Vulnerability for the Wrong Reasons?

Vulnerability is powerful! Championed by heart-centered leaders like Brene Brown, Simon Sinek, and Michelle Obama, we’ve taken notice of how it can pave the way for authentic leadership and deeper connection. Vulnerability has its place in allowing people to feel seen. Learning to lean in to the discomfort to grow, It can serve as a catalyst for change. 

I myself have experienced the positive power of vulnerability as a leader. Yet what if there are times we embrace vulnerability for the wrong reasons? To manipulate others? Forced intimacy to get our needs met? Learned helplessness to be seen and cared for because we find we are unable to help ourselves? Showing up in the form of:

People Pleasing.

Co-dependency.

Manipulation.

It’s not uncommon to support vulnerability as a meaningful tool after trauma. For some, it starts with addressing the absence of vulnerability in a person wanting to feel strong, independent, and in control. For folks with mental health diagnoses of Complex Post-Traumatic Stress Disorder (C-PTSD) and Borderline Personality Disorder, vulnerability within relationships can feel even more complicated.  C-PTSD, for example, recognizes the impact of repeat relational trauma that challenges a person’s sense of safety and security. The unpredictable environment of not knowing if their needs will be met, when they will be met, or how often. Attachment trauma. Rupture with no repair. If vulnerability has the capability of bringing people closer together, can it manifest as a learned behavior with significant consequences? 

As a therapist, I find myself worried that vulnerability can be contrived in response to trauma, pressure, and pleasing of others. Concern that individuals who have had their boundaries violated will embrace vulnerability as a tool but not recognize the risks. What are the consequences of strategic vulnerability for agenda-driven reasons? Perhaps the person receiving the fabricated expression of vulnerability finds it draining or false. Individuals engaged in forced vulnerability to get their needs met may find themselves in burnout, resentment, or fatigue. By embracing inauthentic vulnerability, are we unknowingly elevating our risks of being physically or emotionally hurt again?

With these challenges in mind, I continue to engage clients in an energy wheel exercise in order to explore their relational boundary work each week. Presented as slices of pie, I ask them to map out their energy dedicated to various tasks each week, both personal and professional. Emphasizing relational energy, I encourage clients to remain curious by asking, “what’s my energy pie look like today?”

In the example above, the client indicates spending a lot of energy in Week 1 pleasing her father by spending time with him, meeting his needs, and putting out emotional fires. By actively practicing boundary work over the next several weeks, the client indicates a more balanced energy towards her primary goal of finding a job. By processing the shift in energy, the client recognizes an increase in self-confidence and improved well-being in not feeling as drained by the interactions with her father. This discovery not only reinforces her motivation to continue her important boundary work with family members, it also helps her explore her relationship with vulnerability.

As we can expect, boundaries and vulnerability go hand in hand. From a trauma lens, boundaries and vulnerability are equally challenged by the maladaptive coping skills we develop to survive a threatening experience. Therefore it is important to explore a client’s relationship with vulnerability, identifying how they feel about it, when they embrace it, and how it can serve as an opportunity to bring them closer to connection in healthy relationships while protecting them against unhealthy patterns.

Estrangement Energy: A Cycle for Ruptured Mother-Daughter Relationships

It’s a pattern of devastating hurt. Safety and security are risked again and again. First introduced as the evil step mothers in Cinderella and Snow White, we have even more extreme portrayals of unhealthy mother-daughter relationships such as in White Oleander, Flowers in the Attic or The Sixth Sense where Mrs. Collins poisons her daughter Kyra to get attention from others. Characters we learn to hate due to their psychological and sometimes homicidal behaviors and repeated abuse of their offspring. These characters represent dramatic examples meant to produce an emotional reaction and feelings of protection by the audience for the daughters who are survivors of such abuse.

What about the real-life experiences of attachment trauma? The phenomenon we see for complex trauma survivors who open up about their experiences of their mothers being less than loving? In working with dozens of women over the years, it has become clear that the damage done in a ruptured mother-daughter attachment has long lasting effects. Powerfully captured in Dr. Karyl McBride’s book, Will I Ever Be Good Enough?, daughters go through patterns of grief and loss, questioning their own worth due to the spoken and unspoken messages of their mothers. If young children worry that their parents’ divorce is their fault somehow, it’s not surprising that an adult child of an estranged mother may also feel some sense of responsibility for the damaged relationship.

The responsibility and grief they feel may spur them to come to therapy to find some peace with the estrangement. Let’s take a look at several examples of adult women who are estranged from their mothers after the painful realization that the relationship was unhealthy, unsafe, or unable to shift in ways that felt empowering and worthwhile.

Kendell* has been estranged from her mother for more than 16 years. She left home at 15, got pregnant at an early age, and consumes alcohol daily to calm her nerves. Kendell is a committed mother to her four children, stating she wants to provide for them in ways her mother couldn’t. When engaging Kendell in her trauma work, she recognizes her mother’s mental health challenges prevented affection and her mother saw her as competition for the men she dated, leading to conflict and verbal or physical altercations until Kendell left the family home.  Kendell struggles with being gaslit by her mother who still tries to call her occasionally and has enlisted Kendell’s younger sister to convince her that it’s all “water under the bridge now.”

Nicolette* is celebrating seven years sober from heroin. She has identified her childhood consisting of her mom criticizing her looks, weight, and intelligence. Nicolette’s experience with her mom captures a pattern of manipulation through her teenage years which led her to believe she was flawed, unlovable, and mentally ill. She found herself marrying a controlling man and suffering from various addictions until she was able to get a divorce when the relationship turned violent. Although Nicolette entered substance recovery programs voluntarily to get well, her mom accused her of relapse throughout her sobriety, even physically assaulting her and getting Nicolette arrested under false charges due to her stigmatized label as a former drug addict. Nicolette struggled to release herself from family ties in spite of the abuse, believing she had to work harder to earn her mom and other family member’s love. She has been estranged for four years now and finds herself questioning the estrangement 1-2 times per year, asking herself if there was more she could have done.

Sophia’s* father reconnected with her as a teenager, dying of a rare cancer not long after. Raised by a mother who struggled with poverty, mental health, and substances, Sophia was left to take care of herself and her younger brother in their rural upbringing. Sophia was determined to find independence, moving out on her own and pursuing a career as a helping professional. Sophia currently struggles with high anxiety and demands for control. She doesn’t like change and finds herself on edge and reactive when anticipating outreach by her estranged mother every holiday. She struggles with perfectionist tendencies and rigid thinking. Sophia’s goal is to have stability for herself and her family and she maintains strong conviction to remain estranged from her mother. Sophia prides herself on building other meaningful relationships that feel supportive and loving. 

Each of these women’s stories is unique and their own yet they have something in common, the grief and loss patterns associated with the ruptured mother-daughter relationship. Some daughters are left wondering if they could have done more to salvage or repair the relationship with their mothers. Others hold anger and determination to be nothing like their mothers. Their therapeutic work could begin with questioning their own role or actions. Or perhaps they have concerns about other relationships present in their life. They may work through the core beliefs of feeling unlovable, unworthy, or a failure in believing they were unable to earn their mother’s love or affection. And eventually, with time, they may redefine their identity without a mother in their life, embracing their strengths and boundaries to support healthy, meaningful relationships with others. 

Estrangement Energy, what I call the process for individuals doing this deeper work, can feel exhausting. Here’s the pattern I’ve witnessed in many clients over the years. 

·      There is a cycle of abuse or patterns of negative behavior that have happened for years between daughters and their mothers.

·      The cycle of negative interactions contributes to how the daughter measures her self-worth.

·      There is questioning if this pattern will ever shift, improve, or change for the better, especially when the daughter is aware that other mother-daughter relationships look different than their own.

·      The relationship rupture happens when the daughter has had enough. She makes moves to distance herself from the pain or abuse experienced in the relationship. 

·      With space or at the urgings of others in her life, the daughter is prompted to remove the relationship, labeling it as “toxic” and estranged.

·      The daughter tends to pursue therapy after the estrangement has happened or is in the process of happening in response to immense hurt, pain, and grief reactions that result from the estrangement.

·      Grief and loss followed by new identity development is done in therapeutic settings or through self-discovery over time.

·      A new sense of self emerges, with deeper work on self-worth related to core beliefs of being lovable and worthy in relationships.

·      The Estrangement Energy Cycle can be triggered to continue if current relationships mirror the estranged mother-daughter relationship, leading to resumed questioning of self-worth.

As you can see from this cycle, it can be an emotionally challenging if not draining process to work through estrangement and what it means to an individual. It’s not an easy or fast process, so here are some ideas to help clients do this meaningful work:

·      What’s Your Impression? Understand that some clients will be worried what you think of them as they share their grief and loss of the mothering relationship. Remain curious and neutral, exploring how these worries can become part of the therapeutic process.

·      I’m Second-Guessing Myself. It’s not uncommon for a client to question if the estrangement is still valid after a period of time. Like Nicolette mentioned above, perhaps they find themselves checking in to see if the estrangement still feels right. Normalize the experience of questioning and hold space for them to evaluate the pros and cons of resuming contact.

·      Reconnection or Relapse? Some of your clients will move from thinking about rekindling an estranged relationship to giving it a try. As therapists, it is important that we do not force our own values on our clients, instead supporting them through the process of outreach and connection with their estranged parent while encouraging healthy boundaries, safety needs, and deeper processing in weekly sessions if needed.

The bravery of daughters and clients who choose to work on themselves in order to heal the attachment trauma they’ve experienced is both powerful and inspiring. My hope is that this introduction to theEstrangement Energy Cycle can support both clients and clinicians alike in the journey to being one step closer to healthy self-worth and a renewed, empowered sense of self.

*Client information has been changed to protect confidentiality.

Avoidance and Attendance: Advocating for yourself

It’s that time of year. The time where you might feel the urge to disengage from therapy in response to the season, holidays, or stress.  The time when you may need an appointment the most in order to support you through trauma, family conflict, isolation, and loneliness. For some, the crises seem to intensify during the holidays. Perhaps you are experiencing depression symptoms due to the winter weather or maybe you are battling loneliness in spending the holidays away from your loved ones. Perhaps you are attempting to navigate the unwanted memories of trauma during your family’s holiday dinner or are experiencing high anxiety because of money stress and holiday shopping. You on your journey to sobriety and anticipate having to navigate holiday parties around family and friends where temptation may lead to relapse. Combine these stressful situations with your ability to cope and you may feel you can engage in therapy fully to receive support, or in some cases, desire to disengage in response to the overwhelming feeling of all that is weighing you down. It can feel like a balancing act to engage your supports when feeling stressed, but rest assured, it can be an empowering experience to engage in through the holiday season in support of your personal and relationship goals.

Avoiding Appointments

The more easily measured type of avoidance when overwhelmed is a change in attendance in your scheduled sessions. Perhaps you find yourself canceling sessions when in the past, you’ve been consistent in attending each week. Or maybe you find yourself cancelling last minute due to feeling like you need to use that time or money for another task? How do you explore your needs when you haven’t been able to justify spending the time or money on your own mental health? Depending on how your therapist structures sessions, you may want to consider advocating for yourself in exploring the following:

• Completing a phone call with your therapist to communicate what is going on in your world and attempt to re-engage in sessions to support managing your stress.

• Engaging in a phone session instead of a face-to-face to explore and address present stressors if you are unable to attend in person.

• Identifying a different appointment time that encourages attendance such as an early morning before work or later evening if appropriate and depending on if your therapist has openings at those times.

• Identifying biweekly or monthly sessions for the holiday season to account for financial constraints and time management.

• Reviewing your attendance contract with your therapist to explore opportunities and restrictions, such as possibly placing scheduled appointments on hold and resuming at a later time if appropriate.

Emotionally checking out

The hope is that with ongoing rapport, the conversations with your therapist above can support you with healthy communication and accountability when experiencing increased distress. Your relationship with your therapist, or rapport, becomes even more important when you find yourself engaged by your therapist around a lack of emotional participation in session. Perhaps you begin to notice that you struggle to arrive on time to your scheduled appointments, jumping into sessions with details unrelated to yourself or changing subjects rapidly throughout the scheduled time. Or maybe you remain surface-level in your processing, not dropping down into emotions and deeper meaning in session because you are avoiding the stress or have worries that it will become unbearable when talking about it. With healthy communication, you can name what’s going on for you and process the outcomes with your therapist. Here are some examples of how you might start the conversation:

• In response to running late: “I’m struggling to get here on time and it feels rushed lately, like we have to fit it all in. Can I talk to you more about what that’s like for me?”

• In response to staying surface-level: “I have to admit, it’s easier to talk about the lighter things than the deeper, more stressful stuff. I think I’m worried that if we talk about it, it will just make me feel worse.”

• To encourage connection: “I feel very disconnected from my body, like my head is fuzzy and floating and I just want to be numb rather than this stressed all the time. Can you help me feel more like myself?”

• To encourage feedback: “I’m needing something different in our sessions to help me. Can I talk to you more about that?”

• To name fears: “I’m afraid that if we talk about these things, I won’t be able to function or get things done afterwards,” or “I’m reluctant to talk about this now because we won’t have our next appointment until after the holiday.”

Any of these statements can lead to a supportive conversation with your therapist to further identify and explore your needs. These sessions can prove to be some of the most impactful and fruitful in not only holding space for emotion and processing of stress, but also supporting vulnerability and self-advocacy in exploring how you can engage all of your supports in ways that feel beneficial to you.

Hear me

Vulnerability is hard. Yet for many of us, the power of being seen, heard, and understood makes engaging in vulnerability worthwhile. Your therapist, engaging you from a place of compassion and empathy, can better understand your needs when you speak of them. Your therapist can offer a neutral curiosity with ongoing optimism conveys the message that, together, you can find relief. Whether it be concrete tools for coping or holding space for your emotions, your therapist can create a safety net to address any fear, guilt, or shame you may be harboring in these moments of distress. Engaging in holiday travel, consider your therapy sessions a roadmap to relief! With direction and insight, you can address avoidance and attendance from an authentic, supportive place to best serve you during the hustle and bustle of the holiday season.

“You are as amazing as you let yourself be. Let me repeat that, you are as amazing as you let yourself be.” Elizabeth Alraune

Mastering Mindfulness: Supporting Positive Coping

“I want to turn off my mind, catch my breath, feel less tension, sleep better.” The techniques of relaxation and mindfulness have been around for centuries, both in definition and in practice in various cultures. For some, the process of mindfulness describes being aware of your surroundings and slowing down your mind to remain in the present moment. For others, it has become a vital coping skill for anxiety or distress to allow grounding, emotion regulation, focus, and a sense of calm in otherwise difficult situations. So how does one present the ideas of grounding, mindfulness, or relaxation to clients in meeting their individual needs?

Explore the History

For many, the concept of feeling relaxed or calm is experienced rarely due to elevated anxiety or trauma triggers in everyday life. Perhaps you start a session with exploring the times they’ve felt more at peace or relaxed. Even if it were years in the past, this exercise can provide helpful insight into situations or context that allow your client small shifts or temporary relief from discomfort or anxiety.  Questions that might help you explore this with your client include:

• Can you remember a time when you felt calm and relaxed? Can you tell me more about it?
• How does it feel in your body to experience calm or relaxation? What sensations do you experience?
• What has helped you before in feeling calm or relaxed? What makes that different now?

Become Body Aware

Exploring the history of times a client has felt calm or relaxed is but one piece of the puzzle. Depending on the client’s background, trauma history, or the impact fight/flight/freeze reactions, their body may have adapted to the increased stress and cortisol levels in interesting ways.  Some clients will express increased anxiety or panic in response to relaxation, as it feels vulnerable or uncomfortable in their current, adapted state of functioning.  For others, a numbness may exist where they cannot feel their body with possible contributing factors including depression, hypoarousal/freeze response, or desire to maintain self-preservation. Lastly, clients may easily drop into intellectual conversation about their symptoms but avoid experiencing any sensation in their body due to anticipated discomfort or negative arousal.

Keeping client limitations and comfort in mind, it can be helpful to encourage clients to gently become more aware of their body through various therapeutic activities. It is suggested to start with neutral areas of the body and move quickly from one area to another to prevent exacerbation of sensation that would prevent progress or cause a client to retreat from noticing their body out of fear or discomfort. By engaging them in the following activities, you can support a client in building body awareness and distress tolerance in ways that feel safe.

• Body scan-start at your feet and notice any sensations as you move gently upward to your calves, thighs, hips, waist, etc.
• Concentrated body scan-have the client identify neutral or safe areas that aren’t associated with negative sensation like hands, knees or feet.  Have them focus on one area in detail, asking questions about temperature, sensation when touched, and encouraging the client to engage in use of textures and varying touch to explore sensation.
• Colored Glasses-our new favorite intervention from Dr. Dan Siegel in his book Mindsight, obtain or create colored lens glasses for clients to explore varying perspective of objects around them, insight into sensation in low-risk ways, and connection to memory that all support the practice of mindfulness.

Use all Five Senses

All of the above exercises support experiential learning in session. Another favorite tool that can support a client who experiences any negative sensation or experiences hyperarousal or flooding during a therapeutic exercise is to move their attention outside of themselves and into the room as a grounding technique. To do this, you can ask the client to become more aware of the chair underneath them or their feet on their floor.  A few of our favorite tools are listed below that can be helpful in engaging a client outside of their own body.

• 5-4-3-2-1: What are five things in the room that are blue? Four things you can touch? Three things you can hear? Two things you can smell? One thing you can taste?
• Four Elements by Elan Shapiro: 1) Earth/Grounding: what do you see/hear/smell, 2) Air: Take measured breaths, inhale for four counts, exhale for four counts, 3) Water: Take a drink of water, use gum/mints or think of your favorite food to generate saliva, which serves as a calming agent to activate the parasympathetic nervous system and relaxation response, 4) Fire/Light: think of a place real or imagined that makes you feel calm or safe. Can you describe it using your five senses?
• 5 Minute Mindfulness: have the client pick an object to focus on, either in their hands or within sight. Gently direct them to notice all qualities of the object including temperature, texture, color, height, etc. for five minutes duration.

Modeling of Mindfulness

In addition to the mindfulness exercises listed above, it can also be helpful to create a coping kit of objects that can be engaging and cater to all five senses for client use within your office. Many therapists utilize objects such as essential oils, lotion, touchstones, magnets, putty, carved wooden objects, fur, water, and sand to engage clients in mindful practice. As your client discovers which objects are effective for them to practice mindfulness, you may encourage them to purchase and utilize these objects outside of session as well.

Regardless of which tools or techniques you elect to use in support of your clients, it can be even more helpful to notice your own body and energy in the room. By becoming aware of your breath, posture, and energy levels, you can support client in feeling safe or supported to do this work. By practicing alongside your clients, you model what it means to feel grounded or mindful, which is beneficial not only to your client seeking relief, but to yourself as the clinician mindfully engaging each client in their meaningful work and progress towards health.

Safety Planning with At-Risk Families: Exploring the Benefits

Warning signs, safety measures, plan of action, and supports. These are all vital components of crisis response and safety planning in the field of mental health. Safety planning can be considered a helpful resource to assess safety needs for each family member and develop awareness of individual needs by loved ones when participating in discussion. It can also serve as an empowerment tool to allow advocacy and engagement in positive coping skills when the family is experiencing conflict. Due to family systems becoming more diverse to meet the needs of support and connection, the term family can be defined in non-traditional ways. Not only does it capture the nuclear or biological family, it may also comprise of blended families, extended family, step-parents, foster siblings, or “chosen family.” Chosen family can include but is not limited to, close friends, mentors, and godparents.

Bringing individuals together in their roles in the family system, it has become increasingly important to include all members in safety planning when addressing mental health and safety in order to unify the family and achieve meaningful results. In serving at-risk youth and families in the Denver Metro Area, safety planning has proven to be invaluable in exploring awareness of triggers for disruption and conflict, safety needs; thus engaging the family in exploration to foster empowerment and change. Safety planning allows the whole family to explore their needs rather than isolating one individual as the “identified problem.”

The Benefits

The benefits of safety planning can be demonstrated for one family of seven suffering from neglect, domestic violence, and substance use that lead to Department of Human Services involvement due to ongoing safety concerns. The family system consisted of mom Jenna* (36), boyfriend David (27), daughters Fiona (16), Margot (14), Patricia (6), and sons Julian (9) and Bobbie (2). Jenna and her family were referred to in-home family therapy due to safety concerns with Jenna’s Post-Traumatic Stress Disorder (PTSD) resulting in substance use, domestic violence with her boyfriend David, and neglectful parenting that was negatively impacting each child.

It was the hope of the Department of Human Services to support the family in reuniting and repairing their relationship now that Jenna was sober from substances and ready to actively parent in the household.

Observing and engaging the family in rapport building, it was quickly apparent which role each member played in the family system. Jenna was able to identify her challenges in parenting her children in that they were each struggling with her absence in different ways. Fiona identified her anger that lead to running away from home and engaging in fights at school. Margot reported being a strong student and keeping to herself in her room when not parenting her younger siblings in Jenna’s absence. Patricia was observed to be childlike with attention-seeking behaviors younger than her biological age, whereas her older brother Julian escaped into video games to remain unseen. The youngest, Bobbie, was observed to struggle with meeting developmental milestones and resorted to screaming and hitting himself and others when emotionally dysregulated.

Through engaging Jenna, David, and the kids in a safety planning therapeutic activity, they were able to begin to recognize each of their individual differences regarding warning signs, as well as the coping skills needed to support connection and emotion regulation.  Jenna began to learn more about her children and their needs through identifying warning signs such as isolation, anger, and behavioral changes signifying distress for each child at their developmental level.

Jenna also identified her own triggers and reactions to her children as they related to her trauma and urge to escape.

Connection

When Jenna couldn’t escape her PTSD symptoms through work or substances, she was able to recognize the increased risk of conflict and aggression leading to fights with her boyfriend David. The safety planning served as a tool of discovery for family members and empowered each of them to advocate for their needs through healthy communication. For Jenna and her family, the safety plan served as a means of taking action to support the family in times of conflict and crisis.

Through this process, the children felt heard, Jenna identified goals for ongoing individual therapy work to maintain sobriety, and David and Jenna were able to identify new ways of communicating as a couple in order to bring the entire family closer together. Safety planning can be introduced and implemented early in the therapeutic process to explore family patterns, coping skill needs, and foster trust and safety while empowering families to remain together, connected and aware. A safety plan template is available for professional use along with a suicide risk assessment called the Community Assessment and Coordination of Safety (CACS) at www.cacs-co.com.

*Names have been changed to protect confidentiality