How Therapy and Politics Are Related

(by Toni Aswegan, LMHC)

THERAPY IS POLITICAL.

We can and should and must talk about politics, as therapists. Not in every single individual therapy session, but as therapists we have an ethical duty to be engaged politically, and address barriers that impact our clients’ well-being. Its part of our ethics code (ACA code section A.7.a).

One of many reasons I say therapy is political is that there are 3 different realms where trauma healing happens:

1) Auto-regulation, or self-regulation. This is stuff you do on your own to care for yourself. This is deep breathing, going on a run, listening to music, eating a snack, laying on the ground, practicing self-compassion, meditation, journaling, dancing. Really anything you do on your own that helps soothe your stress response is considered “self-regulation”.

2) Co-regulation. This is stuff you do with other people to care for and with each other. Getting a hug, having a good conversation, laughing, playing with your dog, looking at someone else’s eyes, being told you are loved. These moments of connection in safe relationships regulates your nervous system differently than when you are on your own.

3) JUSTICE. Some call it social justice, but Rev angel kyodo williams has said that all justice is social, so let's just call it justice. We can build safety through self- and co-regulation, BUT IF OUR BODIES ARE NOT OBJECTIVELY SAFE IN THE WORLD, healing is so much more difficult. I don't want you to regulate your nervous system to adapt to oppressive systems and circumstances. Those circumstances need to change. Until black and brown bodies, womxn bodies, trans bodies, queer bodies, Jewish bodies, larger bodies and disabled bodies are safe in the world, we cannot focus only on self and co-regulation as a path to healing. We have to actively work to make the world 1) a place where less injury and trauma happen in the first place, and 2) a place where people can heal and feel safe.

This is not the job of those who experience a lack of safety through oppression and discrimination. This is on those of us with privilege and power.

Healing work is justice work. Therapy is political.

When I say "therapy is political", I do NOT mean:

-we talk about politics all the time in therapy (unless it's a goal of yours);

-we talk about politics if my clients don't want to;

-we try to convince clients to vote in a particular way.

When I say "therapy is political", I mean:

-your mental health is impacted by the systems you live within, and healing is not an entirely individual process;

-we will acknowledge the impact of those oppressive systems in your therapy process;

-if appropriate and agreed upon between therapist and client, we will discuss ways to challenge those systems and ways to continue to live as safely as possible within them;

-as a therapist, we fight, outside the therapy room, to create social change and justice (because it is the right thing to do, and also because that supports change inside the therapy room).

This shows up differently in every therapy session, for every therapist and every client. It shows up differently for every therapist even outside of the therapy room. But, therapy and politics are certainly intertwined.

Thoughts On Why Masks and Phone Calls Are Anxiety-Provoking

Anyone else super anxious when making a phone call? 

Up until I started my own business, I used to have to hand the phone off to someone else to order pizza, make an appointment, etc, because I was too anxious to be on the phone with a stranger. I have heard this over and over again from other people, too. Phone calls are so stressful.

Now that I have some background in how our nervous system functions, I have a theory (emphasis on *theory*, I could be wrong) as to WHY this is the case for so many of us.

It's the same theory for why talking to people with masks on might be creating social stress (other than the obvious stress of living in a pandemic time...P.S. WEAR A MASK).

You've heard about the window of tolerance, also called the social engagement system. (and if you haven't, scroll around my page a bit and you'll find old posts about it). This is governed primarily by the ventral vagal complex (VVC), a big ol' nerve system that runs from the base of your skull all over your face and ears and throat, into your heart and lungs and guts (it's a big one, friends).

The VVC keeps your heart rate regulated. It helps you tune your ears to hear the frequency of human voices over other sounds. It helps you create and appropriately read facial expressions, by noticing the crinkles at the edges of eyes, the shape of someone's mouth, how much teeth are showing, if their nose is moving, crinkled, etc.

When we're able to read facial expressions, we can feel safer knowing whether a person is friendly or aggressive, sad or angry or pleased...in other words--feeling safe is connected to knowing how the other person feels and what their relationship is to us...which is all deeply connected to our ability to see their face. 

Well guess what?! The phone obscures all of the facial expression information. Masks obscure fully two thirds of this information.

We're missing the usual information we would use to help determine safety and how to act in relationship. Anxiety and stress in these situations is NORMAL.**

For those with a history of trauma, this stress might be even more acute and distressing.

Does this resonate with you? Let me know your thoughts!

**WEAR A MASK ANYWAY I'm just validating one potential reason why we might feel more dysregulated lately.

Trauma, Mental Health and Connecting to Your Core Truth--Toni Aswegan Podcast!

A few months ago, Toni was on a podcast with the Sage Sisters!

We talked mental health, trauma, how the body holds onto trauma, how to manage seasonal depression, and self-care. It was such a great conversation, listen below!

Types of Trauma Therapy

Before I talk about types of trauma therapy, I’d like to address a question I get often:

what is "healed trauma"?

First, the word "healed" is tricky. It implies a complete end point, a place where the thing is over and we are done with it. These things don't happen. No matter how "healed" we are from anything, we will always be impacted by it. By no means does this mean we cannot heal trauma. It's just important to acknowledge that we cannot completely eradicate the lasting effects of trauma. That being said, we can CHANGE them.

While trauma is "unhealed", survivors may experience flashbacks, nightmares, hypervigilance, difficulty sleeping, difficulty concentrating, negative thoughts about themselves, feeling unsafe (in the world and in their own body), difficulty trusting, among other things. All of these experiences contribute to a feeling that *trauma* is in charge and is running your life. Trauma decides whether and where you go outside your house. Trauma decides whether and when you remember. Trauma decides whether, when and with whom you feel safe.

First and foremost, healing trauma is putting yourself back in the driver's seat. It is releasing trauma as the primary narrative of your life. There's a great quote from Michael Rosenthal:

“trauma creates change you don’t choose, healing is about creating change you do choose.”

I love this. Trauma healing is about empowerment. Regaining control where you didn't have it before, while also realizing that you'll never have full control of everything.

Trauma healing is about re-learning how to feel safe in your body, and in the world. It is about soothing and rewiring your nervous system. Healing is embodying an authentic sense of self, defined by YOU. It is living with purpose, meaning and connection.

And this healing is totally available to you. I know it.

So, how do we heal from trauma?

There are a million ways to heal trauma--and not one of them is the single “correct” way to go about healing. Different things work for different people, and I want to be clear that psychotherapy is only one factor in trauma healing. A short and incomplete list of other things that support trauma healing includes: social justice, supportive relationships, financial stability and a sense of purpose.

When it comes to therapy though, there are a lot of different approaches to treating trauma. Most therapists you meet will have an eclectic approach, meaning they will blend techniques and interventions from various different theoretical approaches. It's great to ask your therapist what approaches they draw from and what that means for your treatment.

Here are *a few* of the trauma treatment modalities you might run into:

Sensorimotor Psychotherapy (created by Pat Ogden): This is a type of therapy that believes that we store trauma in our bodies through procedural/implicit memory. When trauma becomes PTSD, it is (in part) because our active mobilizing defenses like fight/flight get truncated or are incomplete and subsequently get trapped in the body. Sensorimotor Psychotherapy interventions support regulating autonomic nervous system dysregulation, and help move that truncated defensive response through the body in a mindful way. This expands the window of tolerance and increases embodiment, empowerment and a sense of groundedness. A very similar approach is Somatic Experiencing (created by Peter Levine).

EMDR (Eye Movement Desensitization and Reprocessing; created by Francine Shapiro): EMDR also believes that trauma gets trapped in the body, along with deeply held negative beliefs about self and the world. This can lead to phobic avoidance of traumatic memory which is associated with symptoms of distress like intrusive memories, flashbacks, nightmares, avoidance of triggers, and negative thoughts about self. EMDR uses bilateral sensory stimulation (visual by tracking moving fingers or a light bar, or tactile, typically using light buzzers in each hand), memory recall, and grounding resources to reduce distress and desensitize clients to the traumatic memory.

TF-CBT (Trauma-Focused Cognitive Behavioral Therapy): This therapy asks, what negative beliefs or stories are you telling yourself as a result of the trauma? Examples: the world is not safe, this is all my fault, all people are dangerous. TF-CBT focuses on these thoughts and emotions to challenge these beliefs through both thought challenging and behavioral action.

[Personally, I like to use this in conjunction with SP so we can get at both the thoughts and body memories associated with trauma.]

Prolonged Exposure Therapy (PE): This is quite similar to phobia treatment. The idea is that we become phobic of traumatic memory, and that avoidance of the memory creates greater distress and exacerbates other symptoms of PTSD. PE therapists will help you create a list of graduated exposures (starting with least triggering to most triggering) to practice approaching triggers while using skills to regulate emotion. In PE therapy, you will also tell the story of your trauma repeatedly, again, to desensitize to the trauma memory. 

I won’t speak necessarily to the pros and cons of each type of treatment, because it really depends on the client, type of trauma, and clinician’s experience and training. What is most important when working through trauma in therapy is that you find a therapist you feel safe with, who can explain their treatment frame to you, and that their treatment frame resonates for you. If these factors are in place, then likely any of these modalities are likely to be effective for you.

There are also quite a few therapies that don’t necessarily conceptualize trauma specifically in their literature, but are still quite supportive in healing from trauma. These include:

-Yoga therapy

-DBT (Dialectical Behavioral Therapy)

-CBT (Cognitive Behavioral Therapy)

-ACT (Acceptance and Commitment Therapy)

-IFS (Internal Family Systems therapy)

This is by no means a comprehensive list. The treatment frames listed above are ones that I have training in or am familiar with enough to be able to speak on them. There is no one right way to treat trauma, it's about finding what works for you. As I said before, healing is totally available to you. I know it.

How to Recognize a Trauma-Informed Therapist

What the heck is "trauma informed" therapy? You've probably heard this phrase thrown around a lot lately. It's becoming a thing--which is freakin' GREAT! It's also pretty ill-defined, so here's my take.

As a note, ALL THERAPY SHOULD BE TRAUMA INFORMED. So I'm really just describing good therapy here I guess…

Trauma informed therapy co-creates an environment in which you can access a feeling of safety. This doesn't mean you'll feel safe 100% of the time, and that's okay. It just means that safety, feel safe, is a primary goal between you and your therapist.

To me, this means orienting the room so that clients can easily leave if they need to. It means orienting clients to how much time we have. It means using my language intentionally. It means clearly sharing expectations and boundaries of the therapeutic relationship and maintaining them. It means showing up honestly and authentically, being trustworthy and transparent.

Trauma informed therapists understand the impact of trauma on the body, nervous system, emotions and thoughts. They understand trauma on both an individual and systemic level. They acknowledge racism, sexism, ableism, homophobia, etc. as experiences of trauma, and actively work to be allies to marginalized communities and support clients in processing their histories of discrimination and prejudice. They empower clients through choice and collaboration.

Being trauma informed means that we understand that symptoms and behaviors arise as survival mechanisms of trauma, rather than pathologies or problems. We understand that these skills worked at the time of trauma, but are no longer serving you. We work to find your strengths and collaborate to find resources for you to regulate your emotions and body responses so that you can make more life-affirming choices in the present, rather than responding as if you are still in the trauma.

Trauma informed therapy comes primarily from a place of compassion and belief in your resilience. YOU SURVIVED YOUR TRAUMA AND THAT IS A TESTAMENT TO YOU.

How to recognize a trauma informed therapist:

-They won't blame you for what happened to you;

-They will help you understand how your symptoms or behaviors are connected to what happened to you;

-They will explore with you the impacts of systemic oppression, prejudice and discrimination, and be an ally to marginalized communities;

-They will help you find your strengths to cope, soothe and regulate;

-They will be trustworthy, transparent and clear about their boundaries;

-They will collaborate with you, offer you choices, and respect the ones you make;

-They won't define you by your trauma, but will see you as a WHOLE PERSON.

Even if you aren’t going to therapy specifically to work through trauma or PTSD, it’s important to have a trauma-informed therapist. These characteristics enhance and enrich the therapy process regardless of why you’re there.

All of our therapists at Riverbank Therapy are trauma-informed. Fill out our contact form here and we’ll get you booked for a free 20 minute consultation!

Want to hear more on this topic? Listen to the Toni Talks Therapy podcast episode 4!