All posts by Kate McMaugh

Orientating child parts to the present

27/01/2024UncategorizedKate McMaugh

The development of dissociated aspects of self (“parts”) is an adaption to severe trauma. While it may have been helpful for you as a child, dissociated aspects of self can cause challenges for adult survivors. Sometimes child parts of you can get ‘stuck in time’. They may not be grown up and may not be fully aware of the present. They may feel unsafe, particularly if they feel they have small and vulnerable bodies, or do not understand adult life. They may fear a perpetrator who is in fact deceased. They may be afraid of punishment as if they are still a child. On the other hand, they may be happy, just wanting to play all day, while you need to get to work on time! This can also cause inner conflict between adult and child parts.

Whatever the situation, one of the important roles of the adult, present-orientated parts of you, is to help the other parts of you also be fully orientated to the present. This can initially feel challenging and is best attempted very slowly and carefully. It is best to first attempt this in the way that feels safest and with the child parts that feel ‘closer’ and less dissociated. Ideally, discuss this with your therapist and practice with them at first. If this is not an option for you, take care of yourself and work slowly with these strategies.

Some ideas include:

Encourage child parts to ‘look out your eyes’ or just ‘take a peek’ at evidence – e.g. newspapers with the date, the date on your mobile phone.
Ask child parts to listen to some sounds from the present. This could be a bird singing outside, or some music.
Encourage them to look at your body – the size of your hands, or your size compared to a chair/table or the door frame.
Ask them to stand up and see how tall they are. They will see they are the height of adult– not a child. This might seem scary at first, but it can also be reassuring to be a big adult as having an adult body may feel safer.
Encourage them to look at physical environment – the features of the house they live in now and notice that it is different to the childhood home.
Show them photos from the present – these photos should safe and non-threatening. They could include a beloved pet, a photo of a trusted loved one, or a picture of a recent happy outing or holiday.
Show them ornaments/toys/appliances from the present. These can actually form ‘safe anchors’ to the present (Boon, Steele and van der Hart, 2011)

Try to do this gently, keep it positive, and even try to have some fun. This is a chance for traumatised parts to have a better experience.

Reference:

Boon, Steele and van der Hart (2011). Coping with Trauma-Related Dissociation.

Photo – courtesy of Shutterstock

Living with DID: Improving Sleep

09/01/2018Dissociative DisordersKate McMaugh

It is very common for people experiencing dissociative disorders to have trouble sleeping. This can be for all the reasons that non-dissociative people have sleep problems such as drinking caffeine or alcohol; poor sleep routine; disturbed sleep-wake patterns; or too much screen time close to bedtime.

However people with dissociative disorders typically have other additional reasons for sleep problems. These include:

Traumatic nightmares and flashbacks;
Child parts feeling scared at night;
Activity of Dissociated parts during the night, including parts who feel they don’t get enough ‘out’ time during the day; and
Flashbacks (even hallucinations) when you are on the cusp of sleep or waking.

Steps to Help

Firstly look at your basic ‘sleep hygiene’.

‘Sleep hygiene’ is a rather strange expression psychologists use to describe good sleep practices. While people with DID often need specific practices to help them get to sleep, attending to general healthy sleep practices can also help. This includes: developing a ‘bedtime routine’ that begins an hour before bedtime; turning off screens 45 minutes before bed; avoiding caffeine in the afternoon; avoiding alcohol; getting enough exercise etc. See you counsellor or psychologist to discuss your daytime activity. It might be necessary to speak to them about working internally with parts to develop a healthy daytime routine, as that often helps sleep as well.

Make sure parts have time during the day

Talk inside, using whatever method works for you, to establish unmet needs and unexpressed desires. Make sure parts have a chance for expression during the day. Sometimes there will need to be a compromise, as there are only 24 hours in the day, no matter how many parts you have. This is where the concept of a timetable, rostering or ‘taking turns’ comes in handy. Most child parts can understand this and can wait if they know that they too will soon have ‘their turn’ for an activity.

Prepare your bedroom

Your bedroom should be a nice place to sleep and should feel safe and comfortable for all parts, especially the child parts. Tips to help include:

Removing items from the bedroom that might be triggering. This DOES include screen devices. Not only do screens disrupt sleep but they also can be used by various parts to look up or research things which can be triggering. It is easier to put them away or disable the internet during the night.
Ensure that there are soothing items for the child parts. This could include a soft toy, a soft ‘cuddle blanket’ or soothing music.
Sometimes child parts benefit from the creation of “safe anchors” in the bedroom. These are items in the bedroom that are safe, attractive, soothing or reminders of the present. See the separate information sheet on creating safe anchors.
Consider ‘background noise’ carefully. Scared parts often want some background noise in order to sleep. However the TV or radio are not good for sleep. In addition topics and content can change quickly, meaning that you can be exposed to something scary when you least need this! It is better to play a steady, droning ‘white noise’ or a special relaxation/nature noises recording. You may also like to create your own soothing music playlist. Classical music can be very soothing, particularly Baroque music, but there are also many lists of ‘relaxation music’ available on the internet.

Prepare all parts for Sleep

Child parts, in particular, often live in the past and feel like they are still at risk of being traumatised. It is essential to work with them and find ways for them to feel safer at night.

Ask inside – what do you need to feel safer at night? Ideas might include: a special soft toy, a special blanket, quiet nature sounds. Sometimes it helps to try a creative approach. Child parts sometimes need child-like and play based steps to feel safe. Some child parts like to put a “guardian” soft toy in front of the door to “protect” them. This could be a lion or a dragon. Other child parts like to cuddle this toy in bed with them. It doesn’t really matter if adult parts don’t believe in this. What matters is that by doing the ritual they show the child parts that they care and want to soothe them. This helps the child parts feel heard, cared for and therefor safer. Work with your therapist to discuss these ideas and explore this.

Remind the child parts/traumatised parts that they are safe, that the time of abuse is now over. This might include developing a saying such as “It is 2017. I am now 36 years old and I live in XXX. I live in a nice house and that doesn’t happen here.” Work with your therapist to develop these statements.

Develop a ‘safety anchor ritual’ for the bedroom. This involves looking around the bedroom and focussing on items and objects from the bedroom that did not exist in your childhood bedroom. This reminds the child parts that they are in the present time and is very grounding for all parts. Do this step by step with your therapist.

Consider creating a safe place in your head for child parts/traumatised parts. This could be a special room in a house or some other special place. Scared child parts can choose to go there at night.

Use creative visualisation to soothe yourself before sleep. Creative visualisations are best developed with your therapist or somewhat planned out first. In this step you visualise a special place for yourself that feels nice and calm and as safe as possible. It is important to imagine yourself at this place using all your senses. Examples of places include a garden, the beach, a park, a special room that can be as secure and impenetrable as you want it to be. Your therapist can also provide some examples of pre-written visualisations which you can adjust to suit your needs.

Create a “Sleep Kit”. This can be a box or a container which has all the things you and your parts need to help them feel calm and reassured. This box could contain photos, pictures of beautiful places, a recording of soothing music or sounds, a special blanket, pillow or soft toy, a smooth stone or beautiful crystal to look at or touch, a memento of a positive experience, something beautiful a special friend gave you etc.

This resource has been developed based on:
Suzette Boon, Kathy Steele, Onno van der Hart (2011) Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists, W. W. Norton & Company
Janina Fisher Webinar Program Level 3: Working with Trauma related complexity and dissociation and Level 4: Advanced topics in Trauma and dissociation
Lots of feedback and ideas from clients!

Treating Anxiety: A Whole Brain Approach

11/03/2017General CounsellingKate McMaugh

Anxiety is a horrible feeling that can leave people feeling overwhelmed and crippled by its power. It is one of the most common reasons people come to therapy.

However if you want to beat your anxiety – it really helps to understand how anxiety works in your brain. If you can understand what your brain is doing, you are better equipped to change your brain.

First of all – some basic brain facts need a diagram:

In this diagram the lighter coloured, outside part of the brain is the cortex. It’s the ‘grey wrinkly stuff’ most of us think of as the ‘brain’. This area controls the ‘higher functions’ of language, thinking, planning and problem-solving. This part of the brain uses language and has a concept of time.

The coloured sections of the brain (eg hypothalamus, amgydala, hippocampus) make up a very important part called the Limbic system. This area functions through emotions and body sensations. It is responsible for rapid responses to help us stay alive and function. This includes pleasurable responses, but specifically in relation to anxiety, it also kicks in during times of stress. It controls the ‘fight, flight or freeze’ responses when we are in danger.

Both parts of the brain play a role in anxiety and, unless we treat both, anxiety remains lingering in our lives.

The Cortex is the area most people are thinking about when they think of anxiety. This is the section of our brain that worries, over thinks things and may ruminate when we are anxious. Traditional therapies such as CBT can help treat this aspect of anxiety.

But sometimes therapists overlook the Limbic System. I call this “amygdala anxiety”. This anxiety is characterised by vague feelings of uneasiness, a sick feeling in the stomach, even when there is no obvious danger. You may feel like your anxiety doesn’t have a specific, logical cause but it hangs around anyway.

The cortex causes the thinking symptoms of anxiety, but the amygdalae (we have two of them in the limbic system) are responsible for the other horrible symptoms: sweaty palms, pounding heart, rapid, shallow breathing, tense muscles and upset tummies.

The cortex and the amygdalae talk to each other and reinforce the anxiety. For example, fast breathing and a pounding heart sends a message to the cortex that the body is in danger. This sets the cortex off on a round of frantic worry! Unless we treat both the cortex and the amygdala, anxiety is likely to continue.

It is also important to realise that the Cortex and the Amygdalae operate on completely different timetables. Any treatment needs to take this into account. The cortex is slower, but the amygdalae’s rapid response – geared to survival – can throw you into a panic well before the cortex has time to sort out fact from fiction.

An example to illustrate: If you were out bush walking and you saw a stick that looked like a snake, you might gasp and jump backwards. Your heart will pound and your breath will come in short sharp pants. This is your limbic system (eg amygdalae) working. Then you look again, your brain realises it is a stick and computes: stick= harmless = calm down. This is now your cortex talking. It might run late, but it’s helpful!

However the amygdalae can also override the cortex. A typical example will be someone who had childhood trauma. These people will have over-active amygdalae – they needed this to survive childhood. However as adults, even though a logical rational part of their brain will know the danger is over, their amygdalae will keep on red alert, constantly sending danger signals to the cortex. This can also happen for people who just had an ‘innate anxiety’ as a child, even without an obvious trauma. For these people their overactive amygdalae keeps triggering the cortex to worry.

Treatment

The good news is your brain can be re-wired!

So how do we treat anxiety to make sure BOTH parts of the brain are calmed?

Treating Amygdala Anxiety

Specific treatments are needed to calm the amygdalae to make sure they stop sending inaccurate danger signals to the cortex. If we do this we can ‘get in first’ and get on top of anxiety. To treat amygdala anxiety we have to understand that the amygdalae don’t have words or a good sense of time. The amygdalae can only learn through body sensation and body action. Examples include:

Grounding exercises;
Breathing exercises to encourage a slower and deeper breathing;
Muscle relaxation;
Starting practices like meditation, yoga and tai chi;
Developing a great understanding of amygdala triggers (a therapist may be necessary for this explorative work);

The next most important things to remember is that the amygdalae don’t learn by people (you, or someone else) just speaking to them. They can only learn through experience. Therefore it is vital that the amygdalae get new experiences. For example if someone is so scared that they are afraid to go outside then the amygdalae never get a chance to learn that the outside world is mostly pretty safe. Every time the fearful person avoids the outside world the amygdalae get a mental ‘pat on the back’, a reinforcement that they are doing the right thing. Next time they continues doing the same thing, in an even stronger manner!

HOWEVER if that person gradually tests going outside and realises they are safe the amygdalae get to learn that the outside world is safe. The same applies to all sorts of fears such as bugs, public speaking and night time. An important part of beating anxiety is pushing through the fear barrier to teach the amygdalae about safety. As already said we can’t do this with words alone – as the amygdalae just can’t ‘hear’ them.

Some people refer to these as ‘exposure therapies’ but I don’t think this is a soothing and useful expression. The thought of being ‘exposed’ is enough to make most of us anxious! I would rather think of them as ‘practicing new activities’ or ‘giving your amygdala a new experience’. A therapist can help guide you through a gentle and gradual program.

Treating Cortex Anxiety

Once amygdala anxiety is reduced the cortex is less triggered, but it is still important to work on cortex anxiety. This is done through strategies such as:

Reminding yourself that your cortex is not always right. Develop a healthy scepticism about thoughts. Develop the ability to notice them, analyse them and choose a response, rather than immediately reacting;
Identifying unhelpful thoughts;
Developing more rational thoughts and arguments against unhelpful thoughts;
Using programs such as ‘Wise Mind’ strategies; and
Using mindfulness and thought de-fusion to combat worry and rumination.

Getting More Help

Anxiety can be a very entrenched problem and be hard to shift. However it is possible to re-wire the brain. A useful self help book is: Rewire your Anxious Brain by Catherine Pittman and Elizabeth Karle.

Sometimes people find it helpful to see a mental health practitioner to get support in reducing anxiety symptoms. A counsellor, psychologist or mental health social worker may be a great help in getting on top of anxiety using a ‘whole brain approach’.