Conference on Trauma starting 21st September 2019 - free to view

[Hope67]

Hi Kizzie,
Yes, I purchased the other videos in the last conference, as it was a reasonable price, but this current one is too high, in my opinion - hence I'm trying to watch them.

I've seen Day 3's talk which is by Lisa Ferente and is called "Helping Clients Heal from Sexual Trauma"  (therefore TWs as content is about Sexual Trauma - but there isn't anything graphic).

My notes from today's talk (bearing in mind this content is triggering for me and I felt myself feel spacey in parts):

Pervasiveness - sexual invasion and trauma.  Somatic pain, cognitively affects, Emotionally, Behaviourally and Relational choices all often affected by sexual trauma in early childhood.  Abuser is often someone they know.  Someone who manipulates, grooming is often prevalent and there is abuse interwoven with love.  The body is biologically programmed to respond.  Therefore tremendous confusion.  Confused by reactions.  'You like this' 'You wanted this'  Self-blame and shame and self-hatred and self destructive and demeaning behaviours can occur.
Dirty and damaged and broken.
Damaged or defective.

Impossible to fight or flight.  Can't extricate self.  Only survival response = dissociate and freeze response.
Problem - another residue of shame.  Why didn't I...
Psycho-educative - you survived.
Normalise No 1 coping strategy = dissociate.

Sexual experience: Zone out and dissociate.  Not feeling.  Checked out. 
Teach how to re-connect with safe and chosen partners.  Can re-enact scenarios in sexual relationships.  Pornography can be re-enacting.
Non-judgemental.  Beginning of secure attachment.
Listen for re-enactment of sexual trauma.

Teach new ways to be sexually intimate.  Sex with lights on and eyes open.  Separate past from present.
Talk during sex.  Feedback: what feels good.  Do you need to pause.
Educate re: importance.  Don't push through if in flashback. 
Can I stay present re: touch.
Permission to hold back from sexual experience.  Establish emotional intimacy.
Pacing.
Old days (historically) - pressure to remember and tell - found to be re-traumatising.
Nowadays - anchoring and take time to resource them before accessing traumatising material.
Non-verbal micro-expressions - important.

Pacing and dosing.  Flexible, fluid.  Allow client to pace the work.  Shame = integral part.
Somatization - e.g. migraines etc.
Love-Hate conflict with the abuser.
Hard to feel anger towards abuser.
Psycho-education: Love and hate = confusing.  Non protective bystander. 
We CAN both love and hate.  One doesn't have to negate the other.
Earlier betrayals and violations.
CAN process both.  Both emotions make sense.

Get back their voice.  Assertiveness.  Stop and No means something.
Invite a partner to come into a session.  Normalise experience.
Goals: More safe and communicative.  Sensual pleasure.
Pressure of ticking boxes before any therapeutic alliance formed (noted by Lisa Ferentz when working with therapists and organisations)
e.g. likened this to buying stamps at the Post Office and being asked at the end, 'Oh, and by the way, were you sexually abused?' - mentioning the inappropriateness of such a question and the invasive aspects of asking it.
Unethical to ask intimate personal questions before assessment of personal issues.  Need to establish trust, relationship, resources and resiliency.
Affect regulation skills; Dissociative skills; Re-grounding; Assessing and recognizing triggers.
Therapists to push-back against pressure from external authorities.
Could cause client not to return - if not treated sensitively.

Consider counter-transferential reactions.
Be present and understand that effect on therapists.
Someone should be grounded and present.
Support system for therapist too.

Narratives of sexual trauma
Can give title rather than details.
Don't have to fill in all of the graphic details.
No, they don't need to know or tell all details.
Historically - re-living it in an abreactive  state was trained.  Realised that is inappropriate.
Meaning attached to it.  Blame self and shift this to blaming perpetrator.  Re-connect to the joy of being sexual.
Pleasure - tolerating - a growing capacity.

Attachment to pornography
Strong correlation is an addiction to pornography.  Can be safer than real life sexual relationships.
Therefore, assess the kind of pornography - can be re-enactment or an attempt to repair it.  But this is shame-based information, so needs to be accessed sensitively.
Make it part of the normal assessment.

Hate yourself can lead to hurt yourself.
Punishing body.
Self-destructive behaviour.
Compulsive spending.  Addictions.
Eating disorder - e.g. Binge: Forcing something into body that they don't want there.
Freeze vs mobilisation - when sharing a disclosure, should be not in an immobilized still posture.  Better to 'get them moving'  'swaying' while talking - she recommended this for 'any trauma memory'.

Finally she mentioned self-care for therapists. 

The website for Lisa Ferentz's blog is Ferentzinstitute.com

(I hope these notes make some sense - I am very aware that there is an incredibly resistant part of me today, and it's been tough to bring myself to write these notes, but I have managed it, because I wanted to share them).

Hope 

[Snowdrop]

Hope, your notes are brilliant. Thank you so much.

[Kizzie]

      

[Hope67]

Hi Snowdrop & Kizzie,
Thank you so much.   

**** The talk that Dr Richard Swartz gave on Saturday about IFS and Trauma is going to be re-played again for free tomorrow (25th September 2019) so anyone who missed it, and would like to watch it - can do so ****
Apparently there was a technical glitch on Saturday - which I didn't even notice, so maybe I didn't have that issue - but the great thing is that it will be replayed tomorrow. 

I'm going to do my notes on today's session in a moment, but they will be likely to be harder to comprehend, as I don't think I comprehended it at the start of the talk, but I got the gist by the end, and I think I do understand it better now.  But I'm just going to write the notes as I wrote them, as I don't want to try to re-write things - hope that makes sense.

Hope 

[Hope67]

Notes from Day 4 of the Conference (24th September 2019)
Talk by David Grand PhD entitled "Brainspotting - Reaching the Hidden Realm of the Brain: Bypassing the Neocortex to Access the Subcortex"

(These are my notes on that talk - hope they make some sense - I found it hard to comprehend at first, but began to get the gist of it by the end)

History of the uncertainty principle.  Eisenberg.
Box - advanced super-computer.  Holds ALL the information and we can access it all.  Phenomenal opportunity.  Question - how do we access it and how do we understand it?
Brain - inter-connectivity = immense and vast.
Psychotherapists - you need an understanding but 'beyond our capacity to know' = uncertainty principle.
Client must divulge for you to learn.
Continually revealing itself.

Respecting unfolding and unknowing.
Learning how to respect
Arising organically.
Don't mess it up.
Problem = if we operate on the 'certainty' principle.  Then lose attunement in that scenario.
Therefore keep uncertainty principle in order to hold onto attunement.

Bunch of concepts in Brainspotting.  Applicable across modalities.
More you realise you don't know things, the more comes to you.
Traumatic exposure
Limbic counter-transference.  Vicarious exposure to client's trauma = activating.
Flight - lose attunement, leave the room
Fight - push back
Freeze - soft freeze, hard freeze, fragment.
Limbic counter-transference = expected.
Gently guide self back to the client.
Less attunement resume.
Being aware.

Processing = focused mindfulness.
Set and hold a frame with a client.
Work within the frame.
Set-up process with a frame.
Activates
Client-focused activation.
Follow them in a focused way.
Mindfulness = focused.

Whatever the client brings to the therapist = relevant.
Set a frame around it.
Issue
Being aware of activation (physiological term)
Where do you feel that in your body?
Has to feel right.
Flow with it.
Issue - activation - where in body?
Relevant eye positions.
Use pointers to indicate where they feel something in their line of vision.
Reflexive cues.
Guide client to process what comes up, and what next, and what next...
Focused mindfulness.

?Manageable (Host asks this question)
Regardless of modality, EXPECT overwhelm.
Ultimate resource = relationship.
Dual attunement frame
Attuned presence with client.
Brain-body frame.
The client doesn't feel us.
Clients getting too activated?  Some therapists might jump in with resources, but...
Story brains.  Have a beginning, a long middle - with lots of spiking activation, and it hits an arc - leads towards the resolution.  Dr Brand feels they won't hit the arc if you resource too early, so emphasises tending to give chance to fully express the issue.

The host asked for Examples?
Dr Brand stated "I see miracles in front of me everyday"
Historically - talk therapy.  But Brain-Body work = better.  Then even better =Brainspotting = a leap beyond that.
Somatic Experience (SE) - Peter Levine's work.
Eye contact spot - gave an example of eye to eye (straight on) as a reflex spot.  Talking of different positions that are possible and discussion of earliest memory.  Deep down.  Achieve a lot.
Frame - surrender to uncertainty.  Frame - every psychotherapy uses a frame.  May or may not be articulated.
Mindful of the frame.  Watching healing in real time.  Wait and wait more...
Likened process to a Comet.  The head of the comet is the client.  Therapists are in the tail of the comet, so following the head.  "We'll fall out, but get back in and pursue it"
Flexible frame = ideal.  Mindful of it.
We don't make it happen.  Frame enables it (I used the word enable - not sure what term Dr Brand used)
Heller (host) referred to this way of working as '3rd wave therapy'
Dr Brand said "Art and Science combined"

Dr Brand told us he used to be a Creative writer.
Talked about the brain - using a model of the brain as he spoke to demonstrate.  Spoke of neocortex, and subcortex.  Mentioned that the subcortex is the reptilian brain, and there is no language or thought there, only somatic material, and mentioned that the subcortex gives meaning to the neocortex.
Developmental trauma held in subcortex.  Not in neocortex
Therefore how to accesss - need somatic therapies.  Brainspotting - need sensory systems and accuracy.
Orienting - brain shifts.
Unprocessed trauma - dissociative capsules.  Eye position will reveal unprocessed trauma.  When find it (the correct position) hold gaze on there.  Focused mindfulness.
Minimise language and thought.  Focus on FEELING.  Highest bypassing and more accuracy and depth for subcortex.

Hard to heal in isolation.  Relational = important.
Power of attuned presence that heals.
Will never fully capture it.
Pursue it.

Host (Heller) asked if it's possible to have sessions via Skype?
Dr Brand actually said he prefers phone contact (i.e. without visual link and image) and said he can ask questions about where the person feels it the most, positional questions.  He also sees clients in his office, face to face.  (Not sure he liked Skype as an option - he did mention something about legal aspects, but wasn't sure why he said that - maybe litigation stuff?)
Brainspotting on yourself?  No relationship aspect.  Don't get the relationshional frame on your own.  But can find brainspots.
'Expansion' - opportunities with brainspotting.

Dr Brand gave his website - which is:  Brainspotting.com    He said there are opportunities for therapists to train in brainspotting.

(I've not looked at his website yet, so don't know what it is like)  (I hope these notes make some sense - clearly it's better to watch his presentation, and then you'd get a good idea of what he's talking about - but I found it quite hard to understand - although I have got the gist of it now - having listened all the way through, and I found it interesting, and it makes sense).

Hope 

[Hope67]

Oops, I've been calling Dr Grand, Dr Brand - my apologies to him!  His name is Dr David Grand...
Hope 

[Jazzy]

I also had difficulty focusing and following the beginning of the call. It didn't seem to really fit the topic, but later on he really pulled it together.

A couple of points that resonated with me from this talk:

First of all, it is interesting to hear him say that the most helpful tool any therapist has is their relationship with the client. Perhaps this is why I haven't had much good come from therapy; I've never had a good relationship with my therapist. At best, I've actively disliked them all. I'm not really sure how to change that (or maybe I deserve to be fussy about my therapists?), but at least there is potential for improvement there.

He said he found this out unintentionally when doing client/therapist role play sessions at his training events. He said that the "therapist" would sit with the "client", but he did all the work personally, to make it easier for the "therapists". Even though he was the one who did all the work, all of the "clients" were really appreciative of the "therapist" for being there with them. This is what made him realize how important the therapist/client relationship is.

The part of the talk that had the biggest impact for me is when he explained the difference between the neo/subcortex, and how trauma can live in the subcortex. I've never heard this explained before, and I found it really validates why it is so much easier to understand something, but that doesn't mean the relating trauma has actually been dealt with. This idea of trauma being "stuck" (in the subcortex) has really bothered me since I learned about CPTSD, and made me feel it was impossible to heal, but it sounds like there is hope.

The neocortex is where our "advanced" brain functionality lives. Things like logic and language live here. This is the part of the brain we're using when we go through our healing journey by learning and studying (like listening to these videos) and participating in talk therapy.

The subcortex is where our senses and somatic experiences live. Dr. Grand says that trauma that is not able to be fully processed by the neocortex (especially at a younger age), will be pushed down to live in the subcortex. Through somatic therapy we can access this trauma, and begin to heal it. The primary example he used is that different parts of your field of visions are more/less connected to the trauma. Looking in a particular direction (to the left, to the right, above/below/at eye level), or sometimes even the spot where our vision naturally rests will connect with this buried trauma, and cause a physical reaction. Focusing on this spot while working through the trauma will help bring it to resolution.

He also points out this technique can be used the opposite way, and gave an example of how when he was in pre-op for surgery, he had to wait a long time, and kept his vision locked in the spot where he felt most grounded. This kept his anxiety about the upcoming surgery contained, instead of it growing out of control.

That's the best I understood it. I'm really not familiar with somatic therapy, or work in the subcortex. Its something I plan to look in to, but it was just such a relief to hear that this logic/experience difference is a known and understood occurrence, so I wanted to write about that.

[Hope67]

Hi Jazzy,
I read what you wrote yesterday, and I think your notes are really great.  I noticed the difference between how I tackle my notes, in that I repeat what was said by the person, rather than try to say it in different words, and that's because I literally find it hard to process it, but I can see that you have articulated so many things that the speaker said, and you've put it so well - and it shows me that you really understand it - I am wishing I could do the same thing, but I am only able to re-iterate the words, and not try to make sense of them in a discussive way.  I'm not sure if this is making sense, and I almost wish I'd not started to try to explain this, as I feel I'm not managing to express myself very well. 

Anyway I'm just impressed by what you wrote.

*********
Here are my notes from Day 5 - 25th September 2019, which was a talk by Dr Bonnie Goldstein called "Helping Our Adolescent Clients Help Themselves Through the Lens of Sensorimotor Psychotherapy: Engaging the Body to Overcome Trauma and Face Transitions."
(I found this harder to focus on, as I ended up dissociating and going into flashbacks of memory, and ended up crying!  I wasn't even sure why - it was very emotive for me, so please bear that in mind that there may be gaps in my notes - but I hope they are helpful)

My notes:
Adolescents often feel others refer them to therapy.  Therefore Dr Goldstein looks at ways to help adolescents to embrace therapy.  Builiding a collaborative aspect.  To enable transitions.
She worked with Pat Ogden (who developed Sensori-motor psychotherapy) - Bonnie trained with Pat and found the skill so applicable to her work.
Telling the story is LESS important.
But, noticing what happens in the room.  Capitalise on curiosity.  Body - what's happening - help shifting.
What happens 'in the moment'.
'What might emerge spontaneously from the body'.
Focusing attention away from verbal narrative and focusing on how relationship in body.
Procedural tendencies.  Present moment movement - shift of head, coming forward, moment of panic (examples)
Focus on patterns and motions.  Established patterns.  Attachment patterns.  Pat Ogden refers to 'Embedded relational moments'
Attachment - explore early history.
Attachment system organises proximity.  Stop reaching out to others.  Eye contact.  Check out with client what feels comfortable re: distance etc.
Proximity seeking actions.  Follow our teens, see where they want to go.  Dance.  Also want to lead them back.
Involve family, school, environment.
Teens trying to differentiate and separate.  Validation and positive regard.  They will change.  Developmentally - there are changes.  Vision shifts from day to day.  Nomenclature of 'parts'. 
e.g. I will never speak to my parent again - one part believes that.  Another part may develop and express another aspect/belief.
Point out body movements supportive of boundaries.  Movement to facilitate communication.
Therapist - represents adults.
Therapeutic experiments: Observe through a lens - frame it.  Bring something to awareness in the body.  Teen may say 'I feel nothing' - but you can notice shifts in the breath.  Comment on them.  In the movement attunement.
'They feel felt' = so powerful.
Awaken parts that are in exile.  Integrated and embedded moment to moment in attachment focused therapy.
Dan Siegel - paying attention to the present moment.  Neuro-plasticity.
Let's try something: Experiments - extend arms open wide.  Notice shift in breathing.  What happens?  What do you notice in your body?  What do you notice in your breath?  Notice eyes.
Try pushing away.  Try beckoning.
Notice where in our body we feel these things?  Brings up emotion.
Use of props, to facilitate movement.  e.g. Dark office.  Large ponchos to wear to cover chest.  Pillows. 
Group work - chamaraderie.  Sharing and see other peoples' reactions. 
Exaggerate the very movement: e.g. setting a boundary.  Hands - pillow - push.  Push against wall, push against ball etc.  Notice what happens.  What shifts as we do this?  Noticing and studying. 
Possible resistance: 'No, I'm not doing that' - Client can lead the way.  Paving the way.  Physicalising of these actions.  Along with verbal narrative etc.  Explore physicality and meaning making, social and emotional interventions.
Teens need to be seen, to be known, to be recognised.
Teens sit where they feel most comfortable.  They have some say where to sit.  Shift temperature in the room.  Adjust light.  Or close blinds.  Notice.  They are architects of our work.  Co-regulate.  Meaning-making.
Curious about how they understand their experience.
Developing a coherent self.  Mary Maine's work - history, trauma, coherency.
Recognition.
Dr Goldstein showed a 1 minute video of a boy and girl adjusting proximity seeking actions and boundary setting actions.  Success of them working together to establish these.
Also discussed a client called Stella, and discussed Martine Shapiro's work in EMDR, and purposeful tapping.  Helping with regulation - cross-lateral tapping. 
Drumming out an emotion.  Without words.  Successful.
Being able to yield.  An important tool.  Demonstrated by asking client to 'sit back in chair' maybe against pillows to make them more comfortable.
'That feels good'
What happens in your body when you feel that?
'I don't know'.
'Let's notice your breathing'  Breath slowing.

Yoga movement of 'hot-air balloon' - make hands and arms into that shape of hot-air balloon.  Builds in noticing present movement experience.  Slows things down.
Helpful in situations where high arousal. 
'Clap' hands before expressing something.
Teens say this wakes them up, slows the moment.

Window of tolerance.  Safe but not too safe.  Resources to recalibrate.
Sensori-motor psychotherapy - grounding - feet down on the floor, and hands on legs and push down - very grounding.

Dr Goldstein mentioned that the training is world-wide and there are many workshops.  They want to share tools.
She mentioned her website where she said there are materials that are downloadable for FREE. 
This is:  Drbonniegoldstein.com
I think the other website she mentioned was psychotherapy.org - but I'm not sure if that was correct or not.  I've not tried to access either website yet.

Help teen clients to engage and embrace and lead the way.
Groups: Break existential sense of aloneness and concluded by saying 'Knowing not alone makes all the difference'.

(I hope those notes makes some sense). (I found her talk very inspiring and also very emotional, as I think emotion within me was evoked - and I can't relate to the exact reasons why, but it was incredibly emotional).

Hope 

[Jazzy]

Thank you Hope, that is very sweet of you to say. A lot of my old job was a kind of technical translation, so there was a lot of re-writing what people were saying. I'm glad I can still put that skill to use. Although, I wish I was better at taking notes like you do. They are much more concise, and are less likely to deviate. When I want to say something, everyone has to clear their schedule for it.

I don't have much to add today, your notes are great, and I didn't find myself connecting too well. It seems you are more in touch with a lot of things that I'm still struggling with. The only thing I really want to put down is that the second website is:

sensorimotorpsychotherapy.org

[Hope67]

Hi Jazzy,
I've noted the title of that website, and I think we've made a great team in looking at the Conference together, I'm glad you're watching it too, as it's been great to hear your thoughts as well. 

So, I've taken notes from today's talk (Day 6 - 26th September 2019)
Talk by Dr Peter Levine PhD entitled "Somatic Experiencing and Autonomic Dysregulation Syndrome"
Dr Peter Levine developed somatic experiencing model.  He wrote "Waking the Tiger" and "Through a Child's Eyes" and many other books too.
He talks of the theme of 'revisited pain' and he was working clinically in the 1960's and 1970's at a time when there wasn't much medicine for pain or anxiety.
He mentions working with 'haunting memories' or 'flashbacks' and said there were more people with chronic pain issues.
He noted that what underlay the memories was pain.  Pain was how the body remembered.
He united the idea of pain and memory.
He talked of a client he saw in 1969 called 'Nancy'
Nancy - had many very painful conditions, things he said would now be labelled as things like fibromyalgia, irritable bowel, etc etc and he said she was 'very anxious' and had chronic agoraphobia, and panic attacks.  She had seen numerous specialists and had been passed on numerous times, and finally she was seeing a psychiatrist who was a friend of Dr Levine (I think he said the psychiatrist's name was Dr Jackson - but not sure).  Dr Levine mentioned the lack of medication for anxiety, and that he had developed relaxation exercises for people with high blood pressure, and had found it was effective for reducing high blood pressure.
Therefore Nancy and her psychiatrist came to the appointment with Dr Levine for help.
Dr Levine used relaxation exercises with her, and her blood pressure reduced. 
Dr Levine felt so relieved at first.
But, short-lived relief as her heart rate continued to drop, going from high 160's down to 55 bpm
He said this was when he discovered 'relaxation-induced panic' and dysregulation syndrome.
He had said to Nancy at this point:
"Nancy, you need to relax.  Just relax."
He then thought of an image that appeared at the far wall of the consulting wall - a Tiger crouching and ready to pounce.
He said
"Nancy, there's a tiger chasing you, Run! Escape over the rocks and get away.  Escape!"
Her body went through movements.  Shaking and trembling.
Cycles of movements and then resting movements were noted.  This went on for 45 to 50 minutes.
When her blood pressure had been very low (55 bpm) she had said "Don't let me die"  Horror and terror in her eyes at that point.
But later, when she felt better, her gaze on him was 'soft' later.
She asked him "Do you want to know what happened?"
"I saw the tiger, my legs felt like lead and I couldn't run"  But Dr Levine encouraged her.  She could climb rocks and get away.  She told him the tiger had changed to either a mask on her face, and a memory of when she was 4 years old and having a routine tonsillectomy operation, and how she had felt terrified.  Immobile and terrified. 
After that session - she had no further panic attacks.
Dr Levine did further sessions with her - focusing on relaxation, and her symptoms reduced further.

He noted that trauma and pain are connected.
Implicit procedural memories (body memories)
Neurophysiology was his area of study at this time.  He mentioned that Donald Wilson (in a Zoology session) had talked about the tonic immobility of an animal when captured or preyed upon. 
The low level heart rate - signals dorsal vagal response.  Hypo-arousal.
Dr Levine said he wrote his doctoral dissertation on this area.  Fear and immobility.

At a similar time, another researcher - Dr Stephen Porges had written an article on measuring the beneficial effects of Ritulin on children with ADHD. 
Dr Levine sent Dr Porges his doctoral dissertation and they subsequently met up and talked for hours - sharing ideas.
Discussed para-sympathetic response that shuts down the autonomic system.
Poly-vagal theory attributed to Dr Steven Porges.
Dr Levine mentions they are co-mentors.
Spoke of high heart rate = autonomic system and Low heart rate = dorsal-vagal theory
Poly-vagal theory - landmark model helping people track and intervene in psychotherapy.
Dr Levine stresses that it is critical to understand the difference between sympathetically dominated arousal state, and shut-down, and terms shut-down as being 'life-threatening' 'realm of walking dead' and 'state of shut-down'.
MUS = medically unexplained symptoms.  Dr Levine and Dr Porges said - these are NOT MUS, they have a root.

Pain - Buddha states that we will not escape this world without experiencing pain.  That we will be touched by pain.  He or she who is touched by pain, then retracts, but then feels second pain, which reinforces the first pain, and leads to experiencing fear and helplessness. 
Dr Levine mentioned the book 'Life of Pi' by Yan Martel, and that only fear can defeat life.  FEar can lock in these physical symptoms.  Don't know if they're going to stop.  Therefore leads to worry.
Something comes and there's danger - shoulders go up.  When threat is over - shoulders go back down.  Startle perceived as fear.
Veteran - shoulders may stay contracted.  For years or months.  Will generate pain.
If it becomes chronic, then will be diagnosed e.g. as fibromyalgia or other condition.
Autonomic nervous system - increased ++
When came down - plummeted ++  Therefore extremes.
Hyper-arousal and hypo-arousal.  Need to work towards the Mid Range.
Somatic experiencing - helps with tools to track experiences.  Gradually go into hyper and then into hypo - gradually.  FLOW.  Mid-range.  'flow' 'goodness' 'wholeness'.
Enabling people to come into mid-range.
Books 'An Unspoken Voice' and 'Trauma & Memory' - books written by Dr Levine.
Pain = symptom that can be worked with.

Images of things that happened in the past.
Patterns - Accumulate over time.
Foetal stress - no content or context.
Early bonding, attachment.
No conscious memories.
But "the body remembers"

Chronic pain - frequently attachment issues exist.
Autonomic dysregulation syndrome.
Somatic experiencing.
Stress-reduction therapy was original name.  Currently 25,000 to 30,000 therapist trained.
Dr Levine mentioned meeting a 'serial entrepreneur' at a Boston conference (not sure if he mentioned his name, possibly Jay...?) who asked to talk with him after the talk.  Mentioned all the people suffering in the world, and how Dr Levine said "I would like to be able to help these people who suffer from fibromyalgia"  How?  Online programme, measure responses and devise exercises to help them.
Suggested the entrepreneur should experience it for himself, and so he flew out to California to have sessions 'blew his mind' and became his 'biggest fan'.  Developed an app - at initial testing phase.  To help regulate the autonomic nervous system.  Dr Levine is excited. 
He said that Trauma and pain = facts of life, but don't need to be a life sentence.

Body posture: shoulders chronically tight.  Dissociate from pain.  What do shoulders want to do if contracted.  Tense and release millimetre by millimetre.  Titrate, incremental.  Relief and spontaneous breathing = result.  Working with trauma and pain together. 

There may be a physical cause for pain - e.g. tumour and therefore must have comprehensive medical work-out prior to therapy, to rule out the possibility of medical causes or medical issues.

Somatic experience = helpful.  Important to understand the underlying autonomic dysregulation.

As therapists - empathy considered important.  BUT, need to know the arousal state of the client.  If hyper-aroused, help bring them down.  Feedback to slow heart.  Reciprocity.  Empathic sway.  But if in shut-down, consider setting chairs at 90 degrees rather than face to face, to enable 'own space' and less threatening.  Careful to respect space, or will shut-down more, as empathy can drive them more into their trauma.  Empathy perceived as threat when in shut-down. 

Ruth Lanios (Not sure of spelling of her name) - she studies Neurobiology of Trauma and is based in Canada - she showed people a Friendly Empathetic Face photo - if show this to people who are NON-traumatised, then their pre-frontal cortex lights up, and the amygdala reduces (on brain scans), but if show the same photo to someone with chronic trauma then the front part of the brain shuts down, and the amygdala turns up really high.  Therefore if someone is in a dorsal -vagal shut-down state - must do things to help them out of this state.
Simple: get up and walk around the room together side by side.  Less threatening than sitting.
More active, less passive.
Dr Levine used to walk bare-foot with clients on grass and sit by river with feet in water. 
Movement.

Chronic pain - work very slowly.  Movements - very slow.  Engage and bring on line the frontal brain.  Shut-down = regulation.
Hug and gentle squeeze to muscles.
Physical and emotional pain involve most of the same circuits.
Islands of safety - work with these.
Even bringing awareness to the pain will increase it.  So VERY gradual.
Contraction and expansion.  All animals - movement, universal rhythm.  Flow and pain cannot co-exist.
Shame = pervasive in dorsal-vasal state.
Here and now - versus - there and then.
Orientating to more current time things.
Nancy - felt held in warm tingly ways - after her session.  Flow experience.
Create, invite, and support state shifts.

Porges provides a clear framework for therapists.

Dr Levine's book 'Unspoken Voice' - how body holds pain and is also the healer if its wisdom is heard.
Regulation = important.

He mentioned a book by Porges at the end, and I must admit I didn't get the title, but I know Dr Stephen Porges is going to be talking in a couple of days time.

(I enjoyed this talk by Dr Levine, really exciting to see him talk, and I value his work.  I think the entire conference is very good.  Looking forward to tomorrow's talk).
Hope 

[Kizzie]

   Hope, tks again for your notes!

[Jazzy]

Thank you Hope. I'm glad for the opportunity to see all these talks, and it is nice to, in a way, share the experience with you. To be honest, I'm glad you are doing most of the work sharing notes too. I think I would feel really pressured otherwise.

I'm a big fan of neurobiology, so I thought it was really interesting when he said that when a person feels physical pain, a lot of the same circuits are activated as when a person feels emotional pain. jhnmmmm (Sorry, cat jumped on keyboard). This really drives home the point that physical and emotional pain are not only connected, but are at least in part, the same thing.

I also thought it was really interesting how he talked about some simple exercises you can do when stuck in that dorsal vagal ("shutdown") state. Little things like clenching your jaw, making a fist, or aggressive exhalation can help bring about more awareness. I hope I can remember to try these next time I find myself in that state.

In this sort of a state, everything is perceived as a threat. A lot of therapists had a hard time believing it, but even their empathetic behaviour will be taken as threatening. This really connected with me, because I have spent so much time in a state like this. Its not as bad as it was a few years ago, but that is my normal. Basically everything and anything that comes up feels threatening. I have told my psychiatrist many times that I just wish I could feel safe.

I'm having a really hard time getting my thoughts together tonight, so I'll leave it at that.

[Jazzy]

Oh no, there are no notes from Hope!  I will try to do a brief summary.

The topic today is "Navigating the Nervous System: A Polyvagal Theory Guided Approach to Therapy", and it had slides, huzzah for slides!

The Three Principles of Polyvagal Theory:
1) Neuroception
2) Hierarchy
3) Co-regulation

1. Neuroception, is like perception, but without the perceiving. This is the action of our immune system taking in cues of safety or danger from within our body, our environment, and relationships with others, without use of the prefrontal cortex (awareness).

2. Hiererarchy, is how we react to our surroundings based on information gained during neuroception.

A) Ventral Vaga - "newest" (200 million years).  Diaphragm and up. Heart, breathing, facial expression, etc. System of Safety and Connection. Health, growth, restoration. This is where you want to be when there is no danger, and we naturally gravitate to this response. When it is not safe, move to B.

B) Sympathetic Nervous System - Middle of spinal cord (thoracic/lumbar). Protection through action, similar to fight/flight, but it is a system of mobilization.  Scanning for danger, narrow focus, not tuned in to friendly voices, feeling separated. Misread neutral as dangerous. If resolved through action here, move to A, otherwise move to C.

C) Dorsal Vaga -  diaphragm and down (digestive system). Protection through disappearing. Last resort, conservation mode, heart rate and breath slows, hard to move, low energy, disconnection, disassociation. Safety feels unreachable After resolution, usually move to B, but we want to skip to A.

She spoke about practicing awareness while in the ventral vaga state, and engaging with your other states. This will help you be able to keep an anchor in your ventral vaga state, to help when you fall in to one of the other states.

3. Co-regulation - someone must remain regulated or others will automatically move out of connection (A) and in to protection (B/C). Of course, this should be the therapist, but in family or other situations, someone needs to remain regulated. Anchor helps with this.

[Blueberry]

Thanks Jazzy! I've just watched it and taken quite a lot of notes, which I may add tomorrow or Sunday. I don't have time now.

Just a couple of things that really stuck out for me: (1) The speaker Deb Dana mentioned the tool: A Glimmer A Day meaning someone like us would notice just a glimmer of ventral vagal state, take note of it and email therapist and get  back in response. Well, that's a lot of what some of us do on the forum - noticing little bits of progress or just 3 Good Things a Day and then getting a response from someone on the forum whether       

(2) When you move down from Ventral Vagal state to Sympathetic state (nothing to do with being sympathetic, caring), there is a physiological change in a muscle within your middle ear which leads you to be on high alert for sounds of danger and you simply do not hear sounds of friendly voices. (So much for it all being in our heads, haha.)

[Hope67]

Hi Kizzie, Jazzy and Blueberry
So glad you're all here, and that you've summarised things from that talk by Deb Dana (Jazzy - they are great points you summarised there).
I did take notes, but I'm not up to sharing them, due to a couple of things that I mentioned in my Journal.  I think the summary that you gave, Jazzy, and the points you added Blueberry are great anyway! 
I've just seen that today's has been posted, so I'm hoping to watch it, and I might be able to share notes - depending on how I feel later.  I'll see how it goes.
I am so glad to have been able to see all the talks in this Conference, I think it's been really good.
Hope