Dissociation, Attachment Trauma & the Brainstem with Nikki Nooteboom

Dissociation, Attachment Trauma & the Brainstem with Nikki Nooteboom

In this episode of Going Inside, Dutch therapist and trainer Nikki Nooteboom joins John to explore how neurobiology is reshaping trauma therapy. From the vestibular system to dissociation and the default mode network, Nikki breaks down the deep physiological roots of trauma — and how to work with them more effectively in clinical practice. If you've ever wondered why some clients can't stay grounded or why insight alone doesn't lead to healing, this conversation is for you.

🔑 3 Key Takeaways

1. Why Knowing Isn’t Healing: Insight alone doesn’t shift trauma — the body must first rediscover safety through bottom-up integration.
2. The Vestibular System’s Role in Trauma: Learn how trauma disrupts orientation and balance at a neurological level — and why that matters more than we think.
3. Beyond Coping: Creating Real Safety in the Brain: Discover how consistent, structured grounding practices can actually rewire a brain organized around survival.

👤 Guest: Nikki Nooteboom

Nikki Nooteboom is a Dutch therapist and trainer who integrates neurobiology with trauma healing methods like IFS, EMDR, and somatic therapies. Her work focuses on making therapy more effective by working with the brain from the bottom up. She also trains other therapists, social workers, and bodyworkers in neuro-informed approaches through the Finding Solid Ground program and the Trauma-Informed Academy.

• Website (Therapy): www.neuroinformedcare.com
• Website (Trainings): www.traumainformedacademy.org
• LinkedIn: Nikki Nooteboom
• Instagram: @traumatherapeut_nikki

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Transcript

Nikki Nooteboom: [00:00:00] You need self energy to be able to communicate with these parts. Mm-hmm. And to give this feeling of safety, of crio, of, or curiosity, all the a Cs. Right. Um, but how do you know as a therapist that someone is really in that self energy?

John Clarke: Going Inside is a podcast on a mission to help people heal from trauma and reconnect with their authentic self. Join me trauma therapist John Clarke for guest interviews, real life therapy sessions, and soothing guided meditations. Whether you're navigating your own trauma, helping others heal from trauma, or simply yearning for a deeper understanding of yourself, going inside is your companion on the path to healing and self-discovery.

Download free guided meditations and apply to work with me one-on-one at johnclarketherapy.com. Thanks for being here. Let's dive in.

Nikki is a Dutch therapist and trainer who works with trauma from a neurobiological perspective. [00:01:00] She has studied with multiple researchers and clinical developers. In the last years, she started working more from a neurobiology. More from neurobiology as a basis for I-F-S-E-M-D-R, and Somatic Therapies.

She recently added the Finding Solid Ground Program to her practice. This program marked a turning point in her own approach to therapy, shifting her focus even more clearly to trauma Healing methods backed by neurological insights. Nikki also provides trainings in neuro informed. Working to other therapists, social workers and body workers.

Uh, Nikki, thank you so much for being here. How are you doing? And, um, maybe a little more about who you are and how you got here. 

Nikki Nooteboom: Thank you. Thank you for the invitation. 

John Clarke: Sure. 

Nikki Nooteboom: So, yeah, I, I, I work more from neurobiology since, uh, a few years now. And, um, because it gives such a clear view on how trauma works on a deeper level, um, [00:02:00] and you can really work more bottom up instead of top down, uh, which makes a lot of, a lot clear, uh, to the therapist.

To know that you, that there is a chronological order on building up a brain and what happens in trauma. And, and also what is very important is that you start knowing that what doesn't happen when there's trauma. So what parts of the brain are not active or are not, uh, in a default? Uh. Mode network. Uh, so it's very important to when, you know that is, it makes it a lot more logical.

John Clarke: Mm-hmm. Yeah. Yeah. Let's keep going with that. So, uh, based on Yeah. Your research and learning, what do we know about trauma in the brain? Um, yeah. 

Nikki Nooteboom: So, just to be clear, I, I'm not the one doing the research. Sure. [00:03:00] Um, I work with the research, uh, that is done and I have two people that are very dear to me.

They're really good, uh, trainers. Um, first that is Dan Siegel. Of course, everybody or most people will know him probably. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Um, the hand model of the brain, the window of tolerance. Uh, and Ruth Lanius, and she's, um, she's a, a Canadian neuros neuropsychiatrist. And, um, and she developed together with her whole team, she developed Finding Solid Ground Pro program based on her neurological research.

Uh, and she has been doing research on trauma and especially dissociation. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Uh, from for, well, decades. Decades now.

John Clarke: Yeah. 

Nikki Nooteboom: And she, she, she gives, she does a lot of research [00:04:00] and what she does, and that is, that is very amazing, is that she, she not only does this research for on trauma and, um, and dissociation, but she also, um. When she developed Finding Solid Ground, what she did together with her whole team, of course, is not only her, but what they did is that they didn't only.

Test the program by talking to people or, uh, asking them about how they are feeling or, but what they really did is that they actually put these people through scanners and see, uh, how their brain was reacting. So it is not, you can actually see in deeper in the brain if they're, if the brain is organizing differently, more towards safety instead of towards survival.

John Clarke: Mm-hmm. 

Nikki Nooteboom: Which. Well, it, it gives a perspective on is there only coping? Because when you're doing [00:05:00] these, these therapies, of course you, you hope that things are really, will really change like on a deeper level, but you never really know that. Right? And the moment that you can make the brain visible and you can see how the brain can adapt, not only.

How it started as being adapted and organized towards unsafety, that it can actually change towards safety. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Which is, which is amazing. 

John Clarke: Mm-hmm. Yeah. Yeah. So say more about how, how trauma affects the brain. 

Nikki Nooteboom: So there are different things happening when, when, uh, a, a brain is organized towards survival and.

There is, the thing is, is that we talk a lot about the nervous system, right? And these days when we hear the word nervous system, often people think that we're talking about the autonomic nervous system, right? So [00:06:00] the, the parasympathetic and the sympathetic branches, uh, we talk a lot about the vagal nerve, um, and the vagus nerve, and that is correct, but.

It's not the, the autonomic nervous system is not the only part. It's only a part of the whole nervous system. So what we see in therapies is that often therapies are either organized top down from the thinking brain, from the prefrontal cortex, downward right towards feelings. Or it's, and now that's done a lot, right?

That we are working with the autonomic nervous system to see if we can regulate and stimulate the vagus nerve so that we get, but the thing is, is that what we actually, uh, forget is that the center of our nervous system where everything gets directed from, is the brainstem. So it's in the middle of those two.

[00:07:00] And, um, in, in the brainstem, what happens is, and when, when we think about trauma as being, having its basis in, um, in attachment, right? So that is the, the most trauma that we work with is attachment based, right? It's attachment trauma. And what happens there is we see that. When you experience something overwhelming as a child, there's no no way that you can flee, right?

There's, this is what we will try to do first, try to flee, then we try to fight. So in, in both cases, a child is not able to do that. Which is a big problem. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: So what happens is there, first there will be tonic immobility, right? So the, the child gets, there's a lot going on of a, or anxiety and, and [00:08:00] stress inside, but the body cannot move anymore because it can't.

And when it goes further and further and a child is so used to being in this overwhelming situation, then in the end the whole system will collapse. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And so what is actually amazing is that we have this primal way to survive, and that is dissociation. So if you can't make yourself. Get yourself out of a situation, out of reality.

It's not only reality that you wanna move away from, it's particularly the feelings that you have because of reality. 

John Clarke: Yeah, yeah. Right. 

Nikki Nooteboom: Because you need your parents, you need the people around you. You need adult, an adult system to help you. Stay safe and to help you process and regulate all these feelings that you're having.

So [00:09:00] being left alone with these feelings in a surrounding of people that were supposed to keep you safe is that the attachment system just keeps looking for the safety and it can find it So. What it needs to be doing is to make itself scarce, right? It, it, it pulls itself away from, from the, uh, from reality, but also from the feelings that you're feeling inside.

And one of the things, or, or. There is a system that is in the basis of the brain that is so extremely important to even be able to experience safety. Um, and that's the vestibular system, right? That is a, a part in the, in the mid ear. And it gets, in the end, it gets the, the, the core of the vestibular system is in the brainstem.

So the brainstem is, is the part of the brain that [00:10:00] collects all the raw data. From all parts of the nervous system. Right? It's from the bottom up, it comes from, it comes from the vagus nerve of course, but also comes from the central nervous system. Um, it comes from all your senses like hearing, seeing, smelling, uh, touch all these sensations, uh, but also the interceptive parts.

Right? That is also a sense. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: The vestibular system is a, is a very important part of the brain, and it gets developed when the baby is from five weeks in the womb. So when the baby is in the womb, he or she's already, um, noticing gravity. And what we notice is that when a, when a baby gets, uh, is born, it is supposed [00:11:00] to, to start developing outside of the womb.

Vestibular system needs to, to develop more, of course, but in the womb, you see that the baby gets bigger and the water gets less, right? So slowly in those nine months, or after five weeks until nine months, you notice that that vestibular system gets well acquainted. With gravity more and more. And when the baby gets born, that vestibular system, um, gets, needs to develop, uh, pre, um, postnatal.

John Clarke: Mm-hmm. 

Nikki Nooteboom: And it does that by play. So by literally playing like balance techniques and things like that, uh, but also safe connections. So that it can be right in, yeah, in the moment. It can just stay here. It doesn't have to leave. It doesn't have to go. It doesn't have [00:12:00] to make itself scarce. It just can be here, and it's kept safe here.

John Clarke: Mm-hmm. 

Nikki Nooteboom: So that's very important in the moment that there is no safety and that attachment is not safe, the placebo system doesn't get developed well. 

John Clarke: Mm-hmm. 

Yeah. 

Nikki Nooteboom: And when the, when the system, and when we, when we use IFS in this, when there are parts that know this, this place is not safe, and our feelings are not safe, and we need to get the hell outta here, right?

We need to get away, and we are not, we, we cannot be here. This is what happens, that the whole system gets oriented towards staying away from the body and staying away from the ground. 

John Clarke: Mm-hmm. 

Yeah. 

Nikki Nooteboom: Um, so there's a vestibular system and then there is the proprioception system. Mm-hmm. And that is the system that, that [00:13:00] well, that is in contact with their muscles and.

The moment that you don't know where the ground is and where you are in relation to your surroundings. 

John Clarke: Yeah. 

Nikki Nooteboom: That, that brainstem is shouting. 

John Clarke: Yeah. 

Nikki Nooteboom: It's it's shouting alarm all the time. Right, right. Yeah. And that is a, that is a development in the brain that is such on a deep, basic level that. You can say that people with attachment trauma, they all have some sort of dissociation.

John Clarke: Mm-hmm. 

Nikki Nooteboom: And it can be on the hyper, hyper arousal part. Right. By ruminating thinking all these parts that are so busy with control, the managers Right. They are so busy with, with trying to to, to [00:14:00] cope and to. Keep control. Uh, but it can also be in the hypo arousal, so it can be in a state of, um, not being here.

John Clarke: Mm-hmm. 

Nikki Nooteboom: And, and when we look at polyvagal, we can see it in a sympathetic or in a dorsal state. Yeah. 

John Clarke: Makes sense. 

Nikki Nooteboom: And that's, yeah. Mm-hmm. It makes a lot of sense. And the thing is, is that when, um, when it happens. The basis is not there. It's very hard to process trauma. 

John Clarke: Yeah. 

Nikki Nooteboom: When someone is dissociated. Yeah.

And doesn't even know where the ground is

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 It's fascinating, you know, digging deeper into this piece around orienting, um, I'd love to dig into that a little bit more. Um, I'm, I've been on this journey of. Going through the Somatic Experiencing Program, the Peter Levine's program, and, um, a lot of that program and approach is around orienting, um, and just [00:16:00] very subtly and gently, and slowly working with that orienting response that is, um, for a lot of folks with, with trauma, um, quite disorganized or tentative or, um.

Yeah, a kind of unstable, so how, how important is that orienting piece and then again, this piece around the vestibular system, not really a piece I was familiar with, but how important is the vestibular system to orienting? 

Nikki Nooteboom: Very, very much so because the core of the vestibular system is in the brainstem and the vestibular system is, is working of course, together with, uh, the balance system.

So when that is not what you see with young children who are traumatized, right? Who have, uh, attachment trauma, you see that they probably feel fall a lot, right? They bump into things, uh, their fine motor is, is like off, right? Is because that system [00:17:00] doesn't know where the ground is. Mm-hmm. And that, that kid just needs to be, to get out of there.

And the orientation that you. Need. The problem is, is that because you have, um, difficulty with orienting is that you, you start being oriented inward instead of outward. 

John Clarke: Yeah. 

Nikki Nooteboom: So, 

John Clarke: yeah, and when you're oriented inward, it's too much and. 

Nikki Nooteboom: Of course. 

John Clarke: Yeah. 

Nikki Nooteboom: Yeah. And then what happens then is what we see is that when someone is dissociated and has trauma, there is no connection with the prefrontal cortex.

With the cortex in general. Right. So there are other parts of the cortex that are very, where there are almost offline. 

John Clarke: Yeah. 

Nikki Nooteboom: And which makes a lot of sense because if the, the brainstem decides to go. Uh, the peri gray is a part of the brainstem that [00:18:00] decides if you go into survival or not. Mm. And if it decides that the, especially the prefrontal cortex needs to go offline.

Yeah. 'cause it's way too slow. And I always say to my clients, well, if you need to run for a bear, you're not gonna think, what color shoes am I gonna wear? 

John Clarke: Yeah. 

Nikki Nooteboom: Right. Yeah. So it needs to go offline. It needs to make way to just act. 

John Clarke: Yeah. To mobilize. Yeah. 

Nikki Nooteboom: Right, right. That mobilizing, 

John Clarke: yeah, that mobilizing response is so essential to.

Trauma and the trauma, um, response and the impact of trauma. Um, something bad is happening and I can't do anything about it. Something bad is happening and I can do something about it. I can, I can mobilize. Right. Can be the difference between whether or not an event is traumatic or not. Yeah. [00:19:00] Yeah, yeah.

Nikki Nooteboom: Yeah. So. That is, that is something that, that, especially when someone had to dissociate and therefore that whole vestibular system wasn't able to develop and the proprioception, uh, is, is not well developed. Um, then you start orienting inward. 

John Clarke: Yeah. 

Nikki Nooteboom: Right. And what happens is that we have a default mode network in our brain.

And that default mode network. And, uh, Ruth Lanius has done a lot of research about that. The, the default mode network is a network in your brain. It's to, it's a network of brain functions that gets activated when you are safely attached, when you feel safe, and you have some feeling of safety. Now what happens is [00:20:00] that, um, when you're not, um, when you're in rest, let's call it that, when you're in rest, you can just think about yourself and you have some self-reflect.

You can have memories, right? You can. And but the moment that you need to be in the outside world, you're here. Right? And then that default mode network just gets put away. But the problem with trauma is, is that when you have experienced these kinds of things in the past, the brain decides to keep the, to keep the past present.

John Clarke: Mm-hmm. 

Nikki Nooteboom: And that is what we see in the default mode network. And the default mode network doesn't switch off. 

John Clarke: Yeah. In your, how, how is that adaptive? Or how or why is the brain adapted to. To do that. To like keep remembering 

Nikki Nooteboom: [00:21:00] why you mean. 

John Clarke: Yeah. 

Nikki Nooteboom: Yeah. So, well, it is very important that you keep your eye on the ball, right?

And. The problem is, is that when you're so young and you need to develop survival skills and you need to keep the danger close to be able to recognize it all the time, is that when you're in survival, you're not able to develop well, so you're not able to learn. And it is very important that these, that this moat network and that the past just keeps present.

Stays present in now. Right. Because your brain and all your parts have decided, we're not gonna do this anymore. Right? This will never happen again. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: So this is why it, it's, it stays close and it stays activated. 

John Clarke: Mm-hmm. [00:22:00] 

Nikki Nooteboom: The brain is wired towards survival and not towards development and safety. 

John Clarke: Yeah.

IFS is simple but not easy, on the surface, it's about parts and self. But when you're in the room with a client, things can get complex fast. Helping someone meet a protective part or wounded exile, that takes skill and most importantly, it takes safety. My name is John Clarke, trauma therapist and IFS therapist, and in this free webinar for therapists and practitioners, we're gonna explore the subtleties that make IFS so powerful and how to navigate them with more clarity and confidence.

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 This is just kind of a, a curiosity to mine. How, given all of [00:23:00] this understanding of the brain, the vestibular system, all these pieces, um, how do you factor in addiction, um, to, to all of this 

Nikki Nooteboom: Addiction? Uh. Well, what, what we know, we also know from IFS is that if you have all these feelings that you don't know how to handle, you find ways to not feel it.

Yeah. Do not, and whether it be anxious feelings or whether it be rumination and a, a constant thinking loop, because this is what trauma also does. It disconnects, right. The feeling loop and the thinking loop, and they just have different worlds. So you can know everything and you could have read all the books in the world.

And you don't know your feeling. Just, you know they're not connected. 

John Clarke: Yeah. 

Nikki Nooteboom: And you can have feelings. Too much feelings [00:24:00] or too little feelings, and you have no idea why. 

John Clarke: Yeah. 

Nikki Nooteboom: So there's this disconnection, and of course there are parts that are more connected to the prefrontal cortex that say, well, those feelings, we don't know what to do with that, so let's find ways to, to numb it.

And it works. It works. Those parts are very, they, they know how to handle that. 

John Clarke: Yeah. They know exactly how to handle it. Yeah, 

Nikki Nooteboom: yeah, yeah. And that's great. 

John Clarke: Yeah. Um, yeah, from that perspective, it's, it's great. It's effective. It's doing, it's very effective. It's intended to do. Um, so, um, what was I gonna say? Um, yeah, I guess understanding all this well, we.

So many of us, both clients and therapists alike, we come at things from this kind of figuring out perspective, this like analytical [00:25:00] mode of like, okay, um, I had this mother who is incredibly demanding and now there's a part of me that's hypercritical. It's like, okay, if knowing that enough to heal, you would've done it by now, right?

Because like. Clients are very smart. You know, I've been out here in Silicon Valley for most of my career, so I have clients that are very intelligent and very, um, analytical. Right. And they bring a lot of those, an analytical parts to, to therapy. Right. Of like, I'm on the hunt for just figuring this stuff out.

If I can figure it out, then I can crack the code, then this trauma stuff won't be a monkey on my back anymore. And yet it doesn't work like that. 

Nikki Nooteboom: Yeah. Because trauma is about safety. 

John Clarke: Yeah. So, and how do you, yeah. How do you reestablish safety? So switching to some of this pieces, some of these pieces around what we know of trauma in the brain, which I know we're just scratching the surface, and also how does this inform therapy and especially for you, like the way that you work.[00:26:00] 

Nikki Nooteboom: Great question. I think that the research that especially Ruth Leus has, has done shows that the brain, when the brain gets. Develops, right. It develops from the bottom up. And developmental trauma means that there are gaps in that development. And one of those gaps, especially when you had to dissociate a child because you couldn't be here, it gives, this is, it has a huge response on how the vestibular system and proprioceptive system develop.

Uh, but that is our basis. It's our fundamental, it's our right. You can build a house on water. So we need to go back to where it all starts. And that means is that how can you activate the vestibular system, [00:27:00] which is very important, right? So what I do. Well, let's go back to when we, when we look at IFS, right?

You need self energy to be able to communicate with these parts. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And to give this feeling of safety, of crio, of, or curiosity, all the eights, right? Um, but how do you know as a therapist that someone is really in that self energy? And of course you can guide your client towards own blending. 

John Clarke: Yeah.

Nikki Nooteboom: And see if you can find as much self-energy as possible. But that self-energy is based in gravity. In grounding, yeah. In presence now. Because what we do in IFS is see the difference [00:28:00] between then and now. 

John Clarke: Yeah. 

Nikki Nooteboom: Present in the past. Right. But how do you do that when a brain doesn't know where the present is?

John Clarke: Yeah. 

Nikki Nooteboom: How do you know where it doesn't? When it doesn't know where the ground is? 

John Clarke: Mm-hmm. 

Nikki Nooteboom: That's where it starts. Yeah. It starts being on the ground. 

John Clarke: Yeah. 

Nikki Nooteboom: And being able to orient to your surroundings and know where you stop. Right. Where you end and other things and people around you start. Yeah. Because trauma feels very closed up.

John Clarke: Mm-hmm. 

Nikki Nooteboom: It feels like a really small, small space. Yeah. And there's nothing else there. And there's a lot going on, but time is all mixed up. Yeah. Feelings are mixed up. Parts are running around. Right. There's this whole fighting inside going on, so that's where you start. You start with activating the vestibular [00:29:00] system.

Which you can do in many ways. That's the good thing. You can do it in many ways. What I notice in my practice is that there are a lot of people, especially when they had cognitive therapies or even IFS because IFS is a way of understanding, right? 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Um, what I notice is that, um, especially people who.

I have done IFS is that they're in the sessions, they can reach some self energy, but the moment they get out of the session, 

John Clarke: right, 

Nikki Nooteboom: it's gone. 

John Clarke: Yeah. 

Nikki Nooteboom: And what happens, and what I notice with my clients, and this is the reason why I started moving more to towards, um, neurobiology, is that. When you don't know where the ground is and you don't know where the present moment is and you can't, your can bring yourself out of dissociation.

Then parts [00:30:00] managers start using IFS. Like there is, you can get this high focus or parts like this, hyper alertness on parts. That you hear people saying, well, and then I know there's this part, and there's that part, and they have, and I don't know how to unblend from that. Mm-hmm. Right? So they get really hyperactive because of that.

So what I do, and for some people it's, it's weird because I say, well, you can notice gravity, right? You can just feel gravity. You can start by noticing the contact points between you and the chair. See if you can notice gravity as a pulling, pulling force under your chair. Right? So, so it's keeping you in the chair so you're not floating around, you're, you're staying here, but there are people that, for that you need some interceptive mm-hmm.[00:31:00] 

Possibilities. Right? And when the insular is not online, that's very difficult to do. So all these feelings and being lower than being here, everything that is lower is so scary. People find that very difficult. So what I do is that I say, well, just, let's just stand on one leg. So this is what I do with them, right?

Mm-hmm. When we start, we start finding ways to get them grounded and standing on one leg. You don't have to feel inside. You don't have to notice. You don't have to be even cognitively present. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: You don't have to have your attention there. You can just stand on one leg. So I say to them, well, if you can stand on two legs, you can stand on one leg.

So do that whenever you can, as much as you can. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And in [00:32:00] that, finding ways to ground yourself. That's where finding solid ground, a program comes in. 

John Clarke: Yeah, right. 

Nikki Nooteboom: It gives you so many ways to ground, but there are different, different situations. 

John Clarke: Yeah. 

Nikki Nooteboom: Right. Yeah. So there are situations that you get really triggered and you're really ungrounded and you're really dissociating and you're in this really narrow space.

How do you get yourself down? 

John Clarke: Yeah. 

Nikki Nooteboom: That's regulation 

John Clarke: right. 

Nikki Nooteboom: So how do you get yourself towards another state? The problem with that is, is that when you would only ground during those moments, your brain is not susceptible to learn. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: So you can cope. It's a way of coping. Right. Bring yourself, regulate yourself.

Bring yourself to another state, which means that if your brain doesn't learn from that, you need to do this all [00:33:00] the time. 

John Clarke: Right. Right. 

Nikki Nooteboom: So there's another situation, and this is why in finding solid ground, it's so important to teach your clients that these ways of grounding are most important when you do it, when you are not triggered.

Mm-hmm. Or when you are not in a high state of dissociation. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Because dissociation is not something that is just there. You know? 

John Clarke: Yeah. 

Nikki Nooteboom: It builds up. You read something and you get annoyed or you get anxious and then everything, and then the space narrows. Right. So, and then you notice it the moment that the stress is way, way too, too much.

Yeah. Or you are totally shut down. 

John Clarke: Yeah. 

Nikki Nooteboom: So when you, when you get yourself to the ground structurally during the day, you just. Let your system know that it can move within the window towards, it [00:34:00] can just move up and down without going up or going all the way down. Mm-hmm. And when you do that structurally, and you do that for weeks, months, right.

Then your brain starts making, starts firing in different parts. 

John Clarke: Yeah. 

Nikki Nooteboom: Your vestibular system gets more activated. Mm-hmm. And becomes part of your present experience. 

John Clarke: Yeah. It's more integrated. 

Nikki Nooteboom: Yeah. So that's integration. 

John Clarke: Yeah. So 

Nikki Nooteboom: different, different situations. And when you are dissociated and you have to get yourself down.

It probably will take a lot more than just standing on one leg. 

John Clarke: Yeah. So 

Nikki Nooteboom: this is one thing that I do, but there are many ways to do that. Yeah. Many ways, right? You can use a weighted blanket, you can use, you can rub your feet [00:35:00] over the ground, you can put your feet cold water. Um, there, there are so many ways.

But it's very important to do it structurally, right? Yeah. To make sure that you have this integration. 

John Clarke: Mm. 

Nikki Nooteboom: In the brain. 

John Clarke: Well, I, I would guess, in fact, I know that a lot of therapists kind of do grounding kind of haphazardly or when clients are just extremely dysregulated. Right. And, um, yeah, there, there's just like a very basic understanding of what needs to happen or trying to get a client to quote, calm down, you know, whatever it is.

And it's, um. You're not necessarily like speaking the language of the nervous system. In my experience, and again, that to me that's what models like se are actually equipping therapists to do, which for most of us who come from a true talk therapy background, it's pretty novel. Right. No one in my grad school told me to tell clients to stand on one leg, you know, uh, or, or anything of that nature.

Right? [00:36:00] Yeah. And, and, and yet that's. And, and taking this bottom up perspective, it's exactly the type of thing that we should be doing with our clients. I think so. And it's a very non-cognitive process, right? Where they, and again, they come in with these figuring out parts and thinking, I'm here in therapy to figure stuff out.

Nikki's gonna help me figure stuff out and draw some epic connection between then and now. It's like, okay, you've probably already drawn that connection and yet here we are. Like the healing still hasn't happened, right? Yeah. 

Nikki Nooteboom: Yeah. And you can know everything. 

John Clarke: Yeah. And, 

Nikki Nooteboom: and this is the problem of our society.

John Clarke: Yeah. You 

Nikki Nooteboom: know, we are pushing children from a young age to develop their cortexes. 

John Clarke: Yeah. 

Nikki Nooteboom: Right. It's, they have to know it's all this, this knowledge that they, but we have analytical 

John Clarke: analytics, autonomy. Yeah. 

Nikki Nooteboom: Right. So even in our school system, if we, if we look at how we are asking children not to listen to their own feelings or their own, um, [00:37:00] uh, things that they need to do right from their development, no.

John Clarke: Yeah. Right. 

Nikki Nooteboom: We all tell them, don't do that and just sit on the chair. And yes, you can run around for, for 30 minutes, but only when I say so and in the way that I tell you to. 

John Clarke: Yeah. 

Nikki Nooteboom: Right. So this is children learn to dissociate. 

John Clarke: Yeah. We 

Nikki Nooteboom: teach children to dissociate. 

John Clarke: Yeah. Yeah. The message there is comply and sit in this stationary chair for six hours and if you don't, you're gonna the principal's office, you know?

Right. Even though you're five, you know? 

Nikki Nooteboom: Right. And if you're angry. You have to go. They isolate you. 

John Clarke: Yes. Yeah. Right. You have to go regulate yourself in another room, you know? 

Nikki Nooteboom: Yeah. But it is a scream of a child for I have all these feelings and I have no idea what to do with it. Please help me. 

John Clarke: Yeah. 

Nikki Nooteboom: Right.

But we shame it. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And when there is a, a child that that dissociates a lot or [00:38:00] pleases a lot. They have parts that are pleasing all the time to be seen. We say, you're such a good girl. 

John Clarke: Yeah, yeah, exactly. Which is insane. It is insane. 

Nikki Nooteboom: The message. The message is always you can be here. 

John Clarke: Yeah. 

Nikki Nooteboom: Yeah. Not everything of you can be here.

Only the parts that we want can be here. 

John Clarke: Yeah. 

Nikki Nooteboom: Which is. Very difficult. 

John Clarke: Yeah. 

Nikki Nooteboom: So getting into that brain when we, the, the, the great thing about neurobiology and uh, neurology is that we can go backwards in development. So we go back to the basis. So what is the, the fundamental thing that we build our brain on it is this, the, the sense that we built.

When we are five weeks in the book, 

John Clarke: it's, it's so fascinating. I mean, I, I have, um, two case studies every day, which, because I have an eight week old [00:39:00] daughter and a five-year-old daughter. And, uh, so I have constant, you know, uh, observations and experiences and, uh, I, I remember seeing. Some random thing about how like, rough housing with your kids or when they're like toddlers is actually very good for them and even can be good like before bed.

And I had already found that my, my five-year-old, you know, for the past few years, she has always loved that type of play with me. And like that roughhousing, we still, we do it all the time and she loves to be flipped upside down and like, you know, just do all sorts of wild stuff and she just. Absolutely loves it, but I can imagine we're seeing it through this lens of the vestibular system, how, how good that is for her little vestibular system that is learning.

Right. And then she goes to school on the playground and learns to balance on a beam. And you know, that's like extremely enriching for a little kid, even though as an adult you're like, you're just walking across some random thing, you're just playing, but there's so much more going on than meets the eye.

Right, 

Nikki Nooteboom: right, right. [00:40:00] And especially when you talk about se 

John Clarke: Yeah. 

Nikki Nooteboom: Is that when, when a child feels not safe or, or wants to move around and it's not able to move around like in school? Yeah. Or when you live in a household where, where the parents are, are very strict. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And sit still and don't show yourself and listen and don't scream and then.

What are you gonna do? Right. And then it gets stuck. That's what Peter Levine of course, talks about. Right. It gets stuck and it can't be processed because the, the, um, prefrontal cortex is not even developed well now. 

John Clarke: Yeah. 

Nikki Nooteboom: Yeah. Um, so starting with the vestibular system is very, very important. Mm-hmm.

Because if you don't have any basis, how are you gonna build? 

John Clarke: Yeah. Yeah. Well, I, I think, you know, when I think [00:41:00] about, again, my 5-year-old, it's like, I think she's seeking both that proprioceptive, um, input as well as connection. You know, she's getting both from me. Like that's kind of a win-win, you know?

Nikki Nooteboom: Great. Well, that's exactly what, it's what it needs. 

John Clarke: Yeah. 

Nikki Nooteboom: And that is where safety comes from because the thing is, is that if we didn't have gravity, the earth will probably not even exist. Mm-hmm. Right. It is. It is the basis. Nothing on earth would be what it is now if we wouldn't have gravity. Right. So it's so important that our brain knows where it is.

John Clarke: Yeah. And 

Nikki Nooteboom: how it can stay connected with that. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: It's so important. So what I also do is, because there's a difference, of course, with your children, and it's so good that we have this information now. Right. That if, if a child feels something that it, and it needs to move, that it has the space to move and that it needs to play and it needs to [00:42:00] fall out of a tree and it needs to, you know, all these things.

It's so important to do that. Um, but we work often, or at least I do, I, I don't work with children. I know a very well, very well known occupational therapist in Texas, and she works with children, um, but I work with adults. Yeah. Meaning that they probably have lived in this really narrow space of trauma their whole lives.

Right. And this is the only thing, it's like this powerlessness, hopelessness feeling of not being good enough, like these trauma states of, of feeling not lovable, not good enough. So, and all this stress that is there and they have to keep themselves in check. All these parts that needs to keep you in check and the outside world in check.

So one of the other, um, exercises that I do with my clients, and I always start with this, um, and this I learned from Ruth [00:43:00] Lanius as well, is that we start with, with. Noticing gravity. And then what we do is orienting, or at least being aware of the broader space. And it sounds really simple again, but it is so very effective.

John Clarke: Mm-hmm. 

Nikki Nooteboom: Because when you have, you are always focused inward and you stimulate your clients to. For example, I say just be aware of what is right in front of you. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And what is right behind you, left and right. Right. And then see if you can notice the, the, the actual distance between you and what is next to you or in front of you.

And see if you can, while sitting in the chair feeling and noticing. Gravity, see if you can reach your awareness out toward that. 

John Clarke: Mm-hmm. Right. 

Nikki Nooteboom: So that you can [00:44:00] broaden and widen and deepen your awareness. And then we, we make a step broader. So be aware of the space that is outside the room. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And it is, it doesn't even matter what is there, but just see if you can reach out to that.

John Clarke: Mm-hmm. 

Nikki Nooteboom: If you can reach your. Expand your awareness towards the space there, and you can even do it further away. I live in the Hagen, the Sea is there. Right when I feel closed up, I just reach for the sea and I reach for, you know, and then you can even throw, make it wider. And then you can say, be aware of where the sun comes up.

John Clarke: Mm-hmm. 

Nikki Nooteboom: Where the sun goes down. That is all like noticing where you are. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Where am I in space? Where's the ground? But also what is my relation [00:45:00] towards the things around me? 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And that you can reach out and then what you notice is that people really feel more space. 

John Clarke: Yeah. 

Nikki Nooteboom: And often you just, they do like that.

John Clarke: Yeah. 

Nikki Nooteboom: It is the same with like sounds right. The moment that your basic sense is not on, like your vestibular system and your proprioceptive system are not developed well. Mm-hmm. And are participating. What your other senses do is they get hyperactive. So you get Yeah. Compensate hyper phone. 

John Clarke: Mm-hmm. Sorry.

They compensate. Yeah, 

Nikki Nooteboom: of course. 

John Clarke: Of course. 

Nikki Nooteboom: So your eyes become hyper alert and the hearing like, I dunno about your clients, but they all have a problem with sound. So what I often say is, well just notice. [00:46:00] So first I do the grounding and then I do the orienting and the. Reaching out to the bigger space.

And then I say, well see if you can just notice if you can hear something. 

John Clarke: Mm-hmm.

Nikki Nooteboom: Is there a sound around you? It can be inside the house or it can be outside the house. And then first, just notice the direction of the sound. Where does it come from? And then see if you can notice what is, what is the source of the sand?

Is it a car or is it a person or is it a dog or whatever? Is it the wind? And then see if you can really notice the distance between you, where you're sitting, where you're noticing right gravity. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: And the distance towards the source. And can you place it there? Right. Can you just place it there?

John Clarke: Yeah. Instead 

Nikki Nooteboom: of here, because this, it feels like it's really close and it's all closed up and it's almost feels like they're attacked by the sound. 

John Clarke: Yeah. 

Nikki Nooteboom: Right. [00:47:00] So. See if you can just put it there where it belongs. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Outside. This gives a feeling of there is more than only what I perceive as being me.

John Clarke: Right. Right. Which is, in my experience, where a lot of that collapse happens, you know? And so working in this way is the counter to that collapse? 

Nikki Nooteboom: It does, 

John Clarke: yeah. 

Nikki Nooteboom: It does. Mm-hmm. And, and there are so many other ways in how you can make someone present. 

John Clarke: Yeah, yeah, 

Nikki Nooteboom: yeah. And when they notice that, 

John Clarke: yeah. 

Nikki Nooteboom: They can start noticing the difference between present and past.

John Clarke: For, for me, the, the key is all of this has to be incredibly slow and gradual and careful. Many therapists, um, tend to go too fast in their own busy, productive, helping parts, wanna do this quickly or skip past this, or [00:48:00] working slowly in these subtleties of the brain and nervous system is. Almost feels like not enough or am I not giving my client enough or whatever.

And so, um, I just find that all of this has to be way more slow, um, and gradual and titrated than, um, than we often like to go. And especially in our busy, efficient, obsessed world. You know, we can tend to go through this fast, but all of it is just so slow and steady and intentional, which is. Again, you know, Peter Levine talks about the trauma vortex and the healing vortex.

So that's where that healing vortex is. It's the, the antithesis of how the trauma happened, which is fast and sudden and too much and out of control. So therapy has to be the opposite, even if it's 20 minutes of therapy or 40 minutes a week or whatever it is. So, but just spending time in that counter vortex is in itself.

Money in the bank, so to speak, is in itself therapeutic, just to spend more time there. You know, so that, that's what I find with [00:49:00] clients and we're basically yeah, expanding their window of tolerance again. So this is, this is great stuff. Um, Nikki, we're somehow out of time. We're overtime, but, uh, I could go on for days and I bet you could too.

'cause you're, you love this stuff so much and it's great. And again, there's so much. Yeah, there's so much. Yeah. Again, we're just scratching the surface, which is, which is fun. But yeah, I'll have to have you back for a part two. Um, in the meantime. How else can people, or how can people learn more about you and your work and, and you know, reach out?

Nikki Nooteboom: Well, I, um, I have a website. I have a Dutch one because I'm Dutch. 

John Clarke: Mm-hmm. 

Nikki Nooteboom: Um, I have a Dutch website, but I also have an English version, uh, which, which can be reached, uh, under a neuro informed care.com. Um, and there I explain how I work and you can get in contact with me also through LinkedIn. Instagram, so Great.

John Clarke: Easy enough. We'll put links to all that in the show notes and description as [00:50:00] always. And um, again, Nikki, thank you so much for your, um, time and contribution. I'd love to have you back some time to build on this. 

Nikki Nooteboom: Great, thank you. Cool. Thank you for your Thanks again. 

John Clarke: Yeah, my pleasure. Have a good day.

Thanks, you too. 

Nikki Nooteboom: Thank you. Bye.

John Clarke: Thanks for listening to another episode of Going Inside. If you enjoyed this episode, please like and subscribe wherever you're listening or watching, and share your favorite episode with a friend. You can follow me on Instagram, YouTube, and TikTok at johnclarketherapy and apply to work with me one-on-one at johnclarketherapy.com.

See you next time.