THE NEUROAFFECTIVE RELATIONAL MODEL IN HISTORICAL CONTEXT
A brief historical summary will help the reader understand how NARM both integrates and departs from psychodynamic and cognitive psychotherapies, as well as from traditional somatic and expressive psychotherapies.
Psychodynamic Psychotherapies
Psychoanalysis and psychodynamic psychotherapies have established the significant influence of attachment dynamics, early family life, and personal history on the developing personality. The NARM approach integrates elements of various psychodynamic clinical orientations: ego psychology, object relations, self psychology, and the important recent developments of attachment and relational theories.
NARM departs from psychodynamic approaches, however, in how it clinically applies the understanding of these approaches. Whereas psychodynamic therapies focus on attachment and developmental themes with the perspective that the past determines who we are in the present, NARM explores personal history to clarify patterns from the past that interfere with being present and in contact with self and others in the here and now. It brings an active process of inquiry to clients’ relational and adaptive survival styles, building on clients’ strengths and helping them to experience agency in the difficulties of their current life.
While it is true that a psychotherapist must be able to traverse difficult affects with the client, in order to avoid regression the NARM therapist always supports a mindful dual awareness of past and present—staying anchored in the bodily experience of the present moment, NARM supports the awareness of the distinction between what was then and what is now. The focus is less on why people are the way they are and more on how their survival style distorts their experience and their life in the present. Avoiding the trap of making the past more important than the present, NARM uses a dual awareness that is anchored in the present moment while exploring cognitive, emotional, and physiological patterns that began in the past. The NARM approach of emphasizing the here-and-now expression of survival styles, rather than focusing on a person’s history, is a complex and intricate process that is detailed in Chapter 10.
Working with the NARM approach progressively reinforces the connection to self in the present moment. Using resource-oriented techniques that work to recognize subtle shifts in the nervous system adds significant effectiveness. Tracking here-and-now experience in the nervous system is fundamental to disrupting the predictive tendencies of the brain. Paying close attention to the process of connection/disconnection, of regulation/dysregulation, in present time, helps us strengthen our sense of agency, feel less at the mercy of our childhood experiences, and most importantly, it supports the re-regulation of our nervous system. It is in the connection to our body and in relationship with other people that healing is possible.
Transference Dynamics
Psychodynamic psychotherapies often advocate the use of the transference relationship to facilitate the repair of attachment wounds. Psychodynamic psychotherapists implicitly encourage their clients to re-experience their original relational dynamics within the transference relationship, believing that it is intrinsic to the therapeutic process.
Recognizing transference dynamics is an important aspect of the NARM approach as well. However, NARM’s nervous system perspective adds significant clinical interventions to working with transference. In early attachment dynamics, the baby’s nervous system is first organized in an implicit way, responding to and being regulated by the healthy nervous system of the mother. Because the process of attachment follows a nervous system–based developmental sequence, it is premature to focus on transference dynamics when self-regulation has been strongly impaired or disrupted by early trauma. The underlying deficits in nervous system organization must first be addressed. It is our sense that many of the problematic transference reactions that analysts and psychotherapists describe may be needlessly difficult, or even terrifying, because the therapist has not taken into account that the foundation of nervous system organization and regulation is not yet in place. A nervous system–based approach can avoid the re-traumatizing abreactions and regressions that are created when the transference is used as the primary vehicle for the therapy before clients have developed sufficient neural organization. Prematurely focusing on the transference relationship can quickly plunge a person into disorganization and distress. Tending to the basic organization of the nervous system is a fundamental element of working with transference processes that needs to be integrated into mainstream clinical interventions.
NARM works with the vulnerable preverbal and nonverbal elements of an individual who has suffered early shock or developmental/relational trauma. Individuals manage this kind of early trauma by developing the Connection Survival Style. These clients come to therapy struggling with the regressed elements of their personality and with ideas about themselves developed in response to early environmental failures. They need help to learn to self-regulate. Therapy for the Connection Survival Style can become re-traumatizing when it is not sufficiently titrated or resource oriented. On an identity level, using the transference relationship as the primary organizing principle may reinforce identifications with regressed aspects of self rather than release them. To regulate the nervous system, it is more effective to work consistently with the organized “adult” aspects of the self in order to integrate the disorganized, regressed “child” aspects. By supporting a dual awareness that is firmly anchored in the organizing here-and-now felt sense experience, we can explore adaptive survival styles that began in childhood while avoiding painful regression and abreaction and the trap of making the past more important than the present.
Somatic Psychotherapies
For the last seventy years, a cornerstone of somatic psychotherapy has been that our aliveness, vitality, and authenticity are accessed in connection to the body. The Western somatic psychotherapy tradition began with Wilhelm Reich, a medical doctor and psychoanalyst, as well as Freud’s pupil and later colleague. Reich was the first psychoanalyst to emphasize the importance of including the body in psychotherapy; his goal was to anchor in the body Freud’s belief in the biological foundation of the psyche. Reich believed that our biologically based emotions govern our psychological processes. He is best known for his insights on what he called character structures, which, he contended, are kept in place by defensive armoring, the muscular rigidity that is the protective response to living in emotionally repressive environments that are hostile to aliveness and the life force.
Building on Reich’s breakthrough understanding of the functional unity of body and mind, Alexander Lowen, MD, developed Bioenergetics, a somatic approach that included his own psychodynamically based character structure system. Lowen identified five basic developmental character structures, which consistent with the thinking of his time, were given names that emphasized their pathology: schizoid, oral, psychopathic, masochistic, and rigid. Lowen’s five character structures clearly tapped into a fundamental understanding of human nature and have influenced many subsequent body-based psychotherapies, including NARM.
Similar to Reich, Lowen believed that character structures were the outcome of thwarted drives. Wilhelm Reich and Alexander Lowen retained the pathologizing orientation consistent with the psychoanalytic principles of their time in that they emphasized the importance of working with defenses, repression, and resistance. Reich’s and Lowen’s therapies encouraged regression, abreaction, and catharsis. They both believed that the therapist’s job was to break through a patient’s character armor—the psychological and somatic defenses—in order to release the painful emotions held in the body.
Bioenergetics, for example, recognizes that deep emotion, conscious or unconscious, is held physically. It encourages clients to express their emotions through kicking, hitting, biting, and yelling, with the goal of discharging these powerful affects and in the hope that doing so will lead to greater emotional freedom and health. Reich’s and Lowen’s unique contribution was to recognize that defenses were held not only in the mind but also in the body’s nervous system, musculature, and organs. This significant breakthrough was ahead of its time and anticipated many current developments in the neurological and biological sciences.
The Reichian/Bioenergetic tenet of the functional unity of mind and body is consistent with NARM. NARM’s nervous system work, however, is much subtler, consistent with the advances in neuroscience research of the past two decades. We will see how using the two organizing principles of somatic mindfulness and mindfulness of adaptive survival styles can guide a gentle return to nervous system coherency with far less possibility of re-traumatization.
From a NARM perspective, intensely cathartic affective interventions can have the unintended effect of causing increased fragmentation and re-traumatization. Focusing on the pain, emptiness, or rage caused by early loss, neglect, or trauma does not in itself lead to healing. The orientation in the NARM approach is to use mindful awareness to help the client tolerate strong emotion, neither acting it out against the environment nor directing it against the self. Rather than being discharged through catharsis, powerful emotional and energetic states are contained so that they can be integrated and transformed into an increased capacity for connection. Mindfully staying present to and containing intense affect increases nervous system resiliency and supports the development of emotional depth.
Somatic Experiencing®
Somatic Experiencing® (SE) was originally developed by Peter Levine, PhD, and elaborated upon by the senior faculty of the Somatic Experiencing Trauma Institute, which includes co-author Laurence Heller. It is an effective short-term, bottom-up approach to therapy that supports nervous system re-regulation in the aftermath of shock trauma. SE is a step-by-step approach designed to treat shock trauma and the resulting nervous system dysregulation. It is a progressive and gentle approach that supports the biological completion and discharge of the intense survival energies of the body’s fight-flight responses.
Traditionally, SE does not focus on attachment, emotional, or relational issues as part of its therapeutic scope. NARM adds to SE by providing additional tools to address developmental, attachment, relational, affective, and transferential issues.
Gestalt Therapy
Gestalt therapy is an existential, phenomenological approach developed by Fritz Perls, MD, who early in his career was a psychoanalyst but later strongly rejected psychoanalysis. Gestalt’s phenomenological orientation involves paying attention to what the client is experiencing in the moment. From the NARM perspective, this shift represents a significant therapeutic step forward, because it addresses the client’s direct experience and moves the emphasis away from the endless exploration of personal history. Incorporating the role of the body and the importance of emotions, as Gestalt did, was a movement forward from psychodynamic therapies that ignore the present moment and the body. Both Bioenergetics and Gestalt encourage catharsis and emotional release. It is our experience that, for many clients, catharsis is not helpful and can even impair the capacity to self-regulate. The more traumatized and disorganized a person’s nervous system, the more likely catharsis can be re-traumatizing.
Cognitive Therapy
Cognitive therapy focuses on identifying cognitive distortions and their negative impact in our lives. This is an important contribution and brings the focus of the therapy into the here and now, emphasizing a person’s agency in his or her life difficulties. However, when dealing with developmental trauma, attachment difficulties, and early shock, the new understanding from the neurosciences supports the importance of working with affect regulation over cognition. Working with affect regulation and the nervous system is an essential element of the NARM approach.
Cognitive therapy introduced an important version of mindfulness to clinical psychological practice by helping clients examine their thinking and teaching them to interrupt and be mindful of their negative thought patterns. However, cognitive therapy does not address the nervous system imbalances that drive cognitive distortions; particularly when working with early trauma cognitive therapy is only minimally effective. In the case of the earliest Connection Survival Style, for example, focusing on changing distorted cognitions is particularly difficult because with early trauma, the cortex is not yet fully developed, and it is mostly the underlying bottom-up nervous system and affective imbalances that drive the cognitive distortions.
NARM presents a broader clinical application of mindfulness than is found in cognitive therapy by separating the story related to the distress states from the physiological distress itself. As the nervous system becomes more regulated, many cognitive distortions drop away. Elements of cognitive therapy are useful in working with the top-down aspects of the distress cycle, but particularly when working with someone who has experienced early trauma, it is essential to work with the distress cycle both top-down and bottom-up.
Affective Neuroscience
Significant developments in the field of neuroscience in the last twenty years have established and documented the biological foundation and psychological importance of affect regulation and interpersonal and social connection. Important developments in affective neuroscience include Stephen Porges, PhD’s research on the polyvagal system and his focus on the role of the Social Engagement System (SES); Daniel Siegel, MD’s interpersonal neurobiology, which clarifies the role of the neural substrate of relationship; and Allan Schore, PhD’s regulation theory, which documents the critical function of the right orbitofrontal cortex in supporting resonant contact and the repair of attachment wounds. These findings, as well as the research of other major neuroscientists, provide a scientific basis for the clinical approach that has been developing in NARM since the 1970s.
Esoteric Approaches
The limitation of what we take to be our personal identity is addressed in many esoteric traditions and has been popularized by well-known authors such as Eckhart Tolle and Ken Wilber. Psychodynamic orientations work to solidify the sense of identity and strengthen the ego, whereas esoteric orientations hold that Ego is an illusion that separates us from Being and keeps us from experiencing the spaciousness, fluidity, and fullness of our essential nature. Both perspectives are important. Esoteric approaches address the limitations of what they call Ego but generally do not incorporate the clinical awareness of the importance of attachment and developmental trauma in the creation of our sense of self. In addition, esoteric approaches do not address the primary role of nervous system dysregulation in the formation of the fixed identifications that come to be confused with identity.
NARM integrates both psychological and esoteric traditions and adds a biologically based approach that at times helps to solidify a person’s sense of identity and at other times supports the exploration of the fluid nature of identity. The NARM approach holds that the most immediate access to spiritual dimensions is The meditation technique of Vipassana is one important tool in the mindfulness process that can lead to the awareness and direct experience of the fluid nature of the Self. Because it is a powerful tool, however, it can potentially opens meditators to painful or overwhelming affective states that they are not equipped to process. We have worked with many individuals who during meditation retreats became anxious and overwhelmed by their emotions. Any system of self-exploration that does not take into consideration trauma and attachment issues and the resulting disrupted functioning of the nervous system creates the danger of dysregulating and re-traumatizing its practitioners.
One of Eckhart Tolle’s core principles is that nothing that happened in the past can keep us from being fully in the present moment. Although theoretically true, this orientation can be hurtful to those who have experienced trauma and suffer from significant nervous system disorganization. Traumatized individuals, which includes most of us to differing degrees, need both top-down and bottom-up approaches that address nervous system imbalances as well as issues of identity. Many people recognize the “power of now,” as Tolle calls it, but because of their nervous system dysregulation they are unable to remain in the present moment. Falling short of this ideal becomes another reason for individuals with trauma to feel bad about themselves.
A FUNDAMENTAL SHIFT
NARM utilizes elements of all the approaches mentioned above in a system that introduces a significant and fundamental shift in how these theoretical elements are applied. NARM holds psychodynamic, nervous system–based, and Eastern healing traditions as equally important and complementary. Building on and moving beyond the approaches mentioned above, NARM is a unified systemic approach that works with both developmental and shock trauma.
A Unified Systemic Model
Building on and adding to psychotherapeutic, meditative, and personal growth traditions, NARM offers an understanding and techniques that use connection to the parts of self that are organized, coherent, and functional to support new patterns in the nervous system. NARM is resource oriented, non-regressive, and non-cathartic. It works in the present moment with the felt sense using somatic mindfulness to help regulate the nervous system in order to support the increasing capacity for connection and aliveness. In this approach we see that it is in the connection to ourselves, to our body, and in relationship that we find healing regulation.
The NARM approach to growth and therapy is an antidote to deterministic approaches and maintains that the past does not determine the present. It is the persistence of adaptive survival styles along with the related nervous system disorganization and distortions of identity that negatively affect our present experience. Understanding adaptive survival styles provides practical tools and techniques to address these distortions of identity and nervous system dysregulation. Being present and regulated in our bodies helps us become aware of and disidentify from the many inaccurate ideas and judgments that we have about ourselves, other people, and the world.
