“I’m worried….” is not an uncommon statement to hear coming from my mouth.  In the past year or so, I’ve been trying to really notice how often I start sentences with “I’m worried…” It’s been eye-opening because I don’t consider myself a terrible anxious person (neurotic is another story…perhaps my neuroses works so well that I don’t even notice obvious signs of anxiety.  Who knows!!)

So when I say “I’m worried about the therapists….” I don’t say that lightly.

I’m worried about the therapists.

While I’m on clinical sabbatical, I’m working with a LOT of therapists in consultation- individually and in groups.  I’m a part of several therapist social media groups, including one I moderate.  I am continuing to teach a lot of therapists.  I’ve got a pretty good pulse on what’s going on behind closed doors for these invisible front-line workers.

And it’s not good.

Being a therapist is really really really really really really hard.  The in-the-room work is exhausting but also so amazingly rewarding…and when we’ve got a good balance going on, the rewards are so great that we can keep moving through the exhaustion.

Eight weeks ago therapists across the country (world, probably, though I have less awareness of what’s going on outside the US) were thrust into a way of doing therapy that most did not ask for- telehealth.  While tele-mental health isn’t new, it was new for the majority of therapists on March 15, 2020 when the country shut down (and some of our NYC area therapists have been locked down even longer).

Therapists took their caseloads and moved to a platform they knew nothing about, weren’t comfortable with, and had no interest in using.
Thank you.

All of the sudden, they were utterly and completely alone.

With a platform they didn’t know and didn’t like.

They showed up to do their jobs with their foundation crumbling.  When you haven’t ever done telehealth before, you have a HUGE adjustment to figure out how to create relational connection- the absolute FOUNDATION of doing our work and doing it well.

Now do this with 20 or 30 people in crisis.  All at the same time.

NOW do this with children.
Watch your client’s struggle while you sit helplessly on the other side of the screen.  Then the screen freezes.  The client can’t see or hear you for a moment.  There is a time lag.  Then the software crashes.  You both try to reconnect.

NOW do this while you are experiencing the exact same crisis that all your clients are experiencing.

I’m worried.

Dear therapists.  I see you.  I’m shaken down with gratitude that you just keep trying.  You keep using a platform you hate.  You miss your clients, your office.  You’ve been waiting for this to be over and just get back to your four walls.

And now you realize that there is no going back to what it used to be.

Therapists are brainstorming how on earth they will sanitize their toys.  Which toys should I get rid of?  Which toys are cheap enough that Ican make individual play therapy kits for all my clients?  What do I take out the waiting room?  What sanitizing practices between clients are sufficient?  How am I at risk?  How are my clients at risk?  Do we insist clients wear masks?

Dear therapists.  I see you.  I have no solution but I see you.  We will probably lose some of you and I get it.  This is so hard.
Our very very hard jobs have gotten very very much harder.

I see you.

I’m thinking about you all the time.  My husband has heard me say “I’m worried about the therapists…” a lot.  Like….many times every single day.  Especially at the end of the day.  I’m trying to figure out what to do.  I have no idea.

So this is my first step.  A little note.  I see you

Thank you for continuing to try. And when you just can’t try anymore, I understand.

Robyn

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Robyn Gobbel, LCSW, RPT-S  (when not in the middle of the coronavirus pandemic) is a blogger, teacher, trainer, and consultant for therapists and professionals working with children with a history of complex trauma.  
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“…Our mind can be pictured as a bicycle wheel, with the hub at the center and spokes radiating at the outer rim. The rim represents anything we can pay attention to or become aware of. The hub is the inner place of the mind from which we become aware of all that’s happening around and within us…” Dr. Dan Siegel

I can only imagine how I’d be managing this life-upending pandemic if it wasn’t for my immersion into interpersonal neurobiology and the relational neurosciences.

If it hadn’t been for the science, I don’t know if I would have ever risked wading into the waters of integration, relational connection, and regulation.

IPNB turned this graphic…the idea that we have a hub of the mind and we can shift our attention to connect with things out on the rim….from a theoretical idea that sounded nice into a reality.

I lived my life completely on the rim. I didn’t NOTICE a feeling. I WAS a feeling. I was swept away. I had no sense of a hub. I had no sense of a ME.

I DEFINITELY had no idea what it meant to be with the ‘both and’.

And here we are. At the beginning of a crisis that will change our lives forever. NOTHING will ever be the same. And also there is the reality that it’s highly likely that me and my family will be one of the lucky ones. We will recover financially. We will not lose our house. If we get sick, we will probably get healthy again (though it seems to be more and more clear that this virus is unforgiving and we are ALL at risk of getting sick and not getting healthy again).

What about the people who cannot visit their dying loved ones…loved ones already on hospice when this started.

What about the folks who had their first day of sobriety on March 15th…

What about the children who live with adults who already cannot manage stress…and are flooded with emotion that makes them violent or turns them toward substances? And now these children aren’t in school, aren’t around other safe people.

I could write for days about the scenarios…the real-life scenarios that I would sit here and make up but that are actually happening to people out there RIGHT NOW while I sit in my home office and contemplate how I will dress warm-enough to go for a walk when it’s 30 degrees. I could write for DAYS about those scenarios but they aren’t scenarios, they are real.

And four or five years ago? Honestly…I’d sit here in complete paralysis about those scenarios. I’d sit in paralysis about my OWN situation, which truly, isn’t dire. I’d rage and cry and convince myself that the worse-case-scenario is absolutely inevitable so what is even the point.

And today? Well…actually…I’m still doing those things. But the difference? The difference in me today because I’ve lived and breathed and loved the relational neurosciences to the point that it has changed the cells in my body?

Today I can pause. Today I can see the terror, the paralysis…as points on the rim. And I can notice them, allow them to grab my attention…and then I can move on to the next point on the rim. And sometimes I find myself stranded at the rim not even knowing that any other point on the rim could possibly exist. And sometimes I stay in my hub, noticing these rims points and moving on to others.

When I hang in my hub, I can be with the both and. I can be with two completely contradictory experiences AT THE SAME TIME. I can welcome them all. I can not shame any part of me. I can acknowledge that terror, grief, and a toddler-like tantrum are all welcome. And so is peace, leaning into the unknown, and gratitude for all my good-fortunes.

The best part about the hub? Sometimes I am sitting so solidly in my hub that I can watch other people dancing on their rim…and not get pulled onto my own rim point. I can see them as simply being swept away. But I can stay in my hub. And maybe, I can even LEND them my hub. Maybe not. But hey…you never know.

I’m going to do my best to stay in my hub today. To notice all the things. To allow the terror. To allow the OKness. I’m also going to practice compassion when I return to my hub after being fully swept onto the rim. I won’t judge myself or shame myself. I will be grateful I could come back to the hub.

And I will be forever grateful to my mentors in the IPNB world…to my therapist…to my dear dear friends who support me in my hub…and to my husband.

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Robyn Gobbel, LCSW, RPT-S  (when not in the middle of the coronavirus pandemic) is a blogger, teacher, trainer, and consultant for therapists and professionals working with children with a history of complex trauma.  

No, really, they do. (We MAY have to adjust our definition of ‘behave well’ because we often have very inappropriate expectations for behaviors…but anyway….)

Let’s break this down.

Regulation.

Without going into the theory of regulation and all the nitty gritty that makes me confident to make such a strong statement (that would take longer than a blog post), regulation is about keeping the accelerator and the brakes of arousal in balance (Dan Siegel, Parenting from the Inside Out).

When we are regulated, we are mindful of ourselves and others.  Our brain is engaged at the level that is expected given our development (meaning, the regulation and engagement of higher level thinking of a three-year-old is quite different than a 16-year-old).  We can see multiple options, don’t feel rigid or controlling.  IPNB might say we are Flexible, Adaptive, Coherent, Energetic, and Stable.  We are connected to ourselves and to others.  We are NOT in a state of neuroceiving danger- we are experiencing safety and connection from the environment, from the people we are with, and from ourselves.

Dysregulation doesn’t HAVE to look out of control.  It could – but dysregulation exists on a continuum and could look, on the outside, quite calm.

Connected.

As human beings we are absolutely positively designed and created to be in connection with others.

Our mind, brain, and body develops inside the context of relationship.  The vental vagus nerve…the nerve that eventually allows for what many people refer to as self-regulation, the part of the autonomic nervous system that allows us to rest into connection and social engagement…is literally myelinated (it develops, works better, faster, etc.) INSIDE the co-regulated relationship.

Social Baseline Theory tells us that connection is our BASELINE.  When conditions are right, our baseline, our default, is to seek and be available for connection.

Felt Safety.

WAAAAAY below conscious awareness our brain is determining our level of safety.  This is subjective because below conscious awareness means without cognitive thought.

Neuroception is the term used to describe this process- and Deb Dana eloquently states that our unconscious system is searching “inside, outside, and inbetween” to determine if we are safe.

Inside means we scan the felt-safety of our internal system.

Outside means we scan for cues of safety in the environment.

Inbetween means we scan for cues of safety in the relationship and the person we are with.

If we are safe, our system is open and available for connection.  Remember- connection is our baseline.

If we are not safe (again, this is subjective) our brain switches into a defensive stance- fight/flight/freeze/collapse is initiated (mild to severe…it could just be an on-alert orienting or it could be full blown aggression or dissociation).

Defensive strategies prioritize protection NOT connection (though we are looking for ways to find connection, still, because connection is often brings about safety).

It’s normal to feel frustrated with a child’s defensive behaviors because “NOTHING IS UNSAFE!!!” But we have to remember this is subjective.  Maybe nothing is unsafe to you- but clearly, something is unsafe to the child.  Even if we don’t know what it is.  Even if THEY don’t know what it is.

An important cue of safety is that the person I am with is regulated- THEY are not in fight/flight/freeze/collapse.  THAT person is neuroceiving safety.

If the person I’m with is neuroceiving danger, in a defensive state, or even in the most mild state of fight/flight/freeze/collapse, the child is unable to get a cue of safety from that person and they lose felt safety.

This is tricky because when children are acting ‘badly’, we as adult often flip into a defensive state.  We get controlling, annoyed, irritated, angry, etc.  Now we have lost one important pathway toward helping the child come back into connection and regulation- our own felt-safety.

If a child is behaving in a way that is NOT inviting connection (aggressive, manipulative, under-achieving, back-talk, ignoring, lying, stealing, controlling, lazy….any of the words we use to describe behavior we don’t like) then that child’s nervous system is either NOT regulated, NOT connected to themselves or other, and /or NOT safe (one, two, or all three of these…sometimes it’s hard to isolate them).

Period.

When we are regulated, connected, and feeling safe we are designed to be in connection, in relationship, and our best selves.

Sometimes we have competing inner-parts- a part that feels safe and a part that doesn’t….or we have secondary experiences.

Meaning…sometimes connection can bring about regulation and felt-safety but then immediately becomes a cue of danger and causes a child to LOSE regulation and felt-safety because of their previous experiences in an unsafe attachment relationship.

But that’s an article for another day :)

Regulated, Connected Kids who Feel Safe Behave well is true about all kids, all humans.  It has nothing to do with trauma. Kid with a trauma history have more vulnerabilities to neuroceiving a lack of safety.  Their systems are developmentally delayed with regulation (because regulation is cultivating in secure attachment) and their experiences with connection have been frightening or dangerous.

But the idea that regulated connected people who feel safe behave well is universally true of all humans.  Beyond Trauma Informed, we are moving into an era of understanding the Neurobiology of Being a Relational Human.

Therapists and helpers are so committed to their craft and their clients.  Our hearts to help and heal are enormous, and we’d do anything to help a client experience their true self the same we that WE experience them- as precious, loveable, and exactly who they are supposed to be.

There is nothing wrong with you!!!!

We are so committed to this that we can become preoccupied with learning the next new technique or protocol.  These tools offer so much hope.  And we want to help our clients feel better as fast as possible!  Our job is to work ourselves OUT of a job…as quickly as we can!!!

But the thing is…therapy usually isn’t very fast. 

How could it be fast when the hurting has lasted for years?  Maybe a lifetime.  And the double whammy is that the faster we try to do therapy, the more we rely on a technique or a protocol at the expense of attunement and relational resonance, the slower therapy will go.  Like so many things, it’s the ultimate paradox.  The thing we think will speed it up is actually slowing us down.  If we decide to be OK with the slow pace, it will actually go faster ;)

May 2020 be the year we focus on the ‘being’ in therapy and not the ‘doing’ in therapy. I’ve been lulled into thinking I needed to learn the latest and hottest technique, too. It built my confidence and helped me stay regulated in session when the “what on earth do I do now” moments came up. But I have been watching with growing curiosity at the field of psychotherapy as more and more ‘techniques’ and ‘protocols’ come out. Sliding into a left-brained technique and following a strict protocol will break the resonance…and the resonance is needed for integration to occur.

I’ve benefited from techniques, to be sure. EMDR. SE. Theraplay. I’ve benefited as a therapist and a client and absolutely weave these modalities into my treatment approach!!  So I’m not saying at all that there is no place for techniques!!  But a technique or protocol is such a teeny tiny part of the therapeutic experience and can only be successfully implemented inside a relationship full of felt-safety and attunement.

It literally isn’t possible to strictly follow a protocol and stayed attuned.

Use the ‘bones’ of the protocol and stay fiercely attuned to and connected with your client. Focus on widening your own window of tolerance- especially for uncertainty and ambiguity- and be deeply committed to looking at your own implicit vulnerabilities- WE ALL HAVE THEM.

Find your people.  Don’t do therapy without colleagues who speak your language, share your theoretical orientation, and understand the intensity of the work we do.  Find a mentor.  Always be in consultation.  Don’t do this alone.  It is inside relationship where WE can grow our capacity to hold our client’s stories.

Practice being with.  A lot.  It’s good for you :)