Episode 299 - Michael John Cusick, "Trauma-Informed Care, Part 2"

Welcome to Restoring the Soul with Michael John Cusick. In this second part of our exploration into Trauma-Informed Care, we continue to understand how our past experiences inform our present reality and how vital it is to feel safe and secure—not just in our external environment but within the therapeutic space.

Today, we’ll delve deeper into the pillars supporting a trauma-informed approach—one that equips you with the resources to understand, manage, and develop the intrinsic tools necessary for self-care, especially in the face of life’s triggering events. We're looking at how techniques like breathing exercises, somatic awareness, and other strategies can help us navigate the waters of emotional dysregulation, all from the comfort of our homes or even online.

ENGAGE THE RESTORING THE SOUL PODCAST:
- Follow us on YouTube
- Tweet us at @michaeljcusick and @PodcastRTS
- Like us on Facebook
- Follow us on Instagram & Twitter
- Follow Michael on Twitter
- Email us at info@restoringthesoul.com

Thanks for listening!

Transcript

0:00

Hi, everybody, it's Michael John Cusick. Welcome to restoring the soul. We are back for an episode where we're talking about trauma informed care. But in the last episode, we talked about the importance of traumain informed care in organizations and in clinical settings. And today I want to talk about five pillars of traumain informed care, and specifically why it's important to understand for therapists and for clients. I alluded to in numerous conversations whenever I talk about this, but in the last podcast, to the fact that this phrase is thrown around more and more, and I want to dispel a myth at the start as I talk about five pillars of traumainformed care. The first is that if you are a client and you have trauma or abuse or some kind of adverse childhood experience in your life, and you go to the website of a therapist and it says, I specialize in trauma. It's important to check out what that means. Oftentimes that means that a therapist will have had a course in trauma, perhaps during graduate school or maybe afterwards. Or it means that they read a book about it and they didn't even have a course, and that they simply have an interest in that. So there's a difference between someone who works with trauma, works with abuse, even says that they specialize in it and being trauma informed. And the difference is, as I think you'll hear in this podcast, pretty profound. And it can make all the difference in terms of the kind of progress and outcome that clients have in therapy. It's also very important for therapists to understand, because it helps therapists to be proactive in serving their clients. But it also is a great way of understanding our colleagues and our peers, that when someone says trauma informed, there's a certain set of assumptions for what that means. And so these five pillars are taken from the literature, taken from different ways that the field talks about these, but I've put them into my own language, and this is really what restoring the soul is about. As we say, we are trauma informed. Number one, let's discuss each of these. Number one, traumainformed care is based upon an understanding and a taking into account of a person's life experience on their present experience. I'll say that again, it's understanding and taking into account the impact of life experience on our present experience, and specifically on the central nervous system and the brain. In other words, our life, our childhood, the way that we went through our psychosocial development, all of that has impacted who we are today, including how we see the world, how we respond to the world, how we attach to others in relationship. Now, this may seem like a really obvious thought forever. Therapists seem to have been talking, know, from Sigmund Freud onward, how your mother treated you or what happened to you when you were little, and that was the cause of your psychological problems. Now, we understand in far greater detail and with greater scientific foundation that it's not just a theory or a hypothesis like Freud's id, ego and superego, but it's actually a way that our life experiences, shapes our body, shapes our nervous system. We call this in the field, epigenetics. So genetics are what are given to us. And the simple way of talking about epigenetics is taking what was given to us through genetic material and then adding in life experience, and how that life experience on top of our genetics actually reshapes our genetics and gives us a different set of coping mechanisms than we would have had. And then it also shapes our genetics in a way where we pass on something generationally that would have been very different without that adverse or negative experience. So this idea of life experience shaping our current experience and psychological struggles, mental health issues, is rooted in interpersonal neurobiology. If you want to find out very quickly if someone is trauma informed, ask them who they've read or what they've studied or what they like about interpersonal neurobiology. I pnb now around those conversations. For those who are listeners to this program or take in the restoring the soul show, you will have listened to Dr. Kurt Thompson. Kurt is a psychiatrist, and I love how he says that he preaches the gospel of neuroscience. Interpersonal neurobiology is this idea that every interaction begins to shape how we are present within ourselves, how our soothing mechanisms, our attachment mechanisms, our perception of the world, the safety of relationships, how that's all shaped. So trauma informed, pillar number one, understanding, taking into account the impact of life experience on the central nervous system and brain. And somebody might be saying, does that include positive experience? And I would say absolutely, both in terms of people who did not have significant trauma, abuse, neglect, or adverse experiences, but also the way that we can have a gained attachment or an earned, secure attachment through positive life experiences. This can move in either direction, but in terms of mental health issues, not necessarily mental health, wellness, or mental health. Specifically, the life experiences that we often deal with in the therapeutic relationship and in therapy room are negative or adverse experiences. The second pillar of a traumainformed approach is that in light of this knowledge, that our life experiences shape our struggles and our real experience today, as therapists, we anticipate that clients will be activated dysregulated or distressed under certain caregiving situations. We anticipate that activation, distress, and dysregulation are going to come up when we seek care, because seeking care is inherently vulnerable. I'll never forget the very first time I went to counseling as an adult. And I walked in and there was a relatively small waiting room, even though there were like five psychologists in this practice, and it was probably three to five people. I don't remember exactly, and maybe there was a couple, but I remember this would have been the year 1989. And I remember sitting in this very cramped waiting room, and there seemed to be like an AM radio station playing in the background that I don't remember if it was music or talk, but it was like bad quality. And there were these old magazines there, and I didn't want to look to my left or to my right. I'm looking out of the corner of my eye and I'm thinking, I'm glad that nobody in here is anybody I know. It was really vulnerable. There was a lot of anxiety there. And a trauma informed approach anticipates that the simple act of picking up the phone, logging onto the website, showing up at the counseling office, or in many cases now, today, telehealth that that is an incredibly vulnerable thing, and therefore that will likely cause activation. You add to this fact that then people may be talking about shameful material or things that they have experienced shame around. They may be talking about a broken relationship, an addiction, some kind of struggle in their life that they're not proud of. And that takes this potential for activation, and it's like throwing gas on that. And so as I've talked about in another context, that this need to understand what's happening in a person's body and the anticipation of that then actually allows us to create some interventions and to be proactive in a way where we're helping to manage people's dysregulation so that they're not walking into counseling sessions already traumatized based on what's happening. I talked about in a previous podcast about going to the dentist and feeling so vulnerable when the dentist simply took pictures of my tooth and posted them on the website, telling me that they were going to do that, but not asking for permission, not having any kind of process to engage me with that. Another example at the dentist, and you can tell that I do not like going to the dentist, is how at my dentist, they will come alongside the chair while I'm lying down and present to me the information, pictures of x rays or whatever the diagnosis is, and then tell me how many thousands of dollars it's going to cost and ask me in that vulnerable position to make a financial decision before I even get up. And that is something where a person who has trauma is likely to either go into a fight or flight mode, which might mean that I just want to get out of here, or I become angry and I'm not going to make a wise decision, or I shut down. And in my instance, with me being a nice guy, and I want to not ruffle any feathers, and I actually wanted to say, no, I need some time to think about this. But in the event of the experience at the dentist, I was just like, okay. And then afterwards I became resentful about that. So the classic thing is that if that had given me an opportunity to be empowered to say, let me think about this, or we'd like to take a moment, have you get up out of the dental chair, and we have this little office where you can sit down on the side and the lighting is kind of dim and there's comfortable chairs. And we're going to have you come back for another appointment that may be inconvenient, but addressing that need in a proactive way, that would be a trauma informed dental office. Okay, so in addition to anticipating the distress and activation of clients when they're seeking care and treatment, the third pillar of trauma informed care is that at restoring the soul, we are seeking to provide a connection with clients that is safe, that is stable and secure. And I want to talk about each one of these individually. Safe is not just physically safe. So we want to make sure that there's no ice outside of our building. In our particular building, that's sometimes the case. And I have to let the building owners know that, hey, they need to come and shovel or put down salt or sand or something like that. That's important. But I'm talking about an emotional safety that then, if that safety is not there, triggers something physically in their body. And now we're not talking about a physical injury, but a physical reaction or physical dysregulation or activation, which takes us back to that very first point of understanding and taking into account the fact that this activation will happen. We try to prevent unnecessary dysregulation and activation, which makes a person feel unsafe. And then we try to proactively create an environment where that doesn't happen as well. But essentially, safety is that it feels safe and it feels good, and it feels right for me to be here in my body at this moment. And I'll often do work with clients where, and this is almost cliche now in some circles, but where we'll ask people to stop, to take a couple of breaths, and to pay attention to what's happening in their body. And I'm surprised, even after kind of having this approach and working in this for over ten years, how many people are talking about material in their past that's not, quote unquote, major trauma? It's not particularly intense. At least they wouldn't identify it as such in the moment. But as they tune into their body, they're aware of feeling tightness in their chest, a clenched jaw, tension in their forehead, tension in their hips, butterflies in their stomach, clammy hands. And then oftentimes we'll just talk about that, we'll stop, and I'll check in, and I'll say something like, if you could give a color to that tension in the middle of your chest, what would that color be? And they might say something like blue or yellow or red. And I'm not trying to attribute a certain meaning to any of those colors, but whatever that color is, that actually helps them to articulate what they might not have words to. And then I might say, if you were to give a texture to that particular tightness in your chest, what would it be? Oh, that's easy. It would feel like sandpaper. Okay, if you were to give it a voice like a cartoon bubble, and that cartoon bubble with words from the Sunday funnies had words in it, what would it say? Oh, that's easy. Or maybe in some instances, they would take a couple of minutes and not know exactly, but they'd close their eyes and just pay attention, kind of looking at that hypothetical imaginary cartoon bubble, and they'd say, I'm in trouble, or, you can't go here. In other words, it's a part of them that is embodied and that's physiological, that feels unsafe. And this safety is so important for people to feel, because it's the foundation of trust. Without people feeling seen and without people feeling safe, trust cannot possibly develop. And without a sense of security, trust cannot possibly develop. And of course, therapy, no matter how mechanical or treatment driven it is, trust is just essential for the therapeutic process. Stability. We provide and seek a connection that is safe, stable, and secure for clients. Let me talk about stability. Stability would have other words, like reliable and predictable. I'm going to be there for you over the prescribed amount of time. So if a person is in weekly counseling, the stability is that the therapist is not always changing. Their schedule around that therapist is not always running a half an hour late, so that the client shows up 15 minutes early, sits in the waiting room, and then half hour in, they're wondering, is my therapist even here? Are they running behind? And then they start to ask questions like, am I important, do I matter to my therapist? Et cetera? Because they fill in the blank when that knowledge is not there. So the stability is that I am here for you, and you can count on me, if you will. I am a stable basis, I'm a stable ground that you can stand on in relationship with me. And then security. A secure connection means not just that I'm going to be here, but that you client from me, therapist know that I'm here for you, you're not here for me. This is a secure place. It's obviously a safe place, and I am a stable person for you. But this is a secure place to struggle, not just the safety of moment by moment, or week by week, or hour by hour activation and dysregulation in the body, but that this is a safe place, and I am a safe relationship for you to struggle, if you will. I've got you, I can handle you, and you can come to rely upon me to be there for you. And so many relationships in our world, and especially in the lives and histories of people with trauma, adverse childhood experiences, and abuse and neglect, those relationships are transactional, they're quid pro quo. So I do something, I get something back, you do something, I give you something back. And for people to develop trust, it's not reciprocal. And the nature of therapy is that it's not reciprocal, except for a transaction of a fee. If I go to a doctor, he's an orthopedic surgeon, and I've broken my ankle, I'm going to pay him or my insurance company is going to pay him. Not talking about that kind of fee for transaction in terms of a fee for services, I'm talking about the therapist that says I've taken care of my needs. I can be having a great day or a hard day, and I'm not going to look to you client to have to validate me, to take care of me, or in any way to do anything other than to be someone who can receive care. That's the nature of the secure relationship. The average counseling student in graduate school will learn pretty early on about this idea of the corrective emotional experience. And that's this idea that the emotional experiences that were harmful, that caused pain, that caused a person to go into a maladaptive or an unhealthy way of relating in the world those kind of wounds that come to us. Very early in the field of psychology, although there was different language that was used, it came to be understood that there's something about the relationship itself that is healing. So much so that about 25 years ago, psychological research was done. And I don't just mean research in the psychology field, about XYZ topics, but research about the field of psychology and the delivery of treatment. That's called psychotherapy research, or psychology research. And a large body of evidence has been built where the conclusion is in cement that across modalities, cognitive therapy, existential therapy, rogerian therapy, interpersonal therapy, psychodynamic therapy, whatever of the hundreds of therapies that exist that the research says, and this is mostly done around depression and other relational kinds of issues, the research says that it's a therapeutic relationship that is the primary transformational ingredient, that the outcomes that were positive were not determined by the modality of counseling, but by the quality of the relationship. And that then leads to a corrective emotional experience. You, client can feel safe here in this relationship where you did not feel safe in the past, you, client can feel a stability and a predictability and a reliability here in this relationship that you did not feel in the past, and you can feel a security here. And we now know with a host of other factors, that that kind of relationship that is safe, stable and secure, allows for the brain to be rewired, that this corrective emotional experience is actually bringing about physiological changes in our neurons and in our neuronal connections. And that's pretty amazing to think about, that a human relationship can have that impact. The fourth pillar of traumainformed care is that at restoring the soul. And a trauma informed therapist in general, has specialized training to manage emotions and dysregulation. Specialized training to manage emotions and dysregulation. Once again, if you are a cognitive therapist, if you are a behaviorist, if you are an EMDR therapist, the key ingredient in trauma informed care, and implicit in what I'm saying, is that there can be a wide variety of modalities that people operate out of, and they can still have a trauma informed approach as long as when the dysregulation and activation happens in a person's nervous system, to say it in a colloquial way, when our buttons get pushed, when our trigger gets tripped, which happens to all of us sometimes in many, many different situations, our bodies become dysregulated. We get outside of our window of tolerance as we've talked about so much on this program, and the trauma informed therapist knows what to do in that instance. It's not a panic. It's not, oh my gosh, we have to fix this. But it's also realizing that our dysregulation is our body communicating to us. It's our body saying, there is a threat. It's our body saying, I'm feeling uncomfortable. It's our body and our brain and our mind, which is not simply our brain, but that relationship of all of our different neural pathways and all the different parts of our body. It's our mind saying, this is a really vulnerable situation and something bad is going to happen. Therefore, we name that. We don't see the dysregulation and the activation as inherently pathological, but actually that response or reactivity, that feels obviously very distressing, that it's actually a healthy response, at least initially, to an unhealthy experience, that it's the body doing what it's supposed to do. And as Bessel van der Kaulk says by his famous book title, it's the Body keeping score, and the body communicating to us. There is a great wisdom of the body, the way that God created us fearfully and wonderfully, and the way that our souls include in this hebrew idea of the rich, rich understanding of soul, that was more than the greek idea of the mind, the emotions, and the will. The hebrew idea of soul was one that was an embodied idea, that our soul includes our bodies. And therefore, if our body has experienced trauma, yes, that affects our mind, yes, it affects our emotions, yes. It affects our choices, our volition, our capacity to choose, but it affects our body, and then that affects everything else. Now, some of these tools, techniques, and protocols to help manage dysregulation can be simple but highly effective things like breathing techniques. Now, there are many people whose level of dysregulation, and especially in instances where there's complex trauma, oftentimes to breathe and to relax and to begin to kind of drop into our center that is so terrifying to the brain because they've lived for so long with a hyper vigilance and a guardedness that to do deep breathing sends a signal to the brain that says, uhoh, our defenses are down. Now we have to ramp up even more. So for therapists that might be listening to this and wondering, why doesn't breathing work with this person? It may be that they need a lot of work to build up to that so that they can then use the breathing on their own. But that their nervous system is too dysregulated and too hijacked in certain moments for breathing to allow them to relax. Other kinds of interventions might be somatic awareness and visualizing and focusing on different parts of the body. Relaxation exercises. There's a tool that I use with clients regularly, and somebody by the name of Weitzman, probably a psychologist or social worker or therapist, way back, created this, and therefore it came to me multiple years ago called the Weitzman relaxation protocol. And instead of just walking people through a visualization, it gives a set of phrases that rotate back and forth. And this is just an example from. Is it possible to. Can you. So, for example, over about ten minutes in the course of this relaxation protocol, I would say, is it possible for you to picture a red balloon off in the distance in front of you, floating gently in front of the sky? And then you wait about 5 seconds, and then you say, can you picture a wisp of cloud rising up in front of you? Then you'd wait about 5 seconds, and you'd say, is it possible for you to gently focus your attention on your right earlobe? Wait 5 seconds. Is it possible for you to gently focus your attention on your left earlobe? Wait 5 seconds. Is it possible, or can you picture yourself floating in warm water? Now, this is something that's done as a way of helping people to regulate their emotions, and that's not a grab bag kind of tool or technique. I will use that after I've gotten to know a person, but that's something that, it's a visualization. It may or may not involve breathing, but it involves giving clear intention of focus. And what's happening is that it's allowing the person to settle by talking in a calm way, by having certain images that are relaxing, like a balloon floating in front of them, but then also by the mindfulness and the attention that's given to focusing on your right earlobe or focusing on the weight of your right arm upon your lap. That mindfulness, plus the relaxing images says to the brain that threat that you thought was going to overwhelm you, that was such a danger. We've got this. It's okay. Other kinds of tools might include tapping. I'm on video for this, so I'm going to model that butterfly tapping, where people will sit with their feet on the ground, close their eyes, and breathe, and they might tap back and forth. Bilateral stimulation on the outer edge of the bicep while they're picturing a safe place or a place of peace with all the different sensory input that they can, they might tap on their knees, just behind their kneecaps, doing what we call resource tapping. Prior to the quarantine and the pandemic, this was all something that was generally done in a counselor's office and at some point into treatment when it felt appropriate, people were given these tools and they could do them at home. But once we all went online during the quarantine and people couldn't go to therapist's office, and they were dealing with trauma and such anxiety from the pandemic, therapists began to use these online, and we've come to realize just how effective they are. So tapping either on the thighs, behind the kneecap, or on the arms like this. These are two of the most popular while visualizing a safe place or a place of peace. And then there's a little more advanced technique where you can actually gently focus your attention on the distressing or unpleasant sensation in particular, and to tap and to bring a sense of focus and relaxation to that. EMDR is another way to help people regulate their emotions. There's other ways, different forms of mindfulness, but all of this comes under emotional regulation, which is something that you can experience in relationship with another. And the benefit of that is so much of our social engagement system as it's spoken about in polyvagal theory, which is not something I'm going to go into now. But our social engagement system is the very first way that our bodies were created to regulate and to get back into a window of tolerance and to feel safe, secure, and in a place of peace. And all that simply means think of the infant or the little child. The little child is standing up less than a toddler, but more than a new infant. Let's just say that they're 20 months old, and they're holding onto the coffee table and starting to say some gibberish baby words, and they fall, and they hit their head on the corner of the couch, and the parent rushes to them and that baby, before they'll even break into tears or a scream, they'll often look for that adult and look into their face and to see whether that adult is horrified, terrified. And that baby, without the cognitive construct, is looking and attuning to the adult as to whether the adult has them. Now, the baby might still cry, but that social engagement system is we're always looking to others to find out if things are okay or if we're okay. And we could probably all take a moment and give examples of from grade school onto a talk that you recently gave at work, where we were kind of looking around, checking out whether people were affirming and nodding our head and tracking with us or not, at which point our heart might start to race. That's enough about training, specialized training. But the trauma informed therapist has these things like a second language. They've got you in your trauma. And as issues come up, and for far too long before I understood the neurobiological reality of trauma, I would talk with people in 1 hour counseling sessions, and we would just dive into their trauma and have them talk about it. And very often people would leave the office very dysregulated, very activated. And then if they were in an intimate relationship, they would go home and they would have these either horrible meltdowns, or they would get depressed, or they would engage in an addiction because they had to find some way to get back to a place of peace, calm and grounding. The fifth pillar of trauma informed care is simply this. It's the fact that some of these emotional regulation tools are what's done in the session. But a trauma informed therapist is all about equipping and empowering their client. Now, in the psychotherapy office, I like to use the old adage, give a person a fish, you fed them for a day, teach them to fish, and you feed them for a lifetime. My hope is that people come to restoring the soul and that they don't just receive clarity about what the nature of the problem is. And they don't just receive direction about how to move forward, and they don't just receive some in intensive healing, but that they are leaving here. And they're being launched to be able to do self care, to be able to understand what's happening in their body, what's happening in their relationships. And therefore, we're giving people resources, internal resources, to build them up and to help them have a kind of tolerance for distress, a tolerance to engage in conflict, a tolerance to remain present when they're experiencing things that are distressing or triggering or activating so that they're no longer as sensitive to certain cues and triggering events. Sometimes we give people handouts, sometimes we give people concepts on whiteboards. Sometimes we're giving people models, literally like the ten block building block that we do about our development, where we discuss how we all need to be experiencing four s's, the s's of seen, soothe, safe, secure. But resources are given in session and for beyond session. So that ultimately a trauma informed approach allows people to go live their life in a way where because of these resources, because of the connection, because of the ways that they've been seen with the anticipation and taking into account the fact that their body has been shaped by their experience, including the traumatic experiences that allows them to have a deep connection that allows healing to happen. So if you are in therapy, if you're seeking therapy, talk to your therapist about what it means for them to be trauma informed. And I want to encourage people to ask for what you need. If you're not feeling safe in your sessions, if your therapist is defensive or reactive or explaining or justifying or in any way making you not feel safe. And I'm not talking about the normal discomfort of doing this kind of deeper work. But if you're not feeling safe, being able to disclose and be who you are in the moment with them, that's something that needs to be talked about and perhaps reevaluating whether that therapist is for you. If your therapist is not providing a stable base for you, and if your therapy is not providing a secure place for you do the work, then it's probably time to reevaluate. We're so thankful, I'm so thankful that you are listening to this podcast and encourage you to continue to dig into our catalog of resources on how we become whole, how we develop deeper connections with our true self, with God, and with others. So thanks for listening on restoring the soul. Bye.