Unveiling the Secrets to Creating Safety in Counseling

I'd like to welcome everybody. Today's presentation on creating safety from a psychodynamic perspective. I am your host, Dr. Donnelly Snipes. We're going to review the basics of psychodynamics. I know a lot of us are familiar with it, but let's just, you know, hit the highlights again so we remember exactly what that definition is. We'll explore phenomenological reality transference, comparing and contrasting techniques in order to help people feel safe, and how to create safety using the PACER method. Remember, PACER stands for physical, affective, cognitive, environmental, and relational. And using mindfulness of the present basic assumptions of psychodynamics. Now, if you remember Back to Psychology 101 Psych. Psychodynamics research really started back with Freud and Jung, but there was a lot of implementation of their philosophies, if you will. You know, all the way up through Bolby. And we still, a lot of us still adhere or believe in a lot of the principles. So what are those principles? There are three basic things that we want to reflect upon if we are using a psychodynamic lens. One, behavior and feelings are significantly impacted by unconscious and subconscious motives. Now, that kind of goes back to Freud and his id, ego and super ego. But we really want to focus on the fact that our behaviors, our feelings, our reactions are significantly impacted by things that are happening in our subconscious and sometimes our unconscious. Our behavior and feelings as adults are rooted in our childhood experiences, including our attachment experiences. A lot of times when we learn things, when we have an experience, especially a. An intense experience, whether it's intensely positive or intensely negative, we form a schema about that experience and we file it away in our memory banks. And a lot of times we don't go back and check in on that schema in, you know, in the future. So we may be using outdated information. A lot of our childhood experiences because we didn't have a lot of prior experiences and because as children we were vulnerable and because the brain wasn't fully developed, so it was more sensitive to stress in the environment. A lot of our experiences as children were more impactful, if you will, because, you know, children think dichotomously. It's either all good or all bad. They have a really hard time conceptualizing that there might be some gray area, you know, when a child is abused by a parent. And this is the. The scenario or example I, I give a lot to try to highlight this. Children have a hard time separating. You know, my parent loves me and my parent hits me. So if my parent Hits me. That must mean my parent doesn't, doesn't love me or I'm not worthy of love. They can't conceptualize. Well, maybe there's another reason. You know, my parent has really bad anger management skills or poor parenting skills. A child doesn't know that. A child thinks dichotomously and they form schema that tend to be dichotomous. Things are all good or all bad. If they are. Well, we'll talk about dogs in a second. And our all behavior. And this is. I love this part. All behavior has a cause and a function. And when I work with clients, I do tend to embrace a lot of psychodynamics in my approach because I believe that the majority of actions and reactions that we identify as problematic behaviors or symptoms are often antiquated schema based on prior learning experiences that are currently serving a protective function. I see a lot of that. And when people start understanding why they're doing something, what the benefit is, then they can start finding other ways to achieve that same end or they can adjust their schema appropriately. So let's talk about some examples. Fear of dogs. A lot of people have fear of dogs and think about a child who was maybe three or four and a dog comes running up to the fence barking and charging and snarling. There are those occasional psycho dogs out there. Um, I have a dog right now who his bark is so much worse than. Thank God he doesn't bite. But I mean, he sounds vicious, but he actually like backs up from people when he, when he barks, which is pretty funny. Um, but if somebody experiences Boo Boo who happens to be an 85 pound boxer, you know, that can feel threatening to them. If they don't have a history with dogs, or even if they do have a history of dogs, it can feel really freaking threatening because he's so big. But for a child that experiences that they may start to, they may not have other dog experiences. So they may start thinking, well, all, all dogs are dangerous. All dogs are going to try to eat me. That all or nothing. That that dichotomous thinking. Dogs are either safe or they're not. And when you start talking to people who have pervasive fears of dogs, you can generally trace it back to an experience in their past where a dog was, you know, threatening to them or to someone else. Remember, we can learn vicariously, we can learn by observing something happening to someone else. So if we have, if our little brother gets bit by a dog, we may not have experienced it ourself, but we saw that happen. And now we may be afraid of dogs ourselves. So dogs is a basic place that we can start explaining psychodynamics to people. We can start explaining how past experiences shape our anticipation, shape our perceptions and expectations of the future. Distrust of counselors is another one. A lot of people come into counseling involuntarily or maybe voluntarily, but they're really not too sure. My grandmother, she wouldn't go to a counselor. Now, granted, she was raised in a time where they were told that it's not okay to air your dirty laundry in front of other people. And if you need to go to a counselor, that means that you're crazy, quote, unquote. And there were a lot of misconceptions back in the, you know, 30s and 40s and 50s about counselors. So she held on to those beliefs and her experiences, you know, seeing who went to counseling. You know, back then, people who went to counseling, there was a lot of institutionalization. So people were afraid to go to counseling counselors because, you know, way back when, you know, if you went to counseling, you know, you might be deemed crazy and put in a locked facility. So there was a lot of fear surrounding counselors. And she never checked that or didn't check that until, you know, I became a therapist and she started seeing that, oh, okay, maybe therapists aren't that. Maybe therapists aren't that scary or threatening. Other people have been involved in the system before and, you know, the system being law enforcement, child protective services, what have you. And counselors are a representation of that system to them. So they may not be as trusting or as forthcoming with clinicians because they see them as part of a system that has taken their control in the past. And all of this, or a lot of this goes into creating a trauma informed environment, recognizing the traumas of the past that are influencing the perceptions of the present and the future. Clinginess and an enmeshment in adult relationships. Well, if we think that a lot of our current reactions and emotions are based on prior experiences, especially attachment experiences, and Bulby wrote extensively on this, then we can see that our current interactions in relationships may be to avoid that abandonment, may be to get that reinforcement or recognition, and trying to find unconditional positive regard, which is so elusive to so many people, what we may see is a. A wounded child who never got that validation, who never got that acceptance, who still trying to get that acceptance, trying to get somebody to tell them that they're okay and they're worthwhile. We get angry when people don't like Us and a lot of us struggle with this to greater or lesser degrees. And when you think back, rejection as a child is hugely devastating because we can't take care of ourselves if we're rejected by our caregivers. That's a huge thing. So if we're rejected in the future, it triggers some of that feeling of loss of control, powerlessness, unworthiness. When we, as we grow up, think about high school, how big of a deal it was when you were in high school, if you felt like you were rejected or people didn't like you, if you weren't accepted into the proper click or environment, there was a, a lot of emotion that went behind that. So a lot of times we carry that into our adult life when we get frustrated, when people who may not have any impact in our life at all disagree with us, don't like us and we get upset. We need to examine, you know, what is this triggering? What is this reminding me of? Does this person, is this person consequential in my life at all at this point? When you were in high school, it may have felt like that person was hugely consequential. Now we can look at this person on Facebook or Instagram or wherever, or Twitter and think to ourselves, you know what? That person really, I don't know them. They're not even in, in my social circle. That goes with becoming more mindful and starting to check those assumptions that are based on those prior experiences. Other situations, anxiety at night, if somebody experienced a trauma at night, anxiety during thunderstorms, if you were, you know, even in the recent past, if you had experienced one of those tornadoes that went through then, when we have thunderstorms now, there may be a certain amount of anxiety. The older you are when something happens, the more memories, the more information, the more data and the more cognitively flexible theoretically you are to deal with things. So things that happen when you were a child and you were thinking dichotomously and very personally probably are going to be more threat provoking, anxiety provoking than necessarily things that may have happened last year. But we do need to remember that every experience we have shapes how we anticipate the future. And so we becoming mindful of how we are experiencing things in the moment is important to helping us prepare for how we're going to experience the things in the future. We just had that tornado, I guess it's been about two months now, that came through Middle Tennessee, and it was terrifying. I had never been through a tornado before, and, you know, I've been through hurricanes and this was nothing like a hurricane. It was terrifying. I am older and I could reflect on that moment and during that moment that, okay, this really sucks right now. But this is an isolated incident and I could use a lot of cognitive behavioral tools that we're going to talk about later to address it. A five year old doesn't have those tools. A five year old is probably going to have a lot more difficulty dealing with the next thing thunderstorm than a 50 year old. One of the things that you can do in individuals and groups when you are trying to teach this concept is have people identify current behaviors that are unhelpful or bothersome and explore the cause of those behaviors and the function. So when somebody gets anxious, maybe they stress, eat. Where did that come from? What's causing that anxiety? What's causing that emotional reaction and what is the function of that emotional reaction? You know, what is what is causing the stress? And then it backwards chaining to identify kind of what's going on. And then we can look at the behavior they're using to cope with the anxiety. But you want to go backwards, say, okay, I am stress eating, all right, that means I must be stressed. So let's go back to what's causing the stress. All right, something's going on right now that's causing stress. Why is this causing stress for me right now and what's it reminding me of? Where is this coming from? Behaviors and emotions that indicate a lack of safety. And I've talked about these before in, in other classes. Fight, flee, freeze. And we'll say forget about it. Your four Fs. When people are in that threat reaction place, that HPA axis gets turned up our threat response system and people either want to fight or flee. But sometimes they feel so overwhelmed they're paralyzed and they freeze. Other times they are just so worn down and so exhausted and feel so helpless that they just throw their hands up in the air and they say forget about it. We need to remember that those all may be indications of a lack of safety, a sense of exhaustion, a sense of learned helplessness. Some of the behaviors that we may see that might be indicative of the four Fs include addictions, sleeping too much, sleeping all the time, or not sleeping at all, social withdrawal, you know, not wanting to be around anybody, just saying, you know what people too much, can't deal with them giving up, giving up easily. When hardships come their way, when they meet any sort of resistance at all, just kind of throwing in the towel and going, screw it, that's not going to work self sabotage. And we do see this sometimes in people who are, if you'll forgive the phrase, afraid of success. They're afraid if they succeed, then they have further to fall if they fail or if they succeed, that people are going to expect more out of them and they're not sure if they can do it. You know, if they succeed in being clean and sober for 30 days, then people may expect them to be clean and sober henceforth an forevermore and that they start thinking about that and they get overwhelmed. So then they sabotage themselves. When they are thinking in, in the short term, just the 30 days, then they may not be overwhelmed. So we want to help them see how things that they've done to self sabotage. You know, they knew better. They can look back and they go, I know, but I know that that wasn't the right choice. I had a client that I worked with for many years and every time he would relapse it would be because he got into a relationship and his relationships were wildly dysfunctional. He knew that that was the main trigger for his relapse. And when he would engage in those behaviors, then you know, he would know somewhere in the back of his mind that he was self sabotaging. When people who are in Recovery and in 12 step programs are feeling triggered, they are feeling urges, they're feeling cravings, and they don't reach out to their sponsor or they don't go to a meeting, then we might look at that as self sabotage and say, you know, why did you choose that option? In what way did you feel that continuing to go to meetings was more threatening than relapsing poor sleep? Hyper vigilance in the environment, you know, be constantly being alert for threats in the environment to our person is one. But also being hyper vigilant in relationships, if your significant other comes home and sits down and just huffs or rolls their eyes or you know, gives you a funny look, you know, being aware of all those micro expressions that may not even be directed towards you. Maybe they grimaced because they had a pain in their belly, but you took it personally. Being hyper vigilant like that is a very normal reaction. When you've been in dysfunctional relationships before, when you've been abandoned before, worrying makes sense. You know, this is more one of those freeze behaviors where people just sit and ruminate on worry or anger or resentment because they don't feel like they're. They have the power to change anything, but they also are afraid to not worry about it because if they don't worry about it they're afraid that they're going to be caught off guard. So they feel like they've constantly got to keep the negative at the 4. Creating chaos is an interesting behavior that I've seen in a lot of clients over the years. And this is especially observable in a residential setting. But you can see it in other situations as well. When a client starts to feel vulnerable, sometimes they will create chaos. You know, throw focus on other things, you know, divert your attention from whatever you're getting too close to whatever's feeling vulnerable. They'll divert your attention over here so they don't have to deal with that because they don't feel safe going here right now. And that's okay. When people start trying to divert my attention from something, you know, I try to turn the attention back to it and go, okay, clearly something is making you uncomfortable about looking at this issue or you're at a point where you're feeling vulnerable. How can we help you feel safe? I'm not going to push them past their feeling of safety, but I want them to recognize that when they feel unsafe, distracting is a way of avoiding that situation. So how can we make them feel safe enough to deal with whatever that issue is? And non suicidal self injury. We see this a lot, unfortunately with clients with borderline personality tendencies, but also in other people. When they start to feel overwhelmed, when they start to fear abandonment, sometimes they will engage in these non suicidal self injurious behaviors in order to get attention, you know, to get us to be there to comfort them so they know that they won't be abandoned. And a lot of times it just comes back to something as simple as that. But the NSSI non suicidal self injury means something. Sometimes they do it in order to feel like they have a sense of control because what is going on in their head is so wildly out of control, so wildly overwhelming that they want to have have something in their life that they can control. And they can control how much physical pain they feel. Not that I'm advocating for that. But when we look at the function the behavior is serving, we start to understand more why the person may be doing something. But we've got to remember the behaviors are often a way of coping with the feelings. So then we need to go deeper and that's where the psychodynamics come in. We need to go deeper and identify what is triggering those feelings. What is triggering that anxiety, that anger, that feeling of threat. For helping people identify what they do when they feel unsafe, have them identify and you can do this on a whiteboard. There are a lot of different ways you can do it, or you can, over time create cards that have common symptoms of, you know, depression, anxiety, addiction, borderline personality, what have you put them in a hat or a box and have people draw a card. When they get the card with that symptom or behavior on it, then they need to explain how that behavior indicates a perception of threat and serves a survival function. So how does, you know, for people with borderline personality characteristics, how does go going from love to. To hate, from admiration to, you know, disgust, like turning on a dime, how does that serve a survival function for people? And it's very protective. It's very protective. From a very primitive place when a child was thinking dichotomously, my mommy either loves me or hates me. I can either trust my mommy or I can't trust my mommy. And, you know, that experience continues to be in that person's psyche and present itself and color the lens through which that person sees the world, thinking in. In dichotomous terms. Now, on the other hand, we also want to be aware of behaviors and emotions that indicate safety. We don't always want to talk about the negative, because, remember, if you just eliminate the negative, then you're left with a void. You have to add positive. We don't just want to take away unhealthy behaviors. You also have to add healthy replacements. You don't want to eliminate, you know, something without putting something else in its place that serves a similar function. May not be exactly the same, but that serves a similar function. For example, if somebody uses cocaine or alcohol to help themselves deal with stress and anxiety and depression and dysphoric emotions, okay, well, that is one way of surviving those emotions. However, if they are exploring the idea of recovery, what are alternate behaviors they can use to cope with those dysphoric emotions besides substances and. And start exploring it from that perspective. So safety. We want to encourage people to look back over their past because our past also tells us things that can help us feel safer. What things make you feel happy? What things make you feel content? What things trigger a feeling of safety? Encouraging people to think back to a time in their life when they actually felt safe. Maybe it was just for a moment, maybe it was in a particular relationship or during a period of their life when they felt safe, what was different, what was the same? Help them identify ways of becoming more assertive. When people feel safe, they're more likely to be assertive. When they feel threatened, they're more likely to either Be aggressive or passive, which relates to that sort of fight or flee. If I feel threatened, I may be aggressive in order to try to conquer or push away the threat, or I may be passive in order to avoid making the threat angry with me. Assertiveness is rarely seen when people are feeling particularly threatened. And we need to help people develop a sense of safety. Now, they may have a little bit of anxiety. None of us likes confrontation. But there's a difference between a little bit of normal anxiety and feeling uncertain. Safe and helping people start to recognize that, recognize the levels of anxiety that they are able to tolerate. We want them to have a sense of confidence and efficacy. That feeling that they can affect their life. And they're willing to do things to make changes, such as coming to treatment, following their treatment plan, going to work, having assertive conversations, determination and. And perseverance. Perseverance. We want to see them willing to continue to keep going. When people fear rejection, when they fear failure, when they fear the unknown or loss of control, a lot of times most of the time they're not going to continue doing something if they feel that that's going to lead to unpleasant consequences and they won't persevere. So when we see determination and perseverance, we also see hope. We also see a certain amount of efficacy. When people feel safe, they often have a certain amount of self esteem. They have a certain amount of confidence and love for themselves. They're able to relax when we feel physically safe, we're able to relax when we feel like our basic needs. Think back to Maslow. When we. When we feel like our basic needs are going to be met, then we're able to take a breath. We're not having to frantically search for a way to meet those needs because we know that the basics are going to be met. And interpersonal connectedness willing to engage in relationships is another sign of safety. A lot of times when people feel unsafe, they withdraw. Now, this isn't always the case. Sometimes they become clingy and enmeshed. But when we see people willing to form healthy relationships, that often indicates a sense of safety. Just like on the other one for unsafeness with safety. Have people identify behaviors that they do that indicate that they feel safe. What do you do when you feel safe? What do those behaviors look like? When have they occurred and what are the necessary conditions for them to occur? For example, maybe somebody knows that they feel safe if they're able to sleep in their bedroom with the lights out. And when they're not feeling safe, they can't Sleep with the lights out or they can't sleep at all. Encouraging them to identify examples that show or indicate that they're feeling safe is really important. Encouraging them to look at times when they've been assertive and how they may have felt confident and safe. In those situations, they felt safe enough to speak up and be assertive about whatever was going on. Which takes us back to phenomenological reality. Situations in the present are perceived through a lens of the past. If you have ever worn blue blocker glasses, it's kind of a weird experience for me because it changes the colors of things. Things that were green or now blue or I can't remember. It's been a long time since I wore the blue blockers. I really hate wearing them because the. The colors get all wonky. But if you're talking to somebody, if you're walking along and one person's wearing blue blocker glasses and the other person's not, and you say, look at that, you know, blue flower over there, and they have no idea what you're talking about, you know, that's kind of what we're talking about. With phenomenological reality. They are seeing life through a different lens through different filters than you are. So they may not see things the same way you do. Situations in the past, such as personal and vicarious experiences. We talked about the dog earlier having personal experiences. They can be positive, too. When I grew up with dogs, so I have always been around sweet, you know, loving dogs. I've had the occasional dog that had an attitude or that got an attitude about something. But I had enough other positive experiences that in order to understand that, you know, if you go back to Piaget with assimilation and accommodation, I had to figure out, you know, my experience was with dogs, they're generally good, they're generally happy, they're generally nice. So what in the world was going on here? How can I fit this into my schema so it all makes sense? Because I don't believe that dogs are dangerous. So why was this dog, you know, aggressive at this point in time? And it's important for us to be able to explore that and explore what we're perceiving. My husband always laughs because I'll go out on runs or whatever, and especially when we lived in Florida, if I would see a dog anywhere, you know, run, especially one running loose, I'm still really bad about that. If there's a dog running loose, I'm getting out of the car, I'm pulling over somewhere going, hey, puppy, puppy, puppy. Because Surely that dog is friendly and lost and in danger and, and you know, it's taken me a while to recognize that that is not always true. My lens was that all dogs are friendly and I had to adjust my lens over time. And that's what we're going to ask people to do now. Mine was positive and I needed to moderate that a little bit. But some people have negative experiences that they need to moderate our education. And I use that term pretty broadly from our family. What our family tells us about other people, other situations, what to expect, that shapes our reality. Our family tells us what's good, our family tells us what's bad. The media and I use that really broadly, not just television, but also movies, books, anything that gives us information. And school, school affects the way we see things because it presents us with very cherry picked media that they have decided, the school boards decided is appropriate for us to learn. But then there is our volumes of other information out there that they had to leave aside because there's just not enough time and hours in the day. So we only have a certain amount of information, sometimes just enough to be dangerous. And then as we talked about earlier developmental conceptualization, if something happens when a child is, you know, early elementary school and younger, they are going to tend to think of it more dichotomously. They have fewer things to compare it against. So it's going to seem extreme to them. They're not going to have interacted with 15 dogs. They're not going to have experienced, you know, 150 thunderstorms or something. So they don't have as much data to say, well, this fits, this is what I should expect, or this is an, this is an anomaly. They tend to think in all or nothing terms, and that's okay because that helps them survive up until the point that cognitively they are able to start looking at the grays, if you will, the in betweens, the exceptions. And you can go back and review Piaget's stages of cognitive development if you want to really see the times that thinking really starts to change. But it is important to recognize that children don't. Young children just aren't capable of automatically coming up with other perspectives and explanations. When we see through that same lens, it helps us understand people's reactions and interpretations. Just like I was talking about with the blue blocker glasses. If you don a pair of blue blocker glasses yourself, then you'll understand why the person had no idea what you were talking about when you were trying to point out the blue flower. It looks completely different, same thing here. When you go through a client's autobio autobiography with them and you try to understand life based on their experiences, if they grew up in a home that was rejecting, that was violent, that was emotionally and. And physically neglectful, then you may understand better their reaction to current situations than, you know, if you're taking it from your perspective where, you know, you didn't experience those things. Have people write what I call an anchored autobiography in order to provide a basis to explore current reactions. I have them think back to their very first memory, whatever they can remember. And for some people, that may be, you know, 13. For other people, that may be four, whatever it is for them. And then every year, they have a different page for every year from that point all the way forward. And if they can't remember ages, then grades are really good. If you have them think about, you know, first grade, do you remember what life was like in first grade? Who was important? Who was involved in your life? Where did you live? What were the most significant experiences that year? You know, maybe tell me about what happened at Thanksgiving or Christmas or your birthday. And then, you know, go to second grade, then third grade, then fourth grade. Sometimes there will be. You'll hit a grade like 8th grade where there's nothing. It's just blocked. And that's okay. Just encourage them to leave that page blank and go to the next page. But this helps them start recognizing in a coordinated fashion, the experiences that they've had that have helped create who they are. And I'm not talking about just negative ones. I want positive ones, too. I'm like, I want to know what was the best thing that happened this year and maybe what was the worst thing. So have them discuss their positive and negative experiences in relationships and environments that have impacted their current feelings and behaviors. Looking back over their own autobiography. And you can do this in group, where people keep their own autobiography. They don't have to share it with anybody, but then ask about positive experiences. You know, who can share a positive experience in their past and in. With their parents or in. In a. In a personal relationship? Who can share a positive experience in the past of, you know, doing something that was hard and succeeding? Encourage them to start looking back at those things. You can also explore autobiographies for themes of abandonment, rejection, failure, safety, loss of control, and. And the opposite. Help them look through and see what experiences they've had. Because most people have had both rejection and acceptance. Have had both failure and success, have had both loss of control and a sense of control. Maybe some of those experiences are few and far between, but they have had them and we want them to draw on those and start understanding the connection between their reaction to current situations and their past, but also recognizing that if, for example, they have a lot of abandonment fear right now, they can look back and understand prior relationship experiences where there have been abandonment issues. But hopefully they're also able to look back over prior relationship experiences in which there were not abandonment issues. A lot of times we pay attention to the things that are painful, that are negative because we want to protect from those, but we don't notice the other things. They have less, what they call emotional valence. We don't notice the people that didn't abandon us. It's important to highlight those people and then help them adjust their schema. So instead of feeling like all people always abandon me, they feel like it's okay. Transference can be positive or negative. Have people think about their best and favorite times and people. And this is kind of an extension of what we just talked about and their worst and disliked times and people. If you remember from the Sound of Music Raindrops on roses she talks about raindrops on roses Whiskers on kittens Bright copper kel kettles and warm woolen mittens Brown paper packages Tied up with string these are a few of my favorite things when the dog bites when the bee stings When I'm feeling sad I simply remember my favorite things and then I don't feel so bad and yes, you're welcome that I didn't sing that today. I've had people actually go through and rewrite that song with their own words with things that make them happy. And that is really great for creative people because a lot of times if we have something that's to a song, we remember it and we tend to sing it more often. But some people aren't down with that. And that's cool too. When people identify situations where they have all or nothing thinking, they're thinking about the worst things that happened in their life, you know, abandonment or failure or rejection, then we can look and say, okay, those happen. Those were awful. Those were terrible. Let's look for exceptions. Let's look for other times when you were safe. You know, we're talking about times you felt unsafe. Let's look for exceptions to that unsafeness. When were you safe? Maybe you felt safe when you went to your great Aunt Sally's house. Okay, what was different? Let's. Let's talk about great, great aunt Sally for a minute. Transference issues. Transference feelings. Transference reactions can be triggered by sights, smells, sounds, and situations. When we are, you know, in a situation with someone or, you know, maybe sitting in a waiting room, we can start to feel unsafe. If somebody walks in that reminds us of someone who hurt us in the past, we can be triggered by somebody who moves. You know, maybe they walk like somebody or move like somebody from our past. Maybe it's the environment. You know, we've been in a, a room like this before. We've been in a, you know, going into an old house or going into a church or a school may trigger feelings from our past. I've worked with a lot of, over the years in prevention programs who have said that, you know what, there's just, there's no way that I'm really not motivated to participate if you hold it at the school. Because even walking into a school brings back tons of awful memories for me. You know, school and me, we didn't, we didn't work so good together. It's important to recognize how, just how environments may trigger resistance or treatment, non compliance or anxiety in people. We want to look how an environment, you know, like a school may trigger a feeling of unsafeness, even if it's not the same school. You're working with an adult now, and you're asking them to come participate in a prevention program at a school they never even went to. But walking into that school, seeing those lockers just puts them right back into whatever school they were when they were, you know, 12, 13, 14, and being stuffed into lockers or failing or whatever it was that was going on. So it can trigger those memories, which means they may feel like they're right back in that moment. Smells are the same way the cleaning smells, the smell of the air, the smell of, you know, an old musty building. Whatever the smell happens to be. Sounds, you know, school bells, fire alarms, the sound of people's voices. Sometimes you hear somebody and it sounds like somebody that you once knew. And that can be good or it can be bad. And then just simple situations like going to the doctor, going to bed, or going to a school can trigger anxiety in people or can trigger anger or fear or a sense of unsafeness because in prior situations they have felt unsafe. And I shared with you, during the swine flu epidemic, we had to take our kids, you know, all the way up to Tallahassee in order to get the swine flu vaccination. And unfortunately, it was a very unpleasant experience for both of my children because the person administering the shot was not gentle. About it in any way, shape or form. So now, whenever they have to go get a shot, their first reaction is one of anxiety, is one of unsafeness because they're afraid of pain. Again, it's important for them to go through the questions we're getting ready to talk about to recognize that this is not necessarily the same situation. And recognize, reflect on the times they've gotten shots, that it hasn't been so bad. It's never a walk in the park, but reflect on the times that you know it, it hasn't been a horrible situation. To allay their anxiety, encourage clients to review current situations that trigger dysphoria. And I use that term in general because depending on the patient, it may be anxiety, depression, anger, guilt, grief, resentment. Explore how those situations are, are shaped by prior learning. Explore how their reactions in the present are shaped by prior learning. When you, you know, if you have an issue with authority figures, for example, you know, how is that shaped by prior learning? What experiences did you have with authority figures in your past that made you feel unsafe, so now you are apprehensive and passive, or, you know, get really anxious around authority figures? Now it's vital for people to be aware of how thoughts, emotions, and reactions from their past experiences can translate into thoughts, emotions, and reactions in the present. You can do flip chart papers around the room if you want to, to get people up and moving and, and put different situations that may trigger anxiety in people on each one of those flip chart stations and have people identify what sorts of situations in the past might make that situation in the present feel threatening. So thunderstorms, if they've been through a tornado, for example, then, or a hurricane, then a thunderstorm may feel threatening. You know, dogs. And it's also important to recognize that it can make people feel the other way too. Thunderstorms. Before the tornado, I used to love thunderstorms because I used to like to watch the lightning in the sky. And I remember, you know, sitting with my grandmother and watching the lightning dance across the sky in the, when we would have, you know, thunderstorms in Florida, which happened like every day. So thunderstorms can bring elicit positive feelings or negative feelings. Dogs can elicit positive feelings or negative feelings in people drinking alcohol. You know, if you came from an alcoholic family or were around somebody who became abusive when they drank alcohol, then obviously that would probably trigger negative associations. So when you see somebody drinking alcohol now, you may accept, expect that things are going to go south, or if you've had positive experiences with people when they drank Alcohol, you may expect the opposite. Raised voices, you know, this is the last one I'll do, and then we'll move on. Can indicate to people who grew up in violent households that there is a threat, that there is danger, or to people who grew up in a household like mine, where we were just loud, it could indicate frivolity and glee. You know, the louder things got in our house, the more fun people were having most of the time. So raised voices mean something different to me than they mean to other people. And it's important to recognize that each one of these things could mean something positive or could mean something negative. But it's important for each person to recognize what it means for. For them. Addressing transference. The first thing we want to do is start with mindfulness, increased mindful awareness. Have people write down, or you can do it on the flip charts. Anger, anxiety, and depression. What are your physical, affective, and cognitive signs of anger? And you may need to prompt them a little bit, reminding them that affective means emotional. When you start to get angry, what is your first sign that your physical sign that you're starting to get angry. What is your first physical sign that you're starting to get anxious? What is the first physical sign you notice when you're starting to get depressed? And go through each of those. So people become more aware of the early warning signs that they are starting to feel a dysphoric emotion. So they can stop and check and say, okay, I. I feel like I'm starting to get depressed. I wonder what's going on here. Have them start developing mindful awareness slowly. I recently worked with a clinician who had a client that dissociates pretty much all the time. And, you know, I encouraged her to have the client start using hash marks when she would come out of her dissociative episodes to identify how many times that that was happening throughout the day and for how long so we could get a better baseline than just all the time. But it became very apparent that this person was unfortunately dissociating, you know, 15, 16 times a day for, you know, long periods, not just for like a second, for several minutes at a time. And it was important to start developing mindful awareness for. For example, you know, she found that one time she was cooking and she was practicing mindful awareness. She was noticing everything that she did. She was talking herself through it, talking herself through, noticing the smells and what she saw. And she started feeling herself getting anxious. You know, before she wouldn't notice those early warning signs, she would just be Cooking and then all of a sudden dissociate and, you know, come back out of it several minutes later. But what she recognized was she started feeling anxious when she was cooking, and she thought back and worked with the therapist to identify the fact that when she was little, when her mother would be cooking and she would go into the kitchen, she would get in trouble and she would get beaten. So being in the kitchen and smell certain smells that reminded her of her past, like when she was cooking certain dishes, would trigger a dissociative episode. So it was important for her to connect those memories and say, okay, now I understand why I'm dissociating now. Now what do I do about it? And we're going to get there in a minute. But when we talk about developing mindful awareness, slowly have people identify times, you know, concrete times that they can say, okay, I'm going to practice being mindful while I'm cooking, while I'm eating, while I'm just sitting, while I'm waking up or going to sleep. You know, it doesn't have. It can be for like two minutes. It doesn't have to be for a long period of time. But having people regularly check in with themselves throughout the day helps them start to become more mindful and aware of how they're feeling. So they can check in for these early warning signs of anger, anxiety, and depression. Once they notice that they are starting to feel a dysphoric emotion, whatever that is for them, have them identify how the current situation is similar to and different from prior situations like this in the sight, the smell, the sound, and the situation. So looking around, encouraging them to notice what's different. We'll stay with the woman who used to dissociate when she. She was cooking. The sights that are similar, she's in the kitchen, the smells that are similar, you know, maybe it was what she was cooking, the sounds, you know, one of the things that she had identified was if she would drop pans or make loud noises in the kitchen while her mom was cooking, that would be sure to trigger an episode. So if somebody dropped something, you know, dropped a pan or dropped a fork, the sound, that sound that made it would cause her anxiety to start going up and she would recognize, okay, this is similar to times in my past when I was little, that and I would get beaten. However, what's different in this situation, I'm in my own house. I am safe now. I'm an adult. There's nobody that's going to beat me. And encouraging her to notice what was similar and triggering it, but also what was different? How are you the same as you were then? Recognizing that she still feels vulnerable. She's. There's still a part of her that is representative of that wounded child. But how are you different now? Well, she's older. She is not subject to having to stay in a situation in which she is being abused or neglected. And what are the facts for and against the thought that you are currently not safe? So if you start. She starts feeling anxious when she's cooking, Checking the facts for and against the thought that she is currently not safe. Looking around, reminding herself, you know, in this particular situation that she is safe, and scanning for anything that would indicate that she's not. And generally she wouldn't find anything. So all of those things were helpful physical safety at home, work, car, and in treatment. And this for this one, I do like when I'm doing it in groups, to have the stations around the room have people identify how they can moderate triggers for physical tension. You know, when you have your muscles all tightened up and your jaw all tight, what can you do to moderate those triggers so you feel physically safe? Mindful awareness is one of them. Just noticing when you're clenching your muscles, deep breathing to help trigger that rest and digest response. Those are two things that people can do. What can you do to help yourself feel more relaxed? And sometimes these overlap. What you can do to moderate the triggers for tension. But sometimes they'll come up with new things, sights. What can you do put so you can see, so you feel more relaxed at night? I feel more relaxed when I can pull the blinds down. I hate being in a house, even in the middle of nowhere on the farm. And having the blinds, you know, the windows wide open in the middle of the night, when I see my own reflection but I can't see what's outside the window freaks me out. So I know for me. For me to feel more relaxed, for me to feel safer, it's important for me to pull the blinds. People who, you know, what do you want to see? Who do you want to see in your environment that can help you feel more relaxed? For me, and he's not a people, but having Brewster Boo Boo, my boxer around, I feel a lot more relaxed. Because in the back of my mind, I really believe that if I was ever actually in danger, he would eat somebody up. And if not, the little rat dog certainly would try. Light levels can help people feel more relaxed. Sometimes people have been abused in situations where there was a lot of low light. So raising the Light levels can help them feel more relaxed. Sounds including volume. Now remember that for people who are neuro atypical, who people who are on the autism spectrum, they may be especially sensitive to light. Light intensity, light flickering, the volume of sounds, the intensity of smells, and all of that can be very traumatic or unsafe feeling for them. So we do need to pay attention to the individual. And what sounds can help them feel safer and calmer? What smells can help them feel more relaxed? There are a lot of essential oils that are supposed to help people feel more relaxed. And I've, as I've told you before, it works for certain scents, work for certain people, but you can't say that. For example, lavender works for everybody. So it's important for people to try and if smells don't really do it for them, that's okay too. It's important for them to be aware though. And behaviors, what other physical behaviors can you do to help you feel physically safe? Breathing, meditation, calling a friend, go on a walk, locking the doors. You know, there are a lot of physical things that people can do to increase their sense of physical safety, affective safety or feeling emotionally safe. We want to moderate triggers for dysphoric emotions. So we want to eliminate or moderate sights, sounds and smells that might trigger anxiety, anger, irritability. But we also want to add in the sights, sounds and smells that can help people feel happier and, and calmer. We want to add triggers for happiness if it's, you know, silly cat videos or whatever it is. Cognitively people need to be able to feel safe at home, work in their car, treatment. You know, those are four distinct areas. So how can people moderate unhelpful or distress intolerant thoughts? And remember, there's lots of videos on the YouTube channel about DBT skills and using distress tolerance skills and emotion regulation and handling distress intolerant thoughts. But it's important for people to identify what can they do if they notice that they are starting to have thoughts that are telling them that they're unsafe? How can they work with those thoughts and what can they do to help themselves think more positively? Sites guided imagery and thought rehearsal, relational safety and at home work in their car, treatment in their car, if they carpool or, or ride the metro or something. How can you moderate triggers for abandonment fears or low self esteem? You know, being physically attacked by others is up there in the physical safety. Relationally we're really talking about acceptance, love, belonging and what can you do to help yourself feel confident and loved. That can include self esteem, activities, assertiveness and interpersonal effectiveness skills. From the moment we're born, we start gathering data about our world. We remember sensory cues that indicate safety and threat. Once learned, those cues continue to trigger emotions, thoughts, and behaviors designed to ensure continued survival. There is a purpose. There is a function to our reactions. Those cues, unfortunately, often become over generalized. So you might think all dogs are dangerous. Helping people become more mindful of the present moment instead of relying on old unchecked data can help them feel safer. Notice I said unchecked and not unreliable. The data may still be very reliable. We don't know, but it's important that they check it and evaluate. How is the situation similar to and different from a situation that was threatening or dangerous in the past? Are there any questions.