Welcome to my next attempt at blogging about trauma therapy and all of the interesting things connected to it. My name is Laurie Belanger LCSWR: a Clinical Social Worker & Trauma Therapist, a Trauma Educator, EMDRIA approved EMDR Consultant, TBRI® Provider, Official SSP Mentor, and Lifelong Student Of Life. I’m trying to start this new adventure in blogging with some of the things I find most foundational in my own practice. The hope is that some of these thoughts will reach my fellow clinicians ducking burn-out in a world that feels increasingly like an unregulated game of vicarious trauma dodgeball. Also, there are always those out there who are genuinely interested in emotional wellbeing for themselves or others. You are welcome here too. Friends and family have asked across my entire career, “How do you do what you do without getting burned out yourself?” If I manage to do this blog on a regular basis, you’ll learn all about that. I’m also planning to add three practical resources at the end of each article. Fingers crossed that you’ll take time to read what’s in-between. So, let’s do this!
The last few years have been…..hard? Hard sounds completely ineffective as a description, yet I really do not have a better word that’s fit for print. There has been plenty of bad hard and there are plenty of other places for you to read about that. Some of the hard was good hard. I am not negating here all of the bad that people have experienced. I just figure you have plenty to choose from if you’d like to read about that. Here, for your discernment, is some of what I found to be good hard over the last few years. This post will focus on the good hard I’ve seen in the area of Relationship. Because, well, as you are going to hear me say over and over: Relationship is everything.
Let’s start in one of my favorite places, my therapy office. As a therapist working straight through the pandemic, I was suddenly pushed to adapt to the world of telehealth in order to continue supporting my clients. Most therapists did at least some telehealth during this time. Anyone who truly knows me knows this was a big ask. I am a deeply sensory oriented EMDR therapist who works with the entire age range, 4yrs old and up. Sitting in a chair and putting a screen between myself and my clients felt a little like someone had chopped both my arms off. Yet, for a period of time this was a lifeline for many. And today, I still blend in-person and telehealth in my practice to better meet my clients needs. I adapted. While telehealth will likely never be my preferred method of providing psychotherapy, I will always be grateful for the option. This was good hard.
Telehealth though was only the beginning of our 2D professional existence. It also became trainings, conferences, IEP meetings….all done on-line for a time. A very lonnggggg time. It was through this experience that I felt such added compassion for the children trying to continue their K-12 education on screens during the pandemic (seriously, Kindergarten this way?), as I struggled myself to learn in my own trainings and conferences in that same fashion. This very 2D educational experience helped highlight some of the “whys” behind many student accommodations that I advocate for everyday. The pandemic made it very clear what parents of children with IEPs and 504s have known all along. Not every child can learn the same way. Different doesn’t mean can not. And neurodiverse students deserve the same opportunities as every other child for a quality education.
Personal disclosure moment here: I am a Trauma Therapist, but I am also an adult with ADHD. My own struggles with ADHD are part of the reason I enjoy working for neurodiverse clients of all ages. I know what it’s like for everyone else’s expectations to have no bearing on my lived experience with my own brain. It can be a very lonely space where you often feel misunderstood and at risk for judgement. And that there is the crux of it….why I’m writing this today and why I titled this blog what I did.(knew I’d get around to it. thanks for patience if you’re still reading!)
Relationship is everything. By that, I do not mean that relationships can fix every problem or heal every wound. What I mean is that our relationships (with ourselves and with one another) are necessary precursors to dealing with any problem or healing any wound. The pandemic actually threw this idea into sharp contrast. Here are three areas that stood out to me.
In Education: It was only when the students had to learn entirely on a screen that many people started to really appreciate the importance of the social/emotional connection that teachers have with their students; and not just for social/emotional development, for academic learning too. Even students who did not usually require special accommodations in class began struggling. Teachers struggled too, both to connect and engage their students and also to present material in such a limited (opposite of embodied and sensory rich) manner. Working as a consultant for school districts during this time, I got to see a couple of administrators begin to understand the impacts of trauma on education (suddenly there was a shared experience that was relatable to everyone). This planted the seed for the beginnings of an increase in compassion for both their educators and for their students around trauma informed care materials. Unfortunately, I also got to see where relationship fell apart in school settings, resulting in often dramatic consequences for both adults and students.
There is still a very long way to go before Trauma Informed Care principles permanently change the culture of education. Yet, the pandemic did provide some good hard that is today inspiring some growth in that direction. Let’s hope we continue to hear the words “relationship” and “felt safety” in educational institutions going forward. Let’s also hope that in the perceived rush to “catch everyone up” we don’t inadvertently end up even farther behind by glossing over the deep importance of connectedness and relationship in our school communities.
In Outpatient Mental Health: I am currently in private practice myself, though I continue to support colleagues through Consultation in the large outpatient clinics where I also got my start as a therapist. In therapy sessions, it was only when clinicians lost the ability to see their clients in the sanctuary of their private offices, that it started to click for many what a big part of therapy is often found in the creation of a safe space for human connection and relationship. Have you noticed that there has been a big spike in the therapy continuing education community talking about somatic approaches and deeper learning about holding space for others? The art of the therapeutic relationship in therapy was pushed to the back burner of continuing education in some respects during the medicalization of psychotherapy. This is my own opinion having watched the rise of HMOs in insurances and it’s affect on mental health delivery systems over multiple decades. I may have to write an entire post on that sometime. For many years, therapists have been under enormous pressure to mimic the medical field in an effort to be covered by health insurance policies. While being covered by insurance has made therapy more widely affordable, a very good thing, it has also had a tendency to pathologize the human experience and reduce quality to those things that are easy for insurance companies to measure. Psychotherapists are professionals, not technicians.
One could argue that the medical field has experienced some of the same devaluing of their professional judgement as well, reducing clinical discernment to an insurance approved fast-food menu of acceptable choices. (Again, I could write an entire post on just this. Tell me if you’re wanting that). And while there is some overlap with medicine, the field of psychotherapy values skills which are not as easily put into convenient little boxes. The pandemic brought back into sharp relief the importance of these less measurable skills; holding space, emotional attunement, mirroring, and co-regulation, to name a few.
Perhaps the difficulties we have faced over the last few years seared into us a deeper collective understanding of the importance of healthy therapeutic connection and relationship. I really hope so. After all, if children learn best in school when they feel safe and in good relationship….is it any wonder that it might be similar in mental health treatment? Is skillfully creating a safe and connected therapy relationship with healthy and compassionate boundaries just assumed or just looked over in continuing education for more impressive sounding accomplishments? Add therapy modality after therapy modality and its corresponding acronyms to your tool box (I do too. I use CBT, NP. I love EMDR, admire SE and I can talk all day about TBRI®). Yet, a very good therapist uses their personhood first. It’s all about relationship.
I’m going to go ahead and put out there that there had become a tendency for therapists to live in specialty silos, pushed in part by the check box nature of insurances. Just as human experience has been pathologized and placed into boxy diagnostic codes, so have the therapists who provide treatment. For example, I am an EMDR Therapist. What does that mean? It does not mean I “DO” EMDR, as if it were a procedure. Non-therapists often do not know the difference. I utilize EMDR Therapy as an entire therapy modality utilizing the AIP model for case conceptualization, often blending it with other modalities like Ego State therapies, TBRI®, influences from Somatic Psychotherapies, from Polyvagal Theory, and even some updated CBT. 20+ years ago when I went through training in Structural Strategic Family Therapy, I was told “You are a (insert any modality here) therapist. Eclectic is sloppy.” With decades of experience under my belt at this point serving the needs of very complicated presentations and vulnerable populations, I can say I very strongly disagree. Thoughtful and studious integrative practice is good and needs to be encouraged, not siloed. Sharing ideas across disciplines and modalities is very good and makes us all better clinicians. Returning to the foundations of therapy as being about a safe relationship and space in which a person might risk, learn, cope and do some healing….very very good. And so, perhaps therapists everywhere will continue to grow in ways they had not even expected as this integrative trend continues. This is Good Hard.
Family Spaces: A third example that pinches the heart to talk about: Our personal lives were all turned upside down during the pandemic. The upheaval had a way of exposing what was healthy and what was not under the surface of relationships. I noticed how it was only when the elderly were isolated forcefully from loved ones by medical rules that society as a whole seemed to appreciate how lifegiving in person connection truly is. Previously, there was so much complacency about the older generation disappearing from participation in community. I’m not here to talk about the shut downs and separations that occurred during the pandemic to judge any of the decisions that were made at the time one way or the other. And pretty pretty please with cherries on top, do NOT turn my lovely little blog into a place to leave angry political comments. You’ll find plenty of that in other spaces if you need a place to vent. Again, here I just want to share some of the hard that helped highlight for me what is good and necessary for humans. There were those during the pandemic that endured a tragic dearth of human connection. There were others that were confronted with the true state of their personal relationships when confined day in and day out together at home. Both in my therapy office professionally, and in my community as a friend, I have witnessed families fall apart and others become that much stronger. What was protective and buffering during these difficult times? Healthy relationship…first with self, then with others.
So if healthy relationship with ourselves and others is so crucial, what do we know about it? One of my favorite areas of interest in therapy (there are so very many areas of special focus, you can literally be a student indefinitely. Something I highly recommend.), is Attachment Theory. This theory is all about relationship and how it (or the lack of it) shapes us as we grow. When I do trainings with educators in our public schools, there is quite a bit of talk about “self regulation”. This is a term you’ll hear in goals people have for children all the time. It may have been used in therapy sometimes to talk about adults and children attempting to be more mindful in their own life choices and/or managing their feelings in a healthy way. It is also a completely unhelpful term much of the time, especially as it relates to children. Someone presenting on emotion regulation, and I dearly wish I could remember who so I could give credit, said something to the effect of “there is no such thing as self regulation, there is only internalized co-regulation”. I love this. It makes so much sense to my webby brain. Let me explain why.
When I explain attachment to parents, I often start this way thanks to TBRI® (Trust Based Relational Intervention): When a baby is born they can not regulate themselves at all. The caregiver is their “external regulator”. All they can do is cry and yell. It is up to the adult to puzzle it out, solve the problem and meet the need. The infant isn’t thinking “I’m cold, get me a blanket” yet…it’s just the “AHHHHHH” of discomfort. If the adult responds well, comfort is achieved, baby learns to trust the regulator to do their job. Felt safety is achieved. This is hugely important for later development. Later, a child becomes able to communicate more than distress, “I’m hungry”, and the adult is able to provide help, ” you may have this or that”, and so the regulation becomes something of a team effort. This team of problem solving between an adult and a young person so that the child might learn how to both identify and meet appropriately their own felt needs is a huge part of education. Co-regulation is what I actually talk to educators about K-12.
So then what is “self regulation” and why are all of the cute Pinterest boards about social emotional learning or SEL about that? Self regulation is when a person is able to turn in towards themselves and co-regulate from the inside. It’s basically internalized co-regulation. Most elementary school children are not really ready for that. If you had an amazingly blessed childhood, your parents were super responsive and available regulators for you, you happen to have no physical, emotional, or learning challenges (or IDK maybe a global pandemic experience)……yeah, still no. You would not be ready to self regulate (internally co-regulate yourself based on your own history of being beautifully regulated by others) as an elementary school child. There is a reason we don’t teach abstract math to kindergartners. That would be developmentally inappropriate, right? Don’t have the brain structure to support that yet, right? Yeah, OK that. So, what to do with all of this regulation talk? What we are really talking about here are the very foundations of relationship. We learn as infants first to connect externally to feel safe and ok (Secure). It’s communication and trust. Then, we learn about back and forth in relationship. Eventually, we learn how to do that back and forth inside. It’s our relationship with in our own selves, AKA your self esteem, your self-talk, your relationship to all the versions of yourself that you’ve been at every age which inform you how to live your life. If there are any therapists out there reading this just now thinking about Ego State Therapies…..you’re right on track. Relationships.
— Oh, and just because you manage to internally co-regulate as you are out there “seriously adulting”, don’t think the other two forms of regulation disappeared. This is not a Trix are for kids kind of moment. Adults co-regulate with each other all the time. If you have ever leaned into a good friend or spouse at the end of a tough day and allowed them to care for you…you’ve been co-regulated. Co-regulating is an important part of adult relationships too. Chances are pretty good you have been, are, or will be co-regulating others, even regulating others (mostly children and in emergency situations with adults) your entire life. Understanding all of this is key to a good and happy life. Or as I titled this long ramble in the first place: Relationships are Everything.
So, now that I’ve laid out why I think relationships are everything and some of the good emphasis we gained during the pandemic (the Good Hard) on just how important relationship is for us (in my rambling ADHD way, you’re welcome), now what?
Well, one would hope you’d be wondering how you might personally go about learning how to become a healthier internal and external emotional regulator, whether you happen to be a professional therapist or not. Perhaps you are wondering if your own attachment style is as healthy as it truly could be? Dr. Karyn Purvis PhD, one of the developers of TBRI® (Trust Based Interventions) once said something approximating, “you can not bring someone to a place you are not”. Not an exact quote, I’m certain, but credit for where I first heard this as you will hear me say it often if we spend enough time together. Professionally, I do not care how many books you’ve published, where you’ve presented, or how long your waiting list for clients might be. The bedrock of a good therapist is the ability to share your own neuroception of safety first and foremost. After this, sure, bring on the advanced trainings and case conceptualizations. To be a safe and trusted Co-regulator through and through means you have done (and continue to do) enough of your own work, cared for your own self. Have you? Do you continue to do this hard work (because it never really ends, even for professionals)?
If you are one of the non-therapists reading this blog and have made it all the way to the end, first of all THANK YOU. Second, aren’t we all trying to be just a little bit healthier than the generation before us? To give our own children and the next generation of community a leg up in the world? I know I am. You don’t have to be critical of your own family or identify as having a significant trauma history to want to continue to grow in health and wellbeing. So I applaud your tenacity in reading my admittedly ADHD influenced ramble about the importance of all relationship.
For those who skimmed to the end for resources: this is where you stop. I promised you three practical resources. I talked a great deal about the importance of relationship, so here are some links to information I’ve found helpful over the years. First, whether you are reading this as a curious clinician or just as a curious human, here is a quick 3min 16 sec intro to TBRI® (Trust Based Relational Intervention). TBRI® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI® is connection. https://www.youtube.com/watch?v=FWScSJKjn1A If you want to do a deeper dive into all things TBRI® (and I highly recommend this for clinicians and curious growing humans alike), check out the webpage at https://child.tcu.edu/about-us/tbri/#sthash.x4fFaFat.dpbs.
Second, if you found the discussion about relationship and its importance for the education of children in school interesting….here’s a link to a video done by Jacob Ham PhD. Dr. Ham is a clinical psychologist, psychotherapist, researcher in psychotherapy and epigenetics, and trainer in traumatic stress. He’s also an Assistant Professor in Psychiatry and Director of the Center for Child Trauma and Resilience at the Icahn School of Medicine at Mount Sinai in New York City and works out of Mount Sinai Beth Israel. I love his illustrations and how he breaks down the science in a friendly way. I’ve shared this one with educators. https://www.youtube.com/watch?v=KoqaUANGvpA
Lastly, if you’re interested in exploring your own attachment style, either as a professional therapist yourself, or as just a generally curious and ever growing human… Here’s a link to an explanation of the Adult Attachment Interview. https://www.youtube.com/watch?v=mcCm_m6hcoo&t=536s I have experienced the AAI myself personally. It was very enlightening and I believe helpful in my continued growth as a therapist and as a healthy enough human in process. I also found a free webinar for therapists to check out that was produced by TTAC on An Introduction To Attachment: Concepts and Research presented by Dr. Judith Solomon PhD https://www.youtube.com/watch?v=lkOyuMHAvA4
Thank you for spending your valuable time reading my blog. Please feel free to comment on what you found interesting and on what you might like me to expand on in the future. Please be kind in the comments! I’m still a newbie at blogging.
Your friendly neighborhood trauma therapist, Laurie