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Mindfulness and Trauma

Mindfulness is very much today’s buzz-word. From blogs to scientific papers people are extolling the effects of this tool to being present. It will help us sleep, lose weight, relax – indeed mindfulness appears to be the latest universal panacea. But there are also significant clinical applications for this ancient technique, which has its origins in Buddhist philosophy and practice.

Addressing a group of health practitioners and counsellors at the Mental Health Professionals Network, Sydney psychologist Philip Hilder described how he uses mindfulness in his specialist trauma treatment, which includes clients who have been raped and sexually abused as well as those with serious addictions and personality disorders.

For Hilder mindfulness allows him to be absolutely in the moment with his clients giving him a chance to really observe their physiological state as well as what their minds are doing.

Hilder bases his practice on the Taoist teaching that it is better to take a step backwards than to advance an inch so, when he finds a client who is having terrible difficulty in addressing current trauma he “takes a step back” to allow them “subjective safety”.

He cites an example of a young woman who was sexually abused a year before she came to him. By being mindful when they first met Hilder observed that, whilst she was actually a grown woman the way she presented to him was like a “frightened five year-old”. Rather than tackling the overt trauma of the abuse Hilder reassured the “child” that she was safe and could leave anytime by taking her around all the exists from his building and normalizing her anxiety about meeting someone new. Once her “child” self felt safe he noticed that her demeanor became much more like that of an adult woman and they were able to move forward.

Hilder strives to help clients become more aware of their physical self by mirroring back how they appear to him. He says many traumatized people are stuck in their mammalian flight or fight response and find it impossible to be present. It is important not to pathologies this “normal” reaction to trauma but to simply notice it and reflect it back in a mindful way to help the client recognize what is happening and to learn how to then calm and regulate these feelings.

Helping clients, particularly those with addictions, relax through mindfulness is important. When locked in a cycle of addiction many clients find it impossible to let go but, when Hilder gives them permission to settle, it helps them reset their physiological state. With one addict he named the man’s exhaustion and asked him to close his eyes and then, once resting, to talk about (with eyes still closed) what is good about resting thus allowing for a new experience of knowing. “Every experience of knowing brings forth a new world” (The Tree of Knowledge, Humberto Maturana). In doing this Hilder offered the client a chance to recalibrate with an intervention that is potentially nourishing.

But mindfulness is not just about recognizing what is happening to a client’s physiology. It is also an important tool for exploring and reflecting back the state of the client’s mind.

Drawing on the work of Stephen Porges, Director of the Brain-Body Center, College of Medicine, University Illinois, Chicago, Hilder posits that stress and trauma leads clients to states that are driven by the sympathetic nervous system – that is their adrenals are stressed and they are unable to rest and relax. Mindfulness helps clients recognize these states of high arousal and to learn to recalibrate.

Mindfulness allows us to recognize these flight or fight impulses but also to observe what part of the mind is “running the show”. Drawing on Salvador Minuchin’s work with Structural Family Therapy Hilder believes we have a “multiplicity of minds” which may compete with one another especially when an individual is traumatized. Using mindfulness the therapist can help “reset” the mind so the different parts are no longer in conflict. First the client must “notice what part of the mind is “running the show” and then realign the mind into the higher order structure where the higher, wiser self” is at the top of the hierarchy.

Therapy is like “an introductory service where you get to know different parts of the mind” says Hilder who cites a gambling addicted client for whom conventional therapy did not seem to be working. By addressing the side of the client who wanted to keep gambling directly he was able to tease out the motives for continuing to gamble before “introducing” this aspect of the client to the side of him who was distressed and wanted to stop. The subsequent “discussion” between the two “sides” proved an effective means towards dealing with the addiction.

You need a “captain of the ship” to be in charge otherwise, with all the different parts acting out, there is no sense of the whole says Hilder, who deals with many clients suffering with personality disorders as well as trauma and abuse. One of the biggest challenges is to help these clients, who often fear abandonment, to find the “adult” in themselves; “the me that has to be there for me”, the inner adult who will look after the child and so allow safe change to take place.

Not only is mindfulness useful in recognizing what is happening with a client’s physiology and brain but it is also a useful tool in recognizing behaviours that may be sabotaging therapy. Hilder has “zero tolerance” for any “sleight of tongue that amounts to self criticism. Using words like “I’m useless” is like an addiction. Teaching clients to be mindful of such negative behaviours is all part of learning to maximize change and harness the higher self.





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