[SPEAKER_00]: Therapy chat podcast episode 5-6 This is the Therapy chat podcast with Laura Regan LCSWC.
[SPEAKER_00]: The information shared in this podcast is not a substitute for seeking help from a licensed mental health professional.
[SPEAKER_00]: And now, here's your host Laura Regan LCSWC.
[SPEAKER_01]: Hi, welcome back to Therapy Chat.
[SPEAKER_01]: I'm your host, Laura Reagan, and this week, continuing our series on EMTR.
[SPEAKER_01]: I'm bringing you a replay of my conversation with Rebecca Kase, who is an EMTR consultant and trainer and developer of Polyvagal informed EMTR.
[SPEAKER_01]: So in this week's episode, we'll be talking about using EMTR for nervous system regulation.
[SPEAKER_01]: Let's dive right in.
[SPEAKER_01]: Hi, welcome back to Therapy Chat.
[SPEAKER_01]: I'm your host, Laura Reagan, and today I'm so excited to be here with Rebecca Case.
[SPEAKER_01]: Rebecca, thanks so much for being my guest today.
[SPEAKER_02]: No, thanks so much for inviting me.
[SPEAKER_01]: I'm really happy to be here.
[SPEAKER_01]: Yeah, I'm excited to talk with you.
[SPEAKER_01]: You do a lot with EMDR and we're going to talk about using EMDR for embodiment and even what that means and why it's important.
[SPEAKER_01]: So before we get into it, let's just start off with you telling our audience a little bit more about yourself and what you do.
[SPEAKER_02]: I'm a licensed clinical social worker in a registered yoga instructor and I own case and co, which is an MDR training and consulting business.
[SPEAKER_02]: So my business teaches psychotherapists how to practice EMDR and we have.
[SPEAKER_02]: are EMDR basic trainings and advanced trainings on specialty topics.
[SPEAKER_02]: I am also the author of Polyvago and Formed EMDR, a neuro-informed approach to healing, which is a book that just came out this year in 2023, which really outlines the path and a framework for incorporating
[SPEAKER_02]: to integrate these two really profound models and how useful they can be to help people heal.
[SPEAKER_01]: It's wonderful and you know, I often say here I'm not an EMDR therapist, so I do intend to get trained soon.
[SPEAKER_01]: I am training brainspotting though, but with EMDR, the complaint has always been about the protocol based manualized aspects of it where people aren't using the whole
[SPEAKER_01]: body.
[SPEAKER_01]: I know that there are many people who do use it in a very embodied way, but with the wide variety of trainings that are now available, so many people are learning in just a very manualized way that is kind of more cognitive.
[SPEAKER_01]: So I think it's really valuable that you are teaching people how to use it in a, let's say maybe a more
[SPEAKER_02]: Yeah, I think if that's a fair way to explore it, you know, the history of EMDR, EMDR was originally developed as an intervention.
[SPEAKER_02]: And so it was developed as something that was pretty technical of, you know, do these and these steps and techniques to take out a sting of a trauma memory.
[SPEAKER_02]: And as Francine Shapiro continued to research and practice it, it grew into
[SPEAKER_02]: EMDR started out as just being known as EMDR.
[SPEAKER_02]: And then it grew into EMDR.
[SPEAKER_02]: And he grew into a whole therapy.
[SPEAKER_02]: And so I think that some of that rigidity that people sometimes feel are perceived with EMDR is, you know, kind of ticklers from the past.
[SPEAKER_02]: And it's historical kind of development and lineage.
[SPEAKER_02]: But now today, in modern times, 2023, we are challenged with how do we step away from the protocol from it, feeling like something that's really rigid to see it as something that's structured with room to dance.
[SPEAKER_02]: and how do we invite in our up-to-date neuroscience on polyvagal theory, wrong the importance of the body, on semantics.
[SPEAKER_02]: And I find that as we incorporate that, it actually integrates really nicely into the EMDR model, and I think helps expand it.
[SPEAKER_02]: It's not that there's necessarily things we're learning that says, oh EMDR's illegitimate, like that changes everything with this new research.
[SPEAKER_02]: It's
[SPEAKER_02]: Oh, wow.
[SPEAKER_02]: Now we can see it in this different way.
[SPEAKER_02]: And EMDR is also often felt like it's not a very relational therapy, because it does feel very protocol and structured and kind of strict.
[SPEAKER_02]: But we know that therapy is, you know, best practice when there's amazing rapport and a solid relationship.
[SPEAKER_02]: And polybago theory really helps us to understand why that's important.
[SPEAKER_02]: and how we can make the relationship more relational in EMDR, as well.
[SPEAKER_01]: Ah, making their relationship more relational in EMDR.
[SPEAKER_01]: So can you say a little more about that?
[SPEAKER_02]: Historically speaking, Francine does talk about her EMDR text, kind of like the Bible.
[SPEAKER_02]: Okay, and the R. That therapeutic reform is really important, but she doesn't really explain how to maintain the relationship when you're providing bilateral stimulation, something that does feel very kind of mechanical.
[SPEAKER_02]: And she doesn't really talk about why that's important from the perspective of processing and memory.
[SPEAKER_02]: EMDR is a memory-based therapy.
[SPEAKER_02]: We focus on the storage of memory and how maladaptively stored memories can contribute to the development of PTSD and anxiety and depression.
[SPEAKER_02]: all the things that people show up with after trauma and toxic stress.
[SPEAKER_02]: And the protocol, again, originally developed as an intervention.
[SPEAKER_02]: So it was very structured and you do ABC and D. But it doesn't talk about you do ABC and D within the context of a safe relationship.
[SPEAKER_02]: And here's how we can understand that the safe relationship is actually a therapeutic in an intervention in and of itself.
[SPEAKER_02]: So the therapeutic relationship in EMDR as for any trauma therapy is kind of the vessel that holds the space for the healing to happen within.
[SPEAKER_02]: But if there's no space for that to be held, then you're just not going to have the same kind of outcomes.
[SPEAKER_02]: In fact, that's when people might say EMDR made things worse for me.
[SPEAKER_02]: I didn't like my EMDR experience.
[SPEAKER_02]: I felt way too vulnerable.
[SPEAKER_02]: I've heard
[SPEAKER_02]: And that's not what healing should look like and often that's because what I hear when I ask more questions is because that relationship wasn't there.
[SPEAKER_02]: And so Polyvagal theory talks about the power of the social engagement system, how we're wired to connect, how we thrive in safe connection, and why it's so important.
[SPEAKER_02]: And so when we think about processing memories and integrating traumatic memory, I really think that that's a very important piece of
[SPEAKER_02]: You're processing it with the new adaptive information of what it feels like to be safe as you process it What it feels like to be safe and seeing as you're working on something that's been so vulnerable for you That's maybe shame ridden that's you know the stuff you're like oh gosh I don't tell anybody about this stuff
[SPEAKER_02]: thing.
[SPEAKER_02]: And so when we process memories in EMDR, they shift and they change to this adaptive state where people say like, wow, she doesn't bother me or I look back and I can see I'm so resilient or I'm so strong.
[SPEAKER_02]: And you can just think about how a safe relationship, that therapeutic relationship kind of adds those little pieces into that memory, right, of people being able to feel and experience what it's like to be safe in that process and so that that gets integrated
[SPEAKER_02]: the newly kind of rewired memory network.
[SPEAKER_01]: Wow, thank you.
[SPEAKER_01]: What a beautiful explanation.
[SPEAKER_01]: That was a complicated thing to explain.
[SPEAKER_01]: And I really appreciate how you were able to do that.
[SPEAKER_02]: Thank you.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: So would it be that as part of resourcing in the preparation for the EMDR work
[SPEAKER_01]: ability to have the trusting therapeutic relationship is expanded or it's able to expand within that resourcing.
[SPEAKER_02]: Within eight phases of EMDR, so EMDR has eight phases.
[SPEAKER_02]: And the first two are really pretty, pretty common.
[SPEAKER_02]: I think for any therapist to utilize no matter your orientation or your vengeance that you're using.
[SPEAKER_02]: First one is all about peace conceptualization, getting a sense of what's the lay of the land.
[SPEAKER_02]: How do I understand my client?
[SPEAKER_02]: and also about building rapport and the relationship.
[SPEAKER_02]: Now, unfortunately, in the EMDR model, that component of building rapport is just, it's kind of glossed over.
[SPEAKER_02]: It's not significantly emphasized.
[SPEAKER_02]: And in my framework, a polyvagal informed EMDR, I actually renamed the first phase of EMDR safety and case conceptualization.
[SPEAKER_02]: Because we know from the framework of polyvagal theory,
[SPEAKER_02]: is the foundation of everything right you can't do anything without being safe enough in the relationship and safe enough to feel and so in my model I talk about safety is step one and I'm sure therapists and any healers who are listening to this I bet that one of those things that's most important to you when you're first meeting your client is helping them to feel comfortable with you.
[SPEAKER_02]: And that's probably more important to most of us.
[SPEAKER_02]: I think it should be then asking the questions, getting the history, getting your intake form signed the first session and all that.
[SPEAKER_02]: It's really about how do you set the vibe kind of the tone for the rest of your group of work?
[SPEAKER_02]: And, you know, some clients come in and they're like, I love therapy.
[SPEAKER_02]: I just want to roll in the deep.
[SPEAKER_02]: Let's do it like I trust you and Google do.
[SPEAKER_02]: I've stalked you online, like let's do it.
[SPEAKER_02]: And you don't have to do a whole lot to build that report, right?
[SPEAKER_02]: Then clients who are coming with attachment trauma would never have been to therapy before.
[SPEAKER_02]: They're really feeling avoidance, right?
[SPEAKER_02]: Or they've had some really terrible experiences with therapists before.
[SPEAKER_02]: that can take longer.
[SPEAKER_02]: And so then, yeah, really focusing on the relationship and how you build safety and your relationship and how you create space for vulnerability and your relationship has to be a really important part of those first two phases of preparation, getting ready to do some bigger work, because you can work on those memories if your client doesn't feel safe, safe enough to be vulnerable with you.
[SPEAKER_01]: Right, that's so important and it's like it's so obvious because if I'm going to therapy, I'm not going to walk in, I mean it like you said, it's a vibe check.
[SPEAKER_01]: I walk in.
[SPEAKER_01]: I'm sensing how much do I want to say about why I'm here.
[SPEAKER_01]: And it's like I'm picking up their vibe and I'm like is this.
[SPEAKER_01]: How are they reacting to what I'm saying?
[SPEAKER_01]: And it's also subconscious or unconscious in a lot of ways.
[SPEAKER_01]: But then there can also be what we are knowing that we're holding back.
[SPEAKER_01]: But as therapists, we tend to think, for session, tell me all about yourself and can't you tell how trustworthy and kind I am.
[SPEAKER_01]: And of course, we want to be seen and felt that way.
[SPEAKER_01]: But even whatever we might be holding in our own nervous systems, even from
[SPEAKER_01]: The session we had before that, or even, I know for me, I always get very nervous on a first session with a new client.
[SPEAKER_01]: It's just part of my process.
[SPEAKER_01]: My system is like, what's this going to be like?
[SPEAKER_01]: And I'm working hard to regulate myself and also to be
[SPEAKER_01]: open and remember this is their very first session.
[SPEAKER_01]: They don't know me at all like how do I how would I need the therapist to be if I were going showing up for my first session, especially when you work with people long term and you don't get that many new clients, you know, it's like
[SPEAKER_01]: that butterflies.
[SPEAKER_01]: So if our system is vibrating, I mean, we're all vibrating, but if it's humming at a high level and they come in and that kind of state, it's maybe they can't feel just how safe and trustworthy and kind and sensitive and open and humanistic we might be.
[SPEAKER_02]: absolutely.
[SPEAKER_02]: And this is where PolyBagal theory really helps to explain what's happening there on a neurobiological level and why that's so important.
[SPEAKER_02]: It's even gorgeous, coin the term neuroception, which stands for perception without awareness.
[SPEAKER_02]: And neuroception, I kind of explain it as it's kind of like your internal home surveillance system.
[SPEAKER_02]: It's this passive pathway in your nervous system, it's not active, so it feels kind of unconscious.
[SPEAKER_02]: It's the part of your nervous system, it's always scanning your environment for cues of danger and safety.
[SPEAKER_02]: And it scans your internal environment, you know, oh gosh, I feel tickling my throat, maybe I'm getting sick.
[SPEAKER_02]: Right, or it scans your external environment.
[SPEAKER_02]: Oh my gosh, I walked in this therapist room and all the pictures on their wall are crooked and it smells like salmon and broccoli and it looks like some explosive device went off on their desk.
[SPEAKER_02]: That probably doesn't feel safe to most of us.
[SPEAKER_02]: And it also scans the space in between.
[SPEAKER_02]: So in between us, Alasha, I'm meeting this person for the first time.
[SPEAKER_02]: They're not really making eye contact.
[SPEAKER_02]: They smell kind of funky.
[SPEAKER_02]: you know like that their body posture feels strange to me and you know like well you may be consciously aware of some of that it's narrow section that's constantly scanning and then alerting you like hey this is weird or hey this is dangerous
[SPEAKER_02]: This doesn't feel safe to me.
[SPEAKER_02]: And when neuroception perceives that it automatically activates those pathways of your autonomic nervous system, your vagal pathways.
[SPEAKER_02]: And so if you go into a new therapy space or, you know, just even a new therapy space, therapist you've been seen for years.
[SPEAKER_02]: And there's enough queues of safety like I have this chakra art piece behind me and a lot of my clients say that feels so grounding to me you said that when we jump down together right so I actually put that up strategically because so many people see that as a queues safety.
[SPEAKER_02]: And you know being so mindful of the eye contact we make in our body posture and our vocal tone and of course we have to be mindful of cultural and social differences and neurodivergence and things like that.
[SPEAKER_02]: But if we don't, if neuroception doesn't get enough cues of safety from our therapist's office and our therapist space, it will change your neurobiology and put you into protective and defensive spaces.
[SPEAKER_02]: How could you possibly heal if at the same time your body is trying to protect and defend you?
[SPEAKER_02]: It's just like it doesn't work, right?
[SPEAKER_02]: It's kind of like thinking, I'm going to put this plant in a dark room without sunlight and it'll grow.
[SPEAKER_02]: It won't.
[SPEAKER_02]: So neuroception is so important in the counseling space, no matter whether you're practicing EMDR or whatnot, but I think it also really begs us to really closely consider how his neuroception, missing from the EMDR model, and how can we still practice EMDR, something that feels like a very structured intervention, but also communicate cues of safety throughout the whole process.
[SPEAKER_02]: Because otherwise, EMDR, if we're not relational in it, it can feel like, okay, think about that yucky thing, feel those yucky feelings and follow my fingers, and you're saying you're waving your hand in front of somebody's face, and you're not doing or saying anything.
[SPEAKER_02]: That starts to feel really awkward.
[SPEAKER_02]: But there's ways that you could be really relational in that, like as I'm providing bilateral stimulation, I'm keeping my eyes on you with a soft compassionate loving gaze and maybe I'm using like little small vocal and purgers like, yeah, just just notice that.
[SPEAKER_02]: ride that way.
[SPEAKER_02]: Right, so there's little things we can do that still allow us to maintain fidelity to EMDR and I think actually making EMDR even more powerful because you're playing on the power of the social engagement system and the autonomic nervous system to feel safe and where we feel safe enough then we can integrate that stuff that's been stuck in cause it's so much yuck.
[SPEAKER_01]: Wow.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: I mean, I could feel the difference just in when you did it the first time, and then when you changed it, even before you kind of named the soothing sounds and your voice changed, too.
[SPEAKER_01]: And I think something about that thing of just putting your hands up in front of someone's face whenever someone has said, oh, let's do some EMDR on that.
[SPEAKER_01]: I go, oh.
[SPEAKER_01]: That really doesn't resonate for me when someone just puts their hands up like that and starts doing that.
[SPEAKER_01]: And obviously, therapist friends, you know, they'll, obviously, therapists don't do that to clients that consent.
[SPEAKER_01]: I don't want to be misleading anyone about that.
[SPEAKER_01]: But there's something about it that I think, what comes up for me because I work with so many people who have experienced abuse and
[SPEAKER_01]: You know, power any qualities in relationship, it feels like you're doing something to me instead of like we're doing something together, you know, and can you speak about that in terms of polyvagal theory?
[SPEAKER_02]: The nervous system is always looking for the three C, context, choice, and connection.
[SPEAKER_02]: And if we don't get that, neuroception says this isn't safe, activates, use of, you know, use of defensiveness and protectiveness in our autonomic states.
[SPEAKER_02]: And it shuts down our neural pathways that allow us to heal and to integrate memories and experiences.
[SPEAKER_02]: You know, think about, for example, when your supervisor emails you at the end of the day on
[SPEAKER_02]: And what happens in your nervous system, right?
[SPEAKER_02]: And anytime we feel like we don't have choice or somebody's doing something to us, think about medical procedures, you know, or this definitely applies to bedside manner in the medical community as well.
[SPEAKER_02]: I think that a lot of our therapies because most of our therapeutic interventions and models are founded by white men,
[SPEAKER_02]: By lay on the couch and I'm going to sit in the chair and I'm not going to disclose anything about myself because I got my shit together, but I'm going to tell you what you need to do to get your stuff together, you know, I mean based on this old school doctor and I know better than you and so I'm going to do this thing to you.
[SPEAKER_01]: I think that that I'm the expert in you're the person who's broken and means made a fixation.
[SPEAKER_02]: You need fixing.
[SPEAKER_02]: So I think that we feel that NEMDR, but I think that that's present and most of our therapeutic models, because most of our therapeutic models are colonized forms of healing.
[SPEAKER_02]: But that doesn't mean we need to throw out all of our therapeutic models, all of our interventions, don't throw the baby out with the bathwater.
[SPEAKER_02]: There's a lot of good stuff in there.
[SPEAKER_02]: But to think about, huh, does it have to be like this?
[SPEAKER_02]: Does research really say you have to do it in a non-relational way?
[SPEAKER_02]: There's no research that says EMDR is better practice without a solid relationship.
[SPEAKER_02]: Like we don't research that stuff, right?
[SPEAKER_02]: So, I think that's where it requires us to be really critical and curious.
[SPEAKER_02]: And notice what happens in your bot when somebody tries to do it this way for you.
[SPEAKER_02]: Your nervous system is your greatest study guide.
[SPEAKER_02]: And so, when you notice, well, I can receive EMDR, this kind of prescriptive intervention when we process memories, but when I receive it with like the tender loving care of an engaged and body nervous system.
[SPEAKER_02]: of a therapist who I really feel they're support and their energy around me and I feel so safe with them.
[SPEAKER_02]: I find that my clients rarely have abreactions, they rarely get like overwhelmed in big emotions, they rarely get stuck in processing and they often look back on EMDR pretty much always and are like, oh my gosh, that was life changing for me.
[SPEAKER_02]: And yes, I've been practicing in the arson's 2006 and I own a training business, like, yeah, I kind of know what I'm doing with EMDR.
[SPEAKER_02]: But I don't think that that's just because I'm so advanced with all of my interventions.
[SPEAKER_02]: I think that that's because I'm so relational and how I deliver them.
[SPEAKER_02]: And that makes the biggest difference.
[SPEAKER_02]: And people who come train with us, I mean, we have, you know, people who have already trained in EMDR and come do some of our advanced courses.
[SPEAKER_02]: And then we also have people who come through our basic training who train with someone else and they're like, that didn't work for me.
[SPEAKER_02]: And I heard that you teach this differently.
[SPEAKER_02]: And people often say, this is a different way of doing EMDR.
[SPEAKER_02]: And I feel like I can be so much more myself.
[SPEAKER_02]: I feel that I can be more embodied.
[SPEAKER_02]: I feel I can be more relational.
[SPEAKER_02]: And this is a game changer.
[SPEAKER_02]: And like you said earlier, it doesn't feel like it should be like news flash.
[SPEAKER_02]: It feels like this seems like basics, you know, like intuitive, but I think that that's the colonization of mental health that we forget that we forget those intuitive truth.
[SPEAKER_01]: I agree.
[SPEAKER_01]: I feel like we go in with the right intentions.
[SPEAKER_01]: We get to grad school and it tells us to become a professional, not every school's going to be the same, but my school was very
[SPEAKER_01]: It was very research-based.
[SPEAKER_01]: It was very evidence-based practice focused and which is wonderful.
[SPEAKER_01]: I'm all in support of evidence-based practice, but the message I got was really take you out of it.
[SPEAKER_01]: Don't be in the mix and my style is relational, but I'm also, you know, I believe in collaborative work and
[SPEAKER_01]: helping people to be as empowered as they can within the process.
[SPEAKER_01]: And it's, I think that we are learning in school to become these detached professionals that colonized internalized colonization is,
[SPEAKER_01]: promoted within that structure.
[SPEAKER_01]: And then we come out.
[SPEAKER_01]: And we think if I'm like really rigid and judgmental, I'm on the right track.
[SPEAKER_01]: You know, and it's like, no, doesn't feel good to anybody.
[SPEAKER_02]: it doesn't, and I think a lot of us intuitively feel in that process, this doesn't feel right, this feels confusing.
[SPEAKER_02]: I feel like I'm being taught to do something that doesn't resonate in minorobiology, but experts tell me that's what I'm supposed to do, and that's what research says, so I must, I must be wrong.
[SPEAKER_02]: And I think it can be gas lighting almost on some level and teaches you to be disembodied, not to trust what your God is saying.
[SPEAKER_02]: And again, this is where polybagal theory I think comes in and helps us to kind of reclaim some of those parts of us that we kind of intuitively need to be true because polybagal theory also talks about the power of co-regulation.
[SPEAKER_02]: and that my regulated nervous system can offer a life raft to someone else's dysregulated nervous system.
[SPEAKER_02]: And gosh, as a therapist, I think I definitely want to show up as a life raft, and not like another sinking ship.
[UNKNOWN]: It's a book.
[SPEAKER_02]: My nervous system is dysregulated so as yours.
[SPEAKER_02]: Let's see how effective we're going to be here together.
[SPEAKER_02]: So when we're co-regulating our clients, it requires us to first be regulated and to have a lot of resiliency in our nervous system.
[SPEAKER_02]: Like we need to be the most regulated person in the room.
[SPEAKER_02]: and that allows us to communicate queues of safety.
[SPEAKER_02]: You can't really communicate queues of safety when you're just regulated.
[SPEAKER_02]: And it also allows our client's nervous system a pathway to feeling more regulated and experiencing safety.
[SPEAKER_02]: going back to how that's important for integrating memories.
[SPEAKER_02]: If I'm giving your nervous system kind of this doorway, this portal to feeling connected to feeling safe while you're also simultaneously duly aware of this trauma memory that we're also working on.
[SPEAKER_02]: It's almost like the safety starts to override the lack of safety, the feelings of danger and terror that we're present in that
[SPEAKER_02]: and so that that experience and connection of safety and the therapeutic relationship needs to be more powerful than the fear and the terror held in the memory for that experience to integrate.
[SPEAKER_02]: That's my perspective anyway and why I think that it's so important that we show up as our fully embodied souls.
[SPEAKER_01]: That's a beautiful explanation, I feel like the experience of being not in relationship while reliving the traumatic material is, you know, I mean, that's the same as when no one was there to help that first time when the thing happened, you know, and especially with
[SPEAKER_02]: Yes, and so now you're holding this experience of what it feels like that no one was there while also feeling so fully that somebody sees you and is completely there with you fully present in that moment and allows your nervous system to shed that old narrative in that story of no no one was there then that doesn't mean that no one's here now.
[SPEAKER_02]: It doesn't mean I'm alone here and now.
[SPEAKER_01]: It's so important.
[SPEAKER_01]: So let's talk about that being regulated, being a therapist who's regulated, you know, sometimes our clients come in, appearing.
[SPEAKER_01]: very regulated.
[SPEAKER_01]: It's not like the person walks in and they're, you know, in an acute crisis.
[SPEAKER_01]: They might be very calm.
[SPEAKER_01]: They might be someone who has a very stable life.
[SPEAKER_01]: And internally, though, there's a different experience happening.
[SPEAKER_01]: So, you know, there's a difference between being
[SPEAKER_01]: regulated where you're like disconnected from yourself and regulated where you're actually like attuned to what's happening and still like moving from state to state smoothly.
[SPEAKER_01]: So can you talk a little bit about that?
[SPEAKER_02]: Yeah, yeah, and I would say, you know, I think that also our field of counseling gives us this perspective that the ideal outcome of therapy and the goals is to be regulated all the time.
[SPEAKER_02]: Ray, like if we're supposed to be regulate all the time, we wouldn't have this nervous system that's designed to respond to stress.
[SPEAKER_02]: So it's about how dysregulated is my client on a regular basis and how impairing of their day-to-day functioning is that.
[SPEAKER_02]: do they have skills to regulate can they get to a state of being when we're really talking about regulation we're talking about the window of tolerance and the ventral circuit right that ventral vehicle pathway which when we're mostly connected there that's where we thrive that's where your body can go through regenerative processes and your digestion works and your immune system works and all those good things and you can form relationships there and
[SPEAKER_02]: you can think clearly, you can learn, you can be curious.
[SPEAKER_02]: So that's kind of the zone of optimal experiencing because it's where health and wellness really lives.
[SPEAKER_02]: When we're responding to cues of danger, to cues of stress, our nervous system is primed to go into those responses of sympathetic arousal or dorsal shutdown.
[SPEAKER_02]: And when those states get activated over and over and over again,
[SPEAKER_02]: It decreases or diminishes our capacity to really connect to that ventral circuit, which is going to lead to a lot of complications in life.
[SPEAKER_02]: That leads to the development of clusters of symptoms that we put a diagnosis on from the DSM.
[SPEAKER_02]: It leads to clusters of symptoms that we put diagnoses on in the medical world and say, This cluster of symptoms is this diagnosis or this disease.
[SPEAKER_02]: And a lot of it is all related to vagal functioning.
[SPEAKER_02]: In fact, I've heard for just say,
[SPEAKER_02]: that he doesn't know of any diagnosis in the DSM that he wouldn't say has some component of relationship with the vehicle, with the biggest nerve and how it functions.
[SPEAKER_02]: So what our clients are coming into our office, we're trying to get a sense of how much activation of those defensive circuits do you experience and how frequently does that happen?
[SPEAKER_02]: And you ever get to experience the window of tolerance.
[SPEAKER_02]: Do you have skills to get to the window of
[SPEAKER_02]: And that's where our clients can vary widely, right?
[SPEAKER_02]: Some clients might say, I have no idea what that thing the window of tolerance is as you describe it to me.
[SPEAKER_02]: Never experience in my life.
[SPEAKER_02]: And some clients might say, yeah, I mean, I can feel regulated.
[SPEAKER_02]: I can feel calm and peaceful sometimes.
[SPEAKER_02]: But I get stuck in these kind of chronic patterns and I don't know how to get out of it.
[SPEAKER_02]: And that can look wildly different from really severe high-risk symptoms like suicidal ideation or homicidality, psychosis event or flashbacks, so palm, high-risk dedictions or it can look smaller and not quite so life-imperied, you know, like I just ruminate.
[SPEAKER_02]: And my mind, I can't be present in my body because my brain is so just roominative on that conversation I just had.
[SPEAKER_02]: And what I'm doing tomorrow is I don't know how to fully be present.
[SPEAKER_02]: And those can be very different presentations and different ways that we treat it.
[SPEAKER_02]: So I mean, some of us just don't know how to be present because we live in a society that doesn't teach us to be present.
[SPEAKER_02]: And so it's not a significant mental health issue.
[SPEAKER_02]: It's just about kind of like skills training.
[SPEAKER_02]: Like how do you learn to like practice mindfulness and be present?
[SPEAKER_02]: And then sometimes it's more about dissociation or about kind of chronic hijacking in the autonomic nervous system.
[SPEAKER_02]: That's what I think about it.
[SPEAKER_02]: When your nervous system is chronically hijacked, sometimes that's because nobody taught us the skills to regulate our neurobiology.
[SPEAKER_02]: You learn how to regulate your neurobiology, usually from attachment figures, ideally, or maybe from a therapist, which is why we often feel like surrogate parents, I think, to our clients with attachment trauma because we really are feeling that role of teaching someone how to regulate their biology.
[SPEAKER_02]: But it can also be because of our neurodivergence, how we're wired about our trauma history.
[SPEAKER_02]: There's a lot of factors that go into that whole clinical picture.
[SPEAKER_01]: Yeah, I was thinking when you were saying learn the skills, I was thinking it's like that body to body learning.
[SPEAKER_01]: You know, it's not it might be that your parent teaches you, oh, you're upset.
[SPEAKER_01]: You can take some deep breaths.
[SPEAKER_01]: And oh, you're feeling really scared right now.
[SPEAKER_01]: Like they help you understand what's going on and give you language and teach you something.
[SPEAKER_01]: But a lot of times it's them being regulated that trains your nervous system to be regulated to, but then I guess if you weren't getting that at all.
[SPEAKER_01]: Then, I mean, I'd say my grandmother taught me how to self-regulate through food, you know, like, yeah, wait.
[SPEAKER_01]: It's not necessarily that her nervous system was so regulated, but she was really loving with like, you know.
[SPEAKER_01]: I'm baked a cake.
[SPEAKER_01]: I'd be like that.
[SPEAKER_01]: Yum.
[SPEAKER_02]: Yes.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: My grandmother also taught me to regulate with food.
[SPEAKER_02]: She made this delicious beef stew and chocolate cake that I'm thinking of now.
[SPEAKER_01]: Grandma's.
[SPEAKER_01]: We're remembering.
[SPEAKER_01]: Grandma's.
[SPEAKER_01]: Thank you.
[SPEAKER_02]: Grandma's.
[UNKNOWN]: Yeah.
[SPEAKER_02]: co-regulation paves the way to self-regulation and so we have to have that co-regulation to learn how to self-regulate and so often we we're looking to our clients says you know like they need to learn to self-regulate but we forget the step that comes before that of like you have to co-regulate them so that they learn to self-regulate and then they can do it on their own
[SPEAKER_02]: But without that co-regulation, and that's why, I mean, self-help books are fantastic, absolutely, but there can sometimes be some limited effectiveness to depending on how just regulated you are, because you don't necessarily get co-regulated from breeding a book, right?
[SPEAKER_02]: You get co-regulated from feeling someone else's regulating presence.
[SPEAKER_01]: Mm-hmm.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: Well, that makes me think about how
[SPEAKER_01]: Therapists can get regulated so they can help clients co-regulate.
[SPEAKER_02]: Can you talk about that a little bit?
[SPEAKER_02]: I wish that we talked about this all the time.
[SPEAKER_02]: It's just a regular part of graduate school training and a regular part of all of our course work and advanced advanced trainings.
[SPEAKER_02]: Because without it, we really miss the importance of embodiment and the importance of
[SPEAKER_02]: I don't know about you, but I got very little training and support on what it means to be regulated myself as a healer and a helper.
[SPEAKER_02]: I had a wonderful supervisor who taught me a lot about my curious trauma and really supported me when I had my first really overwhelming by curious kind of trauma experience when I was an intern.
[SPEAKER_02]: But nobody really talks to us about why it's so important that you do your own work and what your own work might look like and how that relates to the clinical space.
[SPEAKER_02]: Your nervous system is your greatest clinical instrument.
[SPEAKER_02]: It's like the scalpel or the water pick that your dentist hears this.
[SPEAKER_02]: And if you went into a surgery room and a doctor was like, oh, we just wheeled out the last patient.
[SPEAKER_02]: Haven't had time to clean.
[SPEAKER_02]: I think this scalp will still good enough.
[SPEAKER_02]: You'd be like, nope, get me out of here, right?
[SPEAKER_02]: Because you need your instrument to be sharp and clean and ready to perform its job.
[SPEAKER_02]: Because we're in the field of healing.
[SPEAKER_02]: Our scalp will is our neurobiology.
[SPEAKER_02]: And so if we don't do our work,
[SPEAKER_02]: We don't go to therapy and heal our own wounds.
[SPEAKER_02]: And if we don't practice self-care on our own time, our scalp will be dirty and dingy and rusty and not very effective.
[SPEAKER_02]: Now, I want to say, because I'm sure a number of people listening when I said self care, they just rolled their eyes because we're also sick of hearing about self care.
[SPEAKER_02]: It's a term that I have become a billion dollar industry and has been kind of stolen by capitalism.
[SPEAKER_02]: I think it's really important that those of us in the healing profession, whether you're a counselor or a massage therapist or a rakey practitioner or a doctor, reclaimed self care and see it as intentional self regulation time.
[SPEAKER_02]: because the more we self-regulates, the better our life is going to be and the better everyone else around us will be.
[SPEAKER_02]: Can you imagine, if we lived in a world where everybody practiced self-regulation 10 minutes a day, can you think of what that would be?
[SPEAKER_01]: I'd like to imagine that, this sounds like utopia.
[SPEAKER_02]: Yes, if we required our politicians to practice self-care, self-care breaks before a session
[SPEAKER_02]: It'd be really different and really if we think about, well, what are self care trying to achieve?
[SPEAKER_02]: Self care is not about expensive vacations and getting a massage and pampering yourself.
[SPEAKER_02]: I think that pampering can be a form of self care.
[SPEAKER_02]: I love massages.
[SPEAKER_02]: I love vacation.
[SPEAKER_02]: Absolutely.
[SPEAKER_02]: But self-care is also doing the things that maybe you don't really want to do, but you know is good for your neurobiology.
[SPEAKER_02]: So for example, getting to bed early when you're really just want to binge a little bit more Netflix and scroll, or eating a nutritious meal when really you just want to go get some fast food and eat a bunch of chocolate.
[SPEAKER_02]: or getting yourself to the gym where you really just like don't want to get to the gym and again, you just want to kind of sit back.
[SPEAKER_02]: That doesn't mean we all need to be practicing like we need to be this ideal picture of health and wellness all the time, not at all.
[SPEAKER_02]: But when we do things to actively take care of our neurobiology, we're going to be better at the art of healing and helping others heal.
[SPEAKER_02]: because if I don't regulate myself and if I don't take care of my neurobiology, I'm not going to be a sharp in the clinical space.
[SPEAKER_02]: I'm not going to be able to feel into my client as easily.
[SPEAKER_02]: Like, I'm not going to be able to really pick up on what's going on for that.
[SPEAKER_02]: I'm not going to be able to tune into the process as clearly.
[SPEAKER_02]: I might kind of work regulated, but maybe I'm talking saster than I normally do.
[SPEAKER_02]: I'm jumping around topics, I'm not able to track my client, maybe I'm really fidgety, and that gives my client the sense of, well, going on with Rebecca, I don't feel like she's really present, which is going to cause them to start to shut down and probably not be so vulnerable.
[SPEAKER_02]: Or maybe I show up feeling just really flat lined and shut down in that dorsal circuit.
[SPEAKER_02]: And I'm not really making eye contact and my vocal tone is kind of flat.
[SPEAKER_02]: And I just feel energetically flat to my client.
[SPEAKER_02]: They might proceed that as I don't think Rebecca really cares about me.
[SPEAKER_02]: I don't think she cares about what I'm sharing.
[SPEAKER_02]: And your client's probably not going to tell you that.
[SPEAKER_02]: You're probably not going to be like, what's up with you today?
[SPEAKER_02]: You feel off.
[SPEAKER_02]: Why are you talking so fast?
[SPEAKER_02]: There's a power differential.
[SPEAKER_02]: They're not going to say that to you.
[SPEAKER_02]: Most people will not.
[SPEAKER_02]: But if we're showing up like that, so many of us therapists think we can just put a mask on.
[SPEAKER_02]: Like, I'm having a terrible day.
[SPEAKER_02]: My life is on fire.
[SPEAKER_02]: I'm just going to put a mask on.
[SPEAKER_02]: You can't put a mask on your autonomic nervous system.
[SPEAKER_02]: And neuroception is way smarter than whatever you're trying to consciously do with your biology.
[SPEAKER_02]: So people will pick up on that, but they won't say anything to you.
[SPEAKER_02]: And how does that create a rupture and your relationship that kind of spirals outward?
[SPEAKER_01]: Well, thank you.
[SPEAKER_01]: That's I love how you explain that.
[SPEAKER_01]: That's really, especially that last part, it's spirals outward.
[SPEAKER_02]: Yeah, I can quickly get away from us.
[SPEAKER_02]: We start to notice, gosh, something feels off in this relationship with my clients, all of a sudden they're like canceling their appointments, may it was on the decide to stop calling.
[SPEAKER_02]: Maybe we are trying to integrate a memory with the MDR and gosh, this just isn't working.
[SPEAKER_02]: Like the memory isn't integrating.
[SPEAKER_02]: They're really stuck in these high levels of distress.
[SPEAKER_02]: And we so often go to, well, am I doing this right?
[SPEAKER_02]: Am I doing this right?
[SPEAKER_02]: And like, we're never really taught or encouraged to,
[SPEAKER_02]: How are you showing up?
[SPEAKER_02]: What's your relationship with like, how do you walk into your session that day?
[SPEAKER_02]: What happened to you before that session?
[SPEAKER_02]: What's going on in your personal life?
[SPEAKER_02]: Are you regulated?
[SPEAKER_02]: I really believe that when when you're having a day When life is happening to you, when you're in a crisis or you've had a fight with your partner and you're just like, I cannot get regulated.
[SPEAKER_02]: That happens to all of us.
[SPEAKER_02]: You need to not go to work because going to therapy sessions when you are more dysregulated than not,
[SPEAKER_02]: So when your sympathetic nervous system or that dorsal circuit had more energy than your ventral circuit, so when they have kind of, they've taken over.
[SPEAKER_02]: If we try and practice therapy, it's kind of like being a physician and going into a surgery room with COVID or the flu.
[SPEAKER_02]: It's just not good.
[SPEAKER_02]: It's contagious.
[SPEAKER_02]: It spreads to other people.
[SPEAKER_02]: And your dysregulated nervous system can absolutely be contagious and spread to other people.
[SPEAKER_01]: Can you share a little bit more about, like, what she mean with that?
[SPEAKER_01]: Yeah.
[SPEAKER_01]: I can, I can guess.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: I'd love to hear exactly what you're thinking.
[SPEAKER_02]: So, think about a day that maybe you were just having a really rough day.
[SPEAKER_02]: You were super disregulated.
[SPEAKER_02]: And somebody like smile that you at the grocery store, or you have to learn a phone call with somebody who you're just a dear loved one, somebody you're really close with, and they're soothing tone and compassionate presence, all of a sudden you're like, gosh, I just feel bad.
[SPEAKER_02]: because that was contagious right now also think about what it's like if you're around somebody who is really dysregulating is having a terrible day kind of hard to not soak it up isn't it it's kind of hard not to feel their anxiety or to feel their hopelessness now that
[SPEAKER_02]: Also happens in our therapeutic relationships through counter-transferts, like we can feel our clients when they're anxious.
[SPEAKER_02]: We can, you know, when you walk out of a session, you're like, I am so exhausted from this session.
[SPEAKER_02]: There's not because so much happened.
[SPEAKER_02]: It's because my client was so flat.
[SPEAKER_02]: Right?
[SPEAKER_02]: So their neurobiology is contagious for us.
[SPEAKER_02]: How can we expect that our neurobiology wouldn't be contagious for them?
[SPEAKER_02]: And so that's why I mean when I think of like art, the state of your nervous system is contagious and that can be used for the power of good or it can be misused for kind of the power of I'm not actually going to be very helpful to my client here.
[SPEAKER_02]: I might actually make things worse for them.
[SPEAKER_02]: And maybe even you can think of a time that you went to a healer or somebody was in a position of power who you were looking to for guidance to heal whether it be your body or your mind or your soul and that person didn't show up fully embodied or fully present or fully regulated or fully attuned.
[SPEAKER_02]: And did that make things better or worse for you?
[SPEAKER_02]: It's usually worse, right?
[SPEAKER_02]: It's usually not even, oh, it was neutral.
[SPEAKER_02]: Because here you are being horrible.
[SPEAKER_02]: You're opening yourself up to someone and they're showing up with a dirty scalpel.
[SPEAKER_01]: Yeah, I can feel that when you said that, I immediately thought of a massage I had where the massage therapist was very disconnected
[SPEAKER_01]: There's even a point where they did something, I can't remember exactly what it was, but it was, they were like really rough with my like leg or something.
[SPEAKER_01]: They just like let it flop down or something.
[SPEAKER_01]: I was like, oh my god, this person is not here, and it was, and I started to feel like I need to get out of here, but then you're laying there on the table, no clothes on.
[SPEAKER_02]: Yeah, I do don't feel safe to say anything probably, right?
[SPEAKER_02]: And here you are, a trauma therapist who knows like, I see what's happening and I'm frozen.
[SPEAKER_02]: I can't do anything.
[SPEAKER_02]: I'm so vulnerable.
[SPEAKER_02]: I'm literally naked on this table.
[SPEAKER_02]: And so I just have to try and protect myself internally until it's over.
[SPEAKER_02]: I doubt you walked out of it.
[SPEAKER_02]: Yeah, I doubt you walked out of it.
[SPEAKER_02]: Sasha feeling like, go, I feel great.
[SPEAKER_02]: That really did the trick.
[SPEAKER_02]: My muscles are so much looser now.
[SPEAKER_02]: It forced you into a free state to try and just kind of get through it.
[SPEAKER_02]: And so that's such a great example.
[SPEAKER_02]: Thank you for bringing that up because metaphorically, that happens in sessions, right?
[SPEAKER_02]: Like, the therapist does something that's not a tuned or that's blatantly disconnected.
[SPEAKER_02]: And you're emotionally and spiritually naked on the couch.
[SPEAKER_03]: right.
[SPEAKER_02]: You can't really say you freeze.
[SPEAKER_02]: You can't necessarily say stop that didn't feel good.
[SPEAKER_02]: I'm going to get up and walk out right now.
[SPEAKER_02]: Some clients might but that's very few.
[SPEAKER_01]: Right because of the power differential that we they still are clients like me if I'm in therapy as a client.
[SPEAKER_01]: I want the person to like me and I want to make them happy and you know,
[SPEAKER_01]: And whatever all my defenses are, that's one of the pieces in it is that, you know, if I just got up and said, this is BS and stormed out, I don't want that type of therapeutic rupture to have.
[SPEAKER_02]: And that's also the power of our social engagement system, and any can also be related to our culture.
[SPEAKER_02]: And our, how we've been gendered and right I identify as a woman and I don't want to be a bitch right I don't want to be rude.
[SPEAKER_02]: I don't want to be mean.
[SPEAKER_02]: I've been taught not to really speak up for myself.
[SPEAKER_02]: So that can certainly be a component.
[SPEAKER_02]: Then oh my gosh, now we're in all this other trauma stuff right.
[SPEAKER_02]: It's like to not have the voice to be just empowered and.
[SPEAKER_02]: Yeah, so so we have to take our role will seriously you have to take it seriously of how you show up to your sessions and and I just don't really hear anyone talking about that I shouldn't say it not anyone but it's certainly not talked about enough and I think it should be the foundation of all of our work the foundation is how are you showing up and have you done your work because
[SPEAKER_02]: It doesn't matter how skilled you are at the EMDR protocol or how good you are at DVT diary cards or how good you are with that CDT or somatic intervention.
[SPEAKER_02]: If you don't have the foundation of having a regulated neurobiological system that can offer co-regulation to your client and enough safety, the interventions just don't matter if that foundation isn't there.
[SPEAKER_01]: that's a that's a beautiful point and so true.
[SPEAKER_01]: It seems like it's in our field now because when I started there were obviously plenty of trainings out there, but it's there's been like an escalation of sort of the commodification of therapy trainings, you know,
[SPEAKER_01]: Which is valuable.
[SPEAKER_01]: We can all learn so many skills, but I think people in school and when they come out of school They think they need to learn all these interventions and techniques and it's more about that part of it than it is about the inner work and the inner
[SPEAKER_01]: The learning that's about how to be in a therapeutic relationship too, you know, it's like a bypass spiritual bypass it is it absolutely the neurobiological bypass right of yeah nobody's really teaching how to be how do you be?
[SPEAKER_02]: as a therapist.
[SPEAKER_02]: And I'm always really curious when I ask folks and trainings, you know, what what feels healing and therapeutic to you when you think about, you know, like your ideal therapist, or a therapist who really made a difference in your life.
[SPEAKER_02]: How were they with you?
[SPEAKER_02]: What were they actually like?
[SPEAKER_02]: And often what I get is
[SPEAKER_02]: kind of cognitive content.
[SPEAKER_02]: Well, they, they really helped me talk about hard stuff in my life and they, you know, it's more of kind of the context and not really tuning into, what did they actually do with their physiology?
[SPEAKER_02]: Because that's really the foundation of it of what you do with your physiology and how your physiology shows up.
[SPEAKER_02]: It doesn't matter what you say so much and that is how you say it.
[SPEAKER_02]: It doesn't matter what you say it matters how you look to it and you said it.
[SPEAKER_02]: It doesn't matter what you say it matters what your body said and so that's where we can think about my physiology.
[SPEAKER_02]: The way I really be with clients is expressed through my body posture and my vocal tone and my facial expression and my eyes and my breath.
[SPEAKER_02]: my presence.
[SPEAKER_02]: And I can't be, I can't have this nice soft kind of vocal tone I'm using right now, but I'm really anxious and worked up.
[SPEAKER_02]: Like my physiology just will limit my access to actually using my muscles in that way.
[SPEAKER_02]: And I can't have a soft kind of compassionate gaze when I'm shut down.
[SPEAKER_02]: My physiology makes it really hard for me to make eye contact with people when I'm shut down.
[SPEAKER_02]: And that's how a lot of us are wired.
[SPEAKER_02]: And so it's not about this self-care is important, so you can survive the field.
[SPEAKER_02]: Yes, that's important.
[SPEAKER_02]: But self-care is important, so your physiology can show up in a way that is actually inviting healing for your client.
[SPEAKER_01]: I love this.
[SPEAKER_01]: I'm just so grateful for the way you're explaining this and I hope that people who are listening therapists or client, you know, of course that therapist can be a client, a client, a career therapist, but whether or not someone is a therapist that they're hearing that
[SPEAKER_01]: It's an inside job, it's an internal experience and we can, the healing needs the right set of, I guess, what am I, what am I, what am I trying to say, like your body is holding your physiology is holding the potential for healing or holding it back.
[SPEAKER_02]: That's a beautiful way to put it.
[SPEAKER_02]: Your physiology holds the potential.
[SPEAKER_02]: Not your interventions.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: Not how many trainings you've gone to.
[SPEAKER_02]: Not how good you are, DBT, diary cards, but your physiology, the holds of potential.
[SPEAKER_02]: So how do you get your physiology?
[SPEAKER_02]: How do you train your physiology to be of the greatest potential to your clients?
[SPEAKER_02]: And that's where things like self care, intentional self regulation, movement, exercise, mindfulness, doing your own therapy, highly recommend.
[SPEAKER_02]: Every therapist go through their own work.
[SPEAKER_02]: Multiple times in your life, we all got stuff to heal.
[SPEAKER_02]: That's what's such a physiology up to have the potential to be a healing vehicle for someone else.
[SPEAKER_01]: Well, on that note, it seems like a perfect place for us to stop for now, but will you tell people where can they find your book and all the things that you do?
[SPEAKER_02]: You can find me in multiple places.
[SPEAKER_02]: My business, case and code, training and consulting business and EMDR and be expanding in 2024 into just offering trauma training serve for therapists so not just EMDR specific.
[SPEAKER_02]: Case and code, you can find us at case.
[SPEAKER_02]: K-A-S-E-M-T-CO-.com.
[SPEAKER_02]: You can also find me on my own website, which is RebeccaKase.com.
[SPEAKER_02]: You'll get a little bit more to vibe for me on that website.
[SPEAKER_02]: And then you can also find us on social, at case and code, on Facebook and our Instagram handle is case code dot dndr.
[SPEAKER_02]: We're pretty active on social.
[SPEAKER_02]: We're always posting inspirational stuff and informative and psychoeducational stuff.
[SPEAKER_02]: And we also do a lot of giveaways on our social too.
[SPEAKER_02]: Folks who follow us, you can find the book, polybago informed
[SPEAKER_02]: Pretty much anywhere on Amazon on WWE Norton on thrift books at Barnes and Noble.
[SPEAKER_02]: It's also available in audio version two.
[SPEAKER_01]: Good one.
[SPEAKER_01]: Nice.
[SPEAKER_01]: Wonderful.
[SPEAKER_01]: Well, Rebecca, I'm so grateful that you were able to spend some time here today and share so much important wisdom.
[SPEAKER_01]: Thank you for being my guest.
[SPEAKER_02]: My pleasure and my delight to be your guest.
[SPEAKER_02]: Thank you so much.
[SPEAKER_00]: Thank you for listening to Therapy Chat with your host, Laura Reagan, LCSWC.
[SPEAKER_00]: For more information, please visit Therapy ChatPodcast.com.