In my work as a Music Therapist, I am sometimes referred clients who have experienced significant physical or emotional trauma in early childhood which has affected their brain development. Some of these clients have difficulty regulating emotions. For example, I might receive a referral that describes a child who has ‘outbursts’, for which neither the child nor the adults around them have been able to identify a reason or ‘trigger’.
To help me with my thinking on this, my supervisor recommended that I read the book ‘Changing Minds in Therapy’ by Margaret Wilkinson. This book pieces together findings from psychodynamic psychotherapy and neurobiology to help think about trauma, affect and attachment. Learning about neurobiology more generally has also been really helpful. I’ve worked through a free online course from the University of Chicago – ‘Understanding the Brain – The Neurobiology of Every Day Life’ to develop my basic understanding and I am feeling inspired to keep learning!
Neurobiology teaches us that the mind, brain and body are inseparable. Our emotions depend on the feeling of our bodies (Mason, P., online course). Experience of trauma might lead to a ‘highly sensitised amygdala store of painful emotional memories that might even be held only in the body’ (Wilkinson, M., 2010, p.11). So, with the referrals I described earlier, although they might not consciously remember their trauma it could still be felt by the body. This could make it really difficult to regulate emotions, as the amygdala is involved in emotional responses and integrates sensory, cognitive and other information to determine whether a situation is dangerous. If a situation is assessed as ‘dangerous’ the sympathetic nervous system is automatically innervated. Autonomic responses are triggered through projections to the hypothalamus and brain stem (Johns, 2014, p. 39), often known as ‘fight/flight/freeze’ responses. For individuals who have experienced trauma, the ‘trigger’ to such feelings could be something seemingly minor that happens in their current environment such as a noise, a touch, a smell, or a feeling which may unconsciously relate to their past experience (Wilkinson, M., 2010, p. 146) and so the body might respond to these every day situations as if they were dangerous.
Dr. Bessel van der Kolk (author of ‘The Body Keeps the Score) has discussed neuroimaging of people who have experienced trauma which have shown that when people try to recount traumatic experiences their frontal lobe ‘goes offline’. This means that the parts of the brain that are involved with thinking and figuring things out are literally not functioning when they are reminded of their trauma. Dr. van der Kolk also describes how the Broca’s area of the participants in the study showed decreased activity (as if they had experienced a stroke). The Broca’s area is the part of the brain understood to be responsible for expressive language. Even people who usually have the ability to talk may be unable to do so when it comes to their trauma experience.
This learning has helped me have compassion for clients who may feel overwhelmed by emotions that they are unable to explain, or comprehend. It has also re-emphasised how important it is that I attune to the body as well as the mind in my sessions. In my Music Training we looked at non-verbal communication in detail so in sessions I am alert to the body language of my clients and the ways they relate to me (through music, but also in other ways). For example I look closely at my client’s body language, changes in skin tone, the way their breath changes (e.g. holding breath, or breathing more rapidly), the pace they speak or vocalise. This all helps me attune my responses to my clients in a way that they can be reassured. This is similar to how a parent might attune to their baby; by offering mirroring and empathy to help make emotions manageable (in healthy, ‘good enough’ parent-child relationships). I aim to provide a holding and containing environment which can help the person be their authentic self.
It seems this area is still at quite an early stage in terms of research, but the good news is that current thinking is suggesting that ‘affective engagement in therapy enables new emotional learning to occur, and that such learning may bring about a profound change in the way the patient relates to others’ (Wilkinson, M., 2010). It seems to me that creative therapies may be well placed to help people who have experienced trauma, as there is no pressure to talk about their experience and the creative medium may provide the needed emotional distance to express feelings safely. So I’m taking away from this a message of hope. Although we cannot change what our clients have experienced, we can promote their resilience by understanding the brain ‘not as a fully formed structure but as a dynamic process undergoing constant development and reconstruction across the lifetime’ (Cozolino, 2006, p.50). Perhaps through long-term engagement in an attuned therapeutic relationship, the person can start to feel safe in their surroundings, with people and in their bodies.
Changing Minds in Therapy – Emotion, Attachment, Trauma and Neurobiology by Margaret Wilkinson, 2010
Clinical Neuroscience by Paul Johns, 2014
The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma by Dr. Bessel van der Kolk https://www.youtube.com/watch?v=53RX2ESIqsM
The Neuroscience of Human Relationships: Attachment and the Developing Brain, by Cozolino, 2006
Free Online Course
Understanding the Brain: The Neurobiology of Every Day Life by Peggy Mason at The University of Chicago, accessed online (2019) at http://www.couresera.org