Next Level Practitioner
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 1
Next Level Practitioner Week 83: Mistakes in Treatment that Led to Professional Growth Day 3: Why Timing Is Crucial in the Treatment of Trauma with Ruth Buczynski, PhD and Peter Levine, PhD
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 2
Week 83, Day 3: Peter Levine, PhD
Why Timing Is Crucial in the Treatment of Trauma Dr. Buczynski: Every moment in therapy matters, especially in our work with clients who’ve experienced trauma. So what happens when you miss a crucial moment? According to Dr. Peter Levine, a missed moment is indeed a mistake, but it’s also an opportunity. Dr. Levine: Oh, gosh. I think of only one mistake. Sometimes when a person comes out of shutdown due to trauma, there's a moment of social engagement where their eyes softly look toward you, reaching for contact.
“When a person comes out of shutdown due to trauma, there's a moment of social engagement where their eyes softly look toward you.”
I’ve looked at some of my sessions (because I use them in teaching and so forth), and I require that when my students do an exercise, they
make a minimum of three mistakes –because otherwise, you're not going to really be learning anything. I also challenge them to describe three mistakes that I made in the session. So, I get a whole collection of mistakes here.
One of the mistakes that I have seen myself do is, when the person is coming out of the shutdown state, and they come into arousal and then down regulate into relaxation and social engagement, there have been times where I have missed that and my eyes weren't available. One of the things I do when I work with clients is I have the chairs at right angles which gives them the choice to either be with themselves or to make contact with me. That's very important.
“There have been times where I have missed that and my eyes weren't available.”
There was a recent study by Ruth Lanius and her colleagues, where they showed a photograph of a kind, friendly face to a group of control subjects while they were in a very high,
expensive MRI. Not surprisingly, the prefrontal cortex lit up when they saw the friendly face, and the amygdala quieted down, regulated. Then they showed the same friendly face to a group of traumatized people — traumatized individuals, chronically traumatized – and when they showed the face to them (and they were also in the MRI machine),
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 3
the prefrontal cortex activity decreased. At the same time, there was an increase in the part of the brain that has to do with freezing and terror, the periaqueductal brain. That area increased, and it lit up. So even though you were there with a friendly face, that was perceived as threatening, possibly even more threatening than a neutral face. I'm not sure. I don't think they did that part of the experiment. Often therapists believe that they need to be face-to-face with the client and be available for face-to-face
contact and compassionate holding and so forth. And that works in some kind of situations and general therapy, general counseling and so forth.
“Often therapists believe that they need to be face-to-face with the client and be available for face-to-face contact and compassionate holding.”
But where there's a lot of trauma, what happens is that actually makes the person shut down even further. I don't think that many therapists really realize that and appreciate that. Getting back to my personal screw-up –
We're facing in right angles, and the person comes out of the trauma, out of the shutdown into the social engagement. And for some reason, I'm just not right there. Then I realize it. And I turn towards the person, but at that moment, they're turning away from me. Usually I get it there, and then just let it be and then let myself be available again. It's when they're in the regulated state, that's when contact actually helps them regulate. So, it's really important to distinguish whether they're in the trauma state, the shutdown state, or whether they have come into what Steve Porges calls the social engagement state, the social engagement system operating. So that's a critical place; timing is really important there. And also, not holding on to the client. When you can kind of feel them pulling back into themselves, also move yourself out of their central field. It's very easy to make a mistake here to offer one response when another one really is what's needed. By making a lot of mistakes, I really got a much better rhythm about this.
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 4
Dr. Buczynski: So what happened with that client? Dr. Levine: What happened with the client, I believe I said something like, "Oh, I'm sorry. I just I was away somewhere for a moment." I think that was helpful in that it was reparative. Because so often — I mean, again, in just general practice, the parents or whatever — they're not available, but they don't acknowledge that we're not available and often blame the child, and then the child feels shame about that. So I would say, again, just acknowledging. "I'm sorry. I just went somewhere else for a moment." Even something like that is corrective, is reparative. We can underestimate the usefulness of using mistakes to repair reach because, of course, most chronic trauma is done in a relational field. And when the person is available for contact, it's important that the person be there. But of course, in the past they weren't there, because often they were the perpetrator.
“When the person is available for contact, it's important that the person be there.”
So again, just to think, “Okay, this is not where you were abused, but still I was not in contact.” Dr. Buczynski: As Peter reminds us, mistakes provide an opportunity to repair, which can be healing for someone who’s experienced trauma. Tomorrow, we’ll be back with Peter to explore how even our best intentions could result in a mistake. But now I want to hear what you think. How will you use these ideas in your work with clients?
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 1
Next Level Practitioner Week 83: Mistakes in Treatment that Led to Professional Growth Day 3: Why Timing Is Crucial in the Treatment of Trauma with Ruth Buczynski, PhD and Peter Levine, PhD
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 2
Week 83, Day 3: Peter Levine, PhD
Why Timing Is Crucial in the Treatment of Trauma Dr. Buczynski: Every moment in therapy matters, especially in our work with clients who’ve experienced trauma. So what happens when you miss a crucial moment? According to Dr. Peter Levine, a missed moment is indeed a mistake, but it’s also an opportunity. Dr. Levine: Oh, gosh. I think of only one mistake. Sometimes when a person comes out of shutdown due to trauma, there's a moment of social engagement where their eyes softly look toward you, reaching for contact.
“When a person comes out of shutdown due to trauma, there's a moment of social engagement where their eyes softly look toward you.”
I’ve looked at some of my sessions (because I use them in teaching and so forth), and I require that when my students do an exercise, they
make a minimum of three mistakes –because otherwise, you're not going to really be learning anything. I also challenge them to describe three mistakes that I made in the session. So, I get a whole collection of mistakes here.
One of the mistakes that I have seen myself do is, when the person is coming out of the shutdown state, and they come into arousal and then down regulate into relaxation and social engagement, there have been times where I have missed that and my eyes weren't available. One of the things I do when I work with clients is I have the chairs at right angles which gives them the choice to either be with themselves or to make contact with me. That's very important.
“There have been times where I have missed that and my eyes weren't available.”
There was a recent study by Ruth Lanius and her colleagues, where they showed a photograph of a kind, friendly face to a group of control subjects while they were in a very high,
expensive MRI. Not surprisingly, the prefrontal cortex lit up when they saw the friendly face, and the amygdala quieted down, regulated. Then they showed the same friendly face to a group of traumatized people — traumatized individuals, chronically traumatized – and when they showed the face to them (and they were also in the MRI machine),
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 3
the prefrontal cortex activity decreased. At the same time, there was an increase in the part of the brain that has to do with freezing and terror, the periaqueductal brain. That area increased, and it lit up. So even though you were there with a friendly face, that was perceived as threatening, possibly even more threatening than a neutral face. I'm not sure. I don't think they did that part of the experiment. Often therapists believe that they need to be face-to-face with the client and be available for face-to-face
contact and compassionate holding and so forth. And that works in some kind of situations and general therapy, general counseling and so forth.
“Often therapists believe that they need to be face-to-face with the client and be available for face-to-face contact and compassionate holding.”
But where there's a lot of trauma, what happens is that actually makes the person shut down even further. I don't think that many therapists really realize that and appreciate that. Getting back to my personal screw-up –
We're facing in right angles, and the person comes out of the trauma, out of the shutdown into the social engagement. And for some reason, I'm just not right there. Then I realize it. And I turn towards the person, but at that moment, they're turning away from me. Usually I get it there, and then just let it be and then let myself be available again. It's when they're in the regulated state, that's when contact actually helps them regulate. So, it's really important to distinguish whether they're in the trauma state, the shutdown state, or whether they have come into what Steve Porges calls the social engagement state, the social engagement system operating. So that's a critical place; timing is really important there. And also, not holding on to the client. When you can kind of feel them pulling back into themselves, also move yourself out of their central field. It's very easy to make a mistake here to offer one response when another one really is what's needed. By making a lot of mistakes, I really got a much better rhythm about this.
Next Level Practitioner - Biggest Mistakes
Week 83, Day 3 - Peter Levine, PhD - Transcript - pg. 4
Dr. Buczynski: So what happened with that client? Dr. Levine: What happened with the client, I believe I said something like, "Oh, I'm sorry. I just I was away somewhere for a moment." I think that was helpful in that it was reparative. Because so often — I mean, again, in just general practice, the parents or whatever — they're not available, but they don't acknowledge that we're not available and often blame the child, and then the child feels shame about that. So I would say, again, just acknowledging. "I'm sorry. I just went somewhere else for a moment." Even something like that is corrective, is reparative. We can underestimate the usefulness of using mistakes to repair reach because, of course, most chronic trauma is done in a relational field. And when the person is available for contact, it's important that the person be there. But of course, in the past they weren't there, because often they were the perpetrator.
“When the person is available for contact, it's important that the person be there.”
So again, just to think, “Okay, this is not where you were abused, but still I was not in contact.” Dr. Buczynski: As Peter reminds us, mistakes provide an opportunity to repair, which can be healing for someone who’s experienced trauma. Tomorrow, we’ll be back with Peter to explore how even our best intentions could result in a mistake. But now I want to hear what you think. How will you use these ideas in your work with clients?
