We know plenty of strategies for engaging our trauma patients. But do we know what to avoid?
How to help patients heal is not always clear. And trauma patients, given all their diverse history and symptoms, can be some of the most challenging.
So it almost goes without saying that, when working with clients who have experienced trauma, there are extra precautions practitioners need to consider.
Let’s take eye contact for instance.
While many of us would say eye contact is essential, Stephen Porges, PhD has written about the importance of averting eye gaze when working with trauma patients.
Direct eye contact can be interpreted as threatening and may trigger a negative reaction from someone who has experienced trauma.
In his book, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, Stephen describes what happens to the social engagement system of trauma survivors.
Trauma can turn off the social engagement system. Attempts to engage a person with trauma history, rather that eliciting spontaneous social behavior, may trigger defensive and aggressive behaviors.
From a clinical perspective, traumatized individuals often present features of gaze aversion and flat facial affect. If we were to monitor the physiological state of those individuals, we would observe an ANS (Autonomic Nervous System) that is poised to fight or flee (i.e., high heart rate and low vagal regulation of the heart). The traumatic experience functionally retunes neuroreception to conservatively detect risk when there is no risk.
Most therapeutic strategies attempt to engage with direct face-to-face eye contact. Working with traumatized individuals creates a great challenge to therapists, since the normal social engagement behaviors of the therapist may trigger fear and reactive defensive strategies.
But this precaution leads to a new problem.
If we avoid eye contact, how else can we engage with a client?
Dr. Porges offers a solution that involves an entirely different sense all together. This is a strategy you might not have considered.
Music therapy provides a special portal to reengage the social engagement system that does not require an initial face-to-face interaction. Music can be used to stimulate the social engagement system without requiring face-to-face reciprocity. Since melodic music contains acoustic properties similar to vocal prosody, music may be used to recruit the social engagement system by challenging and modulating the neural regulation of the middle ear muscles.
If the social engagement system is effectively recruited, positive facial expressions will emerge, eye gaze will spontaneously be directed at the therapist, and the traumatized individuals will shift to a more calm and positive physiological state.
Through the use of music therapy, it’s possible to stimulate a patient’s social engagement system without triggering defensive behaviors.
So, to get to the eyes, you could go through the ears.
Intrigued? I was.
To find out more, you might want to check out Stephen’s book, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.
Stephen Porges is the creator of polyvagal theory, Distinguished University Scientist at the Kinsey Institute at Indiana University Bloomington, and Research Professor in the Department of Psychiatry at the University of North Carolina at Chapel Hill.
We’ve talked with Stephen before about how the polyvagal system can help us understand reactions following trauma. His research is often illuminating.
He’s also a profoundly wise person, and I’m always glad to share his thoughts with you.
What are some techniques you’ve used with trauma survivors to avoid triggering a fear response? Please share your thoughts in the comments section below.