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NARM Practitioner Training - Module 1 Manual

1NARM Training Institute, LLC

© Laurence Heller, PhD & Brad J Kammer, LMFT, LPCC

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NARM Practitioner Training Module 1


NARM Practitioner Training:The NeuroAffective Relational Model

for Healing Complex Trauma

The Manual

NARM Practitioner TrainingMODULE 1

Brad J Kammer, LMFT, [email protected]

(707) 462 2133

www.NARMTRAINING.com

mailto:[email protected]

http://www.narmtraining.com/




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Training Details

§Class Space §CEU Sign-In & Sign-Out§Video Releases§Confidentiality and Informed

Consent Docs§Personal Inquiry§Student Policy Handbook§Training Manual

§Continued Learning Opportunities§Experiential & Case

Consultations§Consult Groups§Informal, Informational

Lunch with Training Assistant§Peer Study-Practice Groups§Access to Training Videos &

Video Demo Library §Inner Circle Online Program

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Structure of Training

Didactic & Experiential Learning

§Didactic§Lecture§Q&A§Full Class Discussion§Video Session Deconstruction§Live Session Demonstrations§Small Discussion Pods§Case Consultation

§Experiential§Morning and/or After-Lunch

Somatic Exercises §Embodied Self-Inquiry

Exercises§Role Plays §Skill Building§Active Coaching with Trainer

and Training Assistants




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NARM Training Guidelines: Student Policy Handbook

§If you have questions please bring them to our Lead Training Assistants §Some Basic Guidelines to Remember:§NARM Training is highly experiential - challenging emotional material

may come up§You are free to role play or sit out any exercise - please just inform

one of the assistants or coordinators§Demos/Practice Sessions are about therapist learning, not about the

client - please no interpretation of client’s process §Performance anxiety is natural and part of the process - it’s part of

learning new material and clinical skills§Training Team is here to support you - not to judge or criticize you§Please respect confidentiality §Please respect difference, diversity and inclusion

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Training Details: Becoming a NARM Practitioner§NARM™ Therapist / Practitioner§Must attend all modules (1 may be done via video) §NARM Consultations Log•Experiential Consultations - 10 credit hours• Individual and/or Group Consultations - 10 credit hours

§Master’s Level NARM Practitioner (Optional)§Taught by Dr. Heller§Focusing on the “Primitive Edge of Experience” and

Working with Personality Disorders§Other Master’s Level courses being developed




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MODULE 1

§ Complex Trauma: Shock & Developmental Trauma § NARM Organizing Principles§ Connection Survival Style§ Attunement Survival Style§ NARM 4 Pillars§ Pillar 1: Clarifying Therapeutic Contract§ Pillar 2: Asking Exploratory Questions

MODULE 3

§ Countertransference in NARM§ NARM Model of Working with Affect:

Emotional Completion§ Shame, Guilt, Self-Rejection and Self-Hatred § NARM Personality Spectrum

MODULE 2

§ Autonomy Survival Style § Trust Survival Style§ Love-Sexuality Survival Style§ Pillar 3: Reinforcing Agency§ Pillar 4: Reflecting Positive Shifts§ NARM Relational Model

MODULE 4

§ The Dynamics of Attachment Loss§ NARM, the Body & the Polyvagal Theory§ Interplay of Survival Styles§ Relationships, Intimacy & Sexuality§ Solidifying NARM into Clinical Practice§ Disidentification: Freedom from Identity

Highlights of Training Modules

NARM OVERVIEW: The NeuroAffective

Relational Model for Working with Complex

Trauma




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Psychoanalysis/Object Relations:Sigmund Freud, James MastersonMargaret Mahler, Attachment Theory

1st Generation Somatic Approaches:Character Analysis (Wilhelm Reich)

2nd Generation Somatic Approaches:Bioenergetic Analysis (Alexander Lowen) Gestalt, Hakomi, Somatic Experiencing

NeuroAffective Relational Model (NARM)

NARM in Historical Context

Other Relational

& Mindfulness

-Based Models

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NARM Development§Over 40+ years in development§Integrating:§Somatic and Psychodynamic Approaches;

Bottom-Up & Top-Down§ Interpersonal Neurobiology§Non-Western Spiritual Orientation to Identity

§Trainings in North America & Europe§Healing Developmental Trauma book

published in over 10 languages§3 additional books currently in development:§Working with Shame & Guilt§NARM Clinical Handbook§The Mystery of Emotion

Laurence Heller, PhDCreator of NARM

Los Angeles, California




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Connection –Our Deepest Longing,

and Greatest Fear.(Heller and LaPierre)

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What is the primary biological imperative for humans?It is to be connected...

(Stephen Porges)




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The essence of trauma is disconnection from ourselves.

So the real question is: “How did we get separated and

how do we reconnect?”(Gabor Maté)

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Complex Trauma, ACEs & “The Hole in the Soul”




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2 Themes of NARM Training

1. Understanding of Identity / Personality§Exploring clinically from a somatically-based,

developmentally-informed perspective the psychobiological adaptations used to survive early developmental trauma•Attachment Cycle: Attachment, Separation-Individuation

& the Threat of Attachment Loss•NARM Distress Cycle•Distortions of the Life Force•Adaptive Survival Styles•NARM Personality Spectrum Model

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2 Themes of NARM Training

2. Clinical Approach§Supporting personal freedom from historical patterns

and identifications (survival styles), as well as supporting increasing capacity for more connection, intimacy, agency, resilience, health and aliveness•NARM Organizing Principles•NARM Healing Cycle•NARM 4 Pillars•NARM Relational Model•NARM Model of Working with Affect




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NARM Philosophy

This organismic impulse is the fuel of the NARM approach.

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NARM Overview

§Spontaneous movement toward connection, aliveness & healing reflects a deep biological as well as spiritual reality§Movement toward healing comes from that reality

§As therapists, we need to create the safety for this movement toward healing to emerge§We do this by exploring, using a psychobiologically-based inquiry,

into the patterns (adaptive survival styles) that disconnect us from these deep healing resources, never forgetting that these adaptive survival styles once saved our lives

§Our job as NARM Practitioners is to help our clients bring awareness to the psychobiological patterns that they had developed that now get in the way of the deep connection they are seeking




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NARM Overview

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“What are the patterns that are preventing me from being present to myself and

others at this moment and in my life?”

NARM Overview




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NARM Overview

In NARM, we bring curiosity and interest to our client’s inner world

Image by https://www.wallpapersafari.com/sick-computer-backgrounds/

NARM ORGANIZING PRINCIPLES




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ü FUNCTIONAL UNITY BETWEEN THE PSYCHOLOGICAL & PHYSIOLOGICAL

ü CONNECTION & DISCONNECTION

ü SHAME, GUILT & SELF-HATRED

ü PROTEST, ANGER & AGGRESSION

ü EMOTIONAL COMPLETION

ü PROTECTING THE ATTACHMENT RELATIONSHIP

ü THE DISTRESS CYCLE

ü SURVIVAL STYLES & IDENTIFICATIONS

ü NARM HEALING CYCLE

ü INCREASING CAPACITY FOR SEPARATION-INDIVIDUATION (Adult Consciousness)

NARM Organizing Principles

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Top-Down & Bottom-Up Informational ProcessingContinuous cycle of information from:

NARM Organizing Principles:Functional Unity Between Psychological & Physiological

BRAIN

BODY BRAINSTEM

CORTEX




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Neocortex“Thinking”Executive Functionining, Cognition, Language, Speech, Social and Regulatory Centers

Limbic/Midbrain“Feeling”Memory, Emotions, and AlarmCenter (Amygdala, Cingulate)

Brainstem“Sensing”Circulation, Breathing, Digestion, Reproduction, Sleeping, Survival and Instinctual Centers (fight, flight, freeze)

Org

aniz

atio

n of

the

Brai

n

Triune Brain


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This inquiry is explored on the following levels of experience: cognitive, emotional, physiological and relational

Image by © 2016 Life Beginner's Manual ·


§Continuous interplay of all levels of the brain

http://www.lifebeginnersmanual.com/




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This inquiry is explored on the following levels of experience: cognitive, emotional, physiological and relational


Image by Bessel van der Kolk/Beacon House·

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ØCortical and Subcortical Structures• Orbital Medial Prefrontal• Somatosensory• Amygdala• Cingulate and Insula Cortices• Hippocampus• Hypothalamus

ØSensory, Motor and Affective Systems• Face Recognition and Facial Expression Systems• Mirror and Resonance Systems

ØRegulatory Systems• Stress Regulation: The HPA system of hormonal regulation• Fear Regulation: Orbital Medial Prefrontal Cortex-Amygdala balance• Social Motivation: Reward representation and reinforcement• Social Engagement: The Vagal system of autonomic regulation

The Social Brain

“The Social Brain”




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§The Organized Self reflects integration and coherence of all internal systems§Daniel Siegel refers to 9 levels of integration:

1. Integration of Consciousness2. Vertical Integration3. Bilateral Integration4. Memory Integration5. Narrative Integration

§When there’s disorganization, fragmentation occurs: strategies which split off aspects of the self in order to survive (“child consciousness”) §Symptoms (from all areas above) emerge from these adaptations

§Resolution of these survival strategies leads to a more organized self (“adult consciousness”)

6. State Integration7. Interpersonal Integration8. Temporal Integration9. Transpirational Integration


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§There is a functional unity between the psychological & physiological: no psychological process occurs without a physiological counterpart

§For every old identification (top-down) there’s a physiological component (bottom-up) of brace and/or collapse§This dynamic keeps us from living in our bodies, in the present

moment• Limits our aliveness, connection, health, joy, etc.

§As a survival style-based identification dissolves, reorganization in the body happens organically§You’ll observe signs of settling, quieting, alignment, expansion,

warmth, etc.§As organization happens in body, this provides a more solid platform

to address the emotional, behavioral, cognitive and relational symptoms our clients face





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§Working Top-Down• Cognitive Therapies often neglect the nervous system

dysregulation underlying the cognitive and behavioral symptomsoWe need to address physiological dysregulation that affects all

body systems (i.e., nervous system, endocrine, etc.)

§Working Bottom-Up• Somatic Therapies often neglect the identity and cognitive

distortions that fuel and reinforce nervous system dysregulationoWe need to address cognitive identity distortions that create

physiological regulation

§NARM is an Integrative, Systemic Approach• NARM works top-down and bottom-up in exploring the cognitive,

emotional, physiological and relational elements of who we are


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§NARM uses the body differently than other Somatic approaches§Developmental Trauma is more than just physiological dysregulation• Dysregulation is often caused by distorted identifications and

object relations • If you just focus on the symptoms of physiological dysregulation,

you may miss the cause of the dysregulation • Thus, we need to know what the nervous system “activation” is

about; i.e., what are the emotional states that are driving the nervous system dysregulation

§The body is used as a progressively more secure base with which to explore top-down identification distortions driving the dysregulation• Anchoring the body with any positive shift• Moving clients toward emotional completion (not simply biological

completion as in shock trauma)





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Disconnection

Dysregulation of All Physiological

SystemsDistortions of

Identity

NARM Organizing Principles:Connection & Disconnection

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§Identifying the CONNECTION-DISCONNECTION process§Attachment Cycle: Attachment & Separation-Individuation §To be fully connected means to be fully present in the here and

now - both with ourselves AND others• Secure attachment = “on the road to object constancy”

Image by The University of Chicago





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Intimate attachments to other human beings are the hub around which a

person’s life revolves, not only when he is an infant or a toddler, but throughout his adolescence and his years of maturity as

well, and on into old age. (John Bowlby)

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§Healthy development is predicated on secure attachment§ Self-regulation via interpersonal regulation: allows an organism to

function effectively in a broad range of environmental conditions • Mechanism of Resiliency: Capacity to tolerate a wide range of

experiences and states, including the ability to tolerate the sensations of distress that accompany environmental changes and internal shifts

§ Creates the safe base of security in order to increasingly move out and explore the world (”separation-individuation”)

• The inability to experience healthy separation-individuation leads to challenges we have in experiencing our full life force, particularly our healthy aggression and angeroThis then leads to difficulty later in completing trauma responses

due to the overcoupling of fear with healthy aggression & anger




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NARM Organizing Principles:Connection & Disconnection§Separation-Individuation has largely been left out of our modern

psychological understanding, including attachment theory§Built into our biology is the innate mechanism for separation-

individuation• e.g., The fetus initiating the labor process or baby chick pecking

its way out of the shell, is activated by the energetic movement of separation-individuation

• This life force has been at the root of many philosophies and religions (e.g., spirit, chi, prana, vitality, orgone)

§Secure attachment is predicated not only on the conditions for connection, but also on the conditions for separation-individuation§Disconnection or compulsive independence may look like

separation-individuation, but is actually just the opposite - it reinforces stuckness, the acting out of early childhood dynamics, and reflects insecure attachment

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§An Organized Self involves continuous oscillation between the experience of connection AND separation (disconnection)§The rhythm of social engagement: attachment & separation cycles

• Building relational capacity AND authenticity, through which one becomes more relationally secure AND self-definedoRequires the ability to integrate frustrating and pleasurable

aspects of experience with others AND selfoPromotes progressive trust in the capacity to connect to and

regulate with others AND self• Child develops this capacity progressively, in developmental

stages, unless there is unresolved developmental failure





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§Early life experiences shape neural circuitry underlying both physiological (bottom-up) and personality (top-down) development§ More optimal attachment leads to a more organized self• As Siegel describes it, the 9 levels of Integration:üBody RegulationüAttuned CommunicationüEmotional BalanceüResponse FlexibilityüEmpathy

§ Less optimal attachment leads to a disorganized and even disordered self

• “When there is early trauma, the ensuing biological dysregulation forms the shaky foundation upon which the psychological self is built” (Heller)

üInsightüFear ModulationüIntuitionüMorality

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§We cannot survive and thrive without a safe, stable and attuned connection with our caregivers§Early traumatic experiences (e.g., abuse, neglect,

misattunement) are processed as life-threatening§Children cannot recognize their caregivers as failing, so they

internalize these environmental failures• Shame is often the result of splitting, which is a mechanism

for protecting the attachment relationship§ In doing so, children learn to disconnect from and reject their

core needs

Image: http://webpages.scu.edu/ftp/Levans/finalsolitude.htm

NARM Affect Core Principle: Shame, Guilt & Self-Hatred

http://webpages.scu.edu/ftp/Levans/finalsolitude.htm




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§Internalizing environmental failure§Children always blame themselves for environmental (attachment)

failures, even when it is completely irrational§“I deserve this” becomes the default position for children, which

stays with us (unconsciously) into adulthood• e.g., The power of the pivotal scene from Good Will Hunting

when the therapist challenged Will’s unconscious self-belief: “It’s not your fault”

§When a very young child starts off feelingprofoundly defective, self-hatred ensues§This fuels all sorts of symptoms and makes

individuals more vulnerable to being negatively affected by their environment (loss of agency)

Image by Miramax Films


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Image by http://www.voicedialogueonline.com/




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§Shame and Guilt act as protectors: “the guardians of the status quo”§They act in protection of old patterns

• Judgments, shame, guilt, etc. can feel very strong when we’re on the cusp of feeling something very significant (e.g., healthy aggression, grief), when new possibilities and re-organization is happening

§Each survival style is based on shame§The environmental failure becomes an introject of shame that lives

on through the survival style identifications• We learn to shame ourselves in protection of the attachment

relationshipoAny mobilization of our aliveness, connection, self-activation,

etc., inherently threatens the attachment relationship

NARM Affect Core Principle:Shame, Guilt & Self-Hatred

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§Our relationship to anger and aggression is directly related to shame, guilt and self-hatred§Remember, that initially our psychobiological response to

environmental failure is to protest, to self-activate toward getting our needs met• But this aggression energy feels threatening for us to contain

internally and also due to the potential effect on our environment, so we split it off in various ways (acting-in and acting-out)oOur parasympathetic brake comes on to help us manage the

threatening affectoThis is the mechanism of shame, guilt & self-hatred

§When clients are able to reintegrate the protest it changes one’s relationship to their self§The message: “I don’t deserve to be treated this way”




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NARM Organizing Principles:Protest, Anger & Aggression

§Abuse, neglect, misattunement lead to protest, aggression, rage§The intent of this emotional process (aggression) is to impact and

change the environment: to get our needs attended to and met§But because it isn’t safe to express our aggression directly

in our environment, we shut down our access to this important self-activating mechanism

§This leaves us helpless and vulnerable§Distorted aggression: turned inward and/or outward§Acting-In and/or Acting-Out Behaviors§Splitting and projection help us manage underlying rage§Developed to protect the attachment relationship

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§Many symptoms and disorders can be understood through the lens of working with split-off anger and aggression§ Including “freeze”, which in developmental trauma signifies an

intrapsychic conflict, revolving around split-off, unexpressed anger§Once clients are able to feel what the anger is trying to affect, that

itself is a major part of integrating the anger energy§Healing occurs in re-owning disowned, rejected and split-off parts of

ourselves - instead of symptoms, there’s more energy available for aliveness, connection, joy, pleasure, love, creativity, etc.

§ It’s essential for us as clinicians to understand our own anger and aggression so we have a better understanding of our clients and the interpersonal therapeutic process§More on this coming when we learn:

• The NARM Model of Working with Affect• The NARM Relational Model

NARM Organizing Principles:Protest, Anger & Aggression




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NARM Organizing Principles:Emotional Completion

§Therapist’s curiosity around the central question:

what is it that’s unfinished here?§Revolves back to the core issue of rejecting and disconnecting from

our psychobiological needs, and the emotional responses associated with not getting these basic needs met (i.e., anger, grief), in order to protect the attachment relationship• As NARM Practitioners, we acknowledge and respect the need to

protect the attachment relationship from the child’s perspective, while supporting the possibility that from their adult consciousness they can relate to these old affects in a different way

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§In healthier families, where parents have developed more organized selves and therefore can provide more secure attachment, the child develops in an atmosphere supporting a flexible balance between loving availability (attachment) & personal freedom (separation-individuation)§In unhealthier families, where parents did not do their own work

towards more organized selves and therefore provide more disorganized attachment, the child develops in an atmosphere where there is an impossible bind between staying connected to others (attachment) and oneself (separation-individuation)§These binds are what we refer to in NARM as Core Dilemmas

NARM Organizing Principles:Protecting the Attachment Relationship




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§Core Dilemmas are created early in human development around the basic needs of: 1. Staying attached and connected to our attachment figures and2. Separating and individuating one’s sense of self

§There is an inherent self-activating force to develop one’s identity which can conflict with the inherent orientation to others as a source of protection and nurturance§A child cannot healthily separate and individuate too early nor can

they stay attached too long; either direction leads to an experience of loss• Total separation causes overwhelming anxiety of having to move

out into the world on one’s own, disconnected and helpless• Symbiotic attachment also causes anxiety, inhibiting the need for

growth, autonomy and personal freedom


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§The core dilemma is the impossible conflict between one’s life force and the adaptations (survival styles & identifications) we had to make to survive§ This double bind emerged early in life and shapes development:

• Connection: I need connection but can’t safely connect• Attunement: I need attunement but can’t safely be attuned to• Trust: I need to be able to trust others but can’t safely trust• Autonomy: I need to experience my own autonomy but can’t safely

experience my own autonomy• Love-Sexuality: I need to reach out with and receive love but can’t safely

reach out with and receive love§ As adults, this turns (unconsciously) into:

• I need to connect but I am afraid to• I need to attune but I am afraid to• I need to trust but I am afraid to• I need autonomy but I am afraid to• I need love and sexuality but I am afraid to





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NARM Organizing Principles:The Distress Cycle

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§Developed as a means to protect the attachment relationship, psychobiological patterns emerge that reject biological needs and keep us from being connected to self, others and that which is greater than us§Adaptive Survival Styles coalesce around patterns of nervous

system dysregulation, distorted emotions and beliefs:• Rejecting existence (“Connection”)• Rejecting needs (“Attunement”)• Rejecting dependence (“Trust”)• Rejecting autonomy (“Autonomy”)• Rejecting heart and/or sexuality (“Love/Sexuality”)

§Identifying and supporting resolution of our client’s core dilemmas is one of the primary organizing principles of NARM

NARM Organizing Principles:Survival Styles & Identifications




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NARM Organizing Principles:Survival Styles & Identifications§Even though these environmental failures happened long ago, these

patterns (adaptive survival styles) continue to shape our lives§Our Brain works as a predictive organ (“object relations”), predicting

the future based on what we’ve already experienced in the past• “Futuristic Memory” = we futurize something we’ve already

experienced but haven’t fully processed, integrated or metabolized (i.e., re-enactments)oModel for understanding people’s fears: most of what we fear we

have already survived §Survival Styles help us in organizing our clinical approach, but it is not

the primary focus in NARM §We work with humans that identify with survival styles, not survival

styles!

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The past is never dead. It’s not even past.

(William Faulkner)




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Psychobiology & Culture§Each specific culture tends to be supportive of individuals in some

biologically-based needs and undermining or even attacking of others§The cultural milieu defines how our psychobiological needs are dealt

with (cultural conditioning)§Different kinds of wounding happens in different cultures; and

different kinds of resources and support happens too §We want to help our clients distinguish between cultural resources

and cultural identifications§Cultural resources: those aspects of their culture that support their

authenticity, creativity, fullness, aliveness, etc.§Cultural identifications can be very strong (and may be identified as

resources): we want to respect them and the role they play, but also invite clients to explore how they relate to them, and how they may be in their way of what they want for themselves


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§We have 2 main safeguards that helps buffer us from cultural bias:1. We never impose an agenda on our clients: We use Pillar #1:

Clarifying the Therapeutic Contract to assure that our clients are “steering the ship” of therapy and that we as therapists are supporting their own unique exploratory process

2. NARM is fueled by a deep curiosity, openness and desire to learn about our client’s internal worlds

§We do not hold any particular opinion about our clients’ cultural beliefs and practices other than to respect them and learn about how our client relates to them§Our role is to be there to learn from our clients, not to dictate to

them or get them to adhere to some agenda we hold• It is up to our clients what they do with what they are learning and

connecting to in therapy





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NARM Organizing Principles: NARM Healing Cycle

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§Central understanding that guides NARM: The need of the child to do whatever it takes, including rejecting parts of oneself, to protect the attachment relationship§The child learned to disconnect from their psychobiologically-based

needs in order to protect the attachment relationship§But these needs did not go away which caused an (unconscious)

emotional response (e.g., anger, grief)• This created an intrapsychic conflict, along with systemic

dysregulation, caused by the rejected, split-off aspects of our selves oUltimately we need to bring these parts “back to the table”; back

into integrity and connection §Clients need to learn to tolerate these powerful energies that

manifest in dysregulation in our body and distortions of our identity• Have to own their emotions and capacity to be present with them





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§Trusting in the spontaneous movement towards health & aliveness, we track disconnection patterns that disrupt integrity & wholeness §We DO NOT push for connection but explore the challenges of

reconnection: what is getting in the way from connecting to the deepest part of our selves and others• The more we try and fix or change, the more stuck we get• Old patterns of disconnection (i.e., identifications, object relations)

dissolve in atmosphere of curiosity, understanding & compassion §Ultimately, NARM holds that we’re never really disconnected, we

just don’t know we’re connected – we lose the sense of connection on a consciousness level§When we lose that connection we become symptomatic§When we reconnect, we increase capacity for connection to self and

others, as well as our own aliveness


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NARM Clinical Approach IS NOT: NARM Clinical Approach IS:

Reductionistic Non-Reductionistic

Historically Focused Present-Moment Focused

Regressive (Child Consciousness Focused)

Grounded in Here & Now (Adult Consciousness Focused)

Cathartic Containment-Oriented

Pathologically-Oriented Resource-Oriented

Goal Driven Inquiry Driven

Strategically Based Curiosity Based

Protocol Based Organizing Principles Based

Practitioner Driven, with Client following their lead

Client Driven, with Practitioner providing new opportunities for exploration




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§The development of the organized self:symbiosis attachment separation individuation

§An infant’s secure base begins with a state of total merging and identification with the attachment figure(s), which becomes the foundation of future growth of an organized self• One’s “self image” - who we take ourselves to be - emerges out of

this relationship to one’s attachment figure (internalized parental image or “object image”)

• When the child is separating from their attachment figures, introjections occur, which become the building blocks of identification (“self-image”)

§With more secure attachment, the infant progressively experiences increased separation from the attachment figure(s) yet retains the loving support (“good internal object”)

NARM Organizing Principles: Increasing Capacity for Separation-Individuation

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§When the attachment process is disrupted, the progressive process of separation-individuation is disrupted§The unremitting symbiosis between the child and their

psychological parents (“child consciousness”) is at the root of our failure to adequately develop and as adults can lead to symptoms and disorders

§Survival styles develop as an aggregate of a variety of different object relations, identifications and physiological dysregulation patterns• Object Relations: self image, object image, and affect that binds

those two togetheroAffects such as anger, fear, sadness, grief that emerge out of the

survival need to protect the attachment relationship• Identifications: who the person takes themselves to be





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§Thus, adults experience themselves and the world through their “child consciousness” and never fully “grow up”§This is experienced as lack of agency and a reliance on a variety of

survival strategies and defense mechanisms§The felt sense of these old identifications are constricted, tense,

heavy and burdened, while experiencing one’s life narrowly and without many options, leading to a low range of resiliency• Shifts toward more grounded, settled and/or expansive states are

often followed by a counter-reaction or “over-coupling” that leads to contraction and back into the identificationsoThis explains why some approaches can have positive short-term

effects but then people pop right back into their old patternsoe.g., relaxation and meditation can be anxiety-provoking for so

many people


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§In NARM, we track these expansion-contraction (or connection-disconnection) cycles in the service of disidentification§Disidentification: Resolving old identifications and object relations

leads to increasing psychological separation-individuation§Emotional Completion: As clients build greater capacity to be

present to, tolerate and integrate unresolved affects - including the terror of one’s anger and grief - the bind weakens between one’s survival need to protect the attachment relationship and the separation and individuation of one’s self• As these old binds and related identifications dissolve, it is often

experienced as more expansion, spaciousness, less pressure, lightness, fluidity, connection to pleasure, joy and creativity, while experiencing one’s life with increased resiliency, greater possibilities and increased sense of freedom





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§As Mahler described: the process of Separation-Individuation leads to the Psychological Birth of the Human Infant & Emergence of the Self§What we might refer to as “adult consciousness”§A more organized sense of self: we can be who we truly are

• We become less dependent on our environments, more free to follow our own autonomy and creativity, while also becoming more available for healthy connection and real intimacyoFlexible balance of connection between self & other


DISTORTIONS OF THE LIFE FORCE MODEL: Differentiating Shock

& Developmental Trauma




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Distortions of the Life Force: Shock & Developmental Trauma

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§Unified theory of shock and developmental trauma§Core Energy / Life Force: Aliveness energy is hard-wired for

surviving, responding, connecting, growing, thriving, etc.• On Shock side (Brainstem mediated):oActivation: Survival energies fueling the exploratory and

defensive orienting responses (Fight/Flight/Freeze)• On Developmental side (Limbic/Cortical mediated):oSelf-Activation: Energy fueling bonding, attachment and

separation, expression of our core needs, and the capacity for “healthy aggression” to move out in the world with strength (Attachment & Separation Cycles)

§ In NARM, we don’t rely on “activation” to describe our internal states, as we are wanting a more precise understanding of the emotional message which can highlight the intrapsychic conflict

Distortions of the Life Force: Shock & Developmental Trauma




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§Results when our capacity to cope with threat is overwhelmed§ It is usually sudden, unexpected, with a distinct beginning

and end, and ends relatively quickly (acute)§ It interrupts the flow of one’s life and individuals often feel

stuck in the experience (“frozen in time”)§These experiences of overwhelm engender:

1)A psychobiological process of unresolved FEAR that disrupts regulatory functioning

2)Symptoms, out of the incomplete hyper- and hypo-aroused patterns of survival response (fight/flight & freeze)

ØDefined by Post-Traumatic Stress Disorder (PTSD), emphasizing the following cluster areas of symptoms:

• Hyperarousal • Avoidance/Numbing

Distortions of the Life Force: Shock Trauma

• Re-experiencing

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Post-Traumatic Stress Disorder: PTSD

Image by http://www.consultant360.com/




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§Results from significant and chronic misattunement from caregivers§ It is usually prolonged, familiar, without a distinct beginning and

end, and feeling that it’ll always be like this (chronic)• However, early shock trauma also becomes developmental

§ It shapes the development of one’s life as individual responds to life experience based on past (“frozen in time”)

§These experiences of misattunement engender:1)A psychobiological process of SHAME that disrupts multiple

facets of both physiological and psychological functioning2)Efforts to ward off underlying shame and associated emotions3)An unstable core self

ØDefined by Developmental Trauma Disorder (DTD) & Complex PTSD (C-PTSD), emphasizing wide-ranging psychobiological symptoms

Distortions of the Life Force: Developmental Trauma

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Nearly 40 Years after the APA controversially, yet officially recognized PTSD as a mental disorder that required

clinical treatment…

On June 18 2018, the World Health Organization (WHO)

released the ICD-11, including a new diagnosis:

6B41: C-PTSDComplex Post-Traumatic Stress Disorder




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C-PTSD:Complex Post-Traumatic Stress Disorder

6B41: Complex Post-Traumatic Stress DisorderComplex PTSD is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is

difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical

abuse). The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is

characterized by: 1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and 3) persistent difficulties in sustaining

relationships and in feeling close to others.

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üDisturbed attachment patternsüComplex disruptions of affect regulation üRapid behavioral regressions & shifts in emotional statesüFailure to achieve developmental competenciesüLoss of autonomous strivingsüChronic feelings of ineffectivenessüSelf-hatred and self-blameüAggressive behavior against self and othersüAltered schemas of the worldüAnticipatory behavior and traumatic expectationsüLack of awareness of danger with self-endangering behaviorsüLoss of bodily regulation in areas of sleep, food, and self-careüMultiple somatic problems – e.g. GI issues, migraines, pain

DTD:Developmental Trauma Disorder




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DTD:Developmental Trauma Disorder

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ACEs Study: The Hidden Epidemic




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ACEs Study: The Questionnaire

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Threat of Attachment Loss:

When attacked by a bear, you don’t worry about losing the

love of the bear.

But we do anything to not lose our parents’ love.

So resolving the trauma becomes dangerous!

Difference Between Shock & Developmental Trauma

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Shock & Developmental Trauma: From a Clinical Perspective

§Differentiating working with Shock & Developmental Trauma§With Shock Trauma you’re dealing with lower brain functions, not

much executive function when there’s an incomplete fight/flight/freeze response• Due to so much information being processed externally and

internally, largely on a non-verbal & instinctual level, clinicians must work carefully and with the implicit (body) processesoClient’s are highly susceptible to re-traumatization

• Less relationally-oriented and thus less clinical transference• Working with regulating nervous system activation

§ It’s often easier to work with shock than developmental trauma due to less complexity associated with the relational aspects of trauma• However, shock trauma does often open a ”Pandora’s Box” of

unresolved developmental trauma




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Shock & Developmental Trauma: From a Clinical Perspective§With Developmental Trauma, except for the earliest developmental

stages (i.e., Connection Survival Style) we have greater access to our executive function and a working defense system• “Overwhelm” is experienced differently since generally the

misattunement, abuse and neglect are chronic and progressive, and executive function and explicit memory systems are (to some extent) onlineoNot as much risk of re-traumatizing clients as shock trauma

• More relationally-oriented and thus more clinical transference, as well as clinician countertransference

• We must identify and work with the complex dynamics our clients are expressing, and not just regulating nervous system activationoClinical process primarily focused on the Self and the foreclosed

aspects of self, which is a bottom-up & top-down clinical process

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§Can’t just import shock trauma techniques into working with developmental trauma§Due to the significant psychological and physiological disruptions

– which mutually reinforce each other – a “top-down” and “bottom-up” approach must be employedØGoal of shock trauma recovery is to move out of overwhelm

and helplessness (freeze), repair the thwarted survival responses (flight, fight, tend & befriend), and establish homeostatic self-regulation

ØGoal of developmental trauma targets the life-long systemic dysregulation and identity distortions (e.g., self-hatred, guilt, shame) that have disrupted one’s capacity for connection, health and aliveness




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Ø Just working Top-Down:§Difficult to shift beliefs, emotions and behaviors without greater

regulation of the nervous system which shapes and directs them§Not embodied, felt sense of the impact of the exploration, insight,

completion and/or integrationØ Just working Bottom-Up:§Difficult to shift physiological states in atmosphere of toxic self-hatred§When physical symptoms are being driven top-down, if you don’t address

the intrapsychic conflict being reflected in those symptoms, you can use regulation skills (e.g., resourcing, pendulation) but you’re not addressing what’s really going on

§Sometimes both the cognitive and somatic stories/symptoms can distract us from what’s truly happening internally§Understanding the core dilemmas created by the adaptive survival styles

provides us a map for how to support clients both top-down & bottom-up

NARM ADAPTIVE SURVIVAL SYLES: An Introduction




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The ability to identify and release these frozen structures are a major key to unlocking our suffering of trauma and our potential for healing and growth. Thus, in dealing with traumatized people, it is crucial

to examine where they have become stuck and around which…they have built their secondary

psychic elaborations. (Bessel van der Kolk)

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NARM Survival Styles in Historical Context

Reich/Lowen NARM

Schizoid CONNECTIONOral ATTUNEMENT

Psychopathic TRUST

Masochistic AUTONOMY

Rigid (Phallic & Hysteric) LOVE/SEXUALITY




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NARM Survival Styles

§Based on the early Character Structure work of Reich and Lowen, the NARM Survival Styles provides a way of understanding human behavior that is archetypal§The Survival Styles are universal§All of us have some element of all 5 survival styles in us§People generally have a dominant style§Each style has 2 subtypes§Each stage effects later stages as it is a developmental process

§Each survival style is named for missing or compromised resource during that developmental stage

vWho are we when we are fully present without the filters of our survival styles?

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DEVELOPMENTAL PERIOD

SURVIVAL NEED ISSUE CHARACTEROLOGICAL EXPRESSION

SURVIVAL STYLE

PRE & PERINATAL;ATTACHMENT / BONDING

Existence/Safety Self & Others are source of pain, not comfort

Dissociation, withdrawal, thinking and spiritualizing subtypes; Polarity: Presence and Absence

CONNECTION

ATTACHMENT / BONDING

Need/Attunement Needs are denied or too great to be met

Dependency on or gratification of others at expense of self; Polarity: seeking dependency gratification and providing dependency gratification

ATTUNEMENT

SELF & OTHER DEVELOPMENT

Trust/Dependence Can’t rely on others; Identity found in “false self”

Attempts to maintain the false an grandiose self; Polarity:Grandiosity and Worthlessness

TRUST

SELF & OTHER DEVELOPMENT

Autonomy/Independence Control of self by overpowering others; violation and definition of one’s inner world

Subservient, guilt and shame inducing, passive-aggressive, resentful and spiteful; Polarity: Controlled and Controlling

AUTONOMY

SELF IN SYSTEM DEVELOPMENT

Love/Intimacy Disruption and splitting of love and sexual impulses

Denial or exaggeration of sexuality, competition and love; Polarity: Sexual (Seductive) and Asexual (romantic)

LOVE/SEXUALITY





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Distortions of the Life Force In Each Survival Style

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§A resource-oriented model for the chronological and developmental stages of how individuals adapted to environmental failure (environments that were severely misattuned, rejecting, neglectful, abusive)§Specifically, the processes around how we disconnected in order to

survive (protect the attachment relationship) and how this imprint of early experience shaped our identity

§We use childhood experience as way of contextualizing and understanding present experience, providing compassion to the often very dysfunctional patterns that are still at play§Even the most dysfunctional self-destructive behavior has a certain

logic in it, although not based in the here and now




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NARM Survival Styles: Core Capacities & Difficulties

CORE NEED CORE CAPACITIES CORE DIFFICULTIES

CONNECTION • Capacity to be in touch with our bodyand emotions

• Capacity to be in connection with others

• Disconnected from physical and emotional self• Difficulty relating to others

ATTUNEMENT • Capacity to attune to our needs and emotions

• Capacity to recognize, reach out for, and take in physical and emotional nourishment

• Difficulty knowing what we need• Feeling our needs do not deserve to be met

TRUST • Capacity for healthy dependence and interdependence

• Feeling we cannot depend on anyone but ourselves

• Feeling we have to control relationships

AUTONOMY • Capacity to set appropriate boundaries• Capacity to say no and set limits• Capacity to speak our minds without

guilt or fear

• Feeling burdened and pressured• Difficulty saying no directly and setting limits

LOVE/SEXUALITY • Capacity to live with an open heart• Capacity to integrate a loving

relationship with a vital sexuality

• Difficulty integrating heart and sexuality• Self-Esteem is based on looks and performance

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CORE NEED SURVIVAL ADAPTATION STRATEGY USED TO PROTECT THE ATTACHMENT RELATIONSHIP

CONNECTION • Foreclosing connection• Disconnect from body and social

engagement

• Children give up their very sense of existence, disconnect, and attempt to become invisible

ATTUNEMENT • Foreclosing the awareness and expression of personal needs

• Children give up their own needs in order to focus on the needs of others, particularly the needs of the parents

TRUST • Foreclosing trust and healthy interdependence

• Children give up their authenticity in orderto be who the parents want them to be: best friend, sports star, confidante, etc.

AUTONOMY • Foreclosing authentic expression, responding with what they think is expected of them

• Children give up direct expressions of independence in order not to feel abandoned or crushed

LOVE/SEXUALITY • Foreclosing love and heart connection

• Foreclosing sexuality• Foreclosing integration of love with

sexuality

• Children try to avoid rejection by perfecting themselves, hoping that they can win love through looks or performance

NARM Survival Styles: Foreclosure of Self To Maintain Attachment




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§Recognizing that these survival patterns persist and express themselves moment by moment in the relational process, in NARM:§We don’t focus on childhood history - instead, identify how these

distortions express themselves in the present§We recognize that on a very deep level, individuals keep their

attachment patterns alive by recreating around them circumstances that are familiar

§ Individuals filter out any experience that doesn’t fit with the lens they’ve come to view the world and don’t pay attention to the ones that contradict it

§Clinically, we don’t need to figure out what style our clients are - the patterns will emerge as we deepen into the process

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NARM Survival Styles: Shame & Pride-Based Identifications

SURVIVAL STYLE SHAME-BASED IDENTIFICATIONS PRIDE-BASED IDENTIFICATIONS

CONNECTION • Shame at Existing• Feeling like a Burden• Terrified Infant• Flawed

• Being a Loner• Not Needing Others• Not Being Emotional

ATTUNEMENT • Needy• Yearning• Unfulfilled• Empty

• Caretaker• Highly Attuned• Co-Dependent; Making

Themselves Indispensable

TRUST • Small• Weak• Powerless

• Strong; In Control• Successful• Larger Than Life• User, Betrayer

AUTONOMY • Angry• Judging• Burdened• Enjoy Disappointing

Others

• Nice, Sweet• Good Boy/Girl• Compliant• Fear of Disappointing Others

LOVE/SEXUALITY • Hurt• Rejected• Physically Flawed

• Rejects First• Perfect, Seamless, Flawless• Self-Esteem Based on

Looks & Appearance

• Resentful of Authority

• Rebellious Subtype

• Depressed• Undeserving• Inhibited

Subtype

• Feeling of Not Belonging

• Outside Looking In

• Helpless• Used • Betrayed

• Feeling Unloved & Unlovable

• Thinking Subtype• Spiritualizing

Subtype

• Self-Sacrificing• Submissive

Subtype

• Not Having Needs• Unsatisfied

Subtype

• Overpowering Subtype

• Seductive Subtype

• Sexual Subtype• Romantic Subtype




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We don’t see things as they are, we see them as we are.

(Anais Nin)

NARM ADAPTIVE SURVIVAL SYLES:

Connection Survival Style




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When there is early trauma, the ensuing biological dysregulation

forms the shaky foundation upon which the psychological self is built.

(Larry Heller)


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NARM Organizing Principles:The Distress Cycle




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§With the ACEs and other current research studies, our society is beginning to recognize the profound effects of heretofore unrecognized preverbal trauma

§Children who experience preverbal trauma begin life profoundly overwhelmed and thus disorganized §The life-threatening overwhelm leads them to shut-down §This shutting-down creates significant disorganization which

compromises all further developmental stages§The preverbal nature makes it difficult to identify and address

Most mental illnesses…begin far earlier in life than was previously believed.

(Insel & Fenton)


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§Parallel processes of:§Distortion of Identity§Dysregulation in Body Systems

§You can’t have identity distortion without physiological dysregulation and vice versa§For example, all “psychological defenses” are also physiological

• Repression: constricting in jaw or diaphragm holds back feelings and emotions

• Projection: eyes are not engaged, not truly seeing what is in front of us in the present; ocular block

• Dissociation: “1,000 yard stare”; numbness, freeze, coldness• Splitting: various parts of our selves and bodies can become

disconnected and dissociated





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Developmental Period: qPrenatal to 6 months

Core Need: qConnection to self and others

Core Capacities:qCapacity to be in touch with our body & emotionsqCapacity to be in connection with others


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Connection Survival Style§Some events that can lead to early developmental trauma

§Pregnancy Issues• Mental or physical illness, domestic violence, substance

abuse, attempted abortion§Perinatal: Birth and Attachment Trauma

• Early surgery, mother dies in childbirth, adoption, neglect§Trauma for Family During Pregnancy, Birth or Early Bonding§Parents with Mental Illness or Unresolved Connection Issues

• Not being connected to, wanted or even hated §Transgenerational Trauma

• Born into: war, famine, natural disasters, depression, poverty, discrimination, oppression




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§What happens when an infant does not feel safe coming into this world?§ If there’s not a welcoming, safe & secure holding environment?§ If their parents have so much unresolved they cannot attune?§ If there’s active abuse, neglect and rejection?§ If there’s a feeling that nobody’s truly there for them?

§Leads to ambivalence about being alive (“core dilemma”): I need to connect but it’s not safe to connect§Life-force doesn’t expand into body§One foot on this planet, one foot not§“I don’t want to live here, it’s too rejecting”§“Nobody’s here for me…I’m going to check out”§ ‘I don’t exist”


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I don’t have a right to exist

I often feel like I don’t belong

I often feel numb and cold

I feel unlovable

I feel like an outsider

I often hate myself

I never felt welcome in the world

I’m not connected to my body

I feel spaced out a lot

I live in shame

I have chronic anxiety

Relationships scare me

I’m always just coping to survive

I rarely feel safe

Being alive is dangerous, so I have to withdraw from experience




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Core Dilemma:qCan I be connected? To myself and to others?

Core Fear:qIf I feel…I will die or fall apart

Adaptive Statements:qIf I am not in my body, I won’t feel the painqIf I can get into my head, I can handle my fear

Compromised Core Expression:qI have a right to existqI have a place in this world


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§Dissociating: ”Bearing the unbearable”§ Freeze, numb

§Withdrawing§ Disconnect from own bodies§ Socially isolate, aloof§ Porous boundaries: weak embodied sense of self

§Splitting / Fragmentation§ Feelings/thoughts and body/mind are split§ Good/bad attachment figures and self

§Projecting§Intellectualizing§Spiritualizing

Connection Survival Style: Coping Strategies




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Shame-Based:• Shame at existing• Terrified infant• Burden on others• Not belonging• Outside looking in

Pride-Based:• Being a loner• Not needing others• Rationality, not being

emotional (thinking-type)• Other-worldly

orientation (spiritualizing-type)

Developmental Theme:To tolerate more charge, aliveness, connection & relationality

“I survived”

Connection Survival Style: Shame & Pride-Based Identifications

“I am fundamentally flawed” “I don’t need anyone”

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Spiritualizing Subtype:• Live in the energetic field• Awareness primarily out of

body• Transcendentally oriented• Sensitive to paranormal

experience• Spiritual seekers

Thinking Subtype:• Highly mental, analytical• Minimize or even disdain

emotion• Value data and facts• Engineer, technical and

computer types

Connection Survival Style: 2 Subtypes

“In Your Head” or “Spiritual Bypass”




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§Highly Intelligent, complex and creative thinkers§Ability to hold attention and process information

non-linearly and multi-dimensionally, on several diverse areas at once

§Ability to see the big picture§Rich imaginations

§Spiritually connected or realized§Attuned to subtle, non-physical phenomena§Intuitive: Heightened ability to read and track energy

Connection Survival Style: Potential Strengths

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Connection Survival Style: Behavioral Characteristics

§Attachment Style: Disorganized, avoidant, lacking affect§Feel like a frightened child in an adult world§Do not know how to deal with their environment§Withdraw at any sign of distress

§Fear their own impulses:§Needing human connection§Moving toward expansion, excitement and aliveness§Yearning to fill emptiness and fearing fulfillment at same time

§Intense ambivalence about connection§Fear both isolation and being overwhelmed by others§Strong need to control self, environment, and others§Usually choose other Connection folks to relate to




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Connection Survival Style: Behavioral Characteristics

§Relate from intellect and/or relate from “spiritual bypass”§Drawn to practices that reinforce dissociation§Have tendency to look superior, with no needs§Unaware they are out of touch§Existentially-oriented

• Want to know “why?”, and ask questions like: “what’s the point?” and “what’s the meaning of it all?”

Image by http://www.abendgallery.com/ Image by https://oneimperfectlife.wordpress.com/2013/04/21/my-dissociation/

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Connection Survival Style: Behavioral Spectrum

§All individuals fall somewhere on a spectrum for each survival style:§ Low End: Extremely sensitive, easily overwhelmed and the self

fragments quickly under any perceived distress• They have great difficulty in basic life functioning• They are constantly afraid of being overwhelmed and thus avoid

most social and other potentially challenging life situations§Mid-Range: Still very sensitive and easily overwhelmed, but can

experience more stability and resiliency of the self • They are challenged in basic life functioning• Wary of social and other potentially challenging life situations

§High End: Sensitive to environmental phenomena but are able to use the self to keep themselves present and functioning• While still challenged in basic life functioning, they are no longer so

immediately fragmenting or going away• May be able to use their sensitivity for connection, growth & healing




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I’ve built walls / A fortress deep and mighty That none may penetrate

I have no need of friendship / friendship causes painIts laughter and its loving I disdain

I am a rock / I am an islandI have my books / And my poetry to protect meI am shielded in my armor / Hiding in my room

Safe within my wombI touch no one and no one touches me

I am a rock / I am an islandAnd a rock feels no pain / And an island never cries.

(Simon & Garfunkel)

Image by CBS Records via Wikipedia.org

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Energy:§Highly sensitive (GHIA, syndromal): Easily overwhelmed, shifting

rapidly and highly symptomatic§Appearance of low energy; energy and flow blocked§Dorsal Vagal Dominance

Body Structure:§Joint tension and disjointed§Cold, clammy skin §Frozen thorax; shallow, constricted breathing§Frozen quality of face§Ocular and occipital blocks§Splits (face, head-body, left-right)

Connection Survival Style: Energy & Body Structure




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§Migraines§IBS, Colic and other GI issues§Chronic Fatigue§Fibromyalgia§Asthma§Allergies§Inflammation§Environmental Sensitivities§Scoliosis

Connection Survival Style: Symptom & Disease Tendencies

§Dissociation and Dissociative Disorders (DID)§Depression§ADD/ADHD§Anxiety/Panic§OCD§Phobias§Paranoia§Self-harm & Substance Abuse

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Bring to mind a client that might fit the description of the Connection Survival Style:

•Symptoms: _________________________________________

•Coping Strategies/Behaviors: __________________________

•Shame & Pride-Based Identifications: ___________________

•Physical Appearance/Mannerisms: _____________________

•Your “Countertransference” Feelings/Reactions: __________

Connection Survival StyleExamples




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§Creating a relational context of safety, security & transparency§Setting up the therapeutic frame so they recognize you have no

agenda for them, you are not trying to push them or get them anywhere (into their bodies, into social engagement, etc.)• Exploration vs goal-oriented

§Appropriate disclosure, particularly around being imperfectly human §Authentic and not techniquey or gimmicky§Working with our own connection issues and countertransference

reactions§Supporting a compassionate presence§Gently identifying chronic, unconscious self-rejection (shame,

judgments, cut-off intellectualization, etc.)

Connection Survival Style: Healing Process

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§Using the therapeutic relationship§The therapist is the representative of attachment & social

engagement, but connection-style clients tend to perceive others as threatening or even attacking• When they begin to let in warmth and connection, initially there

will often be a strong counter-reaction that may be experienced as suspicion and communicated in distrust, shut-down or even attackoTracking how much contact clients can tolerate before becoming

disorganized and contracting§Being mindful of the client’s rage toward perceived misattunement

and how this could be transferred onto you as their therapist• Acknowledging their feelings/needs and the right to their

feelings/needs, even if they cannot be attuned to or metoi.e., not rejecting their needs/feelings but also not falling into trap

of infantilizing client by rushing to meet all their needs/demands





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§Corrective Experience: Recognizing how important you may be to your client - allowing them to be seen, understood and appreciated, often for the very first time§ By holding-in-mind your client’s developing capacities for

connection to themselves and others (“adult consciousness”), and not getting pulled into their enactments (e.g., splitting, rejecting parts of themselves), you are supporting resolution of early attachment failures

§ The therapist’s kind, consistent, and accepting presence contradicts the often harsh internalized introjects they hold, and allows the client the opportunity to introject an empathic other

• C: “The other day I was beating myself up, then I had your voice in my head telling me to be kinder & gentler with myself”

• T: “How is it to notice being kindler & gentler with yourself?”


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§Increasing awareness of the Connection Style§ Identifying ways clients connect and disconnect

• Using NARM tools such as tracking, mirroring, focusing on here and now, inquiry, deconstruction of experience, psychoeducation, etc.

§Understanding the “designated issue” as a symptom of deeper difficulties; the underlying process of disconnection• “I hear that you believe that you understand what your pain is

about, but would you be willing to stay open to the possibility that it may be more involved than that?”

§ Identifying their fear of life and aliveness• ”It may be more useful to explore your fear of living than your

fear of dying”





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§Addressing Shame§Gently challenging identifications and counter-identifications

• Not focusing solely on disrupting the pride-based identifications, which often leaves clients more identified with their shame-based identifications (i.e., helpless child, unloving, undeserving)

• Identifying the shame-based identifications as a way of managing and adapting to the early environmental failureso“As you’re seeing through this image of yourself as superior for

not feeling, it’s also important to understand how life-saving it was to be able to turn off your feelings the way you did”

§Highlighting their strengths and resources they used to manage§Reframe these coping strategies as capacities in service of

protection and survival• Gently challenge the way they frame them in a judgmental,

shaming and dismissive way


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§Titrating Somatic Awareness & Capacity §Not pushing a client too quickly into their body

• Exploring what keeps them from being more comfortably in body• Identifying the fear of high arousal at one’s core• Holding the trust that they will embody as safety is established

§Reflecting and reinforcing experiences of connection and organization with themselves and/or others• Even when they may not recognize settling, relaxing, etc., as they

tend to focus on what’s going wrong• Practicing grounding and containment embodiment exercises to

provide a more stable base within§Redirecting away from client’s focus on discrete and distressing

sensations to their overall experience• Helps to organize and structuralize their inner experience





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§Working with the challenges of reconnection§Providing psychoeducation and normalizing that every increase in

feeling brings with it an upsurge of sensation and emotion• Often, initially feeling their body and emotions will bring a greater

sense of threat, as they connect into their highly overcharged core energy that begins to release and move

• Also, as self awareness increases, so too does awareness of distress states

§Be mindful of the ways we help clients “regulate” these often-intense states• e.g., for some connection-style clients deep breathing, movement

and touch can increase the charge in the body thus further destabilizing them

§ It is as important to work with a client’s fear of feeling as it is to get to the feelings themselves


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§Tracking eyes, gaze and eye contact§Often with the connection style there will be 2 forms:

• Hypertonic Eyes: frightened, angry, constricted, tense, darting, hypervigilant, hyperfocused, “locked-on” gaze

• Hypotonic Eyes: empty, distant, disengaged, dissociated, glossy, sleepy, contactless, diffuse focus, “long-distance” gaze; ”lights on but no one’s home”

§Use eyes and eye contact to track connection-disconnection§ Identifying gaze aversion as a way the client has learned to regulate

and therefore not override by pushing for contact§Monitoring our own eye contact, as it can be perceived as

threatening, critical or even predatorial§More on working with eyes in Module 4





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§Due to their tendency to fragment and dissociate:§Use simple language§Monitor your pacing§Keep the thread of the session and don’t get lost in superfluous

stories, details, sensations, etc. • Pillar #1: Clarifying the Contract is critical

§Don’t push in any way (i.e., for trust, connection, embodiment, etc.)§Gently identify unresolved emotional expressions

• Particularly their rage and hatred for themselves and the worldoAnd the terror associated with this seemingly destructive rage

• Bring curiosity to how they relate to their inner states§Keep in mind the core dilemma: the desire and fear of connection


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§As therapists who identify with Connection Survival Style (more coming on this in later modules):§Tend to steer away from the relational and emotional;

overemphasize cognitive, theoretical, and spiritual§Can stay superior or one-up client by holding the special

knowledge, insight, or wisdom• Often defining client’s own inner experience for them

§2 Subtypes:1. Intellectualizing: highly analytical, cognitive; overusing

interpretation; “figuring out”2. Spiritualizing: spiritual bypass (e.g., pushing prematurely for

forgiveness); imposing spiritual/energetic causes for solutions; overly reliant on working in “energetic field” and intuition

“Countertransference”: Connection Survival Style




NARM ADAPTIVE SURVIVAL SYLES:

Attunement Survival Style

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The oral character does not make a strong effort to reach out for what he wants. In part this is due

to a lack of strong desire, in part to the fear of reaching…He hopes to get what he wants

somehow without reaching for it; in this way he can circumvent the feared disappointment.

(Alexander Lowen)




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Developmental Period: qBirth to 1.5 years old

Core Need: qTo be attended to and cared for

Core Capacities:qCapacity to be attuned to our needs and emotionsqCapacity to recognize, reach out for and take in

physical and emotional nourishmentqCapacity to be nurturing


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Attunement Survival Style§Every child has psychobiological needs

§Attachment§Physical and emotional nourishment§Interpersonal/Social engagement§Loving and caring attention

§What happens when an infant receives profound misattunement to basic relational and nurturing needs?

§Generally, there is some initial degree of attachment but then the nurturing and nourishment gets interrupted - perhaps due to:

• Early surgery• Parents falling physically or mentally ill• Parents engaged in substance abuse• Crisis in family and/or environment




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Attunement Survival Style§Leads to ambivalence about having needs (“core dilemma”):

I need to need but it’s not safe to need§Shutting-down needs§Won’t continue to reach out and ask for needs§Scan environment and just ask for what’s available from

environment, nothing more§Meet others’ needs in the hope they will then get theirs met

§When attachment needs aren’t attended to there is first a protest; there’s a high cost of protesting if the protest isn’t responded to§Leads to despair, helplessness, hopelessness, resignation§We form the identification: “I don’t deserve”

• Thus having needs becomes associated with shame, humiliation, fear of rejection, etc.

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§As we develop, this leads to 3 major issues around needs:

1. We do not know what it is that we need• Or even that we have needs

2. We are not able to ask for our needs

• Or if we do, it’s associated with guilt and shame

3. We have difficulty receiving, taking in, and being nourished

• Identifications: feeling our needs do not deserve to be met• Dysregulation: we are unable to process, metabolize or

integrate when our needs are met




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Feeling pleasure is hard for meI frequently feel disappointed

I often feel deprived

Eating is filled with issues

It seems like I’ll never get what I really want

I often hate myself

I’m afraid to express my needs

I’m ashamed to feel “needy”

I feel that I don’t deserve much

I fear rejection

I’m proud on how little I can get by on

I don’t know what I need

I fear that people will leave me

I’m always taking care of others’ needs

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Core Dilemma:qCan I be attuned to my own needs? Or must I attune to

everyone else’s needs?

Core Fear:qIf I express my needs, I will be rejected and abandoned

Adaptive Statements:qI won’t need more from the environment than what is available

Compromised Core Expression:qI have needsqI have a right to get my needs met





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§Depression & hopelessness§Suppress protest/anger and grief§“It’s always going to be like this!”§Viewing life through the filter of scarcity§Dialing down needs§Become expert at needing less§Compulsively Giving§Giving to others what you’d want to have §Substance/food abuse

Attunement Survival Style: Coping Strategies

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Shame-Based:• Needy• Yearning• Unfulfilled• Empty• Undeserving• Depressed

Pride-Based:• Caretakers, highly-attuned• Codependent, make themselves

needed and indispensable • Inhibited Subtype: Pride in not

having needs• Unsatisfied Subtype: Expect

environment to meet their needs (demanding, entitled)

Developmental Theme:To tolerate more feeling, nourishment, fullness, expansion

“I need”

Attunement Survival Style: Shame & Pride-Based Identifications




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Inhibited Subtype:• Shut-down needs• Pride in how little they need• Guilty about having• Stingy with anything for

themselves: cupboards should be bare (anxious if there’s too much)

• Often forget to attend to body functions (eat, drink, go to bathroom) when stressed

Unsatisfied Subtype:• Demanding of others• Sense of entitlement• Feeling of never enough• Wanting more for themselves:

cupboards should be overfull (anxious if there’s not enough)

• Will take in and consume but don’t know what they really need

• Overeat when stressed

Attunement Survival Style: 2 Subtypes

Often feel that their only choices are to caretake or demand from others

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§Emotionally intelligent§Ability to be very attuned, caring, compassionate, nurturing,

generous, kind, supportive§Value and nurture relationships and connections between

people§Work toward inclusion, bringing people together and creating

community§Nourishing others through connection and food

§Ability to appreciate pleasure through intimacy§Appreciate sensuality§Exhibit radiance

§Able to go to the extreme edges of human experience (e.g., workers in hospice, social work, humanitarian aid, etc.)

Attunement Survival Style: Potential Strengths




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Attunement Survival Style: Behavioral Characteristics

§Looking for their needs to be met without expressing them directly§Not knowing what they need §Fear or rejection and/or disappointment

§Getting attention is equated with getting love§Clinging in a covert way: encourage others to depend on them§ I love you…I take care of you...You have to love me

§Expressing anger is compromised§Difficulty delaying gratification; impatient, frustrated and irritable

§Impulsivity, including addictions, eating disorders, and money issues (under-earning and compulsive spending)§Inability to grieve relationships and recover from loss§Drawn to strays, underdogs and lost causes

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§Difficulty taking in (connection, food, air, etc.)§Low motivation and energy, chronic fatigue§Do not reach out directly due to low energy

§May appear energetic as they attempt to do something to be acceptable, lovable, attuned to others§Difficulty sustaining effort (e.g., jobs, projects, relationships) –

perceives the task is too much§Periods of elation at the beginning of a new relationship, job or

project - without the ability to follow through§Resigned, pessimistic, and “poor me”§Dorsal Vagal Dominance

Attunement Survival Style: Energy




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Attunement Survival Style: Body Structure

§Poor muscle tone, “undercharged”§Frequent physical complaints and injuries

§Collapse and tension in neck, shoulders and thoracic area; shallow breathing§Tend toward upper respiratory and bronchial problems

§Holding, tension and difficulties in mouth, jaw and throat§Ungrounded: Legs don’t support upper body well §Body type: Malnourished and thin or flaccid with baby fat§Often sense an emptiness in their belly§Pleading, yearning, “puppy dog” eyes

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Bring to mind a client that might fit the description of the Attunement Survival Style:

•Symptoms: _________________________________________

•Coping Strategies/Behaviors: __________________________

•Shame & Pride-Based Identifications: ___________________

•Physical Appearance/Mannerisms: _____________________

•Your “Countertransference” Feelings/Reactions: __________

Attunement Survival StyleExamples




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§Traditional therapeutic approaches generally directed clients to revisit early experiences of inadequate attunement, rejection and abandonment§But this often reinforces the identifications (needy child) and

physiological dysregulation (overwhelming weak system)§In NARM, we support clients to:

1. Attune to their own needs2. Work with whatever is in the way of expressing one’s needs 3. Tolerate more charge, fulfillment, expansion, pleasure and

aliveness§The overall arc of therapy shifts from reliving experiences of

abandonment and scarcity to learning how to tolerate expansion on a physiological and structural level

Attunement Survival Style: Healing Process

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§Building the capacity for fulfillment & consistent connection§Confronting the tendency to collapse with strong feelings§Allow space for and be present with grief§Acknowledge and integrate split-off aggression§Support engagement with expansive & positive emotions§Support ability to receive support, nurturance and fulfillment

§Increasing awareness of Attunement Style§Work with cognitive distortion of not deserving§Work with reality that abandonment has already happened§Realize that by being the giver, they abandon themselves§Work with fantasy: “If (or when) I have…then I will be happy”§Help them to acknowledge and be realistic of their needs§Help them to learn how to express their needs directly

Attunement Survival Style: Healing Process




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“Countertransference”: Attunement Survival Style

§Pride-Based: Your need to be there and helping clients leads you to enlist your client in an infantile/child role of needing to be helped, care taken or fulfilled by you §We unconsciously need our clients to need us

•Making ourselves available for clients whenever they “need” •Some clients may need extra help, but that comes out of

providing what is needed, not meeting our own needs§Shame-based: Rejecting our own needs and hating ourselves for

being needy, we project onto our clients our hatred of their neediness and thereby reject their needs to be attuned to§A “never enough” feeling or even disgust can arise, where we feel

that our clients are like sponges, parasites or black holes, sucking us dry, no matter how much we feel we give

NARM CLINICAL MODEL




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We cannot solve our problems with the same thinking we used

when we created them.(Albert Einstein)

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§NARM is a non-pathologizing, non-reductive, non-regressive, and resource-oriented clinical approach for working with:§Systemic Dysregulation

• Developmentally-informed clinical interventions to anchor self-regulation in the nervous system

§ Identity Distortions• Mindful inquiry process of the self in the present moment:oIdentifying and deconstructing the deeper identifications &

counter-identifications we take to be our identityoMoving away from being victims of our past – reinforcing

agency in how we live through our identificationsoTolerating increasing complexity, learning to accept parts of

ourselves we rejected

NARM Clinical Model




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NARM Clinical Model§The NARM approach supports the client in an exploration into their

physiological dysregulation and identity distortions, relying on three aspects of mindfulness:

1. Somatic mindfulness (bottom-up)

2. Mindful awareness of one’s adaptive survival styles (top-down)

3. Dual awareness• Anchored in present moment, even when exploring past• Supports agency, not victim of past• Tracking connection/disconnection &

regulation/dysregulation • Reinforcing connection to self: invites all

disconnected, split-off and rejected parts back to the table

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§Healing occurs in re-owning the disowned, rejected and split-off parts of ourselves§These parts are often referred to as our “child consciousness”§We relate to ourselves and others from this consciousness state§Regressive, cathartic approaches often reinforce fragmentation, as

opposed to supporting integration

§Healing occurs in recruiting the executive & resiliency brain systems (cortical brain, top-down processing) to integrate with and balance the regulatory brain systems (subcortical brain, bottom-up processing)§This integrated brain process can be referred to as our

“adult consciousness”

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ØThe NARM 4 Pillars (aka, “Cedar Model”) offers a structure and rhythm to support the exploratory process into our client’s inner world, often via their physiological and psychological symptoms§Offers a strength-based, resource-oriented approach§Supports collaboration between client and therapist

• We’re not experts in client’s internal experience; our expertise lies in inviting clients to reflect on their own internal experience

§Not solely focused on solution and fixing• Focused on re-organization and transformation

ØThe NARM Relational Model offers a mindful interpersonal approach which has profound implication on therapeutic engagement and understanding between client and therapist§Built upon curiosity and presence§A new model for understanding and applying countertransference

NARM Clinical Model

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ØThe NARM Model of Working with Affect offers a new and unique perspective on emotional feeling and expression, which serves in the re-organization and transformation of survival style patterns§Acknowledges that not all emotions are created equal, and asks the

following fundamental questions:• What is the implicit intention of the affect?• What is the meaning of the emotion?• Does feeling the emotion support freedom from old patterns (adult

consciousness) or reinforce old patterns (child consciousness)?§Does not push people to feel or express emotions, but instead

explores fear of emotion - which supports emotional completion• A containment, not cathartic model

NARM Clinical Model




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ØThe NARM Personality Spectrum Model offers a map for recognizing where our clients are in terms of their personality capacities: on the spectrum of “organized self”, “survival style” & “personality disordered”§This has major implications that shape the therapeutic process,

interventions, prognosis and levels of support§This also helps therapists have a better understanding of therapeutic

alliance and issues of countertransference

ØWorking with Identity - identifications and counter-identifications -and specifically the tool of disidentification§ Integrating a Somatic basis to understanding identity§Oriented from a non-western perspective about what identity is

• Expanding traditional personality theories beyond just creating better psychological adaptations to exploring who we are beyond our lifelong identifications, and the potential for psychological freedom

NARM Clinical Model

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Skill Description

1. CLARIFYING THERAPEUTIC “CONTRACT”

Client setting the intention for the work - what it is that they truly want for themselves; an agency-based process focused on exploration, not specifically results-oriented, which enhances the interpersonal engagement

2. ASKING EXPLORATORY QUESTIONS

Inquiry-driven; gathering information and inviting client to reflect on their own internal process

3. REINFORCING AGENCY

Supporting one’s capacity for awareness of their part in challenges they face as adults [“adult consciousness”];reflecting and reinforcing that adult clients, in most cases, play an active role in their own internal and external difficulties

4. REFLECTINGPSYCHOBIOLOGICAL SHIFTS

Tracking expressions of connection-disconnection; reflecting and anchoring present experience of connection (physical, emotional, cognitive, relational) in the body; supports softening of old identifications, integration, and reorganization

NARM Clinical Model: 4 Pillars




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NARM Clinical Model: 4 Pillars, aka “Cedar Model”

Images by Neal Winblad

NARM Pillar #1 : Clarifying the

Therapeutic Contract




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§The “Contract” is the first step in supporting the client’s agency§What is it that the client wants for themselves?

•“What would be the optimal outcome of our work together? Doesn’t have to be realistic.”

•Or more simply: “What would you like for yourself today?”§And what are the ways they are in their own way of getting what

they truly want for themselves?•“I’ll be glad to explore the difficulties you are having in intimacy”

§This sets the tone for a collaborative and respectful therapeutic relationship where the client is the expert in their own inner world and the therapist is curious about learning more in support of helping the client shift old patterns and identifications

NARM Pillar #1: Clarifying Therapeutic Contract

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NARM Pillar #1: Clarifying Therapeutic Contract1. Asking the client what it is that they want§ Support the client to set the intention for their process§ Therapist should not take the reigns, not assume or figure out

what their client needs, or take sides § Clients generally want behavioral outcomes (e.g. “to stop being

angry”, “to feel less anxious”, “to stop overeating”, ”to feel loved”)2. Change goal or results-oriented into exploration§ Focus is on exploring what’s driving the problem behaviors • “I’m happy to explore what’s driving your anger”

§ Or focus is on what’s getting in the way of what they say they want• “I’m happy to explore what’s in your way of feeling less anxious”

§ Therapist doesn’t immediately agree with what client wants• e.g., If your client wants a “kick in the ass” to get moving on a

project, explore what’s in their way of getting moving forward




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NARM Pillar #1: Clarifying Therapeutic Contract§Especially in early sessions, the contract needs to be clear and reflect

something both the therapist and client can agree on§This could take an entire session, or several sessions

• You are not doing anything wrong if takes several or even many sessions to establish a clear contract - it is reflective of their survival style patterns and part of the healing processoWe do not want to pressure ourselves, or our clients, to arrive at

a contractoIf this makes you uncomfortable or brings up negative beliefs

(e.g. “I’m not getting anywhere”), take time to work with your own reactions as they could be inhibiting therapeutic progress

§ In later sessions, the contract may be implicit or carried over, but it’s useful to re-state it anyway

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§There are times the stated contract is too general to get specifics so just begin exploring§You can always re-contract once you get clearer

§Clarifying the working agreement (“Re-Contracting”) throughout the course of therapy helps to keep the therapy on track:§Keeps focus on client’s intention for fueling the therapeutic

process§Takes the burden of responsibility for the treatment off of

therapist•“I just want to check in with you what you would like for yourself

at this point in therapy? What would you like for yourself now?”

NARM Pillar #1: Clarifying Therapeutic Contract




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NARM Pillar #1: Clarifying Therapeutic Contract§Re-Contracting can be useful throughout the session§Helps clarify - good for when things are getting foggy or off track

• You will know when you’re working without a solid contract, or moved away too far from the original contract, as it often feels unclear, confusing, muddled, tangential, disorganized

• If you feel lost and/or forget the original contract, you can always ask something like: o“So, please remind me what it is that you’d like to get out of

this session?”oOr even more direct, “Please remind me what your original

intention was for our session?”§Helps determine who’s doing what and what the dynamics are§Helps reinforce client’s agency

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NARM Pillar #1: Clarifying Therapeutic Contract§Re-Contracting is often needed when new insights have moved

clients away from their original intention§But don’t prematurely move to re-contracting, as sometimes you

are exactly where you need to be but the client’s core dilemma is threatened, so they want to move away or distract

§ If re-contracting is necessary, make it explicit• For example, saying something like: “Your original intention for

our session was to explore your anxiety, but now I am hearing that you’d like to explore your difficulty in expressing your anger to your husband. Is that correct? OK, I’d be happy to explore…”

§ If you have a strong contract, it gives us the permission to be more directive, or even challenging, in order to help them stay on the path of resolving the core dilemma




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NARM Pillar #1 - LANGUAGING: Clarifying Therapeutic Contract§NARM Languaging Examples of Setting up the Therapeutic Contract

• What would you like for yourself in your therapy with me?• What would you like to get out of this session? • What would be the optimal outcome for our work together? It doesn’t even have to

be realistic. If you could have the top of your wish list, what would that be?

§In response to the client saying, “I’ve got (such and such symptom) and I’d like to get rid of it”, you might offer:• I will be happy to explore with you what this symptom is about.• I’ll be glad to explore the difficulty you have giving and receiving love• I’ll explore with you the difficulty that you have in being in touch with your body.

§Re-contracting when things get murky (for you and/or client)• I’m unclear, please remind me what it is that you want to get out of this session? • You said earlier you wanted to explore (such and such symptom), now I’m hearing

you talk about (a new topic) • For example, You said earlier that you wanted to explore your depression, now I’m

hearing you talk about your anger toward your parents

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§How do we know when we have arrived at a contract?§Before agreement everything may seem unclear and mushy, but

when a clear understanding is reached, there’s an energetic and somatic feeling that things are coming together§We may observe in our clients, or feel these in the resonance:

•More clarity•More simplicity•More connected•More feeling•More presence•More “adult consciousness” online

§Some NARM Practitioners describe this as “kerplunk”

NARM Pillar #1 - LANGUAGING: Clarifying Therapeutic Contract




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NARM Pillar #1 - LANGUAGING: Clarifying Therapeutic Contract§Contract useful for each style:§Connection: to be invited and welcomed to show up, to take time

to create safety and control over the process§Attunement: to feel truly heard and to start to challenge old

identifications of not expressing their needs§Trust: to make sure they are setting the course, not relying on

others (therapist) but also challenging them to have to collaborate; to gradually titrate toward needing help by identifying what they’re there for

§Autonomy: to support them feeling in control and not being driven (once again) by therapist and therapist’s agenda, that they can express their authenticity and still stay connected and open

§Love-Sexuality: to not be perfect and have to achieve or be perfect to be accepted and loved, to open and surrender to the process

NARM Pillar #2 : Asking Exploratory

Questions




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NARM Pillar #2: Asking Exploratory Questions

§NARM is an inquiry-based, process-oriented model; driven by curiosity to deepen our understanding of our client’s inner world§Exploration invites client to reflect on their internal experience and

bring their internal worlds into the therapeutic relationship§Pillar #2 has to do with how we ask questions and begin helping

clients understand, organize and transform their inner worlds§This interpersonal process can help resolve unconscious attachment

wounds (the “R” in NARM)§Many people have never had anyone truly express interest in and

the capacity to stay present with their inner world, instead being focused on behaviors, performance, goals, results

§Even with the best intentions, clients can feel profoundly missed by their therapists

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§Our culture tends toward solution-focused, symptom-reducing approaches that often miss understanding the client’s internal world§Focusing on correcting a behavior can come across as adults,

therapists, partners, etc., having no interest in what’s going on within the child, client, partner that’s driving this behavior

§Inquiry also re-sets the power dynamics§ Instead of us being experts and telling our clients what’s going on

with them - whether cognitively, emotionally, relationally, somatically or spiritually - our expertise and knowledge is used to ask more informed questions

§Along with contracting it supports agency and adult consciousness




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§One of the challenges in working primarily with behaviors and symptoms is that you can have the same external behavior/symptom being driven from different places internally§ If we’re dealing with a particular symptom (maladaptive behavior):

• How long has this been going on?• Immediate or proximal trigger for this symptom?oWe’re not assuming this trigger is the cause, but it’s useful to

know it as it gets us into the dynamicoThe dynamic serves as the bridge between survival styles that

developed in reaction to childhood and how this is showing up in the present

§We will explore this further when we introduce the NARM Model for Working with Affect, and how primary and default emotions are often misunderstood

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§In NARM, we trust that as our clients receive the right kind of support and guidance, they will develop increased capacity (“agency” or “adult consciousness”) for shifting the internal dynamics that are fueling these dysfunctional behaviors§Agency is a central aspect of inquiry, as we’re always holding what

role the client has in their symptoms and behaviors• The tendency is for clients to externalize everything happening out

there and not what’s going on inside meoThis tendency is most obvious on the personality-disordered end

of the spectrum§We must be mindful not to invalidate or pathologize these

behaviors/symptoms (which were at one time survival strategies), but we do want to begin supporting other ways of managing their internal world




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§While the survival styles and identifications will inform the inquiry process, we don’t need to try and figure them out, they serve as organizing principles along our exploratory process§ Remember that our exploration is targeted beneath the cognitive

and behavioral levels to the intrapsychic and physiological levels of how we are organized as human beings

§We’re mindful of not taking over functions of our clients: so we do not interpret, challenge resistance or tell them what they’re feeling§ Instead we explore what’s in the way of what they truly want -

examine the intrapsychic conflicts§ We do share our reactions or thoughts, but be mindful not to

share them as our personal experience and not as truth§ Our expertise is in how we ask more informed questions

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§As therapists, we can get in the way of our client’s increasing capacity for agency and adult consciousness §Therapists often start (with good intentions) by taking over the

reigns of therapy by setting the agenda and program for their clients• Working toward these therapeutic goals, the therapist may then

cheerlead their client, give advice, interpret resistance, or in some cases even pressure their clients to meet their programoIn NARM, instead of directing a client to express their anger if

they feel disempowered, we inquire as to what is getting in their way of doing what it is that they say they want




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§Exploratory questions are built off the contract§This starts with getting clear of what they want§Questions then begin to revolve around what is the client’s part in

getting in their own way of getting it is that they say the want§The “Working Hypothesis” begins, informed by:§The client’s responses to our exploratory questions §Understanding of survival styles and corresponding identifications§Tuning into the therapeutic relationship§Attending to our own inner states and countertransference

§Our “Working Hypothesis” shapes the direction of the exploration§Based on an understanding of the client’s core dilemma that is

keeping these dynamics and symptoms stuck for the client• This is subject to continuous revision as more information

emerges; we may move through several tentative hypotheses

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§As part of our exploratory questions we are attempting to break down complex elements so that the client truly understands them and can relate to them in a new way, free of their identifications§We use two important techniques in this process:§ Deconstruction of Experience: slowing things down so that it

enables the client to become aware of elements that may otherwise be unconscious, automatic and shift rapidly

• It involves using a specific situation (not staying in the abstract) which becomes emblematic of a larger process

• You might be able to start with an opposite experience, e.g., “Are there times when you’re not anxious/depressed?”

§ Drilling Down: gathering more information on all levels of experience via inquiring about the details of whatever it is that’s being shared or experienced by client




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§Deconstruction of Experience: Asking for a specific event/experience to ground the larger issue or theme (from generalized to specific); which helps to bring the dynamics into the present moment§ Instead of just talking theoretically about general themes, or going

around in the various story details, this helps to keep the inquiry more embodied

§This gives therapists an opportunity to slow down these complex, often automatic internal dynamics and reactions

§This helps us in working directly with survival style patterns in a way in which we don’t have to regress back to child consciousness states• We want the adult consciousness (“dual awareness”) to be on

board, as by definition the child consciousness does not have much agency

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§When deconstructing experience, less organized clients often quickly contract (i.e., “overcouple” in fear and self-criticism, or acting-out behaviors) so the inquiry and deconstruction help to slow down (“uncouple”) this quick reaction§ It helps to highlight how a person is disconnecting from their

internal experience on a moment to moment basis• e.g., if your client’s contract was to explore her difficulty in

expressing her anger to her husband, a follow-up question could be: “Can you tell me about a recent time you were in this situation where you had difficulty expressing your anger to your husband?”

• Another example, if your client says “I feel fearful and frozen all the time”, it is more us to move toward a specific experience such as: “My boss was hovering over me and I went blank and couldn’t think of what to say or do.”




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§All of this is at service of a meta-process we refer to as Disidentification§This has to do with bringing a quality of mindfulness to our

consciousness, taking our thoughts and reactions less seriously, not presuming that what we’re feeling is truth, recognizing we aren’t defined by what we’ve taken ourselves to be, and ultimately seeing ourselves less through our survival styles and old identifications

§Often, the client will experience an “aha” moment§They may see the world with new eyes§Have new insight§Feel weight lifted off them§Have a deep sense of settling, quiet§Feel a sense of “growing up”, being more adult§Have a surge of new energy§Experience new emotional responses

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§But also clients might experience something more unsettling as re-organization happens:§Confusion

• Not sure what they were talking about; what they’re supposed to be doing; where they’re going

§Disorientation• Looking to you for direction, guidance, answers

§Unmoored/ungrounded§Dizziness§Nausea

§Somatically, shifting identifications dissolves the physiological correlates that held this structure together for all these years - which can be both stimulating and re-organizing§ We do not want to resource this state away!




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NARM Pillar #2 - LANGUAGING: Asking Exploratory Questions

§NARM Languaging Examples of Asking Exploratory Questions• And, what happens when you say those words to your parents?• And, when you talk about [your abuse from her], what’s your experience right now?• If you saw someone treating your child the way your [mother/father] treated you,

how would you feel?• So from this adult perspective can you see what this protective impulse is about?• When you think about moving forward with this I’m wondering what comes up?• And what happens if you give yourself permission to feel that?• Is there a judgment?• I’m wondering whose face you imagine up there?• I’m wondering, are there any more elements to the vulnerability?• So, let me ask you a specific question. What was your [mother/father’s] response to

your vulnerability?• And, what do you feel when you say those words, [“it’s not fair.”]?• And, who are you saying those words to?

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§NARM Languaging Examples of Asking Exploratory Questions• Do you know what the sadness is about?• Anything else that you can say about this feeling?• So, what you’re feeling right now sounds like it’s pretty challenging for you.• And I notice that as we talk about it more emotions start to come.• Are there any words that come with the emotions?• And what’s the scariest thing for you about [conflict with her]?• How scary on a scale from 0 to 10?• So, it seems that even though it taps into more aliveness that it’s also scary?• [A person talking, for example about their fear of public speaking – next two

questions] What is your worst fear? What’s the worst thing you can imagine?• When you say you’re feeling shame - what are the shaming messages you are giving

to yourself right now?




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§NARM Languaging Examples of Asking Exploratory Questions• Can you think of a specific incident when you had this reaction so we can look at it in

greater detail?• Do you have a recent example of when this came up?• What happens when you talk about that?• Notice how you take that in.• Can you clarify for me what you mean?• And what are you feeling? [Client comes back with a thought] I notice that you’re

giving me a thought rather than a feeling.• I get lost and confused when you start talking about concepts you have vs. what you

are experiencing right now.• What is the meaning that you took out of that experience about yourself & the world?• What’s the emotion? [As the therapist notices there is an overall expansion, shift away

from contractions in the body by asking] What are you experiencing overall right now?• So, when it starts to get too good what happens?• So, there’s stillness and then there’s emotion? What’s it like to be with both of these?

NARM CLINICAL PRACTICE:

Addressing the Core Dilemma




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§The core dilemma is the impossible conflict between one’s life force and the adaptations (survival styles & identifications) we had to make to survive§ This double bind emerged early in life and shapes development:

• Connection: I need connection but can’t safely connect• Attunement: I need attunement but can’t safely be attuned to• Trust: I need to be able to trust others but can’t safely trust• Autonomy: I need to experience my own autonomy but can’t safely

experience my own autonomy• Love-Sexuality: I need to reach out with and receive love but can’t safely

reach out with and receive love§ As adults, this turns (unconsciously) into:

• I need to connect but I am afraid to• I need to attune but I am afraid to• I need to trust but I am afraid to• I need autonomy but I am afraid to• I need love and sexuality but I am afraid to

NARM 4 Pillars: Core Dilemma

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§The core dilemma caused identifications to develop, which originally allowed us to survive and maintain some kind of attachment relationship§The identifications solved our core dilemma growing up§While these identifications allowed our client to survive in childhood

they now cause pain, symptoms, and disconnection as adults§ In most relationships as adults, we are acting out through our child

consciousness as shaped through the core dilemma• And more specifically, the reactions to the core dilemma - the

identifications and strategies used §We must remember that the process of self-rejection is the

mobilizing force for our survival styles• Clinically, we don’t choose sides of the core dilemma, but create

the conditions for all sides to come back into relationship




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§Identifying and supporting resolution of our client’s core dilemmas is one of the primary organizing principles of NARM§ The core dilemma is rooted in a time when the child had no

agency, and truly no possibility of agency - they were at the mercy of their environment/caregivers

§ Now, as adults, we have agency, but we maintain the illusion of a lack of agency

• This is in service of protecting the attachment relationship by feeling and behaving in ways that were appropriate for the child given those early circumstances, but as adults is in our way of connection, health and alivenessoMobilizing what we refer to as self-activation


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§The pathway out of the core dilemma is to embody and actualize the agency we have as adults§ Even in difficult life situations, we have agency in how we respond





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§An example of how this might look in a NARM session:• Client: “I feel like an alien, always an outsider” is an identification

(child consciousness) with lack of agency (adult consciousness)• Increased client agency: “I prefer to be alone” oThis is the starting point for the adult client to realize that she

herself plays an active role in her identification oRecognizing her role in avoiding contact; a strategy that emerged

early to manage an impossible bind (around connection)• Client then names: “I want to be seen, and I don’t want to be seen”oThis is a classic Connection Survival Style core dilemmaoA child needs to be seen but if the child feels danger in being

seen - due to an early environmental failure - then the identification and subsequent strategies of “preferring to be alone” served to protect the attachment relationship


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§ Identifying and reflecting the dissolution of the core dilemma is what we might refer to as emotional completion§ It is the process of healing deep childhood wounds that have affected

us our entire lives; and sets the stage for embracing our true selves§We may notice it in physiological, emotional, behavioral, cognitive

and/or relational signs• e.g., client who was hunched over with constricted breathing now

feels more erect with room to breathe• e.g., client who constantly felt pressured now feels their creativity

without any burden, pressure or internal demands§ It is important for us to reflect these positive shifts back to our clients §Reinforces sense of confidence, competence, mastery, pleasure, pride§This positive reflection helps cement the changes in place and offers

the client hope of continued growth and healthy change





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§NARM Languaging Examples of Reflecting Core Dilemma• [Client said: “it feels so hopeless”] What’s the “it” that feels so hopeless?• [Client said: “it feels like a little bit of a dilemma”] It is a dilemma.• So you have this idea that you can’t be you when she’s around?• So at the same time you feel anger towards her, there’s this message that you’re

not supposed to feel anger?• So this very powerful rule in your life started developing at two to three years old?• We see this connection that if you challenge the old pattern, then it brings up this

feeling of aloneness more, and you go back into shrinking and twisting your body.• So, for you it’s associated with getting into trouble.• So, it sounds like you took on a role, of good girl. Do good girls get into conflict?

What do good girls do with conflict?• If you get in conflict with her then you’ll end up being alone?• [In response to where a client uses understanding to short circuit their angry

feelings] That’s very understanding of you. (Paradoxical intent)

NARM 4 Pillars - LANGUAGING: Core Dilemma

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Core Dilemma & The Working Hypothesis

§We are holding an ongoing curiosity about how our clients are organizing their inner worlds§The Working Hypothesis is our internal process in relating to our

clients’ internal world, and particularly around their Core Dilemma• This mimics an essential aspect of secure attachment, what is often

referred to as “Contingent Communication” or “Synrhythmia” §This curiosity serves to:

• Help us increase our capacity to connect with our clients • Keeps the process in the here & nowoWhile the Core Dilemma was informed by historical experiences,

it is playing out now in their present lives• Keeps the thread of the sessionoThe “Contract” often leads us right into the Core Dilemma

• Recognize what might be missing for our clients




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§Understanding the core dilemma helps guide our inquiry & interventions§What we do want to follow and what we may want to bookmark§Particularly noticing the ways the clients will start acting-in & acting-

out as we get closer to the core dilemma§It is not used as a skill for interpretation or reducing the client’s

experience §It is a trial and error process§We are not ego-attached to our working hypothesis,

we’re willing to be wrong, learn, and adjust our engagement and interventions

§ It is informing us of the client’s inner experience on the basis of limited evidence as a starting point for further investigation

Core Dilemma & The Working Hypothesis

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Working Hypothesis§Choice Points

• Where is the life force?oIncluding the ”cracks” in the identifications

• Which are the dead-end streets?oIdentifications: “Life is always going to be like this, so why bother”

vs. the compassionate grief of never having what they truly wantedo“Smokescreens”

• What is missing here?oPrimary vs Default emotions




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NARM: Part of the Future of Trauma-Informed Care

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It’s important not to underestimate how subversive, and ultimately transformative, this work is. We’re

really challenging what we take to be our identity: a certain kind of fiction about who we are that we’ve

identified as. This challenge is more threatening - and life-affirming - than we may consciously acknowledge. In NARM we’re focusing more on who we’re not and just leaving it as an open question as to who we are.

So who are we? It’s a very good question…(Larry Heller & Brad Kammer)

Image by Jyrah Productions Inc.




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•What was 1 topic we covered this weekend that impacted you (professionally and/or personally)? How exactly did this impact you?

•Any intention for how might like to integrate this weekend out into your clinical and/or personal life?

•Name 1 way the information presented this weekend may help you with one of your specific clients?

•What might you do between now and Module 2 to keep engaged with your learning of NARM?

End of Module 1 Reflection

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qAlmaas, A.H. (1988). The Pearl Beyond Price.qBradshaw, John, Healing the Shame that Binds You.qClarke, Jean and Dawson, Connie (1989). Growing Up Again.qHeller, Laurence and Lapierre, Aline (2012). Healing Developmental Trauma.qHedges, Lawrence (1992). Interpreting the Counter-Transference.qJohnson, Stephen (1994). Character Styles.qJohnson, Stephen (1984). Characterological Transformation.qJosephs, Lawrence (1995). Character and Self Experience.qJudith, Anodea (1996). Eastern Body, Western Mind.qKammer, Brad (2004). Trauma & Civilization. Masters’ Thesis. qKaplan, Louise (1978). Oneness and Separateness.qKessler, Steven (2015). The 5 Personality Patterns.qLevine, Peter (2010). In an Unspoken Voice. qLevine, Peter (1997). Waking the Tiger.qLowen, Alexander (1976). Bioenergetics.qLowen, Alexander (1971). The Language of the Body.qMahler, Margaret, et al. (2000). The Psychological Birth of the Human Infant.qMasterson, James (1990). Search for the Real Self.qMasterson, James (1983). Countertransference and Psychotherapeutic Technique.qMasterson, James (1981). The Narcissistic and Borderline Disorders.qMasterson, James and Lieberman, Anne (2004). A Therapist’s Guide to the Personality Disorders.qMiller, Alice (1997). The Drama of the Gifted Child.

Reference List




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qNathanson, Donald (1994). Shame and Pride.qPierrakos, John (1987). Core Energetics.qPorges, Stephen (2011). The Polyvagal Theory.qReich, Wilhelm (1949). Character Analysis.qRicho, David (2012). How to be an Adult.qRicho, David (2008). When the Past is Present.qRubin, Theodore (1975). Compassion and Self-Hate.qSapolsky, Robert (2004). Why Zebras Don’t Get Ulcers. qScaer, Robert (2005). The Trauma Spectrum.qSchnarch, David (2009). Passionate Marriage.qSchnarff, David (1995). Object Relations Theory and Practice.qSchwartz, Richard (1997). Internal Family Systems Therapy.qSiegel, Daniel (2008). The Neurobiology of We.qSiegel, Daniel (2001). The Developing MindqTotton, Nick and Edmondson, Em (1988). Reichian Growth Work.qvan der Kolk, Bessel (2014). The Body Keeps the Score.qvan der Kolk, Bessel (1996). Traumatic Stress.qWallin, David (2015). Attachment and Psychotherapy.qWinnicott, D.W. (1987). The Child, the Family, and the Outside World.qFor more references and links:§ ACEs Connection Network: http://www.acesconnection.com/§ David Baldwin’s Trauma Information Pages: http://www.trauma-pages.com/

Reference List

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NARM Practitioner Training

Brad J Kammer, LMFT, [email protected]

(707) 462 2133

www.NARMTRAINING.COM

http://www.acesconnection.com/

http://www.trauma-pages.com/

mailto:[email protected]

http://www.narmtraining.com/

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