Treating Trauma and

Emotional Dysregulation Using

Intermodal Expressive Therapies

Kevin Makarewicz M.A., L.P.C., L.M.T.

Expressive Therapy Summit 2014

www.KevinMakarewicz.com kevin@kevinmakarewicz.com

(203) 698-2465

Lets take a few moments

My WorkModalities-Expressive Therapies, Biofeedback-HRV, qEEG, Brainwave Biofeedback, EMDR, Bodywork, Trauma informed Contextual Family Therapy, Group work incorporating the expressive arts,Population-- Private Practice In Old Greenwich CT, Individuals and Families- Seasonal Healing and Celebration Rituals, Drum and Dance-12 Years Residential Psychiatric Facility with Children, Adolescents and Adults- Mankind Project, New Warrior Training, Men’s Support Circles - Boys to Men, Initiatory process for adolescents- School Residency doing Social Emotional Enrichment through the Arts - Restorative Justice Circles with “At Risk” youth

Objectives• Better understand your own and others

psychophysiological reactions to situations

• Be able to be more responsive and alive to ourselves and to others

• Begin or enhance a practice of using enactment for enrichment, empowerment and renewal.

• Support and empower others in their practice.

Method

• We will learn a method of resolving trauma through the expressive arts. I will present this in the framework of a group therapy model.

• This method can be fully employed in individual therapy.• It can be used on your own for your own healing process. • It can also done with a peer, or group of peers.

Bio in a Tale• Once upon a time, StarChild was born in an enchanted kingdom. Fogs of

Madness would drive the King and Queen into stupor, rage and insanity.

• One day, while the King, Queen and Hilda-the old kind one, were in the throes of of their madness, the Dragon came and slayed villagers,

• In horror, StarChild left the kingdom and searched for the sacred mountain of the wise people where he heard that StarMusic was still played.

• StarChild learned to follow the trail of SongLine across the land.

• The SongLine led StarChild to the Old tribe that kept the StarMusic alive. There StarChild learned to stand in the center of the fire, connect to the Stars above and the center of the Earth and come out of the flames unburned. He loved it there but they told him, “You must leave and return to your kingdom.” “But I will loose myself in the Fog of Madness,” StarChild said. So they gave him a buffalo horn, filled with ash and a burning ember.

• Now back in the Kingdom, StarChild, now a man, blows on the sacred embers, and sings the old Star songs. This music pushes back the Fogs of Madness. Others join him in this song, the kingdom shines, laughter returns. And still when the moon is dark, and winds are strong the Madness creeps back into the kingdom.

• And still there is a dragon who bides his time waiting to find his next meal...

Flight Preparation• So.. Like when boarding a plane-

• - know your safety exits, • - put your oxygen mask on first, then help those

around you• - your seat cushion may double as a floatation device!

• This seminar may be challenging or evocative for you. Do what you need to do to take care of yourself.

• Respect your self and only do or share what you are comfortable with. You are welcome to pass on anything,

• Move around as you need to.• You are welcome to ask questions, make comments. I will

do my best to keep our discussion on the track that serves the greater good.

• Use your common sense and clinical judgement about where and when you employ any of the techniques or processes you learn here.

• Hand outs

clip from“Princess Bride”

Objects

Pulse

Rumble if...

Pass the rumble

Pass the rumble - match tone, change, pass

Double Pulse-

Tell us how it was getting here using your drum

Fluid Sculpture

Mime Catch w Rumble

Some Action-

Hakomi Technique “Taking Over”

Playback Theater-“Fluid Sculpture”

Hakomi Technique “Taking Over”

demonstration

Enactment• Externalize experience, have it out

there, rather than just in here

• Gain distance perspective and connection.

• It has an edge In time; It has a beginning, middle, and end

• It has an edge In space; an inside and outside

• We can have a relationship with “It”

• “It” actually becomes a “Thou”

• We can change it; it can change us

Enactment• Objective Correlative- noun, Literature.

1. a completely depicted situation or chain of events that objectifies a particular emotion in such a way as to produce or evoke that emotion in the reader.

• Representation

• Map or Model

• Computer- U.M.L. - Universal Markup Language- the architecture of a program

Medium and ModalityMedium Modality

Body/Movement

Hearing Sound

Image/SIght

Smell

Taste

Touch / Substance

Words

Dance, Drama, Puppet, Art, Sport, Pilgrimage, Yoga, Tia Chi, Juggling, Rope Walking, Martial Arts,

Music, Drama

Visual art, Culinary, Craft, Drama,Photography (video in time)

Perfume, incense

Culinary arts

Sculpture, Music, Massage, Crafts, Culinary, Martial Arts

Poem, Story, Graffiti, # Song, Drama

Exists in space, not time, can be private and social

Exists in time, instantly social

Exists in time and space, private or social

?Space, ?Time

Exists in space, and time, private and social

Exists in space, can mark time private can be social

Words need a modality to existModality give them space or time

can be private or public

Brodmann Areas- 52 regions of the cerebral cortex of humans and monkeys that appeared to have different cellular morphology and organization.

- Over the past century clinical findings and neurophysiological studies have shown that these microstructural differences correlate well with cortical function specialization.

http://en.wikipedia.org/wiki/Brodmann_area

by using different modalities, we engage different brain regions

Medium and Modality High Sensitivity / Low Skill

Medium Modality

Body/MovementBalance

Hearing Sound

Image/SIght

Smell

Taste

Touch / Substance

Words

Dance, Drama, Puppet, Art, Sport, Pilgrimage, Yoga, Tia Chi, Juggling, Rope Walking, Martial Arts

Music, Drama,

Visual art, Culinary, Craft, Drama,Photography ( slide show / video in time)

Perfume, incense

Culinary arts

Sculpture, Music, Massage, Crafts, Culinary, Martial Arts,

Poem, Story, Graffiti, #Song, Drama

Collage, Decksabstract drawing, Playback

Theater

Small Range instruments, call and response, use recorded music, Playback Theater

authentic movementsimple choreography,

imitate nature, Playback Theater

selecting smells

seasoning food

Ephemeral Altars, Flower Arranging, Playback Theater

McKim process- scribe while person touchs things while blind foldedcall and response Playback Theater

Enactment

is to our psyche as the digestive system is to our body.

We can use it to digest, to take in that which nourishes us and to release that which does

serve us, or even poisons us.

Kinds of Listening and Engagement-

• inattentive

• distracting

• critical (rejecting, shaming, condemning)

• competitive

• exploiting (getting a laugh at the expense of another)

• analyzing

• critiquing

• advising

• projecting

• demanding

• present

• curious

• wonder, awe

• respect

• reflecting

• gratitude, appreciative

• sympathy

• empathy

• compassion

• blessing

Intrapersonal and Interpersonal

Why would someone have these attitudes?

“If I really see youI will laugh out loud

or fall silent or shatter in a million pieces

and if I don’t I will be locked in my prison of stone

and cement”

Rumi13th-century poet

22

clip from“Finding Joe”

www.findingjoethemovie.com/introduction to the universality

of the hero cycle

Hero Cycle is an analogue to trauma treatment stages

In the fairy tale that you are living...Who is your prince or princess, or holy grail?

What is the Road of Trials?What is the Dark Night?

Who is the Old Wise Man/Wise Woman?What is the Magic Amulet?

What is the Dragon?What is the Boon or Gift you bring to your

community?

Enact your Fairy Taleor Part of it-

• Draw it

• Write it

• Comic Strip

• Sculpture

• Song / Rap

This need not be the whole tale.It can be just a chapter.

It need not make a lot sense. #

You are welcome to totally lie- also you are welcome to impersonatea client or someone else.

What was writing the story of you life as a

fairy tale like for you?

The Good Earth

clip from“The Sound of Music”

“The hills are alive with the sound of musicWith songs they have sung for a thousand yearsThe hills fill my heart with the sound of musicMy heart wants to sing every song it hears”

https://www.youtube.com/watch?v=0REJ-lCGiKU

Clipboy conducting beethoven's 5th

example of emotional responsiveness and aliveness

• “The dyadic relationship, particularly with primary caregivers helps to develop the sense of self and tone of the prefrontal lobes”.

• Allen Shore

• This sense of self becomes a ground of being, an essential model of who I am who others are and how the world is.

and Suddenly...“an suddenly” a common motif in fairy tales which is analogue for trauma, particularly single incident

big T trauma’s

Clip Star Wars IV

Luke returns home to find his caretakers killed and

house burned

clipTv announcer hasamygdala hi jack

when a lizard jumps on him

https://www.youtube.com/watch?v=QO0iGlV2wbE

Daniel Golemanauthor ofEmotional Intelligence

- Role of the Amygdala

clipGoleman

explains Amygala highjackhttps://www.youtube.com/watch?v=LTItzKrNX68

demonstationinteraction when we don’t get facial or vocal social

emotional cues.Person wears- mask, doesn’t speak, makes

ambiguous gestures.Notice how this feels.

clipStill Face Experiment

regulatory effect of dyad relationshiphttps://www.youtube.com/watch?v=apzXGEbZht0

note there was a time not that long ago when people didn’t think babies

couldn’t socially interact

Window of Tolerance

Hyper aroused

Optimal aroused

Hypo aroused

increased sensationsemotional reactivityintrusive imagerydisorganized cognitive processinghyper vigilance

relative absence of sensationsemotional numbingdisabled cognitive processingreduced physical movements

from Pat Ogden

Stephen PorgesPolyvagal Theory

Social Engagement- Fight Flight- high sympathetic toneFreeze- high parasympathetic tone

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44

45

47

48

• You cannot develop a sense of self without adequate affect regulation

• Affect regulation in the child depends primarily on the mother/primary care giver

• She/He needs to be able to regulate herself and her baby

• Her alignment with her baby builds brain structures and networks

• Primary organizing structure is the pre-frontal cortex

Allen Shore

Impoverished Development of the Orbital Frontal Cortex causes:

• Lack on inhibition of fear, rage, aggression

• Decreased awareness of emotional state of self and others

• Decreased empathy and care for social rules

• Lack of cause and effect thinking

Why trauma survivors have symptoms

instead of memories

Implicit Memory vs

Explicit Memory (ie. Narrative Memory)

PTSDis a disorder of

memory

Trauma

Depression

Irritability

Loss of Interest

Decreasedconcentration

Emotionaloverwhelm

Hopelessness

Shame and worthlessness

Little or no memories Nightmares

Flashbacks

Hyper-vigilance

Generalized anxiety

Panic Attacks

Chronic painHeadaches

Substance Abuse

Eating Disorders

Feeling Unreal or Out of bodySelf Destructive

BehaviourLoss of sense of “who I am”

Trauma

60

Trauma-Dysregulation

Attachment/Developmental

Needs

Big TTrauma

Small ttrauma(s)

TBITraumatic

Brain Injury

The artistic process then facilitates the dialogue between the parts of the brain which rule: (prefrontal) and speaks (Broca’s area and Wernake’s area) and

the parts that KNOW -basal ganglia, insula, and parts that sort it out- hypocampus.

Art/Enactment Bridges Conscious Awareness to the

Silent Depths of the Psyche

Treating TraumaSlaying or Redeeming

the Dragon

Fairy Tales inform us, that to handle “the dragon”, we must first be prepared

ResourceIf you must face the dragon

or make a trip to the pit of hellWhat resource would you need to be successful?

How do you keep your left prefrontal lobe active, amygdala calm, and your affect balanced?

also known as . . .

clip Harry Potter

Prisoner of AzkabanHarry learns the Patronus Spell

"This ancient and mysterious charm conjures a magical guardian, a projection of all your most positive feelings.

This is a great model of learning about using Resources. Also models the Old Wise Manprocess of initiation

ResourcesTheseus -Mitos, ball of yarn to escape the labyrinth, slayed Minotaur

Batman and James Bond’s tech gadgets

Hobbit - Gandalf, courage,

Perseus, Hermes - winged sandles, Athena, shield, Ender- war games at Battle schoolHarry Potter- cloak of invisibilitySound of Music- Song

Relational

ResourcesMastery Symbolic Attitude/

Postural

Amy Cuddy TED.comOur bodies change our minds

Physical posture as a Resource

Resource Enactment

1) Name a resource from your life-relationshipmasterysymbol2) Draw it or pick a tarot card or other icon that holds the imagefind movement that embodies the energy of the resource ( not literally moving the image3) Partner up - learn their resource movement and teach them yours4) Duo partners with another Duo, learn all four resource movements, put them in a sequence5) As ritual of empowerment, group of 4 presents their resource movements to whole group while group supports with drumming, clapping chant6) Make clear this is not a competition! This not a performance it is a ritual of empowerment where we support each other to embody our positive qualities, strength, grounding, courage, grace, sensitivity, balance7) You can also have people make verbal affirmations* explore other intermodal transfers

Facing the Dragon

SUDS- Subjective Unit of Distress

Image- (could be in any sense)

Trigger

Sensation

Emotion

Worst Negative cognition, thought or belief about your self

While holding this memory what is your positive- belief about yourself, emotion, sensation,

Behavior

Where are you on the bridge between negative cog and positive

Break Traumatic Memory in to Components

SUDSSubjective Unit of

Distress Scale0-10

Negative Cognition Worse Negative Belief about self in relation to the situation?

Image of the Trauma/

“Face of the Dragon”

Sensation/Emotion

Body Map

Positive Cognition What would you like to think about yourself now

in relation to that situation? Bridge

between

Cognitions

Processing SequenceForm the enactmentSeperate from enactment get into witnessing perspectiveWitness the enactmentWas that accurate? Watch for body truth response.How was that for you to witness Pendulate from resources to trauma Is response- merged, contemptuous, judgmental, dissociated, or Compassionate? ( Is left frontal or right frontal dominant at this time?)If response is merged, contemptuous, judgmental, dissociated,- enact that.If response is Compassionate- How would you like to respond to this scene?(present time adult ego state can transform the scene- this self must be the source of agency.)Healing interactions- protection, limit setting, explaining, nurturing relationship, blessingRole reverse to have protagonist receive the healing action that he she just gave.Behavioral based homework. Given this new healing light- what can you practically do to continue to support this.

now -click your heals together

three timeand say,

“there’s no place like home”

The Endwww.KevinMakarewicz.com kevin@kevinmakarewicz.com

(203) 698-2465