Compassion and Trauma in Therapy

Okay, well, hi, and welcome, everyone, to the Compassion and Therapy Summit. I'm Dr. Clarissa Seagrand, and I will be your host for this session. I'm an assistant professor at Naropa University in the Mindfulness-Based Transpersonal Counseling Program, and my research interests include contemplative pedagogy, contemplative epistemology, and how clinicians use contemplative practice to enhance clinical practice. so happy to be here with Dr. Dan Siegel to explore the role of compassion and healing trauma within the context of his interpersonal neurobiology framework. Dr. Siegel is a clinical professor of psychiatry at the UCLA School of Medicine, the founding co-director of the Mindful Awareness Research Center at UCLA, and the executive director of the Mindsight Institute. Dr. Siegel has published extensively for both professional and general audiences and serves as the founding editor for the Norton Professional Series on Interpersonal Neurobiology, which currently contains over 70 textbooks. Thank you for being here with us, Dan. Clarissa, thanks for having me. It's great to be here. Absolutely. So just to dive in with the central topic of this conference on trauma and compassion, we would love to hear how you define trauma within the framework of interpersonal neurobiology. And what distinguishes trauma from other stressful experiences? Sure. Well, the general word trauma can be defined as an experience that overwhelms our ability to cope. And that can come in a range of experiences. We can have a car accident where it's terrifying and we're flooded with our feelings or the pain in our body. We can also have Not an accident as an adult, but an assault on our relationships as children called developmental trauma. And that can take all sorts of forms. We can have severe neglect, which is overwhelming our ability to cope because we're not connected to our caregivers. We can have various forms of abuse, physical abuse, sexual abuse, verbal abuse, emotional abuse. All of these. in a way or an assault on the fundamental needs we have as children. So you can have developmental trauma overwhelming us or an event in our adulthood, which is also traumatic but has a different impact because of the timing and the duration of the experience. Yeah, thank you so much. And so just to continue to extrapolate into that in your definition of trauma, trauma. I'm curious, you know, how you might understand that through some of the principles that you talk about, specifically integration and how I know when we experience a traumatic event that we can experience disintegration in our personal lives and particularly when there are certain reminders of traumatic material. So would you care to explain how you understand the concept of integration with trauma? Yeah, well, the word integration is defined in different ways in different fields. So in interpersonal neurobiology, this framework that combines all these different disciplines into one perspective, whether it's contemplative teachings and indigenous teachings or different teachings from the arts, from music, from poetry, from painting, or even academia. you know, from the different disciplines of, you know, looking at philosophy, of history, political science, and looking at the different sciences, you know, anthropology, sociology, linguistics, psychology, biology, chemistry, physics, math. We bring all those together in one framework that's just simply called interpersonal neurobiology. And these textbooks that I've overseen the publication of, they are trying to bring to clinicians the wisdom from all these different disciplines and how to see what the common ground or consilience is what E.O. Wilson would use as a term, what is the common ground across these independent pursuits of knowledge. So that's IPNB, that's interpersonal neurobiology, and for us integration means the honoring of differences and the promoting of linkages, and we simply name that as differentiation. linkage. So differentiation means things are allowed to be specialized or unique, they're allowed to develop in their own different kind of way, so different. Sheation is what differentiation means. And then in the act of linkage, the connection that's established, you don't lose the essence of what's being differentiated. So an example would be walking with your left and right leg. They differentiate from each other, but they link. And in the linkage, they don't lose their differentiated nature of a left leg and a right leg. So then you can walk or run or dance. And that would be an integrative movement. that allows the components, the left and right leg, to be differentiated and linked. It's important to always ask when someone uses the word integration what they mean. So in mathematics, for example, integration just simply means addition, where you lose the differentiated features. So we're not using it in that being a synonym of addition. And in the neuroscience world, the word integration is used to mean how we're using the word linkage. So they use terms like segregation for differentiation, and then they use the word integration for what we mean as linkage. So we're just using integration as a term to symbolize the balance of differentiation and linkage. Yeah. And in the mathematics of complex systems, which is a whole long deep dive, but the bottom line of that mathematical formulation from the 1980s, is that when you look at systems that are having certain features, we call them complex systems, and they regulate their own becoming, and they can optimize that regulation by balancing differentiation and linkage. And if you go outside of that balance, you go to either chaos or rigidity. So that's straight from the field of complexity science. And that mathematical field has beautiful insights, I think, for what we can do in mental health. understand the impact of trauma on relationships and on our nervous system, and then to see how chaos and rigidity are when a system like our nervous system has gone beyond what I call a window of tolerance. And you see that in unresolved trauma. You see people have very narrow windows, and they're readily going to chaos and rigidity. And when they do go there, they tend to stay there for sustained periods of time. That's one way of assessing is a traumatic experience resolved or not. So anyway, that's a long answer to a short question, but that sort of gets us in the ballpark of why for us integration is health. Impaired integration, which happens with trauma, is what has us deviate from the journey of well-being. Yeah, thank you. Yeah, there's so much to go there with that. And I think just to continue to... contextualize what you mean by a system that's perhaps more focused on survival and not yet able to move into those states of integration. I know you spoke about two concepts of rigidity and chaos, that those can be two states that a person enters into when they're just maybe more focused on like surviving and perhaps the brain in those moments. moments are experiencing like a high degree of constraint and kind of lack of flexibility and adaptiveness that you speak to. And so could you care to explain maybe in a clinical scenario, a client who is perhaps navigating either that rigidity or that chaos and how that can show up in their lived experience? Sure. Yeah, well, I mean, I just saw a patient recently and a new patient. And, you know, in doing the intake of really assessing, you know, what was going on with him and how to get a feeling for if it was a good match between what he needed and what I might be able to offer. You know, we explore all sorts of things. And as he was talking about his childhood, he started getting very shut down. You could see his... his muscles in his face got very tight he stopped being able to speak so fluently like he was earlier before we got on the topic of his childhood and he kind of started just going into what you could call a rigid state and I want to just clarify that rigidity while it's sometimes interpreted as hypoarousal doesn't necessarily mean it's hypoarousal it could be that his adrenaline is pumping and his you Muscles are really tight. He's actually quite aroused, but he's just becoming rigid. So what I wanted to do with him in that moment was talk to him about, you know, a window of tolerance. Talk to him about how we were just journeying together in this first session, you know, into exploring just the general idea of how was his childhood. And it felt like his physiology started getting very constricted, very tight. And he noticed it too. So then I gave him some very basic. if you will, integrative practices, which is just to be aware of his breath, focus on his breath, and even though, of course, he's always breathing, like all of us are breathing, the placement of focal attention, that is attention with awareness, on the in-breath, and then the out-breath, and then on the out-breath, and then the in-breath, the out-breath, the in-breath, the out-breath. After a few cycles of breath, what research suggests, and certainly clinical experience supports, is that you start achieving a a higher state of integration likely that has to do with the way you're focusing on the two branches of the autonomic nervous system there's a parasympathetic brakes and a sympathetic accelerator and when we breathe in you're actually turning on the accelerator branch the sympathetic branch and when you breathe out you're actually turning on the parasympathetic brakes so just by focusing awareness on that you're actually giving him a couple things you're allowing him to hold in awareness these two cycles which turns on what's called heart rate variability coherence it makes it more coherent because you're balancing the two branches and the other thing it does i think is that it it gives him the experience of being able to control one of the rare processes another one would be blinking you know where it's both automatic and intentional so it introduces a very important uh what some people call the combined need, which is for control. And we'll talk about seven fundamental needs we have that are assaulted with trauma. And we don't know if he was traumatized or not, but certainly he was breaking through a window of tolerance just with the topic of what was your family like? So anyway, that was an integrative practice that allowed him to come back into this, what you can call a faces flow. There's five features to it. It's flexible, meaning it bends, it doesn't break. Adaptive meaning he can become aware and adjust his state of activation to become more in the flow of harmony. That's adaptive. C is coherent, which means resilient over time. E is energized. He got a new sense of vitality even as we were staying with this topic. And S is stable. So we basically, by creating more integration, we widen the window of tolerance. And there's a whole laminated card that'll be available soon, where you could see what doing an integrative intervention helps you widen it. And then even though this was just the first session, he was experiencing that together in our relationship, there could be space to hold in awareness in him and in me and then between us, this topic, what happened in my family, and then he could also learn within a few moments. that he could have a body-based intervention, we would call it an integrative intervention, where he's not just, you know, a passive passenger along the ride of getting distressed and going to rigidity or chaos, but instead could use his awareness, this consciousness, to make a choice about change. And that was all in, you know, a couple minutes or moments even. And so it's little things like that that would be a... Is that what you mean by a clinical example? Yes, indeed. Okay, yeah. So, you know, and that could be true. It doesn't say whether he has unresolved trauma or not, but he certainly had a pretty narrow window for me saying, tell me about your family. Yeah, thank you. Thank you very much. And just going with that clinical example that you just provided, I am curious if you can share, I know in your work you also talk about the significance of building an autobiographical narrative and how, you know, I'm imagining in this work with this client, you're just kind of taking those first steps with him and learning how to really kind of build that level of even coherence or integration between, you know, the right hemisphere, left hemisphere, and like developing this autobiographical narrative. And it sounds like in this case, he was kind of flooded with that experience of rigidity. So you have to modulate how to just experience the faces like in this work with you. So that first step was really taken. What would you venture are some of these next steps in building towards that autobiographical narrative? Yeah, thank you for the question. So a couple of things. One, just the broad statement about autobiographical memory and trauma is we know in terms of research measures that at least one measure. In the past, it's been the only measure. I don't know if that's still true, but it might be. But it certainly, for a long time, has been the only measure that measures the difference between resolved versus unresolved trauma. So we can do questionnaires, which are really good, to ask people, have they been traumatized? Like the ACEs questionnaire. Did you have adverse childhood experiences, ACE? And You know, in that survey, I had the opportunity to speak with the principal investigator of that study, you know, and it was done by epidemiologists, not about intervention. And the questions were, you know, were you ever, you know, mistreated by your parents? Did they have a drug problem? Were they incarcerated? Did anyone have a mental illness? Was there a divorce? You know, all that kind of stuff. And each one gets you a point on the adverse childhood experiences. They The issue that I said to Vincent Felitti, the principal investigator, was I was concerned that, you know, it was a study, a naturalistic study that didn't do anything to ask about interventions people might have done or ways they might have moved from unresolved trauma in terms of a high ACEs score to resolve trauma. And he agreed that that isn't something they were familiar with, nor could they ask about in a simple questionnaire given to him. tens of thousands of people. So it's a very important study to let us know we should try to avoid adverse experiences for children. But a lot of adults who hear about that are very distressed because there's nothing said in that set of studies about repairing things. So, you know, for me, because I'm trained in attachment, I know you can have a traumatic experience in attachment that can be repaired either by your parents themselves. if they realize the terror that they've created in your life, the way they mistreated you. But also for young people, you know, children, adolescents, adults who have the opportunity to make sense of what happened to them, they can actually free their lives up. And a study that was just conducted by Marty Teicher and Sarah Lazar at Harvard University were able to show that you can actually work with people with mindfulness interventions that reverse the neurological effects of developmental trauma. So that's Lazar and Teicher, T-E-I-C-H-E-R. So I used to talk about that for years because what Marty Teicher had shown was that there are four ways you can measure integration in the brain. And with unresolved trauma, you see that in the hippocampus, a part of the brain that... links differentiated memory systems to each other. The corpus callosum, the bands of tissue that link the left and right differentiated hemispheres to each other. The prefrontal cortex, the part that links the cortex to the lower areas of the body and even the social world. And even a more subtly differentiated way of assessing integration is the connectome. The word connect with O-M-E at the end, connect, O-M-E, is connectome. is impaired in its linkages in trauma. So those four ways we measure functional and structural impairment integration reveal that the big effect of developmental trauma on the unfolding of the nervous system is impaired integration. So what I used to always say for years after Marty found that was, you know, if you look at mindfulness interventions, they actually were in people who had not been. exposed to developmental trauma just the general public those four areas were exactly the areas that grew so what i used to always lecture about was theoretically we ought to assume and research should show and now it has with lazar and taisha's work you know that Since mindfulness interventions actually promote growth in those four ways, and those are the exact four ways integration is blocked with trauma, that we should see that mindfulness will be an important component in resolving trauma because it'll help grow the integrative fibers that have been temporarily impaired in their growth. So this is a very exciting moment to say that a theoretical proposition has now been shown to be empirically validated. approach. And so you would say that, you know, people with trauma, developmental trauma, you know, ought to receive the very intervention, mindfulness interventions that teach you how to, you know, focus your attention. There are three things, focus your attention, open your awareness, and build kindness in your intention, kind of loving kindness. So, you know, these are beautiful ways. Now, we have research backed clinically. informed approaches to working with people who've had unresolved trauma and to help them resolve it. Now, that's all a side issue, Clarissa. Now, to get to your question about autobiographical memory. So, you know, what the AAI, the Adult Attachment Interview, is able to show is that the narrative that comes out as a linguistic response to a semi-structured interview called the Adult Attachment Interview, which is... what I'm trained to give and what I've trained my students at the Mindset Institute to learn how to give with Mary Main's permission was with Mary and I and Eric, you know, had a meeting and she finally agreed to let clinicians use it after the meeting we were together with. Anyway, what you see in the narrative output is that when you ask people, like when I asked that individual, tell me about your family, when you ask them not just about their family but specifically about issues of being terrified of their parents or loss that they've experienced, especially those two questions, then what you get is you get a disorientation in the linguistic output that you assess with the way we assess the AI, the adult attachment review, using something called Grice's maxims of discourse. So for any clinician who trains with us at the Mindset Institute, when we learn the interpersonal neurobiology approach to making sense, You don't need to learn how to apply Grice's maxims because you don't need to do a research assessment, but you can get a clinical feeling for when the linguistic output becomes disoriented. So that's really what you're looking for. You'll feel it in your body as a clinician. You'll get a sense of, wow, this is getting kind of loose and confused. There'll be a confusion of present and past. The person might enter a flashback sometimes even. you know as they're recalling things they're speaking in linguistic terms as if it's happening now and those are all signs of unresolved trauma and unresolved loss um and so from an autobiographical narrative point of view you see this and the disorientation within the narrative output yeah thank you and so as you were speaking about you know this this experience of flashbacks um this challenge of really situating things into a there and then framework so clients who are maybe just unable to put that kind of sense of time or really kind of situate their level of self-concept self-awareness within the function of time it sounds like yeah there's really like this i get the sense like there's this feeling of just kind of really feeling trapped in the past that you can experience with clients in that way And so just going with that example, like let's imagine that we have a client who is experiencing that, that sense of being trapped in the past. Perhaps as you had shared, like mindfulness can really help support kind of broadening that window and supporting clients and having a greater range of flexibility in their response in a moment and kind of moving towards that greater sense of like a cohesive narrative. What might be your next step? Oh. Go ahead. But I'm curious if your next step would be there. Well, a couple of things, a couple of things. And Clarissa, let me just check in with you. Is it okay if I make slight edits on the word? Yeah. And cause these are, these are words that sound very similar. And, and, and in a way, maybe I'm being a little too, as a writer, you know, I'm super obsessed with making sure the words we use have very a clear definition so we would say the narrative would become coherent we would cohesive and the reason to say that is let's say i was coming to see you as your client and you said dan tell me about your childhood experiences i said well and i'm not good with color but let's say i assume your blouse clarissa's green is it greenish it's a bluish yeah my wife always says you don't talk about blue or green okay so let's say you know clarissa um i'm going to tell you a story of who i am and your greenish bluish blouse reminds me that my parents were Martians. And I feel really comfortable being with you because since obviously you must be a Martian wearing that blouse color, knowing I was coming in, you know, I feel comfortable because my parents were really great Martian parents, which meant, you know, they would put me in a closet for a week and then I would see them every Sunday at around 4 p.m. And I called it the Martian time because I would come out and they would kind of be marching in and I would... I see these marching Martians and, you know, so I feel very comfortable being with you. So in a linguistic sense, that was very cohesive. I made a logical comparison of a color to a Martian. I made a funny pun about marching Martians. It all stuck together if I were like a comedian or something like that. But it's not coherent, right? It's incoherent. I'm really disoriented, but it's cohesive. In other words, if cohesive is defined as it's stuck together with logical linkages, that was pretty logical. I mean, it was on the edge, but anyway, maybe I'm pushing that a little bit. But that's why we want to use the word coherent. So coherent is where, you know, it really deeply makes sense. Cohesive is it sticks together. That's one thing. The other thing is before I would work with the person who might be losing themselves in time, I would give them a slight psychoeducational. download and say to them, because I found this over the years, you know, I've been a therapist for 40 years now. I would say, I think it's important as we get into this stuff to see what your narrative said for me to just give you a very quick overview of how the brain processes experience into memory. So are you up for that? And let's say you're my client, Claire, so what would you say? I'd say I'd give it a go. Okay. So just first to let you know that there's a layer of memory called implicit memory, and then there's another layer called explicit memory. And it's important to know the distinction because, you know, when we're very young, we only lay down things into implicit memory. But also, if we have overwhelming events that overwhelm our ability to cope, which is one way of defining what trauma is, you know, that too can block the movement of implicit memory into its... more integrated form, explicit memory. So explicit is really the term we use for the kinds of memory that we can develop after around 18 months of age, but it is the kind that we usually mean when we say, do you remember something? And in the left side of the brain, it's facts. The right side of the brain is autobiographical memory of sense of self and time. And that's what we usually mean, can I remember something? But we need to know that in the brain, when you have an experience, The brain responds by activating itself, that's called encoding, then it stores those encoded experiences in our nervous system into something called storage, and then it stays there in storage until some kind of cue, some kind of memory retrieval cue, activates it into awareness. And the important thing to know about implicit memory is that when it's in its pure form, when it didn't get woven together through an area called the hippocampus into either factual memory or autobiographical memory. When it's in pure implicit form, when it's retrieved from storage, it feels like it's happening in the present moment. Got it. So would you say that that's memory that's waiting to be encoded in some way? In some ways, it's waiting to be encoded into explicit memory. Exactly. Only when we experience it, it feels like it's happening now. which explains a flashback. It also explains how sometimes we can get disoriented in telling our story if we've tapped into implicit memory storage that has never been integrated into explicit form, then we just think we're in an experience then and we can't tell the difference because in the brain it's as if we're experiencing it now. Even memory retrieval. Does that make sense? It does make sense. Yes, really appreciate that because I just think it really speaks to the importance of the left hemispheric action in our work as clinicians. And, you know, I just think too, like you've mentioned this in your book, but just the power of memory reconsolidation of like, you know, really just putting a proper place of these memories in that coherent narrative that we're really supporting our clients and building together. And so, you know, something that we haven't touched in on yet is the ways of being of a clinician. And I know in your framework. there is like the power of resonance and attunement, which is such a kind of right hemispheric process that we engage in with clients. But we're also really helping to support that memory reconsolidation or just helping to encode these implicit memories in that more coherent form for clients. And so would you care to speak to just these ways of being as a clinician and how we really show up and support that work? Yeah, yeah, absolutely. So um, You know, let's say I'm with a therapist and she's asking me about anything that comes to mind about, you know, my feelings about my childhood and whatever. And then I start, and this is a true story, and then I get lost in this feeling of responsibility for everyone in my family and then start feeling this terror that I've caused something I love to do. die and then suddenly I'm with this pair of rabbits that I'm feeding these leaves to because they looked hungry and I'm four years old and then they die in my hands because it's oleander leaves and they're poisonous so she's now with me as my therapist in her presence with me to let me feel like I have the the you space to be vulnerable and let this implicit memory, which is a true story, get reactivated. She has the attunement. She's tuning into what I'm actually experiencing, so that's PA. Resonance, I can see that she kind of feels the terror of those rabbits dying. She's not becoming me. She's not mirroring me, but she's affected by me, like guitar strings resonating with each other, not becoming each other. And then T, I developed the trust. that's needed, you know, for me to feel like I can move forward. And, you know, Steve Porges might call that the social engagement system with my ventral branch of the vagus nerve being turned on, whatever, whatever you want to call it. It's this integrative experience where I can differentiate my experience from hers. She doesn't become me, but we become linked. And then that integrative flow, we're joined as a we, and that part she plays, presence, attunement, residence, and trust allows her to create what. you know my colleagues and i uh metabol and peter sange would call a generative social field it's a i would call it an integrative field where you know honoring differences and promoting linkages is there and in that field that relational field it allows the therapeutic relationship to essentially and this would resonate with a lot of different i think humanistic approaches to therapy create a container that now when you're informed about neuroscience You could say that, you know, she's expanding my window of tolerance for a really painful moment when I was four years old. She's then going to support me in, or you if you're my therapist, you know, in having what you can call a dual focus of attention where one stream of attention is having energy and information flow as if I was a four-year-old child having just given oleander leaves to my cute little rabbits, my first pets. and they die in my arms and I'm overwhelmed with terror that not only have they died, but I led something to die and it overwhelms my ability to cope. And I develop a belief that on the one hand, the world is really dangerous. The other hand, I'm a dangerous part of that world if I don't know everything I need to know. So you can imagine when I became a biology student and became a... a medical student, you know, I was like so driven to make sure I didn't miss any equivalent of an oleander leaf or that could hurt somebody in whatever level of, you know, medical practice I was doing. I was a pediatrician for a little while and, you know, it was overwhelming. So even becoming a psychiatrist, you know, that theme. So if you were my therapist, you would help me work with that belief, you know, that I am you know in a dangerous world always responsible and obviously it's it is a dangerous world and there is a lot of responsibility we have so it isn't that you would just jettison all those beliefs but you loosen them up and what i've done in the last 20 years is work with four colleagues to kind of look at a personality system that we call pdp and say there are nine different ways at least but let's talk about nine fundamental ways that people seem to divide up, interesting, about 85 to 95% seem to divide into one or two of these ways. And trauma then could affect me given my pattern in one particular way. But if I was in a different, you know, pattern of developmental pathways grouping, you know, that same experience with a rabbit might have affected me very differently. So the same traumatic event, you know, the death of a rabbit when I give him leaves, affected me one way because of my temperament and because my attachment experiences with my mom and my dad were really not secure in very different ways with my mom, different ways with my dad, you know, that intensified how my temperament moved forward into my personality and then my work as a person in therapy would be to really understand what's the attachment part of this. What's the temperament part that led to personality? And then what's the trauma part? So what's really exciting about this new model, it'll be out in this book called Personality and Wholeness in Therapy, is that you can look at trauma essentially as an assault on wholeness, only we have these nine different pathways through which we leave wholeness and trauma. can affect us in these nine different ways and and understanding that as a clinician i'm hoping and certainly it's true with me and my colleague david daniels when when he was alive and working with this as a therapist it really gives you kind of a refined way of asking the question how does trauma whether it's you know an adult experience one-time trauma or you know developmental trauma how does it affect people differentially based on their temperament you know and so that's a fun thing we can talk about and i say fun meaning it is so enjoyable so fun so pleasurable so exciting to see how clinicians now can use this and uh i just came off of a month of uh traveling teaching this in different settings and um you know it was really exciting to see people learn the system and then learn how to apply it especially with through the lens of trauma fascinating yeah and so exciting that's going to be coming out for a wider audience soon dan and yeah well this will be for a clinical audience yeah clinical audience wider than the workshop participants yeah for sure people like me there was 16 a workshop and 130 another one they were small workshops so we could we had a lot of personal you know interaction time which i love and it was really um when you see people grok it when they really grasp it you Their eyes go, oh my gosh. And then you realize that, yeah, trauma is really important, but it's really how, in some ways, the trauma, in some ways, intensifies our personality. In a particular pattern, it likely would have been going in anyway. This is our hypothesis. It likely was going in a certain direction. And just trauma, like the rabbit experience, will intensify the kind of personality you... probably would have had even without the trauma got it that's hypothesis could be wrong but i think it's right great yeah great working hypothesis um would you say that relates to genetics in some way or just like our our kind of descriptions yeah yeah well our hypothesis is it relates to temperament interesting about that is temperament is defined as you know the innate meaning not learn propensities of the nervous system pretty much available at birth or right after birth. So it's not things you learn. Now, temperament has a genetic component, but it's not even like a big genetic component. So for example, in one of our workshops we had identical twins, you know, and you know, they had different patterns, which we believe are based on different temperament. So why would that be? Well, you could be in the womb leaning to the left, and maybe one network grows a little more because you're leaning that way, and the other twin is leaning this way to the right, and it grows a little more just from gravity and anatomy, you know, which is not genetic. It's just kind of random. So just because something's innate doesn't mean you inherit it through genes or even epigenetic factors. Those factors would be there, but they may not even be the majority of influences that create temperament. So that's why, you know, yeah, you can do the genetic studies and that would be great and fascinating and all that stuff. But when we had these identical twins show different patterns and they said, see, this is not a temperament issue. I temperament does not imply it's genetic i didn't say with genetic i said it was about your temperament which is innate and innate does not mean genetic wow okay well that is uh yeah in this moment and you know i'm checking our time as well and is there any other distillation that you would like to offer us around what what do you mean by temperament and how can we understand that within the context of trauma yeah so the classic ways For example, when I was in pediatrics, looking at the developmental psychology approach to temperament, it would be things like how sensitive is a child, meaning how much of a stimulus like a sound or a light or something like that do you need before you evoke a reaction? Then the next thing is intensity. When you ultimately get your reaction, how big is it? Is it little? Is it medium? Is it big? And then, you know. What's the tone of that reaction? Is it like scared? Is it, you know, sad? Is it angry? You know, what's the tone of the reactivity about the emotions? You know, and then the other is, you know, how's the response to novelty? Like, do you trigger a kid when things change from the familiar? You know, and some kids love novelty and some kids can't stand novelty. So those are four of, you know, several ways you can assess temperament. So my, my, um, colleagues and I, in what's called the PDP group, Patterns of Developmental Pathways group, this would be David Daniels, Denise Daniels, Laura Baker, and Jack Killen, we put together over a 20-year period, you know, a model of attachment that we first published in 2010 that proposed that in addition to those standard ways of looking at temperament, You can also look at the subcortical motivational networks. Yach Panksepp, P-A-N-K-S-E-P-P, beautifully wrote about these in our mammalian history. And if you look at three of those particular subcortical networks that create what Yach talked about as primal affects, and that would be anger with its variations of irritation, frustration, anger is there, and then fury and rage. Another independent network is that of separation, distress, and sadness. When it's extreme, you know, of course it could be despair. This is a network also that's different from the anger network. And then the third network is the anger of fear, you know, which when it's mild, it's worry. When it's intense, it's terror. So, you know, those three, what Jaak would call primal affects. Beneath them, our view, and Jaak would talk about this, but he wouldn't. emphasize it uh and and so we just took yach's beautiful work took a step back and said what's beneath the affect and what's beneath the active affect is a motivation so the motivation in the anger uh affect grouping when it's frustrated the motive it arises this frustration is for you know basically a sense of agency it's autonomy it's competence it's getting an empowerment you know of your needs being met embodied empowerment So we can label that A for agency. And the idea is that one of these may be more sensitive than the other. We're proposing this as part of temperament. The other one is B for bonding. And this is about relational connections, to be accepted and be a part of a relational bond. So bonding. And the third one that leads to separation, distress, and sadness when it's frustrated. The third one is for certainty. So this is where... prediction allows protection. So it's about a drive for safety. So this certainty drive, you know, when it's frustrated, you get anxiety and fear and terror. So what we propose is that those three kind of vectors, they set a directionality that just happened to be more sensitive than the others. And a little bit of sensitivity at time one leads to more activity just because of sensitivity. Then maybe it becomes more intense because the neurons that fire together wire together. So now at a week of age, it's a little more robust. Now at a month of age, because of the self-reinforcing neuroplasticity loop, What just started as a small sensitivity now is a big sensitivity and intensity and all that stuff. So we think many people have one or maybe two of these vectors that are dominant. When you take those vectors and then say there's another feature to temperament that a colleague of mine actually found in the brain, we just found it in narratives that we're analyzing, and this is whether your attention is inward. or your attention is outward or your attention shimmers between inward and outward very different from the idea of extroversion being you know you're socially inclined or introversion meaning you're rather be by yourself uh this is a very different thing and so uh we i was worried about it questioning it a lot um but it turns out that uh mary helen and mordino yang actually independently found it in in the brain of people just inward outward shimmering between both um so that was kind of an amazing moment hearing about her study so we saw that in the narrative so anyway if you take those three tendencies of attention which i call a tendency and link it to um in the particular vector then you get nine patterns and we believe these nine patterns are the foundation that you adapt to and those adaptive strategies basically become your personality pattern you that get intensified with non-secure attachment including developmental trauma got it wow so i i imagine with this new framework that there's an opportunity to have more incisive and targeted interventions in therapy kind of based on one's um profile so to speak exactly so the the pattern has within it's not a type it's not a personality type it's a personality pattern meaning there's a variety of features with a range of values, but they do invite a clinician or the individual doing the independent individual work to work with their own minds in a very focused kind of way. So in my pattern, for example, you know, you would explore the rabbit trauma, you know, through the lens of someone who's a certainty vector, who happens to be dyadic inward and outward, and I do worst case scenario thinking. as a part of my adaptive strategy. I have this belief system that I'm responsible for all these bad things that could happen, so I need to, in a way, be questioning everything. So it's a questioning pattern. And you would then work with me to help me gain some trust in the universe. You'd have me do the Wheel of Awareness practice, which I have people do, where I get into pure awareness and drop into this state of connection that lets me get back to the feeling of wholeness. This week... we believe ultimately that each of these vectors and their tendencies get activated because we're no longer feeling whole even if our attachment was secure and the journey back to wholeness is a lifelong journey got it okay well certainly excited for this to come out um for us all to to look with and integrate into our work um and i i wanted to kind of bring us back to also the purpose of this summit which is to also explore compassion and trauma. And, you know, I just imagine when we're kind of sourcing from that place of wholeness, when we're in a state of coherence, when we're interpersonally integrated, that compassion is a, it's like a result. It's a resultant state. It's something that we can really like tap into and utilize in working with our clients. And so just as we draw this to a close, is there anything that you care to share around? the power of compassion in doing this work. Yeah, absolutely. I think, you know, we have a saying at our institute that kindness and compassion are integration made visible. So if you really think about integration where you're differentiating linking, your role as a clinician is to offer that compassionate presence so that your clients can be differentiated from you, but then linked. And because you've worked on your own inner life, your window of tolerance for whatever pain they're going through is quite wide. And that gives them the reassurance that no matter what they go through, you can hold the space, bearing witness, staying connected, remaining open. So your presence, attune, resonance, and trust really brings to them the opportunity to widen their windows and resolve their traumas. And that comes from your compassionate stance. your kindness. And the beautiful thing about that is it kind of reinforces its own unfolding so that you're joining instead of it leading to burnout actually is quite invigorating. So people often say to me, even though I've been doing this 40 years, how can you keep on seeing patients? Isn't that hard? I said, actually, I learned so much from my patients. I feel so invigorated by their strength and courage. And I feel so honored to have the privilege. of connecting with them that it actually enlivens my life. And yeah, so I feel very grateful. Don't ever intend to retire. Wonderful. What a beautiful note to end on. So I just want to thank you, Dan, for all of your generative wisdom and being able to touch into this own interpersonal field with you. It was a true honor. And yeah, just invite our wider audience to listen to this one a few times because there's just packets of energy and information for you. So thank you very much. Thank you, Clarissa. And you know, it's so fun to be on this journey with you. You know. finding more and more ways we can help people hear those traumas and feel really the incredible privilege of being alive here now on this planet. Indeed. Thank you. Thank you. And, you know, I'll say one more thing. I just can't help myself. But, you know, as we help people resolve their personal traumas, we really give them this pathway to have what you can call pervasive leadership to realize that, you know, in our modern culture, we get the traumatic lie. of a separate self, but we come to realize that, yes, we heal the trauma of the me, but then we realize we're not just a me in a body, that we're more a Mwe, M-W-E, is our integrated identity. And that kind of self is a self I think the world is waiting for us to realize is the true path towards healing our planet. Thank you so much. Yeah, it's just, it's not just the individual trauma, it's the collective experience that we're here for. so yeah thank you dr siegel thank you clarissa great to be with you you as well

Dr. Siegel is a clinical professor of psychiatry at the UCLA School of Medicine, the founding co-director of the Mindful Awareness Research Center at UCLA, and the executive director of the Mindsight Institute. Dr. Siegel has published extensively for both professional and general audiences and serves as the founding editor for the Norton Professional Series on Interpersonal Neurobiology, which currently contains over 70 textbooks. Thank you for being here with us, Dan. Clarissa, thanks for having me.

It's great to be here. Absolutely. So just to dive in with the central topic of this conference on trauma and compassion, we would love to hear how you define trauma within the framework of interpersonal neurobiology.

And what distinguishes trauma from other stressful experiences? Sure. Well, the general word trauma can be defined as an experience that overwhelms our ability to cope.

And that can come in a range of experiences. We can have a car accident where it's terrifying and we're flooded with our feelings or the pain in our body. We can also have Not an accident as an adult, but an assault on our relationships as children called developmental trauma.

And that can take all sorts of forms. We can have severe neglect, which is overwhelming our ability to cope because we're not connected to our caregivers. We can have various forms of abuse, physical abuse, sexual abuse, verbal abuse, emotional abuse.

All of these. in a way or an assault on the fundamental needs we have as children. So you can have developmental trauma overwhelming us or an event in our adulthood, which is also traumatic but has a different impact because of the timing and the duration of the experience.

Yeah, thank you so much. And so just to continue to extrapolate into that in your definition of trauma, trauma. I'm curious, you know, how you might understand that through some of the principles that you talk about, specifically integration and how I know when we experience a traumatic event that we can experience disintegration in our personal lives and particularly when there are certain reminders of traumatic material.

So would you care to explain how you understand the concept of integration with trauma? Yeah, well, the word integration is defined in different ways in different fields. So in interpersonal neurobiology, this framework that combines all these different disciplines into one perspective, whether it's contemplative teachings and indigenous teachings or different teachings from the arts, from music, from poetry, from painting, or even academia.

you know, from the different disciplines of, you know, looking at philosophy, of history, political science, and looking at the different sciences, you know, anthropology, sociology, linguistics, psychology, biology, chemistry, physics, math. We bring all those together in one framework that's just simply called interpersonal neurobiology. And these textbooks that I've overseen the publication of, they are trying to bring to clinicians the wisdom from all these different disciplines and how to see what the common ground or consilience is what E.O.

Wilson would use as a term, what is the common ground across these independent pursuits of knowledge. So that's IPNB, that's interpersonal neurobiology, and for us integration means the honoring of differences and the promoting of linkages, and we simply name that as differentiation. linkage. So differentiation means things are allowed to be specialized or unique, they're allowed to develop in their own different kind of way, so different.

Sheation is what differentiation means. And then in the act of linkage, the connection that's established, you don't lose the essence of what's being differentiated. So an example would be walking with your left and right leg. They differentiate from each other, but they link. And in the linkage, they don't lose their differentiated nature of a left leg and a right leg.

So then you can walk or run or dance. And that would be an integrative movement. that allows the components, the left and right leg, to be differentiated and linked. It's important to always ask when someone uses the word integration what they mean.

So in mathematics, for example, integration just simply means addition, where you lose the differentiated features. So we're not using it in that being a synonym of addition. And in the neuroscience world, the word integration is used to mean how we're using the word linkage. So they use terms like segregation for differentiation, and then they use the word integration for what we mean as linkage. So we're just using integration as a term to symbolize the balance of differentiation and linkage.

Yeah. And in the mathematics of complex systems, which is a whole long deep dive, but the bottom line of that mathematical formulation from the 1980s, is that when you look at systems that are having certain features, we call them complex systems, and they regulate their own becoming, and they can optimize that regulation by balancing differentiation and linkage. And if you go outside of that balance, you go to either chaos or rigidity. So that's straight from the field of complexity science. And that mathematical field has beautiful insights, I think, for what we can do in mental health.

understand the impact of trauma on relationships and on our nervous system, and then to see how chaos and rigidity are when a system like our nervous system has gone beyond what I call a window of tolerance. And you see that in unresolved trauma. You see people have very narrow windows, and they're readily going to chaos and rigidity.

And when they do go there, they tend to stay there for sustained periods of time. That's one way of assessing is a traumatic experience resolved or not. So anyway, that's a long answer to a short question, but that sort of gets us in the ballpark of why for us integration is health.

Impaired integration, which happens with trauma, is what has us deviate from the journey of well-being. Yeah, thank you. Yeah, there's so much to go there with that.

And I think just to continue to... contextualize what you mean by a system that's perhaps more focused on survival and not yet able to move into those states of integration. I know you spoke about two concepts of rigidity and chaos, that those can be two states that a person enters into when they're just maybe more focused on like surviving and perhaps the brain in those moments.

moments are experiencing like a high degree of constraint and kind of lack of flexibility and adaptiveness that you speak to. And so could you care to explain maybe in a clinical scenario, a client who is perhaps navigating either that rigidity or that chaos and how that can show up in their lived experience? Sure.

Yeah, well, I mean, I just saw a patient recently and a new patient. And, you know, in doing the intake of really assessing, you know, what was going on with him and how to get a feeling for if it was a good match between what he needed and what I might be able to offer. You know, we explore all sorts of things.

And as he was talking about his childhood, he started getting very shut down. You could see his... his muscles in his face got very tight he stopped being able to speak so fluently like he was earlier before we got on the topic of his childhood and he kind of started just going into what you could call a rigid state and I want to just clarify that rigidity while it's sometimes interpreted as hypoarousal doesn't necessarily mean it's hypoarousal it could be that his adrenaline is pumping and his you Muscles are really tight. He's actually quite aroused, but he's just becoming rigid.

So what I wanted to do with him in that moment was talk to him about, you know, a window of tolerance. Talk to him about how we were just journeying together in this first session, you know, into exploring just the general idea of how was his childhood. And it felt like his physiology started getting very constricted, very tight.

And he noticed it too. So then I gave him some very basic. if you will, integrative practices, which is just to be aware of his breath, focus on his breath, and even though, of course, he's always breathing, like all of us are breathing, the placement of focal attention, that is attention with awareness, on the in-breath, and then the out-breath, and then on the out-breath, and then the in-breath, the out-breath, the in-breath, the out-breath.

After a few cycles of breath, what research suggests, and certainly clinical experience supports, is that you start achieving a a higher state of integration likely that has to do with the way you're focusing on the two branches of the autonomic nervous system there's a parasympathetic brakes and a sympathetic accelerator and when we breathe in you're actually turning on the accelerator branch the sympathetic branch and when you breathe out you're actually turning on the parasympathetic brakes so just by focusing awareness on that you're actually giving him a couple things you're allowing him to hold in awareness these two cycles which turns on what's called heart rate variability coherence it makes it more coherent because you're balancing the two branches and the other thing it does i think is that it it gives him the experience of being able to control one of the rare processes another one would be blinking you know where it's both automatic and intentional so it introduces a very important uh what some people call the combined need, which is for control. And we'll talk about seven fundamental needs we have that are assaulted with trauma. And we don't know if he was traumatized or not, but certainly he was breaking through a window of tolerance just with the topic of what was your family like? So anyway, that was an integrative practice that allowed him to come back into this, what you can call a faces flow. There's five features to it.

It's flexible, meaning it bends, it doesn't break. Adaptive meaning he can become aware and adjust his state of activation to become more in the flow of harmony. That's adaptive.

C is coherent, which means resilient over time. E is energized. He got a new sense of vitality even as we were staying with this topic.

And S is stable. So we basically, by creating more integration, we widen the window of tolerance. And there's a whole laminated card that'll be available soon, where you could see what doing an integrative intervention helps you widen it.

And then even though this was just the first session, he was experiencing that together in our relationship, there could be space to hold in awareness in him and in me and then between us, this topic, what happened in my family, and then he could also learn within a few moments. that he could have a body-based intervention, we would call it an integrative intervention, where he's not just, you know, a passive passenger along the ride of getting distressed and going to rigidity or chaos, but instead could use his awareness, this consciousness, to make a choice about change. And that was all in, you know, a couple minutes or moments even. And so it's little things like that that would be a... Is that what you mean by a clinical example?

Yes, indeed. Okay, yeah. So, you know, and that could be true. It doesn't say whether he has unresolved trauma or not, but he certainly had a pretty narrow window for me saying, tell me about your family. Yeah, thank you.

Thank you very much. And just going with that clinical example that you just provided, I am curious if you can share, I know in your work you also talk about the significance of building an autobiographical narrative and how, you know, I'm imagining in this work with this client, you're just kind of taking those first steps with him and learning how to really kind of build that level of even coherence or integration between, you know, the right hemisphere, left hemisphere, and like developing this autobiographical narrative. And it sounds like in this case, he was kind of flooded with that experience of rigidity. So you have to modulate how to just experience the faces like in this work with you. So that first step was really taken.

What would you venture are some of these next steps in building towards that autobiographical narrative? Yeah, thank you for the question. So a couple of things. One, just the broad statement about autobiographical memory and trauma is we know in terms of research measures that at least one measure.

In the past, it's been the only measure. I don't know if that's still true, but it might be. But it certainly, for a long time, has been the only measure that measures the difference between resolved versus unresolved trauma.

So we can do questionnaires, which are really good, to ask people, have they been traumatized? Like the ACEs questionnaire. Did you have adverse childhood experiences, ACE?

And You know, in that survey, I had the opportunity to speak with the principal investigator of that study, you know, and it was done by epidemiologists, not about intervention. And the questions were, you know, were you ever, you know, mistreated by your parents? Did they have a drug problem?

Were they incarcerated? Did anyone have a mental illness? Was there a divorce? You know, all that kind of stuff.

And each one gets you a point on the adverse childhood experiences. They The issue that I said to Vincent Felitti, the principal investigator, was I was concerned that, you know, it was a study, a naturalistic study that didn't do anything to ask about interventions people might have done or ways they might have moved from unresolved trauma in terms of a high ACEs score to resolve trauma. And he agreed that that isn't something they were familiar with, nor could they ask about in a simple questionnaire given to him.

tens of thousands of people. So it's a very important study to let us know we should try to avoid adverse experiences for children. But a lot of adults who hear about that are very distressed because there's nothing said in that set of studies about repairing things. So, you know, for me, because I'm trained in attachment, I know you can have a traumatic experience in attachment that can be repaired either by your parents themselves.

if they realize the terror that they've created in your life, the way they mistreated you. But also for young people, you know, children, adolescents, adults who have the opportunity to make sense of what happened to them, they can actually free their lives up. And a study that was just conducted by Marty Teicher and Sarah Lazar at Harvard University were able to show that you can actually work with people with mindfulness interventions that reverse the neurological effects of developmental trauma. So that's Lazar and Teicher, T-E-I-C-H-E-R. So I used to talk about that for years because what Marty Teicher had shown was that there are four ways you can measure integration in the brain.

And with unresolved trauma, you see that in the hippocampus, a part of the brain that... links differentiated memory systems to each other. The corpus callosum, the bands of tissue that link the left and right differentiated hemispheres to each other.

The prefrontal cortex, the part that links the cortex to the lower areas of the body and even the social world. And even a more subtly differentiated way of assessing integration is the connectome. The word connect with O-M-E at the end, connect, O-M-E, is connectome. is impaired in its linkages in trauma. So those four ways we measure functional and structural impairment integration reveal that the big effect of developmental trauma on the unfolding of the nervous system is impaired integration.

So what I used to always say for years after Marty found that was, you know, if you look at mindfulness interventions, they actually were in people who had not been. exposed to developmental trauma just the general public those four areas were exactly the areas that grew so what i used to always lecture about was theoretically we ought to assume and research should show and now it has with lazar and taisha's work you know that Since mindfulness interventions actually promote growth in those four ways, and those are the exact four ways integration is blocked with trauma, that we should see that mindfulness will be an important component in resolving trauma because it'll help grow the integrative fibers that have been temporarily impaired in their growth. So this is a very exciting moment to say that a theoretical proposition has now been shown to be empirically validated. approach. And so you would say that, you know, people with trauma, developmental trauma, you know, ought to receive the very intervention, mindfulness interventions that teach you how to, you know, focus your attention.

There are three things, focus your attention, open your awareness, and build kindness in your intention, kind of loving kindness. So, you know, these are beautiful ways. Now, we have research backed clinically. informed approaches to working with people who've had unresolved trauma and to help them resolve it.

Now, that's all a side issue, Clarissa. Now, to get to your question about autobiographical memory. So, you know, what the AAI, the Adult Attachment Interview, is able to show is that the narrative that comes out as a linguistic response to a semi-structured interview called the Adult Attachment Interview, which is... what I'm trained to give and what I've trained my students at the Mindset Institute to learn how to give with Mary Main's permission was with Mary and I and Eric, you know, had a meeting and she finally agreed to let clinicians use it after the meeting we were together with. Anyway, what you see in the narrative output is that when you ask people, like when I asked that individual, tell me about your family, when you ask them not just about their family but specifically about issues of being terrified of their parents or loss that they've experienced, especially those two questions, then what you get is you get a disorientation in the linguistic output that you assess with the way we assess the AI, the adult attachment review, using something called Grice's maxims of discourse.

So for any clinician who trains with us at the Mindset Institute, when we learn the interpersonal neurobiology approach to making sense, You don't need to learn how to apply Grice's maxims because you don't need to do a research assessment, but you can get a clinical feeling for when the linguistic output becomes disoriented. So that's really what you're looking for. You'll feel it in your body as a clinician. You'll get a sense of, wow, this is getting kind of loose and confused. There'll be a confusion of present and past.

The person might enter a flashback sometimes even. you know as they're recalling things they're speaking in linguistic terms as if it's happening now and those are all signs of unresolved trauma and unresolved loss um and so from an autobiographical narrative point of view you see this and the disorientation within the narrative output yeah thank you and so as you were speaking about you know this this experience of flashbacks um this challenge of really situating things into a there and then framework so clients who are maybe just unable to put that kind of sense of time or really kind of situate their level of self-concept self-awareness within the function of time it sounds like yeah there's really like this i get the sense like there's this feeling of just kind of really feeling trapped in the past that you can experience with clients in that way And so just going with that example, like let's imagine that we have a client who is experiencing that, that sense of being trapped in the past. Perhaps as you had shared, like mindfulness can really help support kind of broadening that window and supporting clients and having a greater range of flexibility in their response in a moment and kind of moving towards that greater sense of like a cohesive narrative.

What might be your next step? Oh. Go ahead. But I'm curious if your next step would be there. Well, a couple of things, a couple of things.

And Clarissa, let me just check in with you. Is it okay if I make slight edits on the word? Yeah. And cause these are, these are words that sound very similar. And, and, and in a way, maybe I'm being a little too, as a writer, you know, I'm super obsessed with making sure the words we use have very a clear definition so we would say the narrative would become coherent we would cohesive and the reason to say that is let's say i was coming to see you as your client and you said dan tell me about your childhood experiences i said well and i'm not good with color but let's say i assume your blouse clarissa's green is it greenish it's a bluish yeah my wife always says you don't talk about blue or green okay so let's say you know clarissa um i'm going to tell you a story of who i am and your greenish bluish blouse reminds me that my parents were Martians.

And I feel really comfortable being with you because since obviously you must be a Martian wearing that blouse color, knowing I was coming in, you know, I feel comfortable because my parents were really great Martian parents, which meant, you know, they would put me in a closet for a week and then I would see them every Sunday at around 4 p.m. And I called it the Martian time because I would come out and they would kind of be marching in and I would... I see these marching Martians and, you know, so I feel very comfortable being with you.

So in a linguistic sense, that was very cohesive. I made a logical comparison of a color to a Martian. I made a funny pun about marching Martians. It all stuck together if I were like a comedian or something like that. But it's not coherent, right?

It's incoherent. I'm really disoriented, but it's cohesive. In other words, if cohesive is defined as it's stuck together with logical linkages, that was pretty logical. I mean, it was on the edge, but anyway, maybe I'm pushing that a little bit.

But that's why we want to use the word coherent. So coherent is where, you know, it really deeply makes sense. Cohesive is it sticks together.

That's one thing. The other thing is before I would work with the person who might be losing themselves in time, I would give them a slight psychoeducational. download and say to them, because I found this over the years, you know, I've been a therapist for 40 years now. I would say, I think it's important as we get into this stuff to see what your narrative said for me to just give you a very quick overview of how the brain processes experience into memory. So are you up for that?

And let's say you're my client, Claire, so what would you say? I'd say I'd give it a go. Okay.

So just first to let you know that there's a layer of memory called implicit memory, and then there's another layer called explicit memory. And it's important to know the distinction because, you know, when we're very young, we only lay down things into implicit memory. But also, if we have overwhelming events that overwhelm our ability to cope, which is one way of defining what trauma is, you know, that too can block the movement of implicit memory into its... more integrated form, explicit memory.

So explicit is really the term we use for the kinds of memory that we can develop after around 18 months of age, but it is the kind that we usually mean when we say, do you remember something? And in the left side of the brain, it's facts. The right side of the brain is autobiographical memory of sense of self and time. And that's what we usually mean, can I remember something?

But we need to know that in the brain, when you have an experience, The brain responds by activating itself, that's called encoding, then it stores those encoded experiences in our nervous system into something called storage, and then it stays there in storage until some kind of cue, some kind of memory retrieval cue, activates it into awareness. And the important thing to know about implicit memory is that when it's in its pure form, when it didn't get woven together through an area called the hippocampus into either factual memory or autobiographical memory. When it's in pure implicit form, when it's retrieved from storage, it feels like it's happening in the present moment.

Got it. So would you say that that's memory that's waiting to be encoded in some way? In some ways, it's waiting to be encoded into explicit memory.

Exactly. Only when we experience it, it feels like it's happening now. which explains a flashback. It also explains how sometimes we can get disoriented in telling our story if we've tapped into implicit memory storage that has never been integrated into explicit form, then we just think we're in an experience then and we can't tell the difference because in the brain it's as if we're experiencing it now.

Even memory retrieval. Does that make sense? It does make sense.

Yes, really appreciate that because I just think it really speaks to the importance of the left hemispheric action in our work as clinicians. And, you know, I just think too, like you've mentioned this in your book, but just the power of memory reconsolidation of like, you know, really just putting a proper place of these memories in that coherent narrative that we're really supporting our clients and building together. And so, you know, something that we haven't touched in on yet is the ways of being of a clinician.

And I know in your framework. there is like the power of resonance and attunement, which is such a kind of right hemispheric process that we engage in with clients. But we're also really helping to support that memory reconsolidation or just helping to encode these implicit memories in that more coherent form for clients.

And so would you care to speak to just these ways of being as a clinician and how we really show up and support that work? Yeah, yeah, absolutely. So um, You know, let's say I'm with a therapist and she's asking me about anything that comes to mind about, you know, my feelings about my childhood and whatever.

And then I start, and this is a true story, and then I get lost in this feeling of responsibility for everyone in my family and then start feeling this terror that I've caused something I love to do. die and then suddenly I'm with this pair of rabbits that I'm feeding these leaves to because they looked hungry and I'm four years old and then they die in my hands because it's oleander leaves and they're poisonous so she's now with me as my therapist in her presence with me to let me feel like I have the the you space to be vulnerable and let this implicit memory, which is a true story, get reactivated. She has the attunement.

She's tuning into what I'm actually experiencing, so that's PA. Resonance, I can see that she kind of feels the terror of those rabbits dying. She's not becoming me.

She's not mirroring me, but she's affected by me, like guitar strings resonating with each other, not becoming each other. And then T, I developed the trust. that's needed, you know, for me to feel like I can move forward.

And, you know, Steve Porges might call that the social engagement system with my ventral branch of the vagus nerve being turned on, whatever, whatever you want to call it. It's this integrative experience where I can differentiate my experience from hers. She doesn't become me, but we become linked. And then that integrative flow, we're joined as a we, and that part she plays, presence, attunement, residence, and trust allows her to create what.

you know my colleagues and i uh metabol and peter sange would call a generative social field it's a i would call it an integrative field where you know honoring differences and promoting linkages is there and in that field that relational field it allows the therapeutic relationship to essentially and this would resonate with a lot of different i think humanistic approaches to therapy create a container that now when you're informed about neuroscience You could say that, you know, she's expanding my window of tolerance for a really painful moment when I was four years old. She's then going to support me in, or you if you're my therapist, you know, in having what you can call a dual focus of attention where one stream of attention is having energy and information flow as if I was a four-year-old child having just given oleander leaves to my cute little rabbits, my first pets. and they die in my arms and I'm overwhelmed with terror that not only have they died, but I led something to die and it overwhelms my ability to cope.

And I develop a belief that on the one hand, the world is really dangerous. The other hand, I'm a dangerous part of that world if I don't know everything I need to know. So you can imagine when I became a biology student and became a... a medical student, you know, I was like so driven to make sure I didn't miss any equivalent of an oleander leaf or that could hurt somebody in whatever level of, you know, medical practice I was doing. I was a pediatrician for a little while and, you know, it was overwhelming.

So even becoming a psychiatrist, you know, that theme. So if you were my therapist, you would help me work with that belief, you know, that I am you know in a dangerous world always responsible and obviously it's it is a dangerous world and there is a lot of responsibility we have so it isn't that you would just jettison all those beliefs but you loosen them up and what i've done in the last 20 years is work with four colleagues to kind of look at a personality system that we call pdp and say there are nine different ways at least but let's talk about nine fundamental ways that people seem to divide up, interesting, about 85 to 95% seem to divide into one or two of these ways. And trauma then could affect me given my pattern in one particular way.

But if I was in a different, you know, pattern of developmental pathways grouping, you know, that same experience with a rabbit might have affected me very differently. So the same traumatic event, you know, the death of a rabbit when I give him leaves, affected me one way because of my temperament and because my attachment experiences with my mom and my dad were really not secure in very different ways with my mom, different ways with my dad, you know, that intensified how my temperament moved forward into my personality and then my work as a person in therapy would be to really understand what's the attachment part of this. What's the temperament part that led to personality?

And then what's the trauma part? So what's really exciting about this new model, it'll be out in this book called Personality and Wholeness in Therapy, is that you can look at trauma essentially as an assault on wholeness, only we have these nine different pathways through which we leave wholeness and trauma. can affect us in these nine different ways and and understanding that as a clinician i'm hoping and certainly it's true with me and my colleague david daniels when when he was alive and working with this as a therapist it really gives you kind of a refined way of asking the question how does trauma whether it's you know an adult experience one-time trauma or you know developmental trauma how does it affect people differentially based on their temperament you know and so that's a fun thing we can talk about and i say fun meaning it is so enjoyable so fun so pleasurable so exciting to see how clinicians now can use this and uh i just came off of a month of uh traveling teaching this in different settings and um you know it was really exciting to see people learn the system and then learn how to apply it especially with through the lens of trauma fascinating yeah and so exciting that's going to be coming out for a wider audience soon dan and yeah well this will be for a clinical audience yeah clinical audience wider than the workshop participants yeah for sure people like me there was 16 a workshop and 130 another one they were small workshops so we could we had a lot of personal you know interaction time which i love and it was really um when you see people grok it when they really grasp it you Their eyes go, oh my gosh. And then you realize that, yeah, trauma is really important, but it's really how, in some ways, the trauma, in some ways, intensifies our personality.

In a particular pattern, it likely would have been going in anyway. This is our hypothesis. It likely was going in a certain direction. And just trauma, like the rabbit experience, will intensify the kind of personality you...

probably would have had even without the trauma got it that's hypothesis could be wrong but i think it's right great yeah great working hypothesis um would you say that relates to genetics in some way or just like our our kind of descriptions yeah yeah well our hypothesis is it relates to temperament interesting about that is temperament is defined as you know the innate meaning not learn propensities of the nervous system pretty much available at birth or right after birth. So it's not things you learn. Now, temperament has a genetic component, but it's not even like a big genetic component.

So for example, in one of our workshops we had identical twins, you know, and you know, they had different patterns, which we believe are based on different temperament. So why would that be? Well, you could be in the womb leaning to the left, and maybe one network grows a little more because you're leaning that way, and the other twin is leaning this way to the right, and it grows a little more just from gravity and anatomy, you know, which is not genetic.

It's just kind of random. So just because something's innate doesn't mean you inherit it through genes or even epigenetic factors. Those factors would be there, but they may not even be the majority of influences that create temperament.

So that's why, you know, yeah, you can do the genetic studies and that would be great and fascinating and all that stuff. But when we had these identical twins show different patterns and they said, see, this is not a temperament issue. I temperament does not imply it's genetic i didn't say with genetic i said it was about your temperament which is innate and innate does not mean genetic wow okay well that is uh yeah in this moment and you know i'm checking our time as well and is there any other distillation that you would like to offer us around what what do you mean by temperament and how can we understand that within the context of trauma yeah so the classic ways For example, when I was in pediatrics, looking at the developmental psychology approach to temperament, it would be things like how sensitive is a child, meaning how much of a stimulus like a sound or a light or something like that do you need before you evoke a reaction?

Then the next thing is intensity. When you ultimately get your reaction, how big is it? Is it little? Is it medium? Is it big?

And then, you know. What's the tone of that reaction? Is it like scared?

Is it, you know, sad? Is it angry? You know, what's the tone of the reactivity about the emotions? You know, and then the other is, you know, how's the response to novelty? Like, do you trigger a kid when things change from the familiar?

You know, and some kids love novelty and some kids can't stand novelty. So those are four of, you know, several ways you can assess temperament. So my, my, um, colleagues and I, in what's called the PDP group, Patterns of Developmental Pathways group, this would be David Daniels, Denise Daniels, Laura Baker, and Jack Killen, we put together over a 20-year period, you know, a model of attachment that we first published in 2010 that proposed that in addition to those standard ways of looking at temperament, You can also look at the subcortical motivational networks. Yach Panksepp, P-A-N-K-S-E-P-P, beautifully wrote about these in our mammalian history. And if you look at three of those particular subcortical networks that create what Yach talked about as primal affects, and that would be anger with its variations of irritation, frustration, anger is there, and then fury and rage.

Another independent network is that of separation, distress, and sadness. When it's extreme, you know, of course it could be despair. This is a network also that's different from the anger network.

And then the third network is the anger of fear, you know, which when it's mild, it's worry. When it's intense, it's terror. So, you know, those three, what Jaak would call primal affects.

Beneath them, our view, and Jaak would talk about this, but he wouldn't. emphasize it uh and and so we just took yach's beautiful work took a step back and said what's beneath the affect and what's beneath the active affect is a motivation so the motivation in the anger uh affect grouping when it's frustrated the motive it arises this frustration is for you know basically a sense of agency it's autonomy it's competence it's getting an empowerment you know of your needs being met embodied empowerment So we can label that A for agency. And the idea is that one of these may be more sensitive than the other. We're proposing this as part of temperament. The other one is B for bonding.

And this is about relational connections, to be accepted and be a part of a relational bond. So bonding. And the third one that leads to separation, distress, and sadness when it's frustrated. The third one is for certainty. So this is where...

prediction allows protection. So it's about a drive for safety. So this certainty drive, you know, when it's frustrated, you get anxiety and fear and terror.

So what we propose is that those three kind of vectors, they set a directionality that just happened to be more sensitive than the others. And a little bit of sensitivity at time one leads to more activity just because of sensitivity. Then maybe it becomes more intense because the neurons that fire together wire together.

So now at a week of age, it's a little more robust. Now at a month of age, because of the self-reinforcing neuroplasticity loop, What just started as a small sensitivity now is a big sensitivity and intensity and all that stuff. So we think many people have one or maybe two of these vectors that are dominant.

When you take those vectors and then say there's another feature to temperament that a colleague of mine actually found in the brain, we just found it in narratives that we're analyzing, and this is whether your attention is inward. or your attention is outward or your attention shimmers between inward and outward very different from the idea of extroversion being you know you're socially inclined or introversion meaning you're rather be by yourself uh this is a very different thing and so uh we i was worried about it questioning it a lot um but it turns out that uh mary helen and mordino yang actually independently found it in in the brain of people just inward outward shimmering between both um so that was kind of an amazing moment hearing about her study so we saw that in the narrative so anyway if you take those three tendencies of attention which i call a tendency and link it to um in the particular vector then you get nine patterns and we believe these nine patterns are the foundation that you adapt to and those adaptive strategies basically become your personality pattern you that get intensified with non-secure attachment including developmental trauma got it wow so i i imagine with this new framework that there's an opportunity to have more incisive and targeted interventions in therapy kind of based on one's um profile so to speak exactly so the the pattern has within it's not a type it's not a personality type it's a personality pattern meaning there's a variety of features with a range of values, but they do invite a clinician or the individual doing the independent individual work to work with their own minds in a very focused kind of way. So in my pattern, for example, you know, you would explore the rabbit trauma, you know, through the lens of someone who's a certainty vector, who happens to be dyadic inward and outward, and I do worst case scenario thinking. as a part of my adaptive strategy.

I have this belief system that I'm responsible for all these bad things that could happen, so I need to, in a way, be questioning everything. So it's a questioning pattern. And you would then work with me to help me gain some trust in the universe. You'd have me do the Wheel of Awareness practice, which I have people do, where I get into pure awareness and drop into this state of connection that lets me get back to the feeling of wholeness. This week...

we believe ultimately that each of these vectors and their tendencies get activated because we're no longer feeling whole even if our attachment was secure and the journey back to wholeness is a lifelong journey got it okay well certainly excited for this to come out um for us all to to look with and integrate into our work um and i i wanted to kind of bring us back to also the purpose of this summit which is to also explore compassion and trauma. And, you know, I just imagine when we're kind of sourcing from that place of wholeness, when we're in a state of coherence, when we're interpersonally integrated, that compassion is a, it's like a result. It's a resultant state.

It's something that we can really like tap into and utilize in working with our clients. And so just as we draw this to a close, is there anything that you care to share around? the power of compassion in doing this work. Yeah, absolutely. I think, you know, we have a saying at our institute that kindness and compassion are integration made visible.

So if you really think about integration where you're differentiating linking, your role as a clinician is to offer that compassionate presence so that your clients can be differentiated from you, but then linked. And because you've worked on your own inner life, your window of tolerance for whatever pain they're going through is quite wide. And that gives them the reassurance that no matter what they go through, you can hold the space, bearing witness, staying connected, remaining open. So your presence, attune, resonance, and trust really brings to them the opportunity to widen their windows and resolve their traumas. And that comes from your compassionate stance.

your kindness. And the beautiful thing about that is it kind of reinforces its own unfolding so that you're joining instead of it leading to burnout actually is quite invigorating. So people often say to me, even though I've been doing this 40 years, how can you keep on seeing patients? Isn't that hard?

I said, actually, I learned so much from my patients. I feel so invigorated by their strength and courage. And I feel so honored to have the privilege. of connecting with them that it actually enlivens my life. And yeah, so I feel very grateful.

Don't ever intend to retire. Wonderful. What a beautiful note to end on. So I just want to thank you, Dan, for all of your generative wisdom and being able to touch into this own interpersonal field with you.

It was a true honor. And yeah, just invite our wider audience to listen to this one a few times because there's just packets of energy and information for you. So thank you very much.

Thank you, Clarissa. And you know, it's so fun to be on this journey with you. You know.

finding more and more ways we can help people hear those traumas and feel really the incredible privilege of being alive here now on this planet. Indeed. Thank you.

Thank you. And, you know, I'll say one more thing. I just can't help myself.

But, you know, as we help people resolve their personal traumas, we really give them this pathway to have what you can call pervasive leadership to realize that, you know, in our modern culture, we get the traumatic lie. of a separate self, but we come to realize that, yes, we heal the trauma of the me, but then we realize we're not just a me in a body, that we're more a Mwe, M-W-E, is our integrated identity. And that kind of self is a self I think the world is waiting for us to realize is the true path towards healing our planet. Thank you so much. Yeah, it's just, it's not just the individual trauma, it's the collective experience that we're here for.

so yeah thank you dr siegel thank you clarissa great to be with you you as well

Transcript for:Compassion and Trauma in Therapy

Transcript for:
Compassion and Trauma in Therapy