Healing Traumatic Attachment Patterns - Dr Janina Fisher

Ajouté : 2026-05-07

[00:00:00]Well.

[00:00:00]Traumatic attachment is the word we use for what happens to attachment in child abuse and domestic violence, where children live in an unsafe environment.

[00:00:14]And unfortunately, the danger comes from their attachment figures.

[00:00:18]So it sets up, you know, that the natural reaction of children who are not traumatized is to seek out the parent figure.

[00:00:29]Those of us who've lived through the early years of parenting know that you spend years with small children glued to your leg.

[00:00:39]You know you can't walk two steps across the kitchen without having this, this little person, right.

[00:00:46]Holding on to you.

[00:00:48]John Bowlby believed that that was a sort of evolutionary feature, because children who stayed close to the parent survived to become the next generation.

[00:01:12]Okay, Janina, welcome to the show.

[00:01:15]Thank you. Thank you so much.

[00:01:18]To get started.

[00:01:19]Could you maybe tell us what what is traumatic attachment and how might this show up in the therapy room?

[00:01:27]Well, traumatic attachment is the word we use.

[00:01:31]Or what happens to attachment in, in child abuse and domestic violence, where children live in an unsafe environment.

[00:01:45]And unfortunately, the danger comes from their attachment figures.

[00:01:52]So it sets up, you know, you know, that the natural reaction of children who are not traumatized is to seek out the parent figure.

[00:02:04]And, and, those of us who've lived through the early years of parenting know that you spent years with small children glued to your leg.

[00:02:19]You know, you can't walk two steps across the kitchen without having this.

[00:02:24]This little person.

[00:02:25]Right?

[00:02:26]Folding on the that's normal biological attachment drive, right.

[00:02:34]Keep your caregiver close.

[00:02:36]John Bowlby believed that that was a a sort of evolutionary feature, because children who stayed close to the parent survived to become the next generation.

[00:02:52]Now, what happens when that person you have the impulse to cling to also happens to be the person who hurts you or frightens you.

[00:03:06]And what that sets up in children.

[00:03:08]And they've observed this, a very early age.

[00:03:12]Is that less than a year?

[00:03:15]What happens is the child still has that urge to seek closeness, but now it's coupled by the urge, to fight or flee.

[00:03:27]So the child simultaneously feels.

[00:03:31]And, you know, I've got to get closer and I've got to get away.

[00:03:38]So it sets up a huge internal conflict in which the child doesn't feel safe being close to the parent, but also doesn't feel safe at a distance, because as soon as they back away, they have the pulled for closeness.

[00:03:57]Now starting up again.

[00:04:02]So very it's you know, it's very confusing for a one year old.

[00:04:07]It gets even more confusing as it continues to play out through adulthood.

[00:04:15]That, strikes me as just such a tragedy.

[00:04:18]You know, it's sort of like if you were driving a car, you'd have one foot on the accelerator and the other on the brake.

[00:04:25]You know, you're moving forward, but then we can move forward.

[00:04:28]You have to go back.

[00:04:31]And this, you know, this is, you're talking about John Bowlby, and he was he studied a lot of, you know, animal behavior as well.

[00:04:40]And it just reminded me when I do a lot of running here in the Irish countryside, and I'm always running along the roads, country roads.

[00:04:47]And there's always like lamb, like lambs, like on the close to the fences.

[00:04:52]I never I run fast, they always sprint to their, their mother and go to the security action figure.

[00:04:59]You know.

[00:05:01]But something I wanted, I was curious to ask Janina was about mental health professionals and attachment styles.

[00:05:10]Can you share your your thoughts?

[00:05:12]And is like, do you do you think there is a predominant attachment patterns or pattern for mental health professionals?

[00:05:19]And I don't know if you'd be willing to share your own or not, but I was just curious to ask, what what's your own attachment, pattern, if that, if you be open to sharing that.

[00:05:29]Well, you know, certainly there's, there are many therapists who have their own trauma histories, who might have in their personal lives.

[00:05:42]They might have a more disorganized attachment, in their therapy work.

[00:05:50]I'm sure they manage their attachment styles, but there is an interesting piece of research that goes back many years where they looked at the attachment style of the therapist and the attachment style of the client, and they saw how they matched up.

[00:06:09]The best match was between the therapist who was more dismissing, and a client who was more preoccupied.

[00:06:22]Right.

[00:06:23]Which again, Non-traumatic attachment styles the dismissing, often called avoidant and and preoccupied.

[00:06:34]Often called ambivalent for reasons that make no sense.

[00:06:39]So so it was very interesting that that that it it kept the preoccupied client and the and a preoccupied therapist from getting enmeshed.

[00:06:54]Because the therapist style was more dismissing.

[00:07:00]And I would say my, my own attachment style, tends to be what what's called earned secure attachment, meaning you didn't have it secure attachment in childhood, but you acquired secure attachment through adult relationships, through therapy, through raising one's own children.

[00:07:30]Those are all opportunities to rework your attachment system.

[00:07:38]So I feel very lucky.

[00:07:41]I think we're going to explore that more later.

[00:07:43]But before we get into, I'd love to ask you about how you the work of Caroline Lyons, Ruth impacted you as a clinician because this seemed to be a very important on your on your trajectory.

[00:07:55]Well, you know, truthfully.

[00:08:00]Her work, her work helped to make a bridge because she is a researcher who also is a clinician and who worked in a department of psychiatry.

[00:08:17]She made more of a bridge between the research and the clinical implications.

[00:08:24]And she was the first that I recall to make the connection between disorganized attachment or traumatic attachment and dissociation.

[00:08:37]So that's that's really what, what the part of her work that influenced me.

[00:08:47]Most of her work has been 30 years of studying the same group of what were originally one year olds.

[00:08:55]There was now in their 40s, I would guess.

[00:09:01]Yeah.

[00:09:01]And the something that I find quite interesting about, about her work was the impact that frightened or frightened, frightening behavior of parents can have on children.

[00:09:16]Could you maybe speak to this a little bit?

[00:09:19]Yeah.

[00:09:19]So that that finding was actually made a generation earlier by Mary made it was one of the first generation after Bowlby to study attachment.

[00:09:35]So what the researchers noticed at the beginning was they noticed secure attachment.

[00:09:42]They noticed what they called insecure, ambivalent attachment, meaning children who were clingy and fussy, insecure avoidant children who were kind of independent in their own little worlds.

[00:10:00]And then there was this fourth mystery, this group of children who approach the attachment figure and then ran in the other direction.

[00:10:10]And they called those disorganized because they didn't understand what was going on.

[00:10:18]Then they noticed because, of course, part of attachment research is noticing what the child does in reaction to the mother, but the other is noticing the other part of the research is watching the mother.

[00:10:36]And what they found when they watch the mother's behavior.

[00:10:40]Was it the mothers of these disorganized children engaged in behavior that was frightening to these one year olds?

[00:10:51]Again, it's not the kinds of things that would frighten the ten year old, but things that would frighten a baby.

[00:11:01]Like baby runs toward mother.

[00:11:05]Mother pulls away, or baby is crying.

[00:11:09]Mother has a shut down.

[00:11:14]A still face.

[00:11:15]If you're familiar with the still face study.

[00:11:19]And, what were some of the others?

[00:11:24]Eight mothers startled easily.

[00:11:28]And when they startled, that was frightening for the babies.

[00:11:34]Also, I'm trying to remember some of the other ones.

[00:11:41]The parent, was intrusive.

[00:11:47]Their movements were awkward and mis attuned.

[00:11:53]They made loud, startling noises.

[00:11:56]They engaged in mocking the child.

[00:12:00]Imagine mocking a one year old baby.

[00:12:04]It doesn't it doesn't make any sense.

[00:12:09]So they saw this correlation between the the one year old's attachment style and these behaviors, which appeared to frighten the children.

[00:12:25]Yeah.

[00:12:26]Wow.

[00:12:27]And, you know, some memory comes back.

[00:12:31]Comes to mind for me.

[00:12:32]I remember being about about seven, I think.

[00:12:36]And I was on holiday with my with my mom.

[00:12:39]And I remember at one point she was visibly quite, scared or frightened about something that had happened.

[00:12:49]And to me, this stick, this stuck in my memory for ages, like I was. This really upset me.

[00:12:54]You know, so is is the implication here that parents should and I know we shouldn't, you know, pretend to be something we're not or whatever, but is there a case to be made that parents should do their best to maintain or to be a source of strength during those maybe distressing moments, so that the child looks to them and knows that there's a CFI anchor there, as opposed to to, showing the fear.

[00:13:22]What do you think about that?

[00:13:23]Well, I don't I think we can we we don't necessarily have to to go to that extreme, but certainly what we don't want to do if we're frightened, we don't want to to show the fear in a way that frightens the child.

[00:13:44]So, you know, if if we're saying, oh my God, oh my God, this terrible thing is going to happen that will frighten the child.

[00:13:54]If we say, you know, we've got to go inside right now because there's about to be a lightning storm.

[00:14:01]So come on, sweetie, let's go inside.

[00:14:04]That's, you know, the fear is being expressed, but in a way that is reassuring to the child.

[00:14:14]For sure. For sure.

[00:14:16]It sort of reminds me whenever I'm, flying in an airplane and there's bad turbulence.

[00:14:20]The first thing I do is I always look to the, like, the air hostesses.

[00:14:24]And if I see a shred of panic on their face, I'm like, oh. Right.

[00:14:30]If I do the same thing.

[00:14:34]I've heard you say that instead of asking, you know, when a client comes to therapy, instead of asking where you abused as a child, you will often ask where your parent's frightening as a child, and you find this to be quite a fruitful question.

[00:14:49]Can you maybe expound on this a little bit? Yes, because.

[00:14:53]Because, you know, many people will not answer the question, were you abused by your either of your parents because it's a loyalty question for them, not a historical question.

[00:15:08]And or they may feel shame.

[00:15:11]There may be a variety of reasons for them to or they may have minimized it.

[00:15:18]If I say were either of your parents frightened me, I can't.

[00:15:22]More of the details and the details often include.

[00:15:27]Oh, yes.

[00:15:28]You know, my if I said something my father didn't like, I would see the back of his hand.

[00:15:36]Right.

[00:15:37]So?

[00:15:37]So you begin to get, the actual data.

[00:15:45]Yeah.

[00:15:45]That's a that's a really good question to ask.

[00:15:49]Another thing I wanted to bring up in the interview was, I've heard you say that if you were made, you know, president or ruler of the words, I'm getting the getting the phrasing wrong, I apologize.

[00:16:03]But, you would rename borderline personality disorder as disorganized attachment disorder or traumatic attachment disorder.

[00:16:10]Can you maybe tell us about your thinking behind this?

[00:16:14]Yeah.

[00:16:15]Well, first of all, I do.

[00:16:18]We have 30 years of research that demonstrates study after study after study demonstrates that borderline personality disorder is associated with a history of childhood trauma.

[00:16:37]So already you see that the research says this is not a personality disorder.

[00:16:46]This is a set of symptoms caused by traumatic events.

[00:16:53]So all these 30 years we've been treating borderline personality as a personality disorder, as the worst possible personality disorder that no one likes to have around them, when in fact, we have their trauma survivors.

[00:17:15]And particularly they show the impact of traumatic attachment.

[00:17:22]And am I right in saying that we can actually predict borderline with, you know, it's correlates so strongly that you can predict whether a child at the age of one is likely to develop, borderline at the age of 2021.

[00:17:38]Well, that's what the research like.

[00:17:40]Carolyn Lyons, Ruth Research, the research of other attachment researchers, they showed the same thing that that having disorganized attachment at age one is a statistical predictor of developing borderline personality disorder or being given that diagnosis in early adulthood.

[00:18:05]And as are the implications of that, then if we if we become aware of that, then we can intervene in such a way that we might be able to prevent the development of that later and later in life.

[00:18:18]Well, that would be the hope that, as we know, we have social care systems, which are I really inadequate despite our best efforts.

[00:18:31]So you can't get a guarantee that if I take this child out of the home and place that child in a foster family, I can't guarantee that the foster family will be a better environment.

[00:18:50]And so.

[00:18:51]And then we have huge attachment issues that are caused by taking a child out of family.

[00:19:00]So it's very complicated in the US.

[00:19:03]We simply don't have enough foster families.

[00:19:07]And so there's nowhere for the children to go.

[00:19:12]It's terrible.

[00:19:16]Another thing I was curious to ask you, Gina, was is there anything that you believe about attachment or that you've experienced in your decades of clinical work that might surprise people, or might go against the conventional wisdom or the conventional thinking in the area?

[00:19:37]You know, is there anything that.

[00:19:39]Yeah.

[00:19:39]Does anything come to mind when I ask that question?

[00:19:41]If nothing comes to mind?

[00:19:42]Don't worry.

[00:19:43]I was just just wanted to see if anything was there.

[00:19:46]Well, other than saying borderline personality disorder doesn't exist, is that's the most controversy?

[00:19:56]Okay.

[00:19:57]I suppose the other most controversial thing that I keep saying, is that is that we pay much too much attention to the events that occurred and we don't pay enough attention to the fact that abuse children live in a traumatic environment.

[00:20:23]And that therefore they are traumatized every single day, not just on the day that they're beaten or abused in some way.

[00:20:34]Yeah.

[00:20:34]Yeah. It's we can never it's it's so hard to overestimate the importance or underestimate the importance of the context around a person, as opposed to what's happening internally as well, that the two really go together.

[00:20:52]A something else was around the, the window of tolerance.

[00:20:58]What what is the window of tolerance?

[00:20:59]And why is this important?

[00:21:00]Whenever we're talking about attachment and attachment, trauma?

[00:21:06]Well, it actually I think it's important to think about when we're talking about anyone, but the, the window of tolerance is a term, originally used by Dan Siegel.

[00:21:21]And adapted and I would say publicized even more by Pat Ogden.

[00:21:29]And what it refers to is our, our bandwidth for tolerating emotion, stress, impulsivity, hurt, disappointment, you name it.

[00:21:45]If we have a wide window of tolerance, if it's flexible, then we can tolerate grief and other strong emotions.

[00:21:54]If it's very narrow.

[00:21:57]We have trouble tolerating any emotion and and if the problem is that in trauma, we, we rely on our nervous systems sort of highest and lowest settings.

[00:22:18]So in a traumatic environment, we we the threat stimulates the sympathetic nervous system, which increases, nervous system activation to prepare us to take action.

[00:22:38]So the sympathetic nervous system is all about taking action.

[00:22:45]That's why it's there.

[00:22:46]Now, little children obviously can't take action.

[00:22:52]Victims of domestic partner violence can't necessarily take action.

[00:22:58]Even even soldiers in a war can't necessarily take action.

[00:23:05]But they still have that.

[00:23:07]That high arousal, fear, anger, hypervigilance, setting and our other setting for a traumatic, events is the parasympathetic low arousal, where the nervous system does the opposite.

[00:23:29]Instead of increasing activity, it reduces activity to the point at which we have the equivalent of a sort of psychological hypothermia, where we have no energy, no connection to feelings.

[00:23:50]We're just exhausted.

[00:23:53]And sorry to interrupt, Gina, but would it be that, like, how does a person or how would a person's nervous system decide whether to go into that highly aroused sympathetic state or that really low dorsal, like, would that be based on past experiences, or would it be a calculation that happens under the surface?

[00:24:15]Why would that happen?

[00:24:17]Well, Steven Porges says it is, due to our ability to for neurosurgeon, for sensing danger and the brain and body automatically adjusts to the type and severity of the danger.

[00:24:38]So if we're in danger but there's room to flee or fight, we'll go into sympathetic activation.

[00:24:49]If there's no way out.

[00:24:50]If we're trapped, then we go into parasympathetic dorsal vagal states, because those allow us to submit and do okay.

[00:25:04]And then then that can lead to things like dissociation and fragmentation.

[00:25:12]Well, that's the way dissociation is another category of responses of the dorsal vagal state.

[00:25:24]The individual is not dissociated.

[00:25:27]They're just shut down.

[00:25:30]You know, imagine you're in a medically induced coma.

[00:25:34]That's probably the equivalent where and and that's a setting which is necessary often for women and children because they can't run, they can't fight and they can't escape.

[00:25:52]So their bodies go into that dorsal vagal shut them.

[00:25:58]And, they become they can be seen and not heard.

[00:26:02]You know, children are very bad at being seen and not heard.

[00:26:06]It's not in their wheelhouse.

[00:26:10]So that parasympathetic dorsal vagal state helps them to be seen and not hurt.

[00:26:18]Oh, that makes sense.

[00:26:20]And if a child has a parent or parents that are, abusive or frightened or frightening, how does that impact the window of tolerance?

[00:26:32]So a baby's window of tolerance is dependent on the parents.

[00:26:39]Right.

[00:26:40]So ideally, the baby cries.

[00:26:45]The parent, feels a need to take care of the baby.

[00:26:52]Experiments with what?

[00:26:55]What helps that baby feel less distressed.

[00:27:00]And then the baby goes, and just relaxes in our arms.

[00:27:06]And we have these blissful moments of, everything's all right in the world, and, and, and there's a very deep sense of connection.

[00:27:20]Now, that doesn't happen with abusive or neglectful parents because they hear the baby cry and they either get angry or they want to run away.

[00:27:36]So.

[00:27:37]So what a parent, what a parent intervenes and the baby feels distress and then is calmed by the parent.

[00:27:46]That's conditioning the nervous system to grow a window of tolerance.

[00:27:56]Yeah, they don't have it at six months yet.

[00:27:59]Okay.

[00:28:00]And they don't have it at two.

[00:28:02]But but over time, you see you see the results in steadily increasing ability to tolerate their feelings without melting, melting down.

[00:28:17]So, so the extent to which the parent is attuned to the, to the baby or the child is probably correlates with the size of the child when they have to, or the child when they have tolerance that they will develop.

[00:28:31]Right, right.

[00:28:32]Exactly, exactly.

[00:28:36]And something else that I find interesting when I was researching for this conversation was, children, not or even people in later life that find it really difficult to try hard and put a lot of effort into things and mobilize that sympathetic energy.

[00:28:54]This how this is linked with the window of tolerance and attachment during life.

[00:28:59]Can you maybe tell us about this as well, Janina?

[00:29:01]Well, I just think if you if you have to survive as a child by not exerting energy because you're in that dorsal vagal state and there's no energy to exert, and that's how you survive, you kind of slide below the radar.

[00:29:23]Your parents aren't threatened by you.

[00:29:27]You kind of keep to yourself.

[00:29:30]And, you know, what that does is it's conditioning, the nervous system.

[00:29:38]It's conditioning habits of not trying.

[00:29:43]Because if you have no energy, you can't try.

[00:29:47]It isn't a decision.

[00:29:49]It comes from the fact we need energy to try.

[00:29:55]And let's say that there's a therapist listening to this that has a client in that situation.

[00:30:00]Is there anything that they can do to help in these situations?

[00:30:06]Well, they can teach the client about the window of tolerance and get the client interested in how their nervous system works.

[00:30:19]So often we diagnosed those dorsal vagal clients as depressed.

[00:30:26]We give them antidepressant medication.

[00:30:31]And we talk to them about their depressing childhoods.

[00:30:36]That's not going to move the needle to change the parasympathetic dorsal vagal state.

[00:30:46]Right.

[00:30:48]For sure.

[00:30:48]Sure.

[00:30:51]And you know, to me, this this brings up another important point that attachment is pre-verbal.

[00:30:59]This is all learned before we have language. So it doesn't make any sense that we would use language to, to treat these the, these issues.

[00:31:08]Or maybe it I don't know, but it, it seems like we have to go through a layer deeper.

[00:31:13]What are your thoughts on this.

[00:31:15]Oh it's true.

[00:31:16]Talking about these things doesn't tend to change them, as many therapists have have had the frustrating experience of saying, so of change to change it.

[00:31:37]And also talking about attachment is very tricky because if I say to the client, you know, you have a traumatic attachment style, often clients are very defensive, very wounded because it feels like we're talking about them.

[00:31:59]We're saying you have this deficiency.

[00:32:05]So which is interesting because if I say, wow, your nervous system is off the charts here, they don't take it personally.

[00:32:14]But if I talk about their attachment style, it can be very wounding.

[00:32:19]And then that makes a key for difficulty.

[00:32:25]They feel I've empathically failed them, that I'm critical and cold.

[00:32:30]So I don't for that reason.

[00:32:33]I think talking about it is does it work?

[00:32:38]But what I can do is I can validate the attachment challenges they have.

[00:32:49]I can provide a little psychoeducation because Psychoeducation is neutral, right? It's not about them.

[00:32:56]It's about the whole world of trauma survivors.

[00:33:04]What else can I do?

[00:33:06]And then I can help the client work with the attachment style as it comes up in the relationship.

[00:33:16]Because many, many.

[00:33:19]And this is girls goes back to the to the fact that we've diagnosed these clients borderline.

[00:33:27]And so everything they do, we say, that's personality disorder as opposed to when they pull for closeness, when they're very preoccupied with whether we care about them, whether we're warm enough, whether we're going to abandon them when when that happens, the tendency of many therapists is to try to reassure the client.

[00:34:03]The difficulty is, you know, you can't.

[00:34:06]It's hard to reassure a traumatized person because traumatized people have been lied to.

[00:34:14]They don't believe reassurances.

[00:34:15]They've been told, oh, you're safe with me, right?

[00:34:20]Just relax.

[00:34:21]Nothing will happen.

[00:34:23]I mean, they've been told so many lies, and, so they don't believe reassurance.

[00:34:33]So that generally doesn't work.

[00:34:36]And sooner or later we are going to say or do something that hurts the feelings of that of the side of the client that wants to be very close to us and wants us to love the client, and then we're going to get the anger right, you miserable excuse for a therapist.

[00:35:03]You're a miserable excuse for a human being.

[00:35:07]You don't care about anyone but yourself.

[00:35:11]I mean, the names I've been called, they liar, gaslighter, cold and uncaring.

[00:35:21]Of course.

[00:35:25]What else?

[00:35:25]Narcissistic.

[00:35:26]Self-absorbed?

[00:35:30]It just the list goes on and on.

[00:35:33]So there's.

[00:35:34]So we have this feeling of one minute we're being clung to, and the next minute we're being blasted out with a machine gun.

[00:35:43]And, and so it's very confusing for the therapist.

[00:35:51]And it's also very confusing for the trans.

[00:35:55]And when that has happened for you, Janina, maybe in a very extreme case, what have you found helpful for sort of weathering the storm?

[00:36:04]Almost.

[00:36:06]Well.

[00:36:07]Well, I can tell you all the things I've learned that don't work.

[00:36:12]So what doesn't work is to try to, have some kind of rational process in.

[00:36:23]Right.

[00:36:23]So the client accuses me of being, you know, a liar because I said x, and then at another time, I said, why?

[00:36:35]There's no value in trying to process that a factually.

[00:36:43]It's better for it's much better if I say, oh, really?

[00:36:50]Wow.

[00:36:52]I can see how you thought that was loving.

[00:36:56]Yeah.

[00:36:58]And now I'm just thinking maybe I've lost my mind because it does seem rather odd that I said this.

[00:37:05]And, last Tuesday and that I said this other thing this Tuesday.

[00:37:13]So yes, I can see why it was confusing.

[00:37:17]So I'm not saying yes, I agree, I'm a terrible therapist, but I'm also validating the client's perception or or sometimes I say, well, could you tell me exactly what I said and how I said it?

[00:37:38]Because I know, yes.

[00:37:41]That I sounded critical.

[00:37:44]I'm not understanding how I came off that way.

[00:37:50]So it's I mean, obviously it's verbal.

[00:37:54]It's relational.

[00:37:58]But it doesn't get me into this messy situation of either having to defend myself or apologize for something.

[00:38:07]I don't think I've actually done.

[00:38:11]Yeah, definitely.

[00:38:15]And you mentioned earlier that psychoeducation can sometimes be very helpful for lowering a client's maybe resistance or defenses to to therapy.

[00:38:26]And I wanted to ask you, have you found any other ways if a client is resistant to therapy or, approaching a subject, have you found any other ways effective for, lowering those defenses or lowering the resistance?

[00:38:45]Well, the most important thing is and this I learned from Peter Donaghy, whose writing is so complicated I can't read it.

[00:38:57]But hearing him speak as a speaker, he's very eloquent.

[00:39:02]He's a wonderful speaker.

[00:39:03]And and he talked.

[00:39:06]I heard him talk about the just before the pandemic, at a conference in London, and he talked about how could we expect that these clients are going to believe us.

[00:39:24]Right. They've just met us.

[00:39:26]They don't trust us yet.

[00:39:28]They don't trust anybody.

[00:39:30]And we say things thinking that the client will believe us.

[00:39:36]How silly are we to think that we will be believed?

[00:39:41]He says the first thing you have to do with clients is to establish that you understand.

[00:39:49]And if you don't understand, find out how to understand the client.

[00:39:56]And I thought, you know, that's so, so, so true.

[00:40:01]And part of communicating that understanding is often through psychoeducation.

[00:40:09]So the the client says, you know, I, I can't sleep.

[00:40:17]I've just been having a terrible problem with sleep.

[00:40:21]And I say, yes, many survivors of trauma have trouble sleeping.

[00:40:28]It's, you know, it's the most dangerous time of the day for children.

[00:40:34]And and they feel understood.

[00:40:39]Okay.

[00:40:43]Or or I say to the client, oh, here's the good news.

[00:40:48]You're not going crazy.

[00:40:50]But you did get triggered, right?

[00:40:54]That's why you had such a strong reaction.

[00:41:00]Okay, okay, that's what I was going to say.

[00:41:03]Something else. So.

[00:41:05]So what I, what I'm communicating is I understood.

[00:41:09]And that's your behavior reactions.

[00:41:13]Feelings are not are not pathological, right. They're not to be dismissed.

[00:41:24]They are evidence that you were traumatized.

[00:41:30]He.

[00:41:32]And when we're talking about working specifically with, disorganized attachment, are there any things that you would recommend clinicians do or don't do?

[00:41:46]That can be helpful in therapy?

[00:41:50]Yes.

[00:41:51]Yes.

[00:41:52]And the major thing is don't get too close and don't be too distant.

[00:41:59]Try to find a middle ground because if the client is pulling for closeness and I get very close, that's going to then trigger the defenses like, oh, danger, I'm too close.

[00:42:21]Even if the client is saying no more closeness, more closeness for closeness.

[00:42:27]Right?

[00:42:27]I need to talk to you every day.

[00:42:29]I need to know you're still there.

[00:42:32]If we end up getting too close.

[00:42:37]And by too close, I mean, talking, texting or communicating on a daily basis, allowing sessions to go beyond the, the bounds of the, of the time, promising them that we won't abandon them and we just, you know, again, I don't know, a single therapist who started out in practice saying, I'm going to abandon all these patients in ten years.

[00:43:13]It's okay.

[00:43:14]That's not what we do.

[00:43:16]But but when we get caught in this, in this kind of, interaction where the every week the client is saying, I know you're going to abandon me, I know you're going to abandon me.

[00:43:32]And we promise, no, no, I'm not going to abandon you.

[00:43:38]We put ourselves in in a difficult position because because we haven't we haven't created enough distance for the client to actually experience.

[00:44:00]That they can tolerate a little distance.

[00:44:03]And lo and behold, even if we haven't spoken in five days, I'm the same person.

[00:44:11]We're getting on just as we always have.

[00:44:15]You know, it's like children.

[00:44:18]It's like children when, you know, we learned that we have to we have to meet many of children's needs.

[00:44:29]But if we meet them all, they're going to be ten more.

[00:44:34]Okay. And that's.

[00:44:35]And that no will become a bigger, scarier word if we never say it.

[00:44:43]The children have to hear lots of yes, but they have to hear enough, know that they can tolerate no and still feel that the parent is there with them.

[00:44:57]That's that's really addressing unhelpful, I suppose.

[00:45:00]I think this leads me into another question I wanted to ask was around, you know, if a therapist is in the unfortunate situation where they they feel it is right to end and the therapeutic relationship, can you tell us about the, I think you use, a metaphor of a winding road and stick figures, on how to. How do you remember?

[00:45:25]Do you know what I'm talking about here?

[00:45:27]Or can you tell us about this place?

[00:45:30]I do, so, I have 2 or 2 ways of of ending the therapy.

[00:45:37]One is when we have to end the therapy because it's untenable.

[00:45:44]Luckily, that happens almost never.

[00:45:48]But if there are times, I mean, I've had colleagues who were trauma survivors themselves trying to treat a client with huge anger issues, and it's just too frightening for the therapist.

[00:46:06]You can't do good work as a therapist if you're scared of your client.

[00:46:10]That's right. So.

[00:46:13]So when we have to do what I call an ethical termination, which is another reason never to promise clients that we won't abandon them.

[00:46:27]Then I, I do it on the basis that therapists have an ethical obligation not to continue a therapy that has become ineffective.

[00:46:42]And it's certainly never an effective therapy.

[00:46:45]If every session is devoted to the client yelling at us and telling us what a terrible excuse for a human being we are, okay.

[00:46:56]It's not an effective therapy, and usually the client isn't making progress if it's a termination or I prefer to call it a graduation, that occurs because the client is ready to graduate, or because our time, you know, in the service or clinic has come to an end.

[00:47:25]Then I do the the winding road approach that that you mention.

[00:47:31]So I draw on a piece of paper.

[00:47:35]I draw a winding road and a little stick figure and I say, right.

[00:47:42]And you began this journey to recovery.

[00:47:47]However long ago it was, and along the way, people joined you.

[00:47:55]Right.

[00:47:55]So I might make another stick figure.

[00:47:57]I say, yeah, here's Alice, your first therapist, and she helped you to get quite a way along this path.

[00:48:05]And then you met Julie, and, and I draw a little stick figure to represent Julie, your second therapist.

[00:48:15]And you.

[00:48:16]And she did a lot of work.

[00:48:19]And you learned a lot from Julie.

[00:48:22]And now.

[00:48:23]Now, here I am.

[00:48:25]I've joined your journey, and you and I are going to go along.

[00:48:31]I've gone along another chunk of the way, and now it's time for someone else to take you the next leg.

[00:48:41]And so to try to help them, not catastrophize every loss.

[00:48:49]I mean, if we think about our own experience of having have therapists or mentors or teachers, perhaps each one left us with a lot of knowledge and insight that we could take in to the next mentoring, helping relationship.

[00:49:10]And so it isn't just you have an attachment and then you lose it, then you have another attachment and then you lose it, which is a very depressing approach.

[00:49:25]And I used to work in a hospital setting where we had to where we had to terminate all our clients and take on a whole new, bunch of clients at the beginning of the next year or the next term.

[00:49:42]And, and so every year these, these poor clients were losing their old therapists and gaining a new one who was a stranger and would take them half the year.

[00:49:54]Two and two to mourn in anticipation of the loss.

[00:49:59]And then it would take another half a year to get used to the new therapist, which would give them only half a year of actual therapy.

[00:50:10]So I was trying to get around that for sure. For sure.

[00:50:15]Okay, so we've only got a few minutes left and there's loads of things I'd still love to ask you, but, one, I think that, you know, I think would be important to ask is for a young clinician listening to this, that is, you know, whenever they see what you've done with your, your, you're working life and the impact that you've had on the field, you know, it's incredible.

[00:50:39]And the people that you've collaborated with, like Bessel van der Kolk and Pat Ogden and these different individuals, have you any sort of words of wisdom for the next generation of therapists coming through about how they can best serve their clients and also make a meaningful impact in the field, anything that you'd like to pass on?

[00:51:00]Well, I think I'm going to pass on second hand wisdom from Bessel van der Kolk.

[00:51:07]Who said and I agreed with him, of course, the instant he said it, his he said to the young therapist, trained in his many modalities as you can because because most traumatized individuals need a number of different approaches, they can't necessarily be successful with one and only one approach.

[00:51:35]So yes.

[00:51:37]Yes.

[00:51:37]Gets your training.

[00:51:40]And then keep on getting host.

[00:51:45]You know, continuing professional development that trains you in other modalities as well.

[00:51:52]And would it be right in assuming here that you would recommend probably going deep with one, and then once you've got that sort of foundation, then then expand that into different approaches?

[00:52:03]Or would you just say.

[00:52:05]I think it depends on the individual therapist?

[00:52:11]I don't think you have to have a favorite.

[00:52:14]I think you can take what's useful from each of them.

[00:52:20]Okay, I like that.

[00:52:22]Well, Janina, this has been our third conversation, and I've loved every minute speaking with you and learning from you.

[00:52:28]It's always.

[00:52:29]It's just always such a pleasure.

[00:52:30]So thank you so much for for sharing some of your insights and knowledge and wisdom with us today.

[00:52:34]And where can people learn more about your work? And, if you were to recommend a book of yours to to get started, where would you where would you direct them?

[00:52:45]I would direct people to my website and my favorite book of all the books I've written is Healing the Fragmented Souls of Trauma Survivors.

[00:52:57]So how could I not recommend my favorite?

[00:53:01]Okay.

[00:53:03]Thank you. Janina.

[00:53:04]Well, it's been a pleasure.