Lydia Peckover is a Northwest Family Life affiliate therapist working with children, teens, parents, individuals and couples. Her specialties include trauma and PTSD, behavioral issues, and life transitions. She often works with art / play therapy, EMDR and DBT skills.
Research shows encouraging results around art / play therapy, especially when compared with talk therapy. Can you talk about this?
Dr. Karyn Purvis states, “Scientists have recently determined that it takes approximately 400 repetitions to create a new synapse in the brain -unless it is done with play therapy, in which case it takes between 10 and 20 repetitions!” To put this in perspective talk therapy requires about 400 instances of talking about the new habit before the brain creates a new connection to exhibit a new behavior with more ease. That is more than a year of weekly sessions! Play therapy would take about 10 to 20 sessions before the brain would create a connection to do the new behavior. Why? Because the brain is more active when we use a sand tray, play, art, music, movement, and/or creativity. This research encourages people to be more open to using play therapeutic techniques in therapy, such as a sand tray.
About half of your work is with children. Can you tell us what happens in sand play?
A sand tray is an Expressive Arts and Play therapeutic technique. The goal is to express your thoughts in the sand. The person (of any age) creates a story in the sand using miniature characters, objects, etc. This form of play therapy is a way to see our thoughts (or the story) as objects in the sand, and it helps to organize our thoughts to help us feel better. A sand tray helps all ages and can be used with dry sand (trauma sensitive) or wet sand, using warm water.
You also use expressive arts therapy with adults. How is using art to access different parts of the brain effective?
Expressive Arts is a way of communicating without necessarily using words. Brain scans have shown more activity in the brain when using creativity, art, music, and movement than when a person is using speech alone. I use somatic experiencing therapeutic techniques, expressive arts, and even “sessions while walking” in therapy because I have seen that when people use more areas of the brain in therapy it speeds up the healing process. Our brain naturally wants to help us heal, we might as well allow more areas of the brain to participate in therapy!
You do a lot of work using dialectical behavior therapy (DBT). Can you tell us about the skills that DBT teaches?
The four types of DBT skills includeMindfulness (being present to experience what’s happening now as a way to take a break from worrying about the past and future), Distress Tolerance (Dr. Marsha Linehan describes it as “how to survive the crisis without making it worse” and skills to “accept”), Emotional Regulation (understanding emotions and using skills to maintain a balance), and Interpersonal Effectiveness (people skills). Many people I work with tell me they like to learn DBT Skills because each skill is described simply and it’s like having an instruction book on how to live a better life.
Who can benefit from utilizing DBT skills?
Everyone, young or more mature, can benefit from using DBT Skills. This is a behavior therapy that helps us change behaviors to “live a life worth living” and to “reduce pain and suffering.” (quotes by Dr. Marsha Linehan, founder of DBT.) I use DBT Skills with children, teens, adults, parents and mature adults. Parents find helpful skills to parent more gently and effectively. DBT is an evidenced based practice for suicidal ideation, bipolar disorder, borderline personality disorder, depression, anxiety, and trauma/PTSD (Post Traumatic Stress). DBT is well researched and proven effective with addictive behaviors as well as preventing nightmares, sleep disorders, grief, schizophrenia, and many other mental health disorders. People who are suicidal come in for DBT Skills therapy because of the pain of living. I have seen many begin to use DBT Skills and begin to participate fully in life.
Tell us about your work with EMDR trauma therapy and how it can heal trauma wounds.
EMDR therapy, founded by Dr. Francine Shapiro, uses the Adaptive Information Processing (AIP) theory; it is our body’s natural tendency to heal itself. For example, with a bacterial infection, our body automatically works to heal the infection. Using the AIP theory, EMDR therapy’s goal is to activate the brain using bilateral stimulation (left and right sides of the body) with either eye movements, sound or touch (like tapping) so the brain can be fully on board to reprocess stressful/trauma memories.
These memories are stored improperly in the brain and cause a trauma response. After EMDR therapy people have found results such as lack of distressing thoughts, emotions, and body sensations. Here is an example of healing traumatic body memories: A survivor of domestic violence has discomfort in a new relationship because they cannot be touched without being triggered by a body memory from past abuse. After using EMDR therapy, this person has reprocessed the body sensations and has no body triggers. This person can be touched and feel the natural feelings of safety and healthy attachment in the new relationship.
EMDR therapy is an evidence-based practice for PTSD (Post Traumatic Stress Disorder). It has been shown to effectively relieve anxiety, depression, chronic pain, migraines, addictive behavior, grief, insomnia, and more. Some therapists listen for negative beliefs in therapy as an indicator of who can be helped by EMDR therapy, because they believe the anxiety, depression, pain, etc. were likely caused by the negative beliefs about themselves.
Negative beliefs such as, “It’s all my fault,” “I have no control,” or “I’m not safe” are formed at the same time as a stressful situation or traumatic event. The goal in EMDR therapy is to create positive beliefs. Holding positive beliefs about one’s self can reduce trauma responses such as depression, anxiety, unexplainable pain or sickness, overreacting or feeling numb, feeling triggered, memory absences, avoidance, nightmares, etc.
Many people have said EMDR therapy has fast results, especially in children and teens. EMDR therapy can be used with other therapeutic techniques such as Attachment Focused therapies, Expressive Arts, Somatic Experiencing (body work) and Play therapy. There is a need for assessment and preparing people for EMDR therapy. DBT Skills help prepare people to stabilize behaviors so they are ready for trauma therapy such as EMDR therapy.
Talk to us about “Installing a future template.”
EMDR therapy provides many therapeutic techniques that help therapists become more effective and efficient. EMDR therapy works on the past, present, and future. Installing Future Templates is an EMDR therapeutic technique that helps therapists see how the person would handle stress in the future. Installing a Future Template also identifies any developmental gaps. For example, if a person experienced a medical trauma, child abuse or substance abuse (such as drug use) in their teen years, this traumatic event could stop or delay development. The adult may need skills to be able to understand their own identity or have difficulty solving problems on their own because they were unable to learn these vital developmental skills as a teen. So we would work on those skills in therapy. Installing Future Templates is a quick check-in and helps a person assess ability just by asking a few questions.
You also work with couples. Tell us about using Gottman skills and DBT skills in this work.
Many times couples ask for the Gottman therapeutic techniques in therapy because of it’s great results. I have found many couples need steps before jumping into using Gottman’s techniques. DBT Skills can be used as steps to help couples understand how to communicate better in a relationship. For example, DBT skills such as the GIVE skill (be gentle with yourself and others, act interested, validate the valid, use an easy manner) can be used to build healthy relationships or the FAST skill to keep your self-respect in relationships. These Interpersonal Effectiveness DBT Skills may be used with Gottman’s “Four Horses of the Apocalypse,” the predictors for divorce (Defensive, Criticism, Contempt, Stonewalling). Also, sometimes therapies can cause a trauma response in those who are trauma sensitive. This is why treatment plans in therapy are unique and tailored to the individual and/or couple’s needs. Some find DBT Skills as a more trauma sensitive approach for couples, yet there is such an effective framework provided by the Gottman Institute. For couples, I like to use both Gottman techniques and DBT Skills.
In your work with families, you’ve said that a big part of it is teaching parents how to calm down. If the parent can self regulate, what can follow?
When the child’s environment is calm the child can work on issues causing distress and engage in trauma work. As the child or teen does their therapy, I continue to work with parents toward healthy attachment with their child and what is developmentally appropriate.
How can trauma affect developmental stages?
Trauma responses include fight, flight or freeze modes. Reliving the traumatic event can mean living in one of these states, in other words, a pretty intense survival mode. These high levels of distress cause our brain to focus on surviving the danger and development is put on hold. An example is a child who experienced early childhood trauma and has speech delays. Later on, the child needs support to develop speech.
Another example is if a person experienced a medical trauma or substance abuse (such as drug use) in their teen years. This traumatic event could have caused their development to stop during the time of danger and could cause a gap in their development. As an adult, they may need support to be able to understand their own identity or have difficulty solving problems on their own because they were unable to learn these vital developmental skills as a teen. So we would work on those developmental skills in therapy.
You can connect with Lydia via her website, https://arisewellcounselingservices.com
Bethany Hendrickson is a mental health therapist practicing in Seattle, WA. Among her clients are people who have survived abuse and trauma. She is a counseling affiliate of Northwest Family Life, and also leads State Certified groups for perpetrators of domestic violence.
Could you talk with us about the intersection between survivors and perpetrators of domestic violence?
The cycle of domestic violence continues until it is broken, and for many people it begins in childhood – witnessing violence between their parents, being targeted for abuse within the family, or even just experiencing an environment of control and disrespect. We learn how to treat others, and how to treat ourselves, first from our parents and families. We see our parents experience emotions and then we see them choose to act, either violently in anger, or respectfully in love. People who grow up seeing and experiencing violence are far more likely to either choose a partner who abuses them, or to abuse their own loved ones.
What are unbearable emotions?
In our domestic violence groups at NWFL we talk a lot about unbearable emotions. What we mean by “unbearable” is simply an emotion that you *hate* to feel. We all have a top few unbearable emotions; emotions that hit us right in the gut and cut through our defenses. It might be loneliness, helplessness, feeling unheard, dismissed, or disregarded – whatever negative emotion just sends you over the edge – that is one of your unbearable emotions.
How can a person deal with unbearable emotions without letting them escalate to explosion?
The key is to take a break from any situation in which you notice tension building (red face, raised voice, heart palpitating, ruminating thoughts, etc.) In our groups people learn to tune in to their body and emotional selves to notice early on when they are feeling upset. This gives them time to calmly take a break, and come back to the situation/conversation/interaction after they have had the chance to calm their mind and body.
What are some de-escalation tools?
Anything that helps calm you down! Non-aggressive physical activity like walking, biking, or yoga, music, art, reading, praying, talking to a friend (probably about something other than what you are upset about). It’s not time to go over and over the event and figure out how to convince the other person that you are right, it is a time to disconnect from anger and reconnect with your inner desires, and your most raw feelings and needs.
How can a person shift their unconscious responses and interrupt the cycle of abuse?
The most important factor is a desire to change. Anyone can learn how to take a break, calm down, speak more respectfully, but it’s hard work to shift abusive responses. It’s hard work to feel our true feelings (the feelings underneath all of that anger and rage). It’s takes courage to face ourselves, and bravery to be vulnerable and to admit wrongdoing. In order to change you have to be willing to release old patterns that you’ve been relying on, and make space for new patterns that will feel odd and uncomfortable at first.
How might someone use their body as a guiding and important signpost?
Our bodies are where our emotions live. When we feel anxious our heart pounds, when we feel sad we have a pit in our stomach. Our bodies experience tension and it shows up in our drumming fingers, bouncing knees, red face, throbbing veins, rising voice. Tension in your body is a sign to tune in to your emotions and take care of yourself by calming down.
What does a “Time Out Contract” look like?
Think through your own triggers/red flags, unbearable emotions that come up, and what you need in order to calm down when you experience these things. It should be a detailed plan that you share with trusted loved ones, so that you can all be on the same page and agree to give each other time to calm down when needed. Taking a “time out” isn’t an excuse to storm away and abandon your partner – it’s a premeditated, structured break.
Could you talk about developing a personalized crisis plan?
A crisis plan is a great document to have, both for people who are experiencing /or have experienced abuse, and for people who are attempting to become safe and change their abusive patterns. A crisis plan should have an “A” plan and a “B” plan (for when plan A doesn’t work out). Think through likely crisis situations that might come up: where are your exits? What will you need? Who will need to come with you? Who will you call? Where will you go? How much money will you need and will you have access to that money? Ask the question: what will keep me, and the people around me, safe in this situation?
You say that survivors struggle to ‘be’ in the world as they want to ‘be.’ How can people become more self-actualized?
The real answer to this question is that it’s a journey. When the world has been an unsafe place it can be difficult to establish safe habits, safe relationships, and the expectation that you will be treated with respect. Survivors can often benefit from similar de-escalation skills as perpetrators – the difference being that the goal for the survivor is to exit the unsafe situation, whereas the goal for a perpetrator is to take responsibility for one’s own actions and create safe space for others. Anyone can get caught in a fight/flight/freeze amygdala response. Creating a self-care/time-out plan to notice early on that your needs aren’t being met can help point the way toward healing and helpful interventions.
How do victims of abuse get stuck in absorbing blame, and how might they shift that?
Like I said, the goal for perpetrators is to take full responsibility for their own emotions and actions. One thing that perpetrators do really well is blame others. People who have experienced abuse are often very familiar with what it feels like to be blamed, and sometimes they even believe that they are to blame for the other person’s actions. Healing for survivors is often a process of sorting through events and taking responsibility only for their own actions, their own emotions – and refusing to take responsibility for what the other person did or said. If each person is in charge of the sidewalk on their side of the street, we need to only be sweeping our own sidewalk. We cannot sweep the other person’s sidewalk – that is their job.
Who has a say as to what can change in a person’s life?
We are all only in control of ourselves! We can only change what we do. We have no control over what anyone else says or does or thinks.
How can people care for their own emotions?
Think holistically: body, mind, spirit. Our bodies need good sleep, nutrition, and exercise. Our minds need a balance of stimulation and rest. Our spirits need connection, community, and a sense of purpose. Once you can tune in to what your body is telling you about your own emotions, you can begin the process of thinking through what that means for you.
Bethany has a book in the works, with positive, accessible info specifically written for perpetrators of domestic violence. We look forward to sharing it with you when it’s released. You can connect with her here.
Q. What is Soul Care?
Soul care is tending to our inner psychospiritual life, which affects our whole self.Soul care doesn’t just mean spiritual care. We are complex intertwined beings. Our soul, body, mind and emotions are all interconnected in who we are.
Tending to thesoul does not preclude listening to our bodies. As I address my false beliefs that drive my unhealthy behaviors and integrate a daily prayer, I am benefiting my whole self. I breathe easier, I am more grounded, I am less stressed, and I am more alive. I am resilient. I am free to thrive.
Q. How might soul care differ from self-care?
At least in popular culture, self-care seems to mean pampering or other activities that we need to add to our lives. In contrast, I see soul care as a deep tuning in and tending to our whole self. It is not necessarily adding activities but reorienting our lives and listening to what our body needs – taking a lunch break or going to the bathroom when needed. It might involve exploring the reasons why we don’t take care of ourselves, and addressing our inner beliefs that drive our unhealthy behaviors instead of simply creating a self-care plan. It might encompass a daily practice that is simple, life-giving, nourishing, and grounding. Soul care is a journey of recovery towards wholeness.
Q. What are some of the aversions you yourself have had to the term “self care”?
I used to think self-caremeant pampering and was thus trivial. I thought I didn’t need it, that I was strong enough.I also felt guilty at taking time for myself in the face of so much injustice and poverty.
Q. Would you share with us a little about how you came to be passionate about soul care?
My passion for soul care arose from necessity – going through the emotional exhaustion and toll of burnout. Ten years ago, if I were to learn that I would become passionate about training and equipping others for a more healthy and sustainable life, I would have been shocked. Like many, I was affected by the stories of trauma I had heard working in a domestic violence shelter, in jail, and a family support center. I felt the weight and grief of people I cared about who were torn apart by immigration, incarceration, abuse, sexual exploitation and addiction. I came to the end of myself and couldn’t go on. I started this soul care journey recognizing that I needed help and to make significant changes. I felt powerless against the effects of accumulated secondary trauma, work holism and codependency. My life had become unmanageable. I was taking step 1 of 12-step programs without knowing it.
Recovery has involved journeying towards living out of being God’s beloved instead finding my identity in what I do, towards freedom instead of desperation to make a difference, and towards loving myself as I love my neighbor. It’s been a journey of pride and brokenness, of learning to say no and asking for help, of healing and renewal, of contemplation and centeredness.
Q. How might someone add rhythms of rest to their life?
In order to change behavior, we need to begin small and daily. Although a daily practice can feel hard to maintain in this midst of many things to do, it can actually make us more alive and equipped for the tasks at hand.
In Laura van Dernoot Lipsky’s book, Trauma Stewardship, she recommends choosing what works for you, for the season you’re in.
It might be centering prayer or other meditation, yoga, reading Scripture, exercise, journaling, coloring pages, going for a walk, or simply sitting with a cup of coffee for a few minutes when you wake up.
Whatever it is, the two key elements are: life giving and daily.
Integrating regular rhythms is essential to be rooted in the truth about ourselves and to be resilient.
Q. Could you talk about small margins in the day that let us take care of ourselves and let go of what we are carrying?
One idea is to have small practices during transitions, when waking up, before going to work, before getting home, in between appointments, or during a lunch break. For example, during or after an appointment we might check in with ourselves:
How was I feeling listening to that person?
How did that appointment affect me?
A transition activity doesn’t have to be a huge time consumer, but rather a simple activity that engages the senses: washing hands, walking around the block, taking three deep breaths, or free-writing for five minutes. Maybe it means not checking email first thing upon waking up or setting a reminder to start unwinding at a certain time of day.
Q. How is one’s identity and what they believe about themselves linked to how they care for themselves?
We have to believe we deserve care. We have to know we are loved regardless of what we do. Self-care is undermined if we don’t believe that we deserve it or need it. Seeking to change our behavior will be futile. Somewhere along the way, many have internalized the message that we are loved for what we do.
When we live out of our identity in what we do, we risk not only hurting ourselves but also hurting others, including those we seek to serve. Those we are trying to help become projects on which our success depends. Their failure is thus our failure. When living this way, the remedy to failing is to try harder and do more. We can begin wanting their change more than they do. Sometimes this develops into a need to control another’s lifeand alienate the very people we are trying to help, leading to an unhealthy codependency instead of a love born out of freedom.
Deeper soul care is needed to ground ourselves in our identity as beloveds, explore the beliefs that drive our unhealthy behaviors, and begin taking care of ourselves.
Q. What are some of the signs of secondary trauma?
- Guilt, feeling bad for taking care of oneself.
- Feeling helpless, like you can’t do enough.
- Physical or emotional exhaustion, hyper vigilance.
- Messiah complex, feeling like it’s all up to you.
- Fear of not being enough, not being accepted, of rejection. Fear for personal safety, of persecution.
- Culturally accepted addictions like codependency and work holism.
Q. Do you have some tools for people to become aware of how their work is affecting them?
These assessments are helpful for some people, not all. They are not meant to add guilt or shame. Rather they can help increase awareness of how you are being affected, validating that you are understandably affected.
- The book, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Othersby Laura van Dernoot Lipsky. Includes the 16 most common responses to trauma and is a great resource. The website http://traumastewardship.comand Lipsky’s TedX talk are also helpful.
- The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization, by Françoise Mathieu
- International Society for Traumatic Stress Studies http://www.istss.org/treating-trauma/self-care-for-providers.aspx. Indirect Trauma (PDF) Free Handout. Self-Care Tips Handout in English/Spanish/French.
Q. What does one do with that awareness?
Pursuing healing and change…begin the soul care journey! Start a daily practice. Build a support team that could include: a consult group, personal therapist, Spiritual director, mentor, ect.
Bethany has a book on Soul Care in the works, full of content that is accessible, relevant, and helpful. We look forward to sharing it with you when it comes out. You can connect with her here
Bent Meyer is an affiliate therapist at Northwest Family Life.
We spoke to him about non-verbal memory, the reactiveness that comes from that place, and how someone might integrate their non-verbal system with their cognitive one.
Talk to us about the non-verbal cues generated in our brains.
Non-verbal cues are evoked by data that come though our input senses (eyes, ears, touch, smell, etc.). It only takes 30 milliseconds for the data to find a pattern match within structures like the limbic system and hypothalamus. The pattern matching comes from previous life experience that was taken in through our senses and recorded in the non-verbal memory system to be accessed later in life.
Once a pattern match is found messaging is sent to various parts of our body to activate glands, muscles, capillaries and such to prepare for action related to what is being perceived. It takes an additional 300 to 500 milliseconds for words to be formed within our rational mind.
What kind of reactiveness comes out of non-verbal memory?
The consequence is we are already in action mode before rational consideration (executive function) can be made to evaluate whether our perception is valid or not.The limbic system is intrinsically designed and sensitive to keeping one alive and out of unpleasantness. Thus, it is biased to be particularly attuned to the negative.This provides some clarity to why defensiveness is most people’s default response when feeling shame and powerlessness.
If non-verbal memory is activating our body 10 times before we can think about it, how can people make a bridge between reacting and evaluating a situation first?
It starts with open curiosity, a felt posture of leaning into and observing without categorizing something as ‘good’ or ‘bad’. The task is not to obliterate our defenses but to regulate them so that they are not super aroused in situations that are benign. When we can bring awareness to the sensations in the body, asking questions about what stimulated this reaction, we can look at the patterns of thinking and behavior that are evoked. The next part is to tolerate the feelings without acting. It is holding long enough to do a reality check, slowing down to let executive function come on line.
Why is it important to be able to put words to what one is experiencing?
The benefit of integrating words with non-verbal cues is the ability to get out what is locked up inside the body without having to act it out. It is a way to not be alone. Words provide a means for others to join in our joy, pain and confusion. Words also integrate abstraction with subjective knowing and slow down reactiveness.
Can you explain a transactional way of relating in relationships?
In our culture we have been taught the values of cause and effect evaluation. It is a default in our communication with others. “I feel this way because you did _______!” I call this transactional. It externalizes the reason I feel what I feel. Each of us is responsible for how we each read and manage our internal cue and arousal. When awareness and responsibility are active, blame shifting is greatly reduced. When two people read well the full bandwidth of verbal and non-verbal communication, both from the other and from ones own interpretive cues, there can be openness to collaborate.
Can you elaborate on thinking in categories of mutuality, rather than of power differentials?
Power differential is useful in hierarchical structures, like business or military organizations, were specific purpose and time sensitive goals must be executed. But, in intimate relationships it is rarely useful.
When it exists in intimate relationships, the one with power is often on an intellectual island, relying only on their own wit. The partner is subject in a role that often is functional, but often not prized as a source of importance. For such a partner, silence is often safest. In order for the subject to have influence, manipulation, or their own power bid, must be employed. It this context, the dynamic becomes one of winning or losing. The relationship is transactional. Inter mutual dependence is unknown within these couples.
And in a scenario of mutuality?
Close intimate relationships that employ mutuality have a fluidity about them. There is an admiration and respect for the mind and abilities of the other. There is simultaneously a real knowing of one’s own current ability to contribute. I say current, because there is also an assurance that my capacity to know and be is likely improved tomorrow. It is an interdependence that collaboratively wrestles, debates, researches, and brings forward disparate resources to formulate what each could or would not do alone.
Can you speak to the process of integrating our cognitive system with our non-verbal one and thus gaining more executive / cognitive control?
The process of integrating our subjective known world and our verbal system is through awareness first, then using descriptive language. At first this might be as simple as a child who says say “Owee” and points to their ear. Obviously, later in life our descriptive language grows to where we can use metaphors to describe inner experience, for example, “I feel like I can’t breathe” to describe terror felt in social settings.
When language is not integrated with non-verbal knowing we are trapped within our skin. The only choice we have to get it out of us is to action it out. Language conventions provide the way for our inner experience, world and thoughts to be joined by others instead of trapped inside us.
Integration is the function of connecting wiring between disparate parts of the brain with enough redundancy to make the communication fuller and speedier. It is to deepen and widen knowing.
You say for most people, in the same way that “different” is often uncomfortable, so is changing our non-verbal experience system. Can you talk about pushing through this discomfort?
If you have played golf, you will likely remember the first time someone showed you how to correctly grip the handle of a club. It like felt odd, and you might have retreated to a hold that felt more comfortable to you. But the joy felt in the increasing performance from your swing made the transition to a new hold possible.
Change involves the POSIBILITY of something different. It is being curious. There is a playful leaning into possibility. What is under that rock on the beach?
I wonder what will happen if I _______? It is a given, that you will not know unless you try, and in the trying, failure is tolerably measure, yet a little on the risky side.
Change occurs with repetition and with increased complexity. This means deepening tolerance while widening variability of experience. This means the tendencies to demand fixed sequences, recipes, and time allocations must be loosened. One must teach the experience system that there are more experiences that are not dangerous, heavy, exhausting, and unpleasant, but rather surprisingly enjoyable.
Connect with Bent here