Separation trauma has lifetime consequences

Most of us who have listened to the sound of a detained child wailing for their parent, or have seen the photograph of the Honduran girl sobbing in fear as her parent was frisked,  experience distress, anxiety, and even outrage. This is because humans are wired to attach emotionally to others. Distressed children evoke a care-taking response in most of us, making a crying child hard to ignore. We instinctively want to comfort, and when we can’t we become angry. Consequently, as anger rose worldwide, President Trump’s Executive Order on Wednesday was met with a huge sigh of relief.

Our parents are our first attachment figures, and how safe and secure we felt with them  has effects throughout our adulthood. If adults grow up with an unreliable, narcissistic, cold, or absent parent they have difficulties feeling safe in their adult relationships, and  suffer from lowered self-worth. Warmth and physical affection in the early years are critical to the development of self-soothing ability and healthy attachments in adulthood. 

Research has shown that children in distress need physical comfort. It is a biological need. In some cases, separated from their parents, children who are not hugged and comforted can die from what has been called “anaclitic depression.” We hope it is fake news, but if it’s true that detained children were not allowed to be comforted physically, then we have damaged these children irreparably. Research on separated children reveals that they go through a number of stages of loss. The first stage is protest evidenced by crying, wailing and begging for the parent, essentially protesting the loss. Vigorous protest is what we hear and see in the children detained at the Mexican border. If the parent initially doesn’t respond to this protest, the child goes into despair, evidencing a sobbing, quieter, less vocal response. If the parent is still not available, the child eventually detaches and evidences the haunted, vacant look seen in war ravaged refugees. Detachment brings relief but it is a sign of severe, sometimes irreversible, trauma. From birth to three years old is considered a critical period for attachment; the worst outcomes are seen when a child suffers attachment trauma during these years without a comforting caretaker.  

While watching children in anguish is painful, for psychologists it has been particularly distressing as we know that once a child detaches, (in other words, no longer cares) it is hard to reactivate the attachment mechanism and switch it back on. The resulting detachment has been called “affectionless psychopathology,” that is, an inability to care. Healing such a disorder can take years as the child goes through anxiety, anger, clinging and rejecting behavior before the ability to trust can return. Some children will become numb and uncaring, others angry and destructive. In certain cases, traumatized children develop personality disorders that make it difficult for them to become responsible members of society. More people who are broken in their ability to care for others is bad for society. While the impact will vary, most separated children will experience trauma with resulting anxiety, depression and distrust of others. The effects can last for years. 

The searing images of children separated from their parents is negatively affecting the reputation of the United States in the eyes of the world. This is part of the reason that though previous administrations have unsuccessfully grappled with the problem of illegal immigration, none has seriously considered parent-child separations a viable option. Regardless of politics and opinions, we must find a better way to deal with the migrant problem. Furthermore, our judiciary understands the harm caused by parent-child separation since separation anxiety is often associated with difficult divorces. There have been divorce cases in which it has been deemed child abuse for one parent to cause a separation between the child and the other parent. Regardless of the reason or entity responsible for a separation, putting a child’s personality structure and ability to form attachment bonds at risk is not just bad for children but for society in the long run. We are all grateful this will not continue!

Co-Written by Drs. Amanda Borlenghi, Psy.D. and RIchard Levak, Ph.D.

Learning From The Body In Real Time

Learning From the Body in Real Time means tuning into the physical sensations that are the visceral manifestations of primary emotions (anger, fear, sadness, surprise, happiness, disgust). These physical sensations are our first signals as to how we feel about something that is occurring. They are designed to give us immediate and vital information about whether our environment is safe and healthy or unsafe and threatening to our wellbeing. In people who have not had traumatic experiences these sensations tend to be a good compass to use when navigating the world. In people who have had trauma, the compass may be in need of recalibration. Regardless of whether one's compass is well calibrated or not, tuning into the physical sensations created by primary emotions is needed for insight into the self, healing when necessary, and navigation throughout the world. 

When working with clients I utilize a bi-directional approach to healing and growth: bottom-up (from the physical sensations to thoughts and actions) and top-down (from thoughts and actions to visceral feelings) (Heller & Lapierre). Clients at both ends of the spectrum of health, such as coaching clients who are seeing me to improve their lives and work, to psychotherapy clients dealing with the heaviest of grief or trauma, benefit from this bi-directional method.

Frequently people coming to psychotherapy or coaching for the first time expecting the top-down approach in which one comes to understand the self through deeper insight into feelings, thoughts, history, and current relationships. Often people also expect to learn behavioral strategies such as those involved in being more effective at work or in relationships, and how to cope better with stress and life's trials. While these are all aspects of the therapeutic process, within the integrative approach I use, they are not the level at which the most fundamental and lasting change and insight occurs. 

Fundamental change occurs at a primal experiential level. Physically, this is due in large part to structures deep within the brain that together are called the limbic system. We share these brain structures with all mammals. The limbic system governs primary emotions, anger, fear, happiness, sadness, disgust, and surprise, the feelings that we have as an automatic and immediate response to things that happen to and around us. These emotions are felt in a visceral manner and does not register as thoughts until they process through the part of the brain (cerebral cortex) that produces conscious thought and creates nuance and complexity in emotions. Simply put, primary emotions are felt as physical sensations before we have a chance to process them in the thinking brain thereby creating more complex emotions. 

It is because of the limbic system that a bottom-up approach needs to be integrated into the therapeutic process. During a therapy session primary emotions are activated by many factors. The content of the discussion, the in-the-moment experience of the relationship with the therapist, or an environmental factor may trigger a primary emotion via the limbic system. Often the experience of visceral primary emotions are unpleasant and we quickly turn them into thoughts and behaviors in order not to have to feel the discomfort they cause. In doing so we may ingrain bad habits designed to get rid of discomfort rather than deal with reality, miss vital information about the world around us and how we feel about it, and forgo the opportunity to recalibrate a misaligned compass. 

In the therapy session a bottom-up sensation-based approach means taking time periodically throughout the session to focus inwardly, track sensation in the body, and mindfully connect the sensation to the trigger that caused it. This mindful awareness of emotional sensation deepens and grounds top-down insights.

Integration of top-down and bottom-up awareness are what allow for an accurate and effective navigation system. A well-attuned awareness of visceral primary emotions provides an accurate compass while insight and clear understanding of effective behavior and thought provide the details of the map.  

For an experiment with attuning to primary emotions try the following:

1) Take deep full breaths. Inhale fully and pause then exhale fully and pause again before the next breath. Do this for 10 breath cycles.

2) Let your breath return to a normal pace and begin to scan the body. Notice sensation occurring inside of you that is not due to an identifiable external cause. 

3) Watch this sensation and notice any tendency to try to push it down or away. Notice how thought intervenes and tries to move your mind away from it.

4) After becoming very familiar with this sensation, stop and think about times in your life that you remember having it. Look for the sensation throughout your day or week and notice the things that bring it on.

5) After you have observed the sensation and its triggers for a while, see if you can name the emotion that is associated with it. If this is hard, remember the primary emotions: anger, fear, surprise, happiness, sadness, and disgust.

If you find this exceedingly hard to do, or become very upset or panicked while tracking your emotional sensations, it may be a good idea to find a therapist to talk to.

Healing Developmental Trauma. Laurence Heller, PhD & Aline Lapierre, (2012)

The incident of the $800.00 Table Number Stands: The Behavioral Economics of Wedding Planning

For those of you who are not familiar with Behavioral Economics, it can be understood simply as the field that studies the way that thinking, feeling, and social influences impact how people and institutions make economic and financial decisions. In my opinion money is one of the most emotionally charged aspects of life as well as one that is most susceptible to confused thinking. However, for most of us there is a massive amount of denial about how vulnerable we are to poor decision making because of emotional or distorted thought.

It wasn’t until I was planning my wedding that I began to fully appreciate how distorted thinking around money can become.  I’m sure that I could write an entire book on the subject, but for the purpose of this post I will focus on how distorted mental accounting almost led me and my husband to spend $800.00 on the stands for the table numbers at our reception.

Mental accounting is a term from behavioral economics that refers to the tendency for people to place differing value on a dollar depending on the mental category in which that dollar will be spent. If we as humans were rational beings, a dollar would be perceived the same way whether we were buying a pack of gum or a computer. The reality is that most of us would think twice before buying a pack of gum that suddenly cost $2.25 when we were used to paying $1.25. Maybe one would even go all the way to a different store to buy a pack of gum at the normal price. However, when buying a computer, I don’t imagine many of us would leave and go to a different store upon learning that the computer we wanted cost $901.00 at the store we were at and only 900.00 at the store down the street.

Now this brings me to the incident of the $800.00 table number stands. Like most couples planning a wedding, my husband and I had to get used to spending many hundreds of dollars here and many thousands of dollars there to create our special day. By the time we reached the week of the wedding, when it came to expenses for the big day, a dollar had begun to look more like 10 cents. And worst of all, like a crab in a slowly heating pot, I did not even notice until two days before the wedding when my husband presented me with the following question: “Do you think we should use the table number holders that Christine (wedding planner) recommended? They cost $800.00 but Christine says that they will be beautiful.” For anyone who is not either extremely wealthy or currently in the clutches of the wedding industrial complex, this is a crazy idea. My husband, who is one of the most financially responsible people I know, under any other circumstance would not have entertained it for a second. However, at that point the mental accounting category of “the wedding” was so distorted that we actually considered it for a solid 20 minutes. Thank goodness rationality broke through the overwhelming haze of wedding preparation, in end we spent $20.00 on barely visible table number stands. In retrospect, I can only imagine the sum our distorted mental accounting cost us on any number of minor decisions.

There are many times in life in which spending larger sums of money will distort the perception of a dollar. To avoid unnecessary cost I recommend the following.

1)         Remind yourself of your understanding of the value of a dollar in smaller purchases

2)         Avoid add-ons: e.g. How much do you really need the $1000.00 seat heaters added to your new car if you live in Southern California?

3)         Practice giving yourself time to evaluate decisions

4)         Think about how much you make per hour of work and ask yourself:  Am I willing to work X number of hours to have this or that?

How Selfishness Can Lead to Better Relationships and a Happier Life

Laura is known as an extremely nice and helpful person. She goes out of her way for others at work, is the first person to help a friend in need, and is the model mother with a continual presence at her children’s school. Laura is also a giving and understanding wife. Like Laura, her husband Bill has a demanding job. Unlike Laura, he often works late to meet deadlines. Laura knows her children need her home for dinner, so she frequently wakes up at 4:30 in the morning to get extra work done. On weekends Laura understands that Bill needs time to shake off the week by surfing or playing racquetball with his friends. While Bill is out Laura thinks of fun and creative ways to entertain and educate her children. When people meet Laura the first thing they notice is her ready smile and her gracious manners. If they look a little closer they may notice a bit of strain around her eyes and the tightness of a clenched jaw. No one knows it but Laura is suffering. Over the course of a couple years, the joy and excitement she used to feel so easily has left her. She finds herself feeling irritable and having intrusive negative thoughts about her husband, children, coworkers, and friends. She chides herself for being ungrateful. Bill has been a good husband and she has been blessed with kind friends and healthy smart children. She feels deeply ashamed. Everyone knows her to be such a good person and she has always believed this of herself, but now she is beginning to feel like a fraud.

The word selfish gets a bad rap in our culture, as does the term self-centered. Meanwhile, selflessness is considered a virtue.  People (especially women) are encouraged to prioritize their spouses, children, and jobs over themselves. Those who do this are reinforced for being a good parent, hard worker, or a generally good person. For people who put themselves behind everyone else in their lives on a consistent basis and receive the accolades that follow, selflessness becomes a cornerstone of identity and self-esteem.

At this point you might be asking yourself: “What is wrong with being selfless? Wouldn’t the world be a better place if everyone put others before themselves?” To this I respond: in an ideal world, perhaps, but a couple of realities of this world get in the way. First, acting selfless in a relationship is no guarantee that others will do the same. It is no secret that there are many people in this world who generally do not put others first. Second, the deepest flaw in the concept of selflessness is that it violates the fundamental reality that everyone in fact has a self. Everyone has a body that needs care, emotions that need acknowledgment, and thoughts that need to be heard. People who chronically deny this truth for the good of others often end up feeling resentful of the loved ones they are putting first. In my opinion this is the saddest aspect of the problem of selflessness.

I see it all the time in therapy: A person comes in feeling depressed, depleted, and irritable, often having very negative thoughts and feelings towards the people they love the most. To add to their suffering, this person invariably feels guilty about their bad feelings and thoughts. They feel like if only they were a better person they wouldn’t feel this way. In this case therapy involves the process of acknowledging the reality of the self, learning to tend to the needs of the self (i.e. being selfish), and learning to help and give to others from the solid ground of having met ones own physical, emotional, and mental needs first (i.e. being self-centered). This process can take awhile in more extreme cases, but in the end depression tends to lift, and relationships improve and flourish. In essence, one learns the lesson every airline attendant instructs before take-off: You have to put your own oxygen mask on first.

The following are 5 ways to begin the process of becoming a healthy, happy, self-centered person:

1.    ATTEND TO YOUR PHYSICAL NEEDS: Drink water, eat nourishing foods, move your body, and incorporate more sleep and rest.

2.    ATTEND TO YOUR EMOTIONS: Take time every day to check in with your feelings. Notice how you feel after completing a task, or interacting with someone. Your emotions are information, listen to them!

3.    ATTEND TO YOUR THOUGHTS: Check in with your opinions and beliefs on the topics and issues that come up throughout the day. Try to differentiate between your own thoughts and the thoughts of others.

4.    TAKE TIME BY YOURSELF: It’s often difficult to hear the needs of the self when continually around others; alone time is essential.

5.    SEEK HELP IF NEEDED: If you find that doing the above causes feelings of guilt, or if you find yourself making every excuse not to, consult a therapist. You deserve to care for yourself, and the people you love deserve a healthy and whole you to love in return.