check out my interview on the HeartSpace podcast!

A little while back, I got to have a juicy conversation with the sweet, smart, and multi-talented Corinne Dobbas (a dietitian + dating coach) on her podcast, HeartSpace.

The episode with my interview went live today, and it was fun to listen back and remember all the good stuff we got into! We cover a broad range of stuff, from Buffy (yuuuup) to trauma to body+self acceptance. 

Head over to your favorite podcast app and check it out! <3

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Valerie Martin

Valerie Martin, LMSW, is a Primary Therapist at The Ranch residential treatment center, where she works with eating disorders, addiction, trauma, and co-occurring mental health issues. Valerie focuses on a holistic treatment approach of mind + body integration, using Acceptance & Commitment Therapy (ACT), somatic and bioenergetic therapy, Dialectical Behavior Therapy (DBT), psychodrama, 12-step, and shame resilience. She is also a Certified Sexual Addiction Therapist (CSAT) Candidate. Valerie received her Bachelor of Science degree in Communications and Master of Science degree in Clinical Social Work at the University of Texas in Austin. She is an active member of the First Unitarian Universalist Church in Nashville, and emphasizes spiritual exploration in her work with clients.

the lasting impact of childhood emotional neglect

the lasting impact of childhood emotional neglect

At this point, hopefully most of us are on the same page that physical or sexual abuse of a child is wrong (read: as morally repugnant as it gets) and incredibly harmful to them long-term. If you're not yet familiar with the term "Adverse Childhood Experiences" (ACEs) or the landmark ACEs study done by CDC and Kaiser, taking a few minutes to explore these will help you understand the link between early childhood trauma and the majority of our societal and public health issues — like substance abuse, depression, and the cycles of poverty and violent crime, to name just a few.

While some people who enter into therapy know they have endured traumatic experiences (and might also know that these experiences are at the root of the other things they struggle with, like anxiety, an eating disorder, or relationship issues), many others have minimized their childhood experiences to an extent that they are not "connecting the dots" with how they are still being impacted by the things that happened (or should have happened and didn't) in their early years of life. 

The Risk of Overlooking Covert Trauma

Emotional abuse tends to be a particularly slippery issue. For instance, if someone is physically or sexually abused during childhood and doesn't know at the time that this was wrong and not "normal," often they learn this fairly early in adulthood. (Though due to the internalized shame of abuse, sometimes it takes increasing pain from dysfunctional coping behaviors before a person is ready to enter therapy for help.) Hopefully with this recognition, and the support of a skilled trauma therapist, the wounds they need to heal are fairly evident, and the path for healing, though not easy, is clear.

With emotional abuse and neglect, however, the experience is often more covert, and thus harder to identify as the root cause of whatever present-day issues someone is struggling with. Sure, some types of emotional abuse are more overt; but again, hopefully in these cases the person is aware that what was happening was not okay, and then has the opportunity to heal. But many times, the impact of more subtle forms of emotional abuse or neglect are like a rust that erodes a person's sense of self (healthy ego development) over time, until she takes on a world view that she is inadequate, does not matter, cannot trust others, will not be loved if others find out who she really is, and basically, better be able to figure things out on her own. She may not make the connection that the impact of a highly critical grandfather and workaholic mother is still impacting her beliefs about herself 25 years later. (And if no one ever helps her to make that connection and do the healing work, she will likely struggle with feeling like no amount of affirmations, anti-depressants, and cognitive behavioral therapy ever seems to help, so she must be right about herself that she's just fundamentally flawed.) 

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what pixar's 'inside out' teaches us about emotions, life, and relationships

insideout.jpg
insideout

***Spoiler alert! If you haven’t seen Inside Out and you don’t like spoilers, stop reading this! Also, drop whatever you’re doing right now and get yourself to a movie theater, STAT.***

This weekend after I saw Disney Pixar’s new film Inside Out, I was beaming. I was overjoyed about both the experience of the movie itself, and also thinking about how it serves as an entertaining mini emotional literacy course for people of all ages, in a culture desperately in need of that. If you’ve seen the movie, then on some level you’ve already been pondering the lessons below — but they are so important that I wanted to write a post to highlight some of the most important takeaways from my perspective as a therapist. I’m also including a little commentary about each one that can help you integrate the lessons from Inside Out into your day-to-day life and relationships. Who knew Pixar would be getting into the personal growth field?!

So-called “negative” emotions aren’t necessarily negative — and they each have an important role.

My clients all know that one of my pet peeves is when people refer to emotions like sadness, fear, guilt, and anger as “negative emotions.” If we’re labeling them as “negative,” then no wonder we want to do whatever it takes to get rid of or avoid them! But guess what happens when you try to avoid feeling, for instance, fear? You won’t do things that fall outside your comfort zone, you won’t take risks, and you end up keeping your life pretty small.

 
In fact, the things that we often do to try to avoid feeling difficult emotions often actually end up hurting us even more in the long run, creating a layer of suffering on top of the original pain. When I ask my new therapy clients about how they’ve dealt with grief and the losses in their life, the most common answer is “I haven’t” or “with my drinking/drugs/eating disorder.” Sadness, as Inside Out so beautifully illustrates, has very important purposes.
 

And of course, we can’t selectively numb. When you try to avoid or short-circuit emotions that uncomfortable, you end up muting the pleasant ones, too, and become a washed-out version of yourself. In the movie, all of Riley’s emotions wanted what was best for her, even the ones that we may have once labeled as "negative"! They each played an important role within her psyche and needed the balance of one another to be able to help Riley make the most effective choices for her overall wellbeing (yin and yang, people, yin and yang).

 
So give it a try: The next time you experience an emotion you might normally label as “negative,” see what it would be like instead to take an approach like, “I notice I’m feeling ______ and it feels like ____ in my body. I am capable of riding the wave of this feeling, and I might need to do ______ to take care of myself so I don’t get too overwhelmed by this.”

 

That said, we need to balance challenging experiences and feelings with uplifting ones, too.

When Joy got sucked up the tube out of headquarters, things got ugly for Riley. (It wasn’t until later that Joy realized it wasn’t just her that Riley needed back in order to be okay — she needed Sadness, too.) Without Joy, Riley felt no motivation or connection to others, and her other emotions could not effectively help her as they’d been able to when she had access to the full spectrum of feelings.

When I say “balance” above, I don’t mean that there is some state of “perfect emotional balance” that you need to achieve, because the fact is that life is unpredictable, and there’s no such thing as perfect or one-size-fits-all.

Frankly, the Positive Psychology movement (positive thinking! affirmations! Law of Attraction!) makes me a little nauseated. Oh, I would love for my clients to just be able to affirm their way to healing from sexual abuse or an eating disorder! But it’s almost insulting to think that if they “just thought more positively,” they wouldn’t feel the way they do. Real mental illness or trauma requires real healing.

I love how neuropsychologist Rick Hanson described his philosophy on this in a recent interview on The One You Feed Podcast:

I don’t believe in positive thinking. I believe in realistic thinking. I want to see the whole mosaic of reality. In Buddhism, the fundamental deep root of evil is ignorance or delusion… so the framework for is to recognize what’s actually true. And as part of that recognition, it’s true that we have a brain that is negatively biased, especially in terms of how we learn from our experiences. And it’s also true that, in terms of the mosaic of reality, there’s a lot of crap out there. Every life has difficult, hard, painful things, and many lives are saturated in hard and painful things — so it’s precisely out of that very clear-eyed, noble take on both the negativity bias in the brain, and the reality of the challenges we’ll all face in this life, that makes it so important to acknowledge the good facts as well as the bad facts… our brain is biased as a kind of well-intended universal learning disability to overlook the good facts, generally speaking, while we continually scan for the bad ones.

Dr. Hanson has a process he calls “Taking in the Good” in which you focus on allowing positive experiences (even as simple as a beautiful sunset) to really “sink in” and get installed in the brain a handful of times everyday, ultimately strengthening the brain's ability to hold onto not just the difficult stuff, but the pleasant stuff, too.

Our personality and responses are shaped by our experiences.

In Riley’s mind, each of her core memories connected to an “island of personality” associated with that memory, ultimately resulting in “what makes Riley Riley.” As an EMDR-trained therapist, I could totally geek out on this one… but suffice to say, this is a pretty scientifically accurate explanation. Our experiences truly do shape us: they shape our mind, which shapes our choices, which shape our relationships and our future experiences, and so on. Riley had a safe, stable family without any significant adverse experiences in her early years, so her core memories were positive and she was a fun-loving, resilient, well-adjusted kid.

Of course, there’s no such thing as a pain-free life, so even sans the San Francisco move, Riley would have had her comeuppance soon enough (after all, puberty is just around the corner). But just think if there had been a different scenario: if Riley’s home life were unpredictable and lonely, an angry alcoholic father, watching her parents fight and have difficulty making ends meet, attending a sub-par school with poor resources and burnt-out teachers, not having nearby safe green spaces to play in.

What kind of core memories do you think would have been “installed” then? Many sad or fearful memories, with fewer joyful ones (because without feeling safe, it’s hard to feel joyful). And these core experiences would have shaped the neural networks in her brain, and thus her personality, in a much different way.

Kids are powerless over their situation and totally dependent on the adults in their lives to meet their physical and emotional needs. And it’s far from a “fair” playing field out there. As adults, we are all responsible for their own choices. But considering the above, I urge you to think twice before judging someone else for behaving in a way that might seem irrational to you.

We are all a product of our environment, and we can only hope that people who were not blessed with safe, loving environments in their childhood will at some point choose to get help and healing (and, along the way, hopefully also have a couple guardian angels looking out for them, like a nurturing grandparent or a kind and attuned school nurse.)

Just as you bring your “stuff” to every relationship and interaction, so does everyone else.

Toward the end of the movie, we get a glimpse into the minds of many other characters, including (hilariously) a random dog and cat. And, not surprisingly, Riley is not the only one with a whole cast of characters in her mind — we all have them! This was one of the funniest parts in the movie, because in addition to great writing, it was just so flippin' *accurate*! We got to hear everyone's internal chatter, and from that perspective, their interactions make so much sense.

If we could only see our spouses or children or coworkers in this way! It’s important to remember that everyone’s got their own history and reasons for saying and doing the things they do (just like you do). When we’re mindful of this, I think we can access a little more compassion for others, even when their choices may not be in alignment with ours.

Again, this doesn’t excuse people for doing cruel things or not taking responsibility for their actions, but it’s just a reminder that we’re all coming into every interaction loaded with our own history, story and perspective on the world. And perhaps the relationships where you’ll learn the most about yourself are the ones where the other person's history and perspective are very different from your own.

Hats off to Disney Pixar for this kick-ass movie that will have a home in therapists’ offices across the world for years to come! I'd love to hear your thoughts about Inside Out in the comments. Also, if you enjoyed my ramblings, make sure you're signed up to receive updates from me (and you'll also get a free gift of my Mind + Body + Spirit Guided Meditation mp3)!

what everyone should know about trauma and trauma resolution

Trauma robs you of the feeling that you are in charge of yourself, [or what is referred to as 'self-leadership'.] The challenge of recovery is to reestablish ownership of your body and your mind — of your self. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed.  - Bessel van der Kolk

Recently, I finished reading Bessel van der Kolk’s new book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. I can’t recommend it enough; the book is incredibly well-written and accessible, and an equally important read for clinicians, trauma survivors, and their loved ones. This post is not intended to be a comprehensive review of the book, but rather a few points that I wanted to pull out and highlight to convey some of the “big picture” ideas about traumatic stress and trauma resolution.

Why Diagnosing Trauma Matters

As a psychiatrist at the Veterans Administration (VA)  in the late 1970’s, van der Kolk witnessed first-hand the impact of traumatic stress on vets returning from Vietnam. At that point, there was no diagnosis for traumatic stress, and very little research into the impacts of trauma on the functioning of mind and body, or how to successfully treat the symptoms these vets were struggling with. In 1980, a group of researchers and clinicians lobbied the American Psychological Association (APA) to include Post-Tramatic Stress Disorder (PTSD) in the DSM-III (third edition of the Diagnostic and Statistical Manual of Mental Disorders). (Gotta love the alphabet soup of healthcare, eh?) The creation of this new diagnosis resulted in a flurry of interest and funding for research and the development of effective interventions for treating post-traumatic stress.

Thirty-five years later, thanks to a wealth of research as well as major advancements in neuroscience, we know a lot about how trauma affects the mind and body and how to effectively treat it. But we’re far from done. Many studies have pointed to the need for additional trauma-based diagnoses, as traumatized individuals don’t all fall into one homogenous category. Different types of trauma impact the body and brain in different ways, and a one-size-fits all diagnostic and treatment approach is woefully insufficient. One study found that traumatized people fell into three basic groups: those with histories of childhood physical or sexual abuse by caregivers, recent victims of domestic violence, and people who had recently been through a natural disaster. The failure of the APA to acknowledge a need for additional diagnoses like Developmental Trauma Disorder (DTD) and Complex PTSD (also known as DESNOS, Disorders of Extreme Stress, Not Otherwise Specified for victims of interpersonal trauma) has a very real impact, as a lack of sufficient funding for research and treatment directly impacts individuals struggling with traumatic stress that do not fit in the “traditional PTSD” box. I will avoid going off on a tangent about just how broken the DSM is, but suffice to say that the American Journal of Psychiatry and the National Institute of Mental Health have both published strong criticisms of the DSM-V, with NIMH’s president stating that the agency could no longer support DSM’s “symptom-based diagnosis.”

One of the topics that fascinated me most in The Body Keeps the Score was the information van der Kolk presents about DTD. I could see so many of my clients in his case studies and descriptions of how traditional mental health treatment fall short for these individuals. He makes a compelling case for child abuse as our nation’s largest public health problem, and as a therapist working with traumatized clients, I couldn’t agree more. So, whether the DSM ever gets on board or not, clinicians need to acknowledge these distinctions and the unique needs of trauma survivors that may not look like the “typical” PTSD patients. Where do we start?

“Top-Down” and “Bottom-Up” Regulation

Van der Kolk asserts that, when your brain has been impacted by traumatic stress and the areas responsible for emotion regulation are out of whack, we essentially have three choices for how to help our brain regulate, utilizing its own natural neuroplasticity. Some of the examples of treatment modalities and interventions below actually combine two or all three of these, and trauma survivors almost always need a combination of these rather than just one in order to achieve regulation.

1) Top-down regulation (via modulating messages from the medial prefrontal cortex):This type of regulation involves “talking, re-connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma.” It's also about strengthening your mind’s ability to monitor your body’s sensations, so mindfulness, meditation, and yoga can be helpful interventions. More traditional methods of psychotherapy such as Cognitive Behavioral Therapy (CBT), and coping skills training like Dialectical Behavior Therapy (DBT) can be valuable for this type of regulation as well, but it’s important to remember that talk therapy alone is not enough for trauma resolution.

2) Working directly with the brain: This can be achieved through taking psychiatric medications that “shut down inappropriate alarm reactions” or utilizing technologies such as neurofeedback and eye movement desensitization and reprocessing (EMDR) that fundamentally change the way the brain organizes information.

3) Bottom-up regulation (via the reptilian brain, specifically the amygdala): This type of regulation focuses on "allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.”  From a neuroscience perspective, it involves recalibrating the autonomic nervous system, which can be accessed through breath, movement, or touch. Thus, interventions such as breath work, dance, massage, somatic and experiential therapies, and utilizing biofeedback (for example, to improve heart rate variability) can be very effective. Yoga is also valuable for bottom-up regulation, as it is proven to significantly improve arousal problems in traumatized individuals, increase self-awareness and self-regulation, and cultivate interoception by "gaining a relationship with the interior world, and with it a caring, loving, sensual relationship to the self.”

What Does it All Boil Down To? 

At the end of the day, trauma treatment is about helping people to:

  • find a way to become calm and focused;
  • learn to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind them of the past;
  • find a way to be fully alive in the present and engaged with the people around them; and
  • not have to keep secrets from themselves, including secrets about the ways they have managed to survive (often self-destructive behavior patterns that originated as protective defenses.)

As van der Kolk reminds us, “these goals are not steps to be achieved, one by one, in some fixed sequence. They overlap, and some may be more difficult than others, depending on individual circumstances.”

I was tremendously inspired by this book, as it validated many of the trauma treatment methods we use with clients on a daily basis at The Ranch, and helped me understand more about the neuropsychological underpinnings of both trauma and trauma recovery. I’m also excited to get my EMDR certification later this year as well as start yoga teacher training in the fall. We need a lot more clinicians who understand the “big picture” of trauma treatment based on the most recent research, and are open to the wide range of holistic interventions to help people find health and healing in mind, body, and spirit.

Is trauma a topic that interests you, and/or has touched your own life? I’d love to hear any thoughts, questions, or stories you’d like to share. Leave a comment or drop me a line at valerie@wakingupinwonder.com

3 reasons you shouldn't try to be fearless

fearless

In the personal growth world as well as overall popular culture, the idea of being “fearless” is often praised. We hear things like, “you have two choices in any situation: love or fear.” And we’re told that if we don’t choose love, we’ll diminish our power and not lead the abundant lives we deserve. Makes sense in theory, right?

But I’m not buying it. As a therapist, I work with clients who have gone to tremendous lengths to avoid, cover up, or anesthetize fear. (In many cases, this started as a survival mechanism to cope with trauma.) We’re a culture of professional numbers and avoiders. We become so obsessed by the idea of “happiness” that we think feeling other emotions means that we’re somehow failing. But by putting pressure on yourself to be somehow “fearless,” it’s likely that you’re actually hurting rather than helping yourself in the long run. Here’s how:

1. You’re more likely to play it safe by keeping your dreams and aspirations small.

If you’ve conditioned yourself to believe that fear is bad, how will you ever truly step outside your comfort zone and challenge yourself, when that likely entails falling down or failing numerous times along the way?

In her book Playing Big, Tara Mohr shares that one of her biggest lessons about fear came from Rabbi Alan Lew, who explained to her that Biblical Hebrew uses several different words for fear. The first is “pachad,” which is “projected or imagined fear.” This is the type of fear that happens when we catastrophize, obsess over the worst case scenario, or believe irrational thoughts our minds tell us, like “if you don’t nail this presentation, your career will be destroyed.” The second word for fear is “yirah,” which Rabbi Lew described as “the fear that overcomes us when we suddenly find ourselves in possession of considerably more energy than we are used to, inhabiting a larger space than we are used to inhabiting.”

Learning about this helped me better articulate what I already knew to be true: that fear in some contexts (pachad) needs to be reframed and challenged, and fear in other contexts (yirah) is a natural part of stretching yourself into the uncharted territory of bigger dreams. If I never experience yirah, I know I’m cheating myself out of living up to my potential.

2. You reinforce blanket judgments about “positive” and “negative” emotions.

I understand what people mean when they say “negative emotions” (typically they’re alluding to sadness, fear, anger, guilt, shame, and loneliness), but what is it that really makes them negative? I like to reframe these feelings as “challenging” or “difficult,” because even calling fear a “negative” feeling is making a lot of assumptions -- and as we just discussed in #1, it certainly isn’t always negative.

Practice taking the judgment out of the fear you’re experiencing, and instead, describe what the feeling is like. Do you feel your pulse racing, your face hot? What would happen if you allowed yourself to sit with that feeling and breathe into it, rather than insisting that it needs to go away immediately? How would you respond differently to the feeling?

3. You’ll be focused on “what you want less of” instead of “what you want more of.”

If you believe that you should be fearless, you’ll do whatever you can to anesthetize that feeling when it inevitably shows up -- even if it’s something that leaves you worse off in the long run. I often ask my clients, “What are the things you do to try to get rid of or avoid fear and other difficult emotions?” Their answers almost always include isolating, emotional eating, shopping, bingeing on Netflix or social media, excessive sleeping, drinking, and smoking. On the more severe end of the spectrum, they mention drug use, cutting, hooking up, compulsive exercise, bingeing, and purging. Almost every time, they say that these behaviors they use to try to numb the feeling actually end up making them feel worse in the end.

When you’re so focused on what we want less of in our lives (like fear), that’s where your energy and actions are centered. This leaves little time and energy for focusing on what you want more of, like connection, spirituality, adventure, play, learning, and giving back.

I’m all for choosing love… but I’m also for befriending fear. Let’s have the courage to not be fearless.

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Valerie Martin

Valerie Martin, LMSW, is a Primary Therapist at The Ranch residential treatment center, where she works with eating disorders, addiction, trauma, and co-occurring mental health issues. Valerie focuses on a holistic treatment approach of mind + body integration, using Acceptance & Commitment Therapy (ACT), somatic and bioenergetic therapy, Dialectical Behavior Therapy (DBT), psychodrama, 12-step, and shame resilience. She is also a Certified Sexual Addiction Therapist (CSAT) Candidate. Valerie received her Bachelor of Science degree in Communications and Master of Science degree in Clinical Social Work at the University of Texas in Austin. She is an active member of the First Unitarian Universalist Church in Nashville, and emphasizes spiritual exploration in her work with clients.