the world from a child’s perspective.

As the NARM process unfolds, a healing cycle (Figure I.5) is set in motion in which nervous system regulation increases and distorted identifications and beliefs diminish and eventually resolve. In a positive healing cycle, the increasing nervous system regulation helps dissolve painful identifications, and as painful identifications and judgments dissolve, increasing capacity for self-regulation becomes possible.

FIGURE I.5: The NARM Healing Cycle

This figure should be read clockwise from the bottom-up. In this self-reinforcing cycle each step builds upon the previous and makes the next possible. The cycle repeats as clients continue to move toward reintegrating their core capacities and life force. Initially, it may not be possible for traumatized individuals to access their somatic awareness; in such cases any experience of self-reference can serve as a starting point.

THE NEUROAFFECTIVE RELATIONAL MODEL IN HISTORICAL CONTEXT

A brief historical summary will help the reader understand how NARM both integrates and departs from psychodynamic and cognitive psychotherapies, as well as from traditional somatic and expressive psychotherapies.

Psychodynamic Psychotherapies

Psychoanalysis and psychodynamic psychotherapies have established the significant influence of attachment dynamics, early family life, and personal history on the developing personality. The NARM approach integrates elements of various psychodynamic clinical orientations: ego psychology, object relations, self psychology, and the important recent developments of attachment and relational theories.

NARM departs from psychodynamic approaches, however, in how it clinically applies the understanding of these approaches. Whereas psychodynamic therapies focus on attachment and developmental themes with the perspective that the past determines who we are in the present, NARM explores personal history to clarify patterns from the past that interfere with being present and in contact with self and others in the here and now. It brings an active process of inquiry to clients’ relational and adaptive survival styles, building on clients’ strengths and helping them to experience agency in the difficulties of their current life. While it is true that a psychotherapist must be able to traverse difficult affects with the client, in order to avoid regression the NARM therapist always supports a mindful dual awareness of past and present—staying anchored in the bodily experience of the present moment, NARM supports the awareness of the distinction between what was then and what is now. The focus is less on why people are the way they are and more on how their survival style distorts their experience and their life in the present. Avoiding the trap of making the past more important than the present, NARM uses a dual awareness that is anchored in the present moment while exploring cognitive, emotional, and physiological patterns that began in the past. The NARM approach of emphasizing the here-and-now expression of survival styles, rather than focusing on a person’s history, is a complex and intricate process that is detailed in Chapter 10.

Working with the NARM approach progressively reinforces the connection to self in the present moment. Using resource-oriented techniques that work to recognize subtle shifts in the nervous system adds significant effectiveness. Tracking here-and-now experience in the nervous system is fundamental to disrupting the predictive tendencies of the brain. Paying close attention to the process of connection/disconnection, of regulation/dysregulation, in present time, helps us strengthen our sense of agency, feel less at the mercy of our childhood experiences, and most importantly, it supports the re-regulation of our nervous system. It is in the connection to our body and in relationship with other people that healing is possible.

Transference Dynamics

Psychodynamic psychotherapies often advocate the use of the transference relationship to facilitate the repair of attachment wounds. Psychodynamic psychotherapists implicitly encourage their clients to re-experience their original relational dynamics within the transference relationship, believing that it is intrinsic to the therapeutic process.

Recognizing transference dynamics is an important aspect of the NARM approach as well. However, NARM’s nervous system perspective adds significant clinical interventions to working with transference. In early attachment dynamics, the baby’s nervous system is first organized in an implicit way, responding to and being regulated by the healthy nervous system of the mother. Because the process of attachment follows a nervous system–based developmental sequence, it is premature to focus on transference dynamics when self-regulation has been strongly impaired or disrupted by early trauma. The underlying deficits in nervous system organization must first be addressed. It is our sense that many of the problematic transference reactions that analysts and psychotherapists describe may be needlessly difficult, or even terrifying, because the therapist has not taken into account that the foundation of nervous system organization and regulation is not yet in place. A nervous system–based approach can avoid the re-traumatizing abreactions and regressions that are created when the transference is used as the primary vehicle for the therapy before clients have developed sufficient neural organization. Prematurely focusing on the transference relationship can quickly plunge a person into disorganization and distress. Tending to the basic organization of the nervous system is a fundamental element of working with transference processes that needs to be integrated into mainstream clinical interventions.

NARM works with the vulnerable preverbal and nonverbal elements of an individual who has suffered early shock or developmental/relational trauma. Individuals manage this kind of early trauma by developing the Connection Survival Style. These clients come to therapy struggling with the regressed elements of their personality and with ideas about themselves developed in response to early environmental failures. They need help to learn to self-regulate. Therapy for the Connection Survival Style can become re-traumatizing when it is not sufficiently titrated or resource oriented. On an identity level, using the transference relationship as the primary organizing principle may reinforce identifications with regressed aspects of self rather than release them. To regulate the nervous system, it is more effective to work consistently with the organized “adult” aspects of the self in order to integrate the disorganized, regressed “child” aspects. By supporting a dual awareness that is firmly anchored in the organizing here-and-now felt sense experience, we can explore adaptive survival styles that began in childhood while avoiding painful regression and abreaction and the trap of making the past more important than the present.

Somatic Psychotherapies

For the last seventy years, a cornerstone of somatic psychotherapy has been that our aliveness, vitality, and authenticity are accessed in connection to the body. The Western somatic psychotherapy tradition began with Wilhelm Reich, a medical doctor and psychoanalyst, as well as Freud’s pupil and later colleague. Reich was the first psychoanalyst to emphasize the importance of including the body in psychotherapy; his goal was to anchor in the body Freud’s belief in the biological foundation of the psyche. Reich believed that our biologically based emotions govern our psychological processes. He is best known for his insights on what he called character structures, which, he contended, are kept in place by defensive armoring, the muscular rigidity that is the protective response to living in emotionally repressive environments that are hostile to aliveness and the life force.

Building on Reich’s breakthrough understanding of the functional unity of body and mind, Alexander Lowen, MD, developed Bioenergetics, a somatic approach that included his own psychodynamically based character structure system. Lowen identified five basic developmental character structures, which, consistent with the thinking of his time, were given names that emphasized their pathology: schizoid, oral, psychopathic, masochistic, and rigid. Lowen’s five character structures clearly tapped into a fundamental understanding of human nature and have influenced many subsequent body-based psychotherapies, including NARM.

Similar to Reich, Lowen believed that character structures were the outcome of thwarted drives. Wilhelm Reich and Alexander Lowen retained the pathologizing orientation consistent with the psychoanalytic principles of their time in that they emphasized the importance of working with defenses, repression, and resistance. Reich’s and Lowen’s therapies encouraged regression, abreaction, and catharsis. They both believed that the therapist’s job was to break through a patient’s character armor—the psychological and somatic defenses—in order to release the painful emotions held in the body.

Bioenergetics, for example, recognizes that deep emotion, conscious or unconscious, is held physically. It encourages clients to express their emotions through kicking, hitting, biting, and yelling, with the goal of discharging these powerful affects and in the hope that doing so will lead to greater emotional freedom and health. Reich’s and Lowen’s unique contribution was to recognize that defenses were held not only in the mind but also in the body’s nervous system, musculature, and organs. This significant breakthrough was ahead of its time and anticipated many current developments in the neurological and biological sciences.

The Reichian/Bioenergetic tenet of the functional unity of mind and body is consistent with NARM. NARM’s nervous system work, however, is much subtler, consistent with the advances in neuroscience research of the past two decades. We will see how using the two organizing principles of somatic mindfulness and mindfulness of adaptive survival styles can guide a gentle return to nervous system coherency with far less possibility of re-traumatization.

From a NARM perspective, intensely cathartic affective interventions can have the unintended effect of causing increased fragmentation and re-traumatization. Focusing on the pain, emptiness, or rage caused by early loss, neglect, or trauma does not in itself lead to healing. The orientation in the NARM approach is to use mindful awareness to help the client tolerate strong emotion, neither acting it out against the environment nor directing it against the self. Rather than being discharged through catharsis, powerful emotional and energetic states are contained so that they can be integrated and transformed into an increased capacity for connection. Mindfully staying present to and containing intense affect increases nervous system resiliency and supports the development of emotional depth.

Somatic Experiencing^®

Somatic Experiencing^® (SE) was originally developed by Peter Levine, PhD, and elaborated upon by the senior faculty of the Somatic Experiencing Trauma Institute, which includes co-author Laurence Heller. It is an effective short-term, bottom-up approach to therapy that supports nervous system re-regulation in the aftermath of shock trauma. SE is a step-by-step approach designed to treat shock trauma and the resulting nervous system dysregulation. It is a progressive and gentle approach that supports the biological completion and discharge of the intense survival energies of the body’s fight-flight responses.

Traditionally, SE does not focus on attachment, emotional, or relational issues as part of its therapeutic scope. NARM adds to SE by providing additional tools to address developmental, attachment, relational, affective, and transferential issues.

Gestalt Therapy

Gestalt therapy is an existential, phenomenological approach developed by Fritz Perls, MD, who early in his career was a psychoanalyst but later strongly rejected psychoanalysis. Gestalt’s phenomenological orientation involves paying attention to what the client is experiencing in the moment. From the NARM perspective, this shift represents a significant therapeutic step forward, because it addresses the client’s direct experience and moves the emphasis away from the endless exploration of personal history. Incorporating the role of the body and the importance of emotions, as Gestalt did, was a movement forward from psychodynamic therapies that ignore the present moment and the body. Both Bioenergetics and Gestalt encourage catharsis and emotional release. It is our experience that, for many clients, catharsis is not helpful and can even impair the capacity to self-regulate. The more traumatized and disorganized a person’s nervous system, the more likely catharsis can be re-traumatizing.

Cognitive Therapy

Cognitive therapy focuses on identifying cognitive distortions and their negative impact in our lives. This is an important contribution and brings the focus of the therapy into the here and now, emphasizing a person’s agency in his or her life difficulties. However, when dealing with developmental trauma, attachment difficulties, and early shock, the new understanding from the neurosciences supports the importance of working with affect regulation over cognition. Working with affect regulation and the nervous system is an essential element of the NARM approach.

Cognitive therapy introduced an important version of mindfulness to clinical psychological practice by helping clients examine their thinking and teaching them to interrupt and be mindful of their negative thought patterns. However, cognitive therapy does not address the nervous system imbalances that drive cognitive distortions; particularly when working with early trauma cognitive therapy is only minimally effective. In the case of the earliest Connection Survival Style, for example, focusing on changing distorted cognitions is particularly difficult because with early trauma, the cortex is not yet fully developed, and it is mostly the underlying bottom-up nervous system and affective imbalances that drive the cognitive distortions.

NARM presents a broader clinical application of mindfulness than is found in cognitive therapy by separating the story related to the distress states from the physiological distress itself. As the nervous system becomes more regulated, many cognitive distortions drop away. Elements of cognitive therapy are useful in working with the top-down aspects of the distress cycle, but particularly when working with someone who has experienced early trauma, it is essential to work with the distress cycle both top-down and bottom-up.

Affective Neuroscience

Significant developments in the field of neuroscience in the last twenty years have established and documented the biological foundation and psychological importance of affect regulation and interpersonal and social connection. Important developments in affective neuroscience include Stephen Porges, PhD’s research on the polyvagal system and his focus on the role of the Social Engagement System (SES); Daniel Siegel, MD’s interpersonal neurobiology, which clarifies the role of the neural substrate of relationship; and Allan Schore, PhD’s regulation theory, which documents the critical function of the right orbitofrontal cortex in supporting resonant contact and the repair of attachment wounds. These findings, as well as the research of other major neuroscientists, provide a scientific basis for the clinical approach that has been developing in NARM since the 1970s.

Esoteric Approaches

The limitation of what we take to be our personal identity is addressed in many esoteric traditions and has been popularized by well-known authors such as Eckhart Tolle and Ken Wilber. Psychodynamic orientations work to solidify the sense of identity and strengthen the ego, whereas esoteric orientations hold that Ego is an illusion that separates us from Being and keeps us from experiencing the spaciousness, fluidity, and fullness of our essential nature. Both perspectives are important. Esoteric approaches address the limitations of what they call Ego but generally do not incorporate the clinical awareness of the importance of attachment and developmental trauma in the creation of our sense of self. In addition, esoteric approaches do not address the primary role of nervous system dysregulation in the formation of the fixed identifications that come to be confused with identity.

NARM integrates both psychological and esoteric traditions and adds a biologically based approach that at times helps to solidify a person’s sense of identity and at other times supports the exploration of the fluid nature of identity. The NARM approach holds that the most immediate access to spiritual dimensions is through a regulated physiology. Whereas for hundreds of years, the body, particularly in Western traditions, was seen as an impediment to spirituality, it is a NARM premise that a coherent biological/psychological self is a springboard to the higher Self. It is only when individuals have a solid sense of who they are that they can open to the fluid nature of Self.

The meditation technique of Vipassana is one important tool in the mindfulness process that can lead to the awareness and direct experience of the fluid nature of the Self. Because it is a powerful tool, however, it can potentially opens meditators to painful or overwhelming affective states that they are not equipped to process. We have worked with many individuals who during meditation retreats became anxious and overwhelmed by their emotions. Any system of self-exploration that does not take into consideration trauma and attachment issues and the resulting disrupted functioning of the nervous system creates the danger of dysregulating and re-traumatizing its practitioners.

One of Eckhart Tolle’s core principles is that nothing that happened in the past can keep us from being fully in the present moment. Although theoretically true, this orientation can be hurtful to those who have experienced trauma and suffer from significant nervous system disorganization. Traumatized individuals, which includes most of us to differing degrees, need both top-down and bottom-up approaches that address nervous system imbalances as well as issues of identity. Many people recognize the “power of now,” as Tolle calls it, but because of their nervous system dysregulation they are unable to remain in the present moment. Falling short of this ideal becomes another reason for individuals with trauma to feel bad about themselves.

A FUNDAMENTAL SHIFT

NARM utilizes elements of all the approaches mentioned above in a system that introduces a significant and fundamental shift in how these theoretical elements are applied. NARM holds psychodynamic, nervous system–based, and Eastern healing traditions as equally important and complementary. Building on and moving beyond the approaches mentioned above, NARM is a unified systemic approach that works with both developmental and shock trauma.

A Unified Systemic Model

Building on and adding to psychotherapeutic, meditative, and personal growth traditions, NARM offers an understanding and techniques that use connection to the parts of self that are organized, coherent, and functional to support new patterns in the nervous system. NARM is resource oriented, non-regressive, and non-cathartic. It works in the present moment with the felt sense using somatic mindfulness to help regulate the nervous system in order to support the increasing capacity for connection and aliveness. In this approach we see that it is in the connection to ourselves, to our body, and in relationship that we find healing regulation.

The NARM approach to growth and therapy is an antidote to deterministic approaches and maintains that the past does not determine the present. It is the persistence of adaptive survival styles along with the related nervous system disorganization and distortions of identity that negatively affect our present experience. Understanding adaptive survival styles provides practical tools and techniques to address these distortions of identity and nervous system dysregulation. Being present and regulated in our bodies helps us become aware of and disidentify from the many inaccurate ideas and judgments that we have about ourselves, other people, and the world.

Working with the Life Force

The spontaneous movement in all of us is toward connection, health, and aliveness. No matter how withdrawn and isolated we have become or how serious the trauma we have experienced, on the deepest level, just as a plant spontaneously moves toward sunlight, there is in each of us an impulse moving toward connection and healing. This organismic impulse is the fuel of the NARM approach.