Day: October 12, 2022

10/12/22 (Wed)

The 4 Signs of the Attach/Cry-for-Help Response ~ Link

The three emerging defense responses to trauma (beyond fight-flight-freeze):

1. Attach / Cry For Help
2. Collapse / Submit
3. Please / Appease

• 3 Alternative Defense Responses to Fight-Flight-Freeze (and How to Identify Them)
• The Profound Impact These Defense Responses Can Have on Your Client’s Relationships
• The Least Understood Defense Response – and Why It May Produce the Opposite of What Your Client Wants
• Why These Defensive Responses Can Leave Your Client Vulnerable to Further Trauma
• A Polyvagal-Informed Approach to Working with Defense Responses

Each response presents its own clinical challenges and requires different interventions to help patients move forward.

Notes: (10/12/22)

• 1. Attach / Cry For Help Response:
• Earliest Survival Response.
• The least understood survival response.
• Not a safe survival defense in an abusive family. It can be dangerous if it triggers the perpetrator.
• It’s not that much of a cry for help. It comes from a more desperate and helpless place. It’s a cry for survival.
• It’s a sympathetic mobilization.
• It can feel intrusive and even threatening for therapists.
• A. List some behaviors that can indicate Attach / Cry For Help:
• Multiple voicemails, and multiple texts.
• Hard time leaving the office at the end of therapy.
• Complain that there’s too long between sessions.
• The client becomes “child-like”.
• Idealization of the therapist.
• The therapist wants to help the client but also needs to strengthen the client’s ability to help themselves (empowering your clients). Set firm boundaries in a warm way.
• B. Have you noticed any of these signs in yourself? Add them to your list:
• C. I can differentiate between signs of the Attach / Cry Response and Borderline Personality Disorder (BPD):
• Both share the idealization of the therapist, but the patient in the attach/cry response will usually become more desperate and childlike.
• D. In Ogden’s attach/cry for help case, what was she trying to shift?
• Help the patient feel safe.
• Move by helping the client to self-regulate.
• E. Fisher suggested a somatic resource to help therapists stay regulated when working with a client in an attach/cry response. What is it?
• F. Steele talked about 2 problematic therapist responses to attach/cry. What are they?
• Very off-putting, feel very exhausted. The tendency is to push back and get angry.
• Have a compassionate care-taking response.
• Both are problematic because it doesn’t help the client to develop a secure attachment.
• G. What polyvagal approach does Dana use with clients in attach/cry?
• Interrupt the automaticity of the sympathetic loop. Tell your client that you can see it and feel it and ask the client to stop that state for a while ~ Ventral Vagal Energy
• Ventral Vagal Energy – Boost your patient’s feelings of safety and activate their ability to socially engage.
• Don’t miss or ignore what is going on with your own nervous system.
• The ultimate goal is for the patient to co-regulate and to self-regulate.
• H. Strategies for working with Cry For Help:
• Be very warm, and very careful.
• Not answering too many texts, and emails. Hold the time boundary at the end of the session.
• This meets the cry for help but not stimulating the more desperate longing. Hold the boundaries without becoming rigid or confrontational.
• Bring warmth to facial expression and tone of voice, but keep “boundary muscles” engaged. It’s a very right-brain to right-brain communication. It’s about going beyond words alone to communicate with your patients. By using non-verbal cues to resonate with your patients.
• 2. Collapse / Submit:
• You’re Here, But Not Here, can leave you vulnerable to more trauma.
• People with this predominant trauma-defense response have tremendous difficulties in interpersonal relationships.
• The body’s defense strategy as a last resort. It’s the last in the series of instinctive defensive responses. This occurs in chronic traumatization. The most adaptive is to flee and if we can’t flee, then we fight.
• The patient becomes very hypo-aroused. A massive release of endorphins occurs to numb out the pain.
• This form of protection can come with a terrible long-term cost. The neurochemicals that are released are associated with chronic depression and feelings of helplessness.
• What happens is that you essentially become “dead” to the world. ~ Dorsal Collapse Shutdown.
• If this is your patient’s habitual survival response, then it can lead them to more trauma as they stop taking in cues of dangers around them, and can’t activate their survival responses.
• A. List some physical signs of Collapse / Submit that Ogden models:
• Seems like the patient is very “complaint”, or “obedient”.
• Your energy starts to “flag” when that dorsal vagal collapse comes up.
• B. Have you noticed any of these signs in yourself? Add them to your list:
• C. I can differentiate between Collapse / Submit and Treatment Resistant Depression:
• Collapse / Submit is a nervous system response that can be triggered in present time.
• D. What are the 4 ways that Collapse / Submit may present?
• a. Mimics Compliance or obedience
• b. Mimics Treatment-resistant depression.
• c. Tremendous difficulties in interpersonal relationships, unable to deal with the situation.
• Difficulties at work. Can’t stand up for themselves and often get taken advantage of.
• d. Social Isolation – Difficulty engaging in anything. This can lead to a huge amount of social isolation.
• E. According to Lanius, what are the neurobiological and chemical changes that accompany Collapse / Submit designed to do?
• F. Draw lines to match:
• i. Dorsal Vagal State – a – submit / collapse
• ii. Sympathetic State – b – fight or flight
• iii. Ventral Vagal State – c – setting a healthy boundary
• iv. Balanced, Socially Engaged – c
• v. Collapsed State – a
• vi. Charged with Energy – b
• Help the patient to engage with their sympathetic nervous system. But you also don’t want them to go into a heightened sympathetic system (flight or flight) either.
• Hone in on the subtle 3 states and help your patient to achieve the Ventral Vagal State.
• Understand how your nervous system says no to each of these states.
• Polyvagal theory in practice ~ Link
• Stay anchored in your ventral vagal state.
• Align your body to prime the pump of “fighting back”.
• Practice boundary motions. Use physical motions of “pushing away” what you don’t want in your life.
• 3. Please / Appease ~ People Pleaser:
• It’s a survival strategy. i.e. My system is really attuned to what it needs to do to not activate the other person’s “fight” response, i.e. abuse.
• It’s an active nervous response that enables people to survive in relationships with active cues of danger.
• It’s a sympathetic state masquerading as being “socially engaged”.
• People-Pleasing: A Trauma Response, and How to Stop It ~ Link
• What’s Happening in the Nervous System of Patients Who “Please and Appease” (or Fawn) in Response to Trauma? With Stephen Porges, PhD ~ Link
• B. How have you noticed any of these signs in yourself?
• C. What’s the function / purpose of the Please / Appease response?
• D. Tummala-Narra, Dana, and Bryant-Davis all modeled ways of responding to a client whose please/appease response is active in the therapeutic relationship. Which are you most likely to use with your clients?
• Give your client permission to disagree with you.
• E. Once you understand the origins of the please/appease response, what does Dana recommend you explore?
• Pay attention to your patient’s nervous system state.
• Check back with your own nervous system.
• Help your patient find out where and when the people-pleasing started. Where did you learn that it was dangerous to have your own thoughts and feelings?