Olivier Rouiller

Draft in progress...

I am influenced by current therapeutic trends that give significant importance to trauma in understanding psychological difficulties and in the approach used to address them. Furthermore, we find the idea that traumas leave their trace in the body (Van der Kolk 2015).

These ideas have gained popularity in mainstream culture, they resonated with me when I was looking for answers, and they have scientific bases that continue to be developed. Finally, in my opinion, thinking about psychological difficulties in terms of trauma allows for the development of therapeutic methods that are conceptually sound and appear effective in practice.

In what follows, I will provide a brief introduction to these models and how they apply in experiential therapies that can be integrated into both CBT and psychoanalytic practice.

My understanding, and the hypothesis I want to explore, is as follows:

Starting from polyvagal theory, we will see how it can be applied to the resolution of shock traumas such as PTSD and how it can be used to regulate regressed states that may occur in relational therapies.

Polyvagal Theory

At the heart of many trauma therapies is polyvagal theory, which describes the different modes of functioning of the autonomic nervous system. Porges starts from the observation that when animals are in a dangerous situation, their nervous system activates different modes depending on the situation. If there is a chance of survival in confrontation, the Fight mode will be activated. If, on the other hand, the chances are low, the animal will flee (Flight). In both cases, energy is mobilized for action; these two modes are hyperactivated and are associated with the activation of the sympathetic nervous system.

Porges also observes that animals in flight mode suddenly freeze when they perceive they have no chance of survival by fleeing. The strategy is then to play dead, hoping the predator will abandon them. This is called the Freeze mode. It is the dorsal branch of the parasympathetic nervous system. This mode is also referred to as hypoactive. Some more recent models also introduce the Collapse mode.

Finally, when animals, and more specifically mammals, are in a state of safety with their peers, the nervous system is in rest and digest mode, or the Social Engagement System. For humans, it is in this mode that we have access to empathy and emotional regulation within connection.

Psychotrauma According to Polyvagal Theory

According to this model, psychotrauma, and in its most acute form PTSD, is linked to a system that has remained stuck in Freeze mode.

Levine notes that when the possum plays dead, if by chance the predator abandons it, it spontaneously emerges from its immobility with erratic movements resembling undirected attacks, or tremors. There is a discharge of energy, and then suddenly the animal resumes its normal functioning mode.

According to Levine, psychotrauma in humans is due to the fact that, when we emerge from a traumatic situation, there has been no discharge, and our nervous system remains stuck in survival mode. It's as if the threat is still present. Levine hypothesizes that the prefrontal cortex inhibits the sympathetic discharge seen in animals, which would allow the mobilization cycle to be completed. This led to Somatic Experiencing therapy.

Somatic Experiencing

Based on these observations, Peter Levine developed his Somatic Experiencing therapy.

SE is an exposure therapy that relies on the felt sense of resources to aid in the renegotiation of traumatic events and thus their integration.

The three conditions for emerging from trauma: Being connected, safe, and oriented in the here and now.

The client is oriented in the here and now by appealing to the safety of the therapeutic relationship, and then progressively exposed to the memory of the traumatic event while incorporating resources to prevent retraumatization. The goal is to mobilize hyperactivation and a differentiated defensive response to exit the freezing associated with the traumatic memory.

Developmental Trauma

In the case of developmental traumas, the threat lies in the attachment bond, and we also find hyper- and hypo-activations. The baby will mobilize resources to ensure that the caregiver meets their needs, and in cases where these needs are not supported or the caregiver is a threat, there will be freezing. Thus, we find mechanisms similar to shock traumas, but the threat is in the bond, and freezing or hyperactivation occurs at earlier developmental stages.

"The price of freezing is that I do not exist"

Anzieux provides a similar definition for developmental trauma:

> This set of transference/countertransference reconstitutes an infantile situation, repeated and prolonged, of paradoxical communication emanating from the parents, which was traumatic in its consequences, at certain precise points, on the development of the subject's psychic apparatus [...].

TODO:

window of tolerance, dissociation, fragmentation, integration, shame as a physiological response, procedural memory, cortical control

Bibliography

Van der Kolk, B. A. (2015). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin Books.