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DO NOT read further than this if you are not ready to . I'm going to share my thoughts on a very controversial idea (seriously, stop reading now). Again, stop reading if this is an idea you're not ready or willing to explore . Last chance. Or take a break and come back later. The blog article continues after the image. The uncomfortable, but empathetic truth is that your parents did their best. I posted this idea to my Instagram, which resulted in an explosion of comments, reposts, anti-posts, demands, anger, agreement, bookmarks, replies, a couple emails and DMs as well. I was personally attacked and personally supported. There were emotional responses (mostly against it or me), but also very measured responses. People agreed but didn't like my approach, my wording, how authoritative it sounded and on and on. And even a couple of measured responses of those that understood and simply disagreed with the premise and led to interesting discussion. I ended up archiving it on my Instagram, simply due to not being sure how I wanted to handle content that was potentially as triggering as this one. I think it's an idea worth delving further into and my blog seems like the best avenue. These are the important components of the substance of the idea: the #stucknotbroken paradigm behavioral adaptations how they were raised precontemplation stage of change lack of safety & co-regulation the vagal brake story follows state other components of change an uncomfortable truth an empathetic truth BUT FIRST To address a few concerns that came up: Am I trying to tell you to forgive? No. (I actually posted "You don't have to forgive" on Instagram on 12/3/19.) Am I telling you what is necessary for your own healing? Not at all. Am I telling you how to feel? Of course not. Am I telling you what to think? Nope. You can reject this. Am I excusing the parents' behavior? Not even a little bit. Am I minimizing the experience of the trauma survivor? On my end, I don't think so. Definitely not my intention or mindset in the least. In fact, people in the comments and my clients have found this idea to be expansive, more encompassing or even a part of their healing. So no, I don't think this is minimizing. Do I tell this to clients? No, it's a conclusion they come to when they are ready. That may not sit well with you, but it's true. And again, in the comments, this claim was echoed repeatedly. I believe this holds true not just for parents, but for all of us. I believe we all do "our best." This blog focuses just on the parents. And I believe it applies to all parenting situations. Some commenters had an issue with me calling it a "truth." Some didn't and agreed on the wording. But the fact is - truths do exist . Saying, "nothing is absolute" is an absolute statement . It's self-defeating and proves the fact that absolutes/truths do exist. "Everything is subjective" is an objective statement and self-defeating. As I wrote this blog, I kept in mind the worst and most evil situations I could imagine. On an emotional level, I wanted to agree that these parents were not doing their best. That they were simply choosing to be evil or were evil by nature. But I kept coming back to the fundamental pieces of what makes it someone's "best." So on an intellectual level, there's some disagreement with my emotions. It helped me to continue to return to the logical aspects of this. This is the discussion of an idea/truth, not of how to feel about it nor on what to do with it . You'll feel how you feel. And you'll do with it what you choose. So you could very well agree with what I am laying out and not emotionally accept it. That's totally fine. It makes logical sense, but I'm mad as hell and am not letting go of that. I have no problem with this kind of statement. Do you. And you can disagree with the premise itself. I'd be curious your rationale. THE #STUCKNOTBROKEN PARADIGM You must know by now that I think trauma survivors are #stucknotbroken. Not ill. Not defective. Very much normal like anyone else. But after surviving trauma(s), our autonomic nervous system can get stuck in a defensive state: flight/fight sympathetic arousal, shutdown or freeze. The same could happen to literally any of us. The Polyvagal Theory lays this out beautifully. I like the word "stuck" here in particular. Because if we're stuck, that means that we have momentum to move forward. As if you're walking along when allofasudden a wall drops in front of you. The walking along is the momentum of life. A natural, instinctive drive toward healthy development, healthy attachment, safety, happiness. The wall representing trauma. Something that slams down in front of you to stop the progression forward. But the momentum is still there . The natural, instinctive drive to find safety is still there. I'm imaging someone running into the wall repeatedly, maybe searching with frustration for a way around it or using a weapon against it, to no avail. Point is - the momentum is there. The progression of life is stopped or slowed in many ways, but the momentum to move forward is still there. I highly recommend Peter Levine when it comes to getting unstuck from trauma, his books and others I recommend can be found in my Recommended Reading page ( In An Unspoken Voice is my favorite for learning. Healing Trauma is great for self healing trauma). BEHAVIORAL ADAPTATIONS But just because the internal, natural momentum is there, doesn't mean the individual actually utilizes it, despite their best efforts. The wall isn't just the traumatic event(s). It's really the aftermath of the event(s). Long after the traumatic event(s) have ended, the memory persists - in the brain and the body. The memory in the body lives on as a dysregulated autonomic nervous system, one the survivor feels intensely as anxiety, panic, anger, rage, overwhelm, numbness, dissociation or depression. And in an effort to self-regulate, the individual may make adaptations to their behavior : addictions, self-harm and even harm to others, among many many other possibilities. So the first piece to understand is that the parents I'm referring to that did "their best" are probably survivors of trauma themselves . And they are stuck in their own defensive state and have made an adaptation in their behavior as a result to being in that state. That adaptation to their behavior could be many many things, including abuse/neglect to their own children. This doesn't make it okay. These adaptations can hang around for a long, long time. Even one's entire life. Think of the smoker that doesn't quit despite all evidence suggesting that they should. But the smoking is their adaptation to whatever they've got going on inside (not necessarily from trauma). Smoking, to this person, "works" or isn't a problem. They are not even to the point of thinking that their behavior adaptation is a problem. HOW THEY WERE RAISED It's easy to demonize parents (and perhaps they deserve this demonization) as if they are simply making a choice to harm their children. But this ignores the trauma of the parent . It ignores that parent has their own internal turmoil going on. Their own stuck freeze energy, felt as rage, panic or overwhelm. Or their own flight/fight energy, felt as intense anger, worry, anxiety. Or their own shutdown lack of energy, experienced as depression, numbness, isolation and disconnect. Combine this intense stuck energy (from their own trauma(s)) with the options they were taught on how to handle it . How many of these parents were explicitly taught or shown through modeling how to handle their feelings? To recognize their feelings? To express them? Did they have safe people to express their feelings to? Or were they taught/modeled to express these feelings by lashing out in anger? By controlling and bending others to their will? Or to recede into themselves and hide? Every parent I've ever worked with can identify in themselves where their parenting choices come from. They can see the multi-generational passing on of abuse. And the teens I work with can see the way they are being parented stems directly from the way their grandparents raised their parents. This component is nothing new or revolutionary. We all know that the way we were raised has a direct impact on the way we raise our own kids. If we don't parent mindfully, nothing changes from one generation to the next . PRECONTEMPLATION STAGE OF CHANGE The Transtheoretical Model of change has "precontemplation" right at the beginning. In this stage of change, the individual is basically unaware that there is a problem . They aren't even to the point of being able to think about making a change, because they don't see an issue. Just like the smoker I mentioned above. Or the alcoholic CEO that hasn't yet experienced the negative consequences of alcoholism. Or the abusive parent that isn't reported to CPS, while also feeling powerful and in control through their abusive behavior. I bring up these negative consequences because these are often what needs to happen for someone to begin to think about making a change. ER visits, seeing their children suffering, a spouse leaving them, developing medical issues. These natural, negative consequences can be valuable to someone that is able to learn from them. They can be valuable to someone that is able to take in and hold the pain of others and use it as motivation for change. They can be valuable to someone that cares about themselves enough to notice their own internal pain, hold it, and use it for motivation to change. I don't think negative consequences are the only path to getting out of precontemplation, but they're often the catalyst. The show Intervention is a good example of this. Part of the actual intervention is confronting the addicted person and laying out the natural consequences of continuing to choose the substance over their loved ones. The parents we are discussing here - do they have the capacity to learn from negative consequences? Were they confronted with negative consequences? Was anyone holding them accountable for their choices to harm their children? No, I don't think the children have that responsibility. There is another piece to coming out of precontemplation which I will discuss in the next section - safety and co-regulation. One of the rebuttals to my claim was that parents "know better" or knew of different options for how to parent. Or were told/informed that what they were doing was wrong. And I agree, I think these parents may actually know better. But that's got nothing to do with their willingness or ability to make change . Just because they may know of other parenting options, doesn't mean they're actually in the stage of thinking about using those or seeking out more information. That would be the "contemplation" and "action" stages of change. One can be in the precontemplation stage of change for a long, long time. Denial keeps us there, lack of consequences keeps us there, finding/using behavioral adaptations keeps us there, avoiding problems or numbing our minds with entertainment keeps us in precontemplation. But so does a lack of co-regulation. SAFETY & CO-REGULATION There is another piece to coming out of precontemplation. And that is co-regulation from safe others. It's a lot easier to make change when you have support . When you have encouragement, positivity and love. Think of Intervention again. The loved ones doing the intervention read from a letter they've written for the addicted person. The letter sets firm boundaries and expectations, but also comes from a place of deep, deep love and hope. The two go together. The parents we're discussing here who "did their best" - did they have co-regulation from safe others? Were others holding them accountable while also giving them their love? Were others giving them their hope and positivity? Did they have anyone in their life like this? No, I don't think it is the responsibility of the children to do so. Through co-regulation, we can climb the polyvagal ladder and get back into our safe and social state. Once there, we can reflect on our behaviors, our choices and set the intention to make better choices. Because we can empathize with the people we've harmed now. We aren't able to do so unless we're in our safe and social state. If we have enough access to our safe and social autonomic state (the ventral vagal circuitry), we can make new plans. We feel motivated to make change, to right our wrongs, to apologize and keep our loved ones safe. But we have to have a co-regulator or our own ability to tolerate distress and climb our own polyvagal ladder. A co-regulator is someone that provides cues of safety: listening, caring, warmth, gentle eye contact, smiles and a general sense of safety. When we are around these people, we are able to access the circuitry of safety. Once there, abuse stops. You can't be abusive while also in your safe and social state. It just doesn't happen. I don't even think you need to be 100% in that state; maybe just enough to hold onto your problem solving ability and your values to ground your decisions. The parents I'm talking about when I say "did their best" don't have access to their safe and social state. They are fundamentally incapable of acting from anything but their evolutionary defensive states. They do not have a co-regulator to help them be compassionate, empathetic or kind to their children. They may not even have a safe environment in which to climb their polyvagal ladder either. For a parent to not be abusive, they need to have access to their ventral vagal autonomic state of safety, connection, empathy and compassion. They need to be able to self-regulate or accept the co-regulation from a safe other. THE VAGAL BRAKE Now, one may say that their parent was very "bipolar." That they were safe sometimes, but dangerous otherwise. This sounds like an issue of the vagal brake, or the window of tolerance, or distress tolerance; whatever you want to call it. The capacity to tolerate moving down the ladder and self-regulating back up . A parent with a strong vagal brake can do so. A parent with a weaker vagal brake is going to have a harder time. A parent with virtually no vagal brake is basically never in their safe and social state. They are always in a defensive state. Without a strong enough vagal brake, the heart rate increases significantly, breathing gets more shallow - the body is primed for danger. The body is ready to run away or to fight. Thoughts follow and become more fear-based, more anxious or aggressive. So the parent who is able to access their safe and social state may not be able to hold it, due to many factors, some listed in this blog. Their drop into sympathetic flight/fight energy seems instantaneous. Once they neurocept danger, they are ready to run or fight. The neuroception of danger probably will come from something that is not actually dangerous. Not an actual threat to their safety. Like a child saying "no." A fairly typical, benign thing that kids do. Parents with a strong enough vagal brake will roll with it and get creative. Parents with a weaker vagal brake may become more controlling. Louder. Aggressive. (Their reaction to the their defensive state is extremely dependent on their own upbringing, what was taught and what was modeled for them.) Being in a state of safety doesn't just mean the parent was fun. It doesn't just mean the parent was exciting. It doesn't just mean they expressed their love. A parent who was in a state of safety - and able to hold it - would be gentle, approachable, exciting, playful, encouraging, soothing, positive, empathetic, compassionate and more. Not all the time; I don't think that's possible and seems an unrealistic expectation for parents. This "safe parent" would predictably be approachable . That's different than the parent who was more erratic and unapproachable. The one who is fine one moment, then the opposite at the drop of a hat. The safe parent is predictable. Their emotions are not seemingly random or "0-60." The parents who I am speaking about that "did their best" - did they have a strong enough vagal brake? Even if they knew better. Even if they had support. Did they have the vagal brake development to tolerate their own distress? STORY FOLLOW STATE The thoughts in our head match our autonomic state . "Story follows state" as Deb Dana says so perfectly . If we're in a safe and social state, our thoughts match. We see hope. Possibility. Goodness in others. We have loving thoughts about our kids. We empathize with them. The parents I'm referring to, that "did their best," are probably not having these types of thoughts. They're in a severe stuck defensive state, so their thoughts match. There is simply no room to have the types of thoughts necessary to make a change in their behavior, not while they are in that defensive state. Even if they learn new information. They may have just as easily dismissed it as nonsense. They knew best. They were "raised a certain way and they turned out fine." The new stories - of improved parenting skills, of how their children are being affected, of the possible consequences of their actions - these stories had no place in their state. These stories don't register with someone who is in a defensive state and has a compromised vagal brake. If anything, their autonomic stories probably reinforced their state - "You deserved it," "I wouldn't have to hit you if you would just listen" and so on. These stories are reinforcing. And that makes sense from an evolutionary standpoint. If you're in a flight/fight mode, thoughts need to be concise, concrete and decisive. If not; if you have to pause and reflect, you risk exposing yourself to the danger that is chasing you. No, this doesn't mean the thoughts are accurate. No, this doesn't mean the child is actually at fault. For the parents I'm discussing - were they able to take on new information? Did their autonomic state allow the mental space for new information? For self reflection? For understanding the pain they were inflicting? THE BIGGER PICTURE So we've got parents that have made behavioral adaptations to their stuck defensive state. Most likely from their own trauma which is still living inside of them. Which also leads to a compromised vagal brake. They may not have received appropriate modeling or teaching from their own parents (probably a multi-generational problem). Their thoughts match their state and don't have the space for self-reflection to make change. They don't have safe relationships with co-regulation and possibly not even a safe environment. All of these pieces result in this parent being stuck in the precontemplation stage of change. They aren't aware of a problem. And their thoughts are preoccupied with the faults of other people, what others need to change, who's guilty of what and what needs of their own are not being met (and so on). Or maybe they're even in the contemplation stage of change, but missing the other pieces required to take action and to maintain that change. Considering all of these pieces - is this parent capable of doing better if nothing else changes? No, it's not the child's responsibility to improve their parents' lives. Yes, we still hold parents accountable for their choices. No, this does not excuse a parents' behavior. OTHER COMPONENTS OF CHANGE Like I said earlier, making a change isn't simply about knowing more. There's a lot more that goes into making a change. A lot. We briefly covered being in a safe environment, having a co-regulator, self-regulation, thoughts of change and empathy/compassion. But here are some other components of change: feeling as if change is possible thinking one deserves change ( Thanks to Irene Lyon for this one) being confident in one's ability to hold onto change being able to tolerate the vulnerability of change the ability to set a clear goal and plan for change the ability to make incremental steps toward change the ability to sustain the changes one is making the ability to problem solve when things go wrong the ability to tolerate distress and frustration when things go wrong motivation and on and on... With the parents we're talking about... were they able to do these things listed above? I highly highly doubt it. If so, they wouldn't be in a stuck defensive state. And they wouldn't be abusing or neglecting their children. ARE THEY DOING THEIR BEST? So I ask you - Is this parent capable of doing better? In my estimation, no. They're not. In these conditions, they're just not. Are they doing their best? Yeah. They are. And it sucks probably. These parents are going to look a lot of different ways - neglectful, abusive, minimizing, invalidating. Some downright evil. When I say "their best" I'm not saying it's good in the least . I can see the issue here being with the words "their best." Because doing one's best implies that person wants to do better. That they are making an effort. And I know, with the parents we're talking about, that's probably not the case. There is no visible effort, therefore, they can't be doing their best. And that makes sense. But remember - if you buy into my paradigm of "stuck, not broken," this necessarily implies that the momentum to do better is there . Though unconscious and trapped behind a wall (or two or three or more), it's there. In my opinion, even with the worst of people. I recommend watching the second episode of Larry Charles' "Dangerous World of Comedy" on Netflix. There's a very brutal/touching example of a warlord/mass murderer/human sacrificer who makes a huge change, stops his killing and turns to being a minister (if I am remembering correctly). Point being - even if the conscious choice to do better isn't possible, I believe the energy to do so is still there. So in that viewpoint, yes, they're doing their best. They just can't access their will or their latent ability to do better. Maybe even at all. But we have to assume the best of people. We have to assume that people have goodness within them, even if they can't access it. That's if you are with me on "stuck not broken." If not, then you don't have to assume people have good within them. Or that they are stuck and can do better. Your parents, without this belief, are indeed evil and that's all there is to it. If you're a therapist and don't believe people have good within them, I'd be very curious to see how you reconcile that with our basic tenet of "unconditional positive regard." No, this doesn't mean we have to accept their behavior. Yes, they should still be held accountable for their choices. No, you do not have to forgive. No, you do not have to sacrifice your own boundaries or safety. Yes, we can assume there is good in someone while also keeping them at a distance if necessary. Now if a parent is capable of doing all of the things from my non-exhaustive list here in this blog and they still choose to abuse , then no, they're not doing their best. I have yet to work with a parent that fits that bill. I have yet to work with a child who has one of those parents. I can't even fathom of a parent (or anyone for that matter) who harms others while also in their ventral vagal, safe and social state. That's like saying a square can be a circle or a bachelor can be married. AN UNCOMFORTABLE TRUTH I know this is uncomfortable to say the least. To think that parents who are downright acting evil are "doing their best." When I say this phrase, it's referring to their potential to do better. If they cannot do better, then by definition, they're doing their best. This is the logical aspect that makes sense, but doesn't emotionally sit well at all. I get that. And I am not attempting to change your feelings. Those are yours. You hold onto those. They are there for a reason. Be as angry or pained as you need to be. It's justified. It's valid. The trick is to hold onto and honor your feelings, while also considering new information. Something can be logically true while emotionally uncomfortable. We can also have empathy for others, while not accepting their behavior. AN EMPATHETIC TRUTH Empathy comes once we are in our safe and social state. Not in a defensive state. If you're in flight/fight, you're not going to have empathy. Nor in shutdown or freeze. Empathy is strictly from access to the safe and social state. In my work with clients who are currently in these homes , they come to this empathetic truth once they are in their safe and social state. Sorry, but it's true. After I've provided lots of co-regulation through the process of therapy, after they've done some somatic holding and cognitive processing, they're able to climb into their safe and social state. Once there, they reflect on their life, including their parents. And they may realize - independently - that their parents are not currently capable of meeting the need that is being discussed. They will often say that they recognize their parents are doing their best (and that it might suck) and that their parents' behavior is out of their control. They also recognize the multi-generational piece of the trauma, being passed on. This is part of why I say this is an "empathetic truth." Because to look at the multi-generational piece requires empathy. Dismissing this piece out of anger is simply not empathy. And the anger may be well justified. I am not trying to take anyone's anger from them. Or tell them how to feel. It's difficult to look at the generational piece and use our empathy. Our thoughts quickly go to, Well then they should know better! And I don't disagree. But the reality is they may not know better or are missing all the other pieces of change I laid out. Remember also, that empathy is not a feeling. It's a tool that is available when in safe and social. When we feel empathy, we take on the feelings of another. And those feelings might be unbearable. Too painful. Feeling the pain of your abuser, alongside your own pain is a lot to hold. That's part of why I suggest that this empathetic truth arrives when one is in their own safe and social state. Not before. When one is able to hold onto their own safety, they can then tap into their empathy and hold the pain of another, even their abusive parents'. No, this is not necessary for healing. No, you don't have to do this. No, you do not have to forgive. This line of thinking comes from a state of safety. Not before one gets to the top of their ladder. Only once they're at the top. Their story follows their state. And the story becomes more empathetic and compassionate. It's truly a beautiful thing to witness - to see these teens recognize the generational abuse that is being passed down, which their parents didn't ask for, but received. Just like them. And to also hear them say that it stops with them . That they won't be passing it on to their own children. FINAL THOUGHTS If you don't like my wording , fine. Saying "did their best" makes sense to me. It also implies some bit of positivity or hope - if they did their best, that's the literal past. The present moment is a new opportunity. Change may become more possible as their life changes. I also recognize these parents are still in peoples' lives as the child turns into an adult. These parents may not have changed, even for their child who is now an adult. But saying they did their best applies not only to decades ago, but also yesterday. And also this morning. And five minutes ago. As a kid, there's not a whole lot that can be done about it. As an adult, you probably have more options at hand. You can cognitively accept the limitations of your parent, honor your own feelings and experiences, then make a new choice. Create a new path for yourself. Is this even worth talking about? I think so. And many comments shared the same. This idea helped them in their own healing. It helped to release and to forgive. So as a tool or a new thought or a reframe, yes, I think it's worth talking about and putting out into the world. I know this doesn't click with everyone. It pisses people off. I get it. It's like I'm sharing a possible end result of the process of healing from trauma. And skipping over all the stuff in between. Or making it seem like the pain of the victim doesn't matter. Of course it matters. And by and large, I think I have a lot of other content that addresses the stuff in between. And more will come. This is really just a small piece. A possible end result. Or a possible tool for you. But why wouldn't I share the end result? Really, if this makes logical sense to you, but not emotionally, I'd recommend just tucking it away. This can be a barometer for where you are at in your process. As you do your own work, whatever that looks like, check in with this idea every now and then and see how you feel about it. Or if you don't like it, don't agree, it doesn't make sense to you or you just think I'm full of s**t - fine. Do you. What's the other option? To just not say it? There was a comment left that suggested that even though it was true, it didn't need to be said. That just doesn't sit well with me. This idea can be helpful, as many comments said. And one comment said they "needed this so much right now." So I understand this is a difficult, emotionally upsetting or "triggering" idea for some, which is why I moved it over to my personal blog and put a heavy content warning at the outset. But it can also be of help. It doesn't seem right to ignore this. Really, pretty much anything can be a trigger . So should we just stop saying all of these things? Or some of them? Which ones? What's the dividing line between what is helpful or triggering? And if something is triggering, well, what do we do with that? Much of what I write and talk about is trauma related. It can't all be cozy. I'd even suggest that maybe the majority of it is upsetting on some level. But to how many? And how much? What is "potentially harmful" and what is not? I honestly have no idea. But for now, I thought writing this out in my personal blog was the best option. And if I suspect that something is "too" triggering or "potentially harmful," I'll probably discuss it here and not in a one sentence image on Instagram. I read every single comment. I considered it all. I thought, reflected, worried, empathized and meditated on it all. I appreciate every single person that put their thoughts in the comments, even the ones that were a direct attack on me or a response out of anger to others in the comments. I found this to be my best option, but I know it won't work for everyone. There is zero chance of that happening.

TOPIC - GENERALIZED ANXIETY DISORDER & THE PVT **Disclaimer: This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of anxiety, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). Anxiety is general, doesn’t need to be about a specific thing, can be about future, present or the past Worry is about a specific future thing In sympathetic arousal, we have energy to survive “Excessive”: If there’s no direct threat to our safety, the energy lingers and then gets placed onto things that don’t require that energy When in safe/social, we simply don’t have out of control anxiety It’s tolerable, noticeable and signals something needs to change in a relationship or we may have to prepare for something like a test It’s accurate, it’s a message related to something Not an issue of actual bodily danger, but that system still kicks on The individual finds it difficult to control the worry. Difficult to ground the self Difficult to control the thoughts because it’s a state issue The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item required in children. Restlessness, feeling keyed up or on edge. Energy within you that needs to be discharged Our experiment with not laughing in presentations Being ‘on edge’ or ‘keyed up’ is the experience of being in a flight/fight state Being easily fatigued. You’re constantly on edge, keyed up, constantly tense and ready for danger Sounds pretty fatiguing to me Exhaustion is a common underlying emotion in therapy Difficulty concentrating or mind going blank. Ready for danger, scanning Hard to focus on one thing that is not dangerous Easy to focus on something and perceive it as dangerous Everything seems like a potential danger Everyone seems like a potential danger Little things become big problems Irritability. On edge, keyed up The experience of being ready to run But the inability to discharge the energy may actually result in dropping further down “Irritability” seems like a mild fight state to me Because you direct it outward Muscle tension. Ready to run On guard Don’t laugh, don’t seek eye contact or escape from a mild distress and see how you feel Or think of something that brings mild irritation like a sound or what someone does: chewing nails Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). Immobilizing is a cue of danger The neural platform is not for sleeping! The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Does flight sympathetic energy cause this? Natch. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). These things are not necessary for flight sympathetic arousal. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder) These things are not necessary for flight sympathetic arousal.

**Disclaimer: This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of bipolar disorder, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. MANIA & MAJOR DEPRESSIVE EPISODES Fluctuation between extreme highs and lows TOPIC - TYPES OF BIPOLAR DISORDER Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes Bipolar II disorder consists of depressive and manic episodes which alternate and are typically less severe and do not inhibit function Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and depression A manic episode is a period of at least one week when a person is very high spirited or irritable in an extreme way most of the day for most days, has more energy than usual and experiences at least three of the following, showing a change in behavior: Exaggerated self-esteem or grandiosity Sympathetic charge Story follows state Flight or fight energy? Dunno. Less need for sleep Sympathetically active Can’t fall asleep when in flight/fight Talking more than usual, talking loudly and quickly Loss of vocal prosody when in sympathetic Shorter breathing leads to faster rate of speaking Easily distracted Sympathetically active due to neuroception of danger Always scanning the environment Doing many activities at once, scheduling more events in a day than can be accomplished Sympathetic energy with no place to direct it Lack of mindfulness of the energy, not being in the moment Not feeling the root of the energy, just acting Probably a low tolerance to being in the moment Increased risky behavior (e.g., reckless driving, spending sprees) No direction for the energy Uncontrollable racing thoughts or quickly changing ideas or topics Anxious or aggressive thinking of the sympathetic state A hypomanic episode is similar to a manic episode (above) but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes and the person is still able to function. A major depressive episode is a period of two weeks in which a person has at least five of the following (including one of the first two): Intense sadness or despair; feeling helpless, hopeless or worthless Shutdown Empty, foggy, detached Loss of interest in activities once enjoyed Anhedonia, the life force energy is gone The sympathetic connection or motivation Feeling worthless or guilty Very much the feelings of being in a shutdown as well Sleep problems — sleeping too little or too much Too much is a shutdown thing Too little might be due to some sympathetic energy returning Or shutdown danger cues being too overwhelming? Feeling restless or agitated (e.g., pacing or hand-wringing), or slowed speech or movements Sympathetic or shutdown Undirected energy of sympathetic emerging Changes in appetite (increase or decrease) Coping skill of the emerging sympathetic energy? Appetite returning from shutdown? Decrease due to shutdown since feeling hunger less? Prepping for death Loss of energy, fatigue Prepping for death Difficulty concentrating, remembering making decisions Cognitive functions of shutdown are… shut. down. Frequent thoughts of death or suicide Preparing for death brings thoughts of death Emerging from freeze is also scary and might be related to suicide imo For another time BIGGER PICTURE OF THE PVT Uncontrolled return of sympathetic energy or maybe uncontrolled release of frozen energy ANNOUNCEMENTS - I’ve got an online therapy interest list now available Therapeer Content Event number 1 is now live! SUPER FAN SUBMISSION - “Thank you for your page. It’s like home.” -keeping anonymous Therapy Interest List - https://www.justinlmft.com/therapyinterestlist APA Bipolar Disorders - https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders Intro/Outro music & Transition Sounds by Benjo Beats - https://soundcloud.com/benjobeats

**Disclaimer: This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of bipolar disorder, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. PTSD & THE POLYVAGAL THEORY - First - PVT defines “trauma” as being in a stuck defensive state And now the DSM criteria - A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: i. Directly experiencing the traumatic event(s). ii. Witnessing, in person, the event(s) as it occurred to others. iii. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. iv. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. Part A1-3 is about the acute traumatic event. There are two paths to trauma according to PVT. This is one of the paths. So far this has covered the source of the PTSD Different than most dx since they cover sx and not sources of why, like bipolar disorder B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: i. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. It’s not just the memory A reliving of the polyvagal state during the event freeze/panic energy flight/fight energy ii. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content. Briefly - I think dreams are the stories of the state we are in during sleep, along with the days’ events and along with And I think our state changes during our sleep without our consciousness to block or subdue or minimize it So the past comes forward iii. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. Severe triggering to the past or the past to the present Loss of executive functioning and being in the present moment What happens when we drop down the ladder into a defensive state iv. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Being triggered by stimuli that is often unpredictable Due to becoming hyper focused on the most salient aspect of the event, like a small detail We focus on what might help us to survive the next time So the scents or the textures of the event become imprinted in the survivor and then get triggered next time v. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Autonomic shifts in breathing, focus, perspiration, facial muscles usage C. Persistent avoidance of stimuli associated with the traumatic event(s) , beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: i. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). ii. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). These are where behavioral adaptations come in Doing these to avoid, adapting our behavior to deal with the defensive state Substance use, ticks, compulsions, self harm D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: i. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs). Hyper focused on one aspect of the event Dissociate during the event, which evolved as an aid to survival ii. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”). Story follows state These negative, persistent or exaggerated beliefs about the self or others are a reflection of the survivor’s own autonomic state iii. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. Story follows state Brain attempts to mase sense of the situation Blaming self, “I shouldn’t have” done this or that iv. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). Sx of the polyvagal state Feelings stem from the state Reinforced by the thoughts and consequences of the bx acted on from the feelings v. Markedly diminished interest or participation in significant activities. Might be due to shutdown Might be due to avoiding triggers, like avoiding family vi. Feelings of detachment or estrangement from others. When in shutdown, people isolate Biological drive to hide and then emerge into safety vii. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). Again. Due to stuck state. E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: i. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects. ii. Reckless or self-destructive behavior. iii. Hypervigilance. iv. Exaggerated startle response. v. Problems with concentration. vi. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). These are all stemming from sympathetic state But a few of these are in relation to the mixed freeze state Large outbursts, exaggerated responses, hypervigilance Weaker vagal brake F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month. Of the intrusions, persistent avoidance of stimuli associated with the event(s), negative alterations in cognitions or mood, marked alterations in arousal and reactivity G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Specify whether: With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following: Depersonalization feeling detached from your own body Derealization: surroundings don’t feel real Check off what you're learning through the Polyvagal Checklist download below. Join the Stucknaut Collective for free  and gain instant access to a course on trauma recovery, practical Polyvagal Theory resources, and exclusive downloadable tools to support your healing journey. SELFISH REQUEST/THANK YOU Screenshot and share Tag me so I can give you a big thank you MESSAGE FROM A SUPER FAN Hi, I am writing to say that the episode on Bipolar from Polyvagal theory perspective was really eye opening. One thing got me thinking. Apart from the fact that I could find myself in most of the descriptions of manic phase, I was really struck by the fact that when you are in shutdown your intellectual potential is less than optimal. I remember my son who struggles with reading and writing... since we started Work, my husband and me, got more regulation... And dedicated some time to connect with him... He's improved so much. Just wanted to share this realization and small success with You in appreciation of your Work. - Danijela DSM Criteria - https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/ Intro/Outro music & Transition Sounds by Benjo Beats - https://soundcloud.com/benjobeats

I was walking with one of my teen clients around the school block when he stopped and watched a car. His body tensed, his eyes went wide and breathing paused for a few moments as he watched. There was something he was neurocepting that I wasn't. He was in a more sympathetically charged state, poised and ready for action. I asked him what was going on and he said cars don't typically drive that slow in this area. He said the people in that care were looking for someone. Was my client neurocepting potential cues of danger or does he have a spidey-sense? I have to let the inner comic nerd come out. One of our regular Instagram Live viewers ( we see you and appreciate you, Daisy! ) used this analogy, which is fitting, but I feel compelled to reign it in a bit. Yes, you do have neuroception. Just like my client in the opening paragraph. But no, you do not have a Spidey-sense, sorry. And neither did my client. Spider-Man has a spidey-sense, but he also has neuroception. We need to discuss what these two things are first... What is neuroception? Neuroception is the word that Dr Stephen Porges created to better discuss the concept of unconsciously detecting cues of safety or danger from the internal world or the external world and then shifting into defensive or safety behaviors. It's part of his larger Polyvagal Theory, which you really must learn more about . By processing information from the environment through the senses, the nervous system continually evaluates risk... [N]eural circuits distinguish whether situations or people are safe, dangerous, or life threatening... [N]euroception takes place in primitive parts of the brain, without our conscious awareness. The detection of a person as safe or dangerous triggers neurobiologically determined prosocial or defensive behaviors. Even though we may not be aware of danger on a cognitive level, on a neurophysiological level, our body has already started a sequence of neural processes that would facilitate adaptive defense behaviors such as fight, flight, or freeze. Dr Stephen Porges, NEUROCEPTION: A Subconscious System for Detecting Threats and Safety What is the "spidey sense"? The Spidey sense is, well, this... Spider-Man possesses a precognitive "danger" or "spider" sense which warns him of potential or immediate danger by the manifestation of a tingling sensation in the back of his skull, and links with his superhuman kinesthetics, enabling him to evade most any injuries, unless he cognitively overrides his automatic reflexes. The precise nature of this sense is unknown, though the Master Weaver states it is enabled by his connection to the Web of Life and Destiny. It appears to be a simultaneous clairvoyant response to a wide variety of phenomena (everything from falling safes to speeding bullets to thrown punches), which has given several hundredths of a second warning, which is sufficient time for his reflexes to allow him to avoid injury. Marvel Database (BTW - Does it scare you that I understand absolutely everything that was said here? I'm not just a polyvagal or trauma nerd.) How They Are Alike Both neuroception and the spidey-sense are there for increasing the likelihood of survival . With the spidey-sense, it's directly an advantage over his opponents. If he can see where the pumpkin bomb is going to explode before it does, he can avoid that blast radius. If Spider-Man can detect which sand on the beach is actually alive, he'll be able to better his chances of defeating the Sandman. Probably with cement. Same with neuroception though. The ability to detect danger and safety is going to increase our chances of survival. We mobilize when we detect danger. Mobilization means we can escape or use physical force. And we shutdown when we detect that our life is under threat. This results in the "playing dead" collapse which may be handy when a bear is around . But neuroception is underneath everything we do, including raising our babies. When a parent hears the cry of their infant, it mobilizes the parent to solve the problem. Changing them, soothing them, socializing, feeding, whatever it is. The parent mobilizes and then co-regulates or provides for a need. This directly increases the chances of the baby surviving, obviously. But first there is the neuroception of danger from the external cue of the crying. That danger detection shifts the parent into a sympathetic/mobilized state along with their access to their safety/social engagement system. With both of these active, co-regulation can happen. Neuroception and the spidey-sense are also both unconscious . Spider-Man does not choose to use the spidey-sense, it just happens. When there's danger around, his head buzzes like crazy (and his hairs stand up straight too apparently). The parent above with the crying baby does not choose to become more sympathetically active. They simply become more sympathetically active. If we had to consciously choose to climb down the polyvagal ladder into our defensive behaviors, our chances of survival would decrease. The time it takes to analyze a situation would leave us susceptible to being prey. Although we can consciously choose to alter our behavior to regain access to our safe and social state . Things like changing our breathing can help with this. Slowing down the exhale will trigger the parasympathetic system that is important for "rest and digest" stuff, including social engagement as well. Fun things like singing, dancing and riding a bike can also help to climb the polyvagal ladder, back into a safe and social state. But it needs to be done mindfully. We can't just move around. I mean, we can. But if the goal is to climb the polyvagal ladder, the movement needs to be combined with a curious mindfulness. The combo of mindfulness and movement is what allows the stuck freeze energy to discharge or for the sympathetic energy to return from a shutdown place. How They Are Different The first way they are different is that Spider-Man is able to "see" into the future enough to react to the danger that is about to happen . He'll spidey-sense the bullet's direction before the finger squeezes the trigger. This is different than neuroception, which is not a future-seeing ability. Although accurate neuroception can absolutely detect subtle cues of danger that may indicate a coming danger. But it's based in the here and now. Detecting someone's more monotone voice is a potential neuroception of danger. That type of voice may cause our own sympathetic system to kick on ever so slightly. That's literally our flight/fight circuitry. But this doesn't indicate their potential for harming someone. It's just our own personal autonomic nervous system response reacting to the here and now monotone cue of danger (though also passing through other filters: culture, our autonomic state, beliefs and more). Our feelings of danger don't necessarily indicate actual danger. Just like with my client in the opening paragraph. He neurocepted potential danger based on the speed of the car. And he might have been right. But Spider-Man's spidey-sense is always indicative of actual, impending danger. The second way that they are different is that neuroception evolved within living organisms . The ability to detect risk through the senses was an evolutionary advantage, allowing for species to recognize movements to approach or avoid. Identifying dangerous movements meant that a species could immobilize and potentially blend into its environment. Or mobilize and avoid the potential danger. The Polyvagal Theory explains that mammals in particular have all three evolutionary building blocks of the autonomic nervous system: 1. Immobilization • Feigning death, behavioral shutdown. • The most primitive component, shared with most vertebrates. • Dependent on the oldest branch of the vagus nerve (an unmyelinated portion originating in an area of the brain stem known as the dorsal motor nucleus of the vagus). 2. Mobilization • Fight–flight behaviors. • Dependent on the functioning of the sympathetic nervous system, a system associated with increasing metabolic activity and increasing cardiac output (e.g., faster heart rate, greater ability of the heart to contract). 3. Social communication or social engagement • Facial expression, vocalization, listening. • Dependent on the myelinated vagus, which originates in an area of the brain stem known as the nucleus ambiguus. The myelinated vagus fosters calm behavioral states by inhibiting the influence of the sympathetic nervous system on the heart. Dr Stephen Porges, NEUROCEPTION: A Subconscious System for Detecting Threats and Safety Conversely, the spidey-sense did not evolve in Peter-Parker. It is the result of a radioactive spider bite which somehow alters his very DNA (which it turns out is probably unrealistic ). His development of his powers and spider-sense was instantaneous. Spider-Man Has Both. You Don't. He has the spidey-sense to warn him of actual, imminent danger. But he also has neuroception which detects cues of "danger." Not necessarily actual danger, but things like ruptures in co-regulation. Like if he were talking to Captain America about some insecurities he has about defeating the Green Goblin and Captain America looks down at his phone. Spider-Man would see that removal of Cap's gentle, empathetic eye contact and neurocept it as a rupture in the co-regulation. Spider-Man's sympathetic circuitry would activate enough so that he felt some insecurity; some anxious energy. Then his story would follow his state, leaving him with doubts about Cap's level of caring and his own worth of being listened to. You're still superhuman. But not literally. I mean, this neuroception stuff is incredible. If you think about it, it's really this awe-inspiring thing. That we can detect super subtle cues from the outside and inside world. Which then shifts us up and down the polyvagal ladder to approach safety or avoid danger. These fundamental approach/avoid feelings are the building blocks for our emotions and behaviors. But without neuroception, we'd have none of it. So in my opinion, you're still superhuman. We all are. But not literally. Sorry.

This is for anyone that needs it , similar to my Open Letters . Apply it to whatever area of your life you need to. Or don’t. If this doesn’t fit for you, then you don’t need it. And the message is simply not for you. I posted this idea to my Instagram feed earlier this week and had a very split response to it. Apparently, this idea in particular is one that needs to be expanded on. And I get why. (I wish I could anticipate these things better.) We all have needs. Real needs. Unmet needs. Like to be heard. To be cared for. To be validated, understood. Space to create, to move freely, to eat healthy. The opportunity to own something and feel pride in ourselves. Or to have a job that brings us a sense of self worth, safety in relationships, have adequate healthcare and you can just go ahead and fill in the blank for yourself. What is the need you have? Pick one that really speaks to you. It may have popped into your mind already. What I would invite you to do is ask yourself - “Is this something that I can do myself? Is it something that I can do for myself? Is it something that I need some support or assistance with but I can do it?” Now before I go on, of course it’s okay to ask for help! Of course of course of course. I think where I personally get very very very worried is when I see people who are in an emotionally desperate place turn to others to get their emotional needs met. And not just turn to others, but rely on others. Become dependent on others for those emotional needs. And that’s a pretty hazy line and super individualized, so I am talking pretty generally. But there’s a lot of desperation living inside of people. And when that desperation combines with a lack of belief in the potential of the self, that gets downright terrifying for me. That’s a recipe for dependence. And with dependence could potentially come exploitation . And whether you’re asking for help or demanding it, the person doing the exploiting couldn’t give a s**t less. As long as you’re dependent. So we all have needs. We all want some kind of change. But we can’t wait for others to provide for these needs. We might need to do it ourselves. You might need to do it yourself. Notice what comes up for you when I say this. That you might need to do it yourself. And again - this might not apply to you. And it’s okay to ask for help. But notice what came up for you when I said you might need to do it yourself. Did you feel some level of sympathetic charge? If you felt like you wanted to attack me, there’s probably some level of fight energy in you. If you felt like turning this off and moving on, there might be some level of flight energy. And if you felt like it’s not worth the effort or like you won’t be able to make the change you want, then you might be in more of a shutdown place. So notice what came up for you. That might be reflective of the state of your autonomic nervous system and what need you have. Or maybe it’s because I’m full of s**t, I’ll give you that. But I’d like to take this in another direction if you’ll join me... Maybe that underlying state shift you felt is kinda where you’re at or where you easily go to. And maybe the thoughts you have about the statement to “do it yourself” is a reflection of your state. Like if you went to, “There’s no point in trying” or “I can’t do it myself,” then those thoughts might be reflective of your shutdown state. Maybe. And maybe just at least when it comes to this topic. Maybe you go to more of a shutdown place and the energy to “do it yourself” just isn’t there. And so the thoughts reflect that. And of course there might be things that you literally can’t do yourself. That’s different and not what I’m talking about. Or if you went to thoughts of aggression, then maybe that’s reflective of your autonomic state that you exist in or go to easily. Maybe. Thoughts of aggression could be obviously aggressive like thinking of emailing me and telling me what an idiot I am. Or actually doing it. (Please don’t email me and tell me what an idiot I am.) And if you went to thoughts of dismissiveness that might be reflective of your flight energy. "There’s no problem here. Move along, move along." Or maybe flight thoughts sound like anxious avoidance. When we feel these shifts in autonomic state, it’s important to notice them. And I want to focus on the sympathetic flight/fight energy. If you’ve got that within you, that’s your key . The issue is now where to point it. You can point it at me, at someone else, at some group of people or you can point it toward yourself. Meaning, to take that sympathetic energy and direct it toward your need, toward the change you want in your life. That’s the key to doing in yourself. Create it. Speak it. Own it. Invent it. Connect with others. Learn. Put the work in. Make sacrifices. Or not. But don’t complain. Don’t demand that someone else do it for you. Don’t guilt trip them. Or shame them for not doing what you want. Or saying or doing what you have decided is the most important thing ever. Or speak on your behalf. All of these things come from sympathetic energy as I see them. Do you really want to be reliant on someone else? Seriously though. I’m really encouraging you to reflect on that. Do you want to be dependent on someone else? And again, I’m specifically talking about the combination of desperation and not believing in yourself. Just sit with that for a second. How does it feel to be dependent? How does it feel to ask more of someone? Of course this depends on what it is and who you’re asking. Again, I don’t know what your needs are. I’m speaking generally. So take these words and apply them to whatever it is that you need and you’re not doing yourself. Do you feel comfortable with giving your spouse or your parent that much control over you? Are you okay with giving them your neediness? With asking them to make you feel whole or to fix whatever it is that you think needs fixing? The answer is of course no. That answer of “no” is within you. It might feel like some fight energy. Hold it. Hug it. Give it love and acceptance. If your answer is yes, that you’re okay with that emotional desperation and not believing in yourself… I truly feel saddened. Because I believe you have more within you. And I don’t even doubt it for a second. I think you are capable of so much more. It’s within you . That sympathetic charge to get things done is inside of you. Here’s the really beautiful thing - the more individuals that find that spark within them, the better our world becomes. But it starts on the individual level. One of the thoughts in the comments of the original Instagram post was around how individualistic the “do it yourself” mindset is. And I can acknowledge where those comments come from. But yeah, it’s pretty individualistic. So what? This isn’t saying cut people out of your life. This isn’t saying stop asking for help. But yeah, this is pretty much saying to rely on the inner energy that you have within you. Ask for help when you need it. But also let that sympathetic energy do its work. Those two things can exist at the same time. And you’ll find that the more you use your own sympathetic energy in the right direction, the greater your thoughts are going to be of yourself. The greater the belief in what you can do and also the willingness to try something new. And I think you’ll also find that you’ll connect with people easier. Your social engagement system will become more active as you use your energy toward a positive direction and give yourself that boost. What’s wrong with that? Isn’t this a whole lot different than being dependent on someone? In my opinion, being dependent is not the same as being connected . If you’d prefer to be dependent, do you. But someone who is dependent is probably not in their social engagement system. If they were, they would probably not be so desperate for help and not so reliant on another to fulfill that. Yes, people in their safety/social engagement state can seek help. But they’re okay when the answer is “no” and can rely on themselves to find another way. Someone in a defensive state is probably going to have a harder time with a “no.” We’re talking about dependence here. Not cooperation. Cooperation happens between two individuals who are able to give and take. Who are able to empathize with each other enough to fulfill each other’s needs. And that only comes from two individuals who are not emotionally desperate and who believe in themselves enough to use their sympathetic energy to make change. We all have needs. And we all have obstacles to getting those needs met. Those obstacles don’t mean the needs don’t need to get met. You might be at a point in your life where you can recognize that you have a need. And you also have obstacles to getting that need met. You have to first be able to hold both of those as true at the same time. You have a need in one hand. And you have the obstacle in the other. Hold your need with some love and compassion. And hold your obstacle with some motivation for change. Let those two intermingle - your motivation for change is going to be the fuel to feed your needs. To do it yourself . You’re creative. You can solve problems. I believe that. I hope you can join me in that belief. If you liked this, I recommend taking a listen to my Open Letters audio album. It's $20 for over 90 minutes of themes that come up in therapy a lot. Written for anyone that needs it.

some links may take you to Amazon, where I get a portion of the sale as an Associate/Influencer at no extra cost to you. EPISODE MAP - main topic Announcements A homework assignment A request of you A few disclaimers: Put yourself first. I keep every episode as safe as I can, but just by the nature of the topics, you may experience some stuff come up. Take a break if you need to. This one doesn’t go into trauma details of course, but it’s a pretty hefty one as far as the depth we’re going to go. This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of depression, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. And these are my personal conceptualizations about how the PVT connects to the DSM . I’m not suggesting you think the same way. In reality, these diagnoses are often very different between providers. And even when agreed upon, they’re potentially understood in very different ways. So this is how I am viewing them in general. As a starting point. BORDERLINE PERSONALITY DISORDER & THE PVT A pervasive pattern of instability of interpersonal relationships , self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: Key words already: “instability of interpersonal relationships” and “impulsivity” as well as themes around confidence or self-esteem disorder may be rooted in development of the self, which suggests a layer of shutdown; “self-image” is also a key word here Impulsivity may have something to do with energy returning, from shutdown into sympathetic or the stuck sympathetic freeze energy getting triggered. Either way, a layer of sympathetic activation here potentially. Impulsivity will have something to do with a weaker vagal brake, especially considering the social impairments of BPD Being with the self in the present moment is impaired Same for all these “disorders,” there is a lack of being in the present moment “Present in a variety of contexts”... why not all? Same issue as with ADHD and neurocepting safety 1. Frantic efforts to avoid real or imagined abandonment. “Frantic” - there is an element of energy, a sympathetic charge to it But the word “frantic” seems very chaotic to me, like there is fear mixed in to the sympathetic charge Not just flight energy, not just fight If it was “just” those energies, they could be directed at what they need to be directed at, like running away from a predator But when those energies are thwarted, or not allowed to complete what needs to happen to get to safety, then fear combines with it and changes those defensive bodily impulses into something else The primary autonomic sympathetic state does not involve fear, it involves bodily instincts and impulses that are acted upon to run or fight. When the energy is not able to complete through an action like running or fighting, then the fear comes in. And that’s where that more frantic energy is going to come from But this also relates to trauma - the sympathetic energy can’t discharge and the body is immobilized while charged, keeping the energy stuck inside This is the Freeze mixed state - the Freeze energy being triggered is very chaotic or frantic Not just flight energy, but panic Not just fight energy, but rage Both are more chaotic, both are frantic; there is less control of the self and less control of the real world; heightened danger and a perception that one’s life is under threat if some action is not taken; something, anything “Real or imagined” - unhealthy neuroception detects risk when there might not be any there Neuroception is the unconscious detection of safety or danger cues in the environment - can be healthy or unhealthy When we’re stuck in a flight/fight/shutdown/freeze state, we see danger where there is none and we amplify danger that isn’t needed to be amplified This unhealthy neuroception is going to pick up on danger cues - triggers to the freeze energy - that may or may not be based in actual danger cues One of those danger cues could be loneliness, isolation, being left alone, rejection, abandonment… The other person is the safety, there’s a dependence on that person. So when there’s a perception of them leaving, it’s a significant danger cue connected to abandonment. “Abandonment” - probably due to unhealthy attachments There is a definite higher rate of hx of trauma and abuse from childhood in BPD Is it actual abandonment or a story follows state? Is the person actually leaving them or is there a shift in the autonomic nervous system, which then gets translated into a story of abandonment? The story could very well be accurate. It could very well come from past history of actual abandonment. But it might also be the brain’s best attempt at explaining what is happening in the ANS state shift, which is of course based on the past and applied to what is currently happening. Now combine the frantic energy - the rage or panic energy - with a perception of being abandoned and everything that comes along with that I think this nervous system - of the individual dx’d with BPD - clearly recognizes that connection and safety are biological imperatives and a must in life, but lacks the sense of self to be themself and bring themself to a safe connection with safe others We all need connection, but to be a full part of a relationship we need to bring our full self; we need to have the self love first, the connection to our self in the present moment, then we bring our self to someone else’s self , who is also in the present moment = healthy relationship How often does this actually happen? Probably actually very seldomly. Peter Levine uses the word “vortex” to describe how trauma lives and stays in the body, I like it for conceptualizing the relationships being described here. It’s a swirling vortex of disconnection from others and from the self: something in the real world or a perception of something happening in the real world → then experienced as a danger cue, which triggers the stuck Freeze energy from prior actual abandonment and/or abuse → then an impulsive action that stems from that frantic energy as a way to channel the stuck freeze energy → then feelings of shame and guilt for having acted on the frantic fear of abandonment, on the rage or panic → then real life consequences for whatever might have happened during those actions which come from the frantic fear of abandonment → then seeking the comfort of others as an attempt to regulate the underlying ANS… but this person has extreme difficulty with recognizing safe relationships due to probably some early life unhealthy attachment and trauma → then you can probably guess where this goes next… It repeats. It’s a swirling vortex of disconnection from others and from the self 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. In defensive states, critical thinking is compromised, like I discussed with OCD in episode 49 As someone said in the comments - it’s an issue of being able to hold two truths at the same time, to be able to think in black and white, not black or white “And ” indicates two truths at the same time - to see where you’re coming from and also where the other person is coming from; being able to see another’s perspective and acknowledge that both are potentially valid But to do so requires we have access to our safety system Not having access to the safety circuitry leads to the “idealization and devaluation” - either the person is all good or they’re all bad versus they’re just a person who messed up or they’re just a person and I messed up or they’re just a person and not the right fit for me or we’re both just people and not right for each other But i can still love myself, i can still maybe love them but not be with them or i can forgive them but not be with them… Being able to see these more balanced potential truths requires access to a calmer way of thinking which is only in the safety state An “unstable and intense interpersonal relationship ” sounds like a hefty level of sympathetic energy to it There’s a chaos to it, a frantic energy - a panic or a rage or both, specifically Fighting, breaking up, blaming, withdrawing, obsessing, jealousy, wondering, impulsive sexuality, self-harm - all require sympathetic activation There’s blame in the idealization or devaluation, there’s aggression, an assignment of value. Very sympathetically charged thinking The black or white thinking is still there, the person is idealized, they’re all good Very sympathetically charged thinking Could the “idealizing” be stemming from flight energy ? Being saved, being safe, being protected Someone else hurt them and this new person is the one they’re running to Could the “idealizing” be stemming from a return of the fight energy from shutdown? The other person is again the savior, bringing them connection They aren’t actually fighting, but there’s a return of energy, from shutdown into sympathetic intensity Could the “devaluation” be stemming from fight energy ? Lots of blame and judgment toward another; it’s aggressive and accusatory Could this be a fluctuation between flight and fight energy toward that person? More or less moving up and down the sympathetic rungs on the polyvagal ladder? Or could this be the freeze state ? Ideally, it needs to slowly thaw, warmed by the social engagement system. But when the freeze energy is triggered, it’s more like the ice shatters. I wonder if this is what we’re seeing with the intense and unstable interpersonal relationships It’s ultimately on an individual basis, but these are some possible paths The other person is bringing them some level of relief or distraction from their own inner pain. But that’s not the same as actually reaching the top of the polyvagal ladder and accessing the safety state and being able to connect with the self and with the partner in a relationship 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 1 and 2 had a sympathetic charge to them, probably a Freeze mixed state And here in number three is where we see the shutdown evidence of the Freeze equation A key piece of BPD is the inability to define their own identity and being dependent on another to do so The unstable self-image or sense of self sounds like shutdown to me Disconnected from the self, from the deeper emotional experiences, connective experiences, personal values, fuller range of thoughts and the underlying bodily sensations Very much a disconnection Not a full on dissociative thing, but there is very much a disconnection and ability to simply be with the self, like with OCD This disconnection from the self combined with the intense frantic sympathetic energy is a scary thing because it results in dependency on another for emotional well-being This is not co-regulation or inviting assistance or seeking support from another, this is dependence 4. Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). PVT concept of behavioral adaptations, similar to the compulsions of OCD Intense, frantic, panicky, rageful energy that is directed toward “potentially self-damaging” impulsive bx “Impulsive” - no thought behind it, no planning, just sympathetically charged action But toward what? Why is this happening? These reckless bx are avenues for the sympathetic energy But there’s no mindfulness or ownership over the underlying sensations So it’s just impulsive, chaotic action which probably comes from the chaotic freeze energy stuck within There’s no ability to sit with the energy and be with the inner self These might be the person’s best attempts at coping, at seeking relief, seeking feeling grounded or discharging the energy... This is a behavioral adaptation that Dr Porges talks about. The energy is too much, so they alter their behavior to discharge it But it fails, then reinforces the stuck state with blame, guilt, shame and consequences from their choices These are also all outward attempts to deal with the intense stuck freeze energy… but what if this intense stuck freeze energy were directed inward?... 5. Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour. “Between 60% and 78% of patients with the disorder have shown suicidal behaviours, with more than 90% engaging in self-harm. 44 , 4 5” - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494330/ This is very much a Freeze thing or a shutdown thing With freeze, the intense stuck sympathetic energy doesn’t just disappear on its own It’s either going to be directed outward or inward when the ice shatters That’s why we need the social engagement system, the safety circuitry to strengthen and slowly warm the freeze state I think suicide and self harm is what we see when the intense stuck freeze energy is directed back toward the self (Peter Levine) With shutdown, the returning intense sympathetic energy doesn’t just go through the self without the person being able to handle it They’re going to direct it outward or inward The trick, at the deepest levels, is not to direct it outward or inward through action, but to simply be with it and witness its process It’s imperative we not wait for a crisis to be mindful, can’t simply rely on coping skills when there’s a problem Do the work ahead of time, in moments of non-crisis This is going to result in greater capacity to handle the crises, more sense of self, more feelings of connection and reduction in intensity of feelings... 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days). “Affective instability” - rapid and intense mood swings that are difficult to control Sound like sympathetic? But instability = chaotic freeze energy , which we see in this next piece - “Reactivity of mood” - reactivity being the key part here. Intense mood that has a Freeze undertone to it Weaker vagal brake; less ability to tolerate distress The freeze energy is easily triggered due to a weaker vagal brake, resulting in a chaotic level of sympathetic energy when triggered Need a stronger social engagement system b/c there is a significant social impairment with BPD They seek social regulation, but don’t have the system to actually accept co-regulation All of this = Chaotic freeze mixed state feel to the affective instability; that intensity feels like the tenseness of freeze to me, like walking on ice 7. Chronic feelings of emptiness. The feeling of emptiness is very much a shutdown thing Foggy, grey, numb, disconnected It’s the conscious emotional experience of the stuck shutdown state, like in depression I can see an underlying, chronic feeling of emptiness along with the freeze energy since shutdown is a piece of the freeze equation But it’s the emptiness plus the stuck chaotic sympathetic energy 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). “Intense” - Sounds like the rage associated with the freeze mixed state “Inappropriate” - the individual is experiencing and filtering the world in a much different way then those around them potentially Triggered easily and can be very intense When in defensive states, our thoughts change as well and we become very good at rationalizing our choices It’s dangerous to admit fault in these states, to be vulnerable Have to be in the safety state to actually feel sorry or take responsibility 9. Transient, stress-related paranoid ideation or severe dissociative symptoms. Dissociative sx stem from a shutdown state or a mixed freeze state When in shutdown, we dissociate or go numb Benefit to the potential survivability of the prey Chronically = Disconnected from the true self Depersonalization - detached from the self Derealization - detached from reality BPD and Trauma “Subjects with borderline personality disorder had significantly higher rates of physical abuse in childhood/adolescence than subjects without borderline personality disorder, with gender controlled (52.8% versus 34.3%; χ2=5.43, df=1, p=0.02), but the groups did not differ in their rates of sexual abuse (29.2% versus 19.4%; χ2=1.46, df=1, p=0.23) or of other types of trauma in childhood/adolescence.” https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.160.11.2018 Borderline personality disorder was not significantly associated with physical assault, sexual assault, or any other type of trauma in adulthood ... Stems from childhood trauma Subjects with borderline personality disorder had a significantly higher rate of PTSD than subjects without borderline personality disorder (25.0% versus 13.0%). Though this does not include CPTSD I’d anticipate higher levels of trauma that the person has dissociated from. Trauma memories can lay dormant for a long time. There is a big focus of the individual dx’d with BPD on the outside world and a clear deviation from the internal world Who knows what’s going on inside? HOMEWORK EXERCISE - Do something you enjoy mindfully. REQUEST Submit an audio clip to me Anytime is fine, but I really want to hear how the Polyvagal Podcast has impacted you in its first year. Has it helped you as a parent? In your relationship? As a worker? In your own level of love for yourself? Let me know through an audio DM or just email me a voice memo from your phone to justinlmft@gmail.com

EPISODE MAP - If you’re just starting the podcast, I highly recommend you read my Polyvagal 101 page on justinlmft.com! Put yourself first. I keep every episode as safe as I can, but just by the nature of the topics, you may experience some stuff come up. Take a break if you need to. And these are my personal conceptualizations about how the PVT connects to the DSM. I’m not suggesting you think the same way. This is how I am viewing them in general. As a starting point. This information is NOT meant to diagnose . If you feel like you may be experiencing symptoms of Narcissistic Personality Disorder, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. So please don’t be trying to diagnose yourself or anyone else and listen to this from a place of learning or curiosity. PERSONALITY DISORDERS What sticks out to you in general? → (Mayo Clinic) - A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work and school. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face. CLUSTER B PERSONALITY DISORDERS What sticks out to you in general? → Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder We are going to see some similarities in borderline and narcissistic PERSONALITY FUNCTIONING CRITERIA What sticks out to you in general? → impairments in identity (experience of oneself as unique, stability of self‐esteem and capacity for and ability to regulate a range of emotional experience) self‐direction (pursuit of coherent and meaningful goals, constructive and prosocial internal standards of behaviour and self‐reflection) empathy (comprehension and appreciation of others' experiences and motivations, tolerance of differing perspectives and understanding the effects of one's own behaviour on others) intimacy (depth and duration of connection with others, desire and capacity for closeness and mutuality of regard). Obviously with the personality disorders, they’re not in a safe and social state. Very dysregulated. NARCISSISTIC PERSONALITY DISORDER of the DSM The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met: (Pathological - any departure from what is considered healthy or adaptive . https://dictionary.apa.org/pathology ) A. Significant impairments in personality functioning manifest by: 1. Impairments in self functionin g (a or b): a. Identity : Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem. Is there an element of safety here? No. But there might be an intrinsic and biological urge to connect with others, like anyone. And this came up with Borderline - the urge to connect w/o the self to do so. Is there an element of flight here? Maybe. But I am not personally getting a strong sense of that. Is there an element of fight here? Maybe. And I’m feeling this one a bit more. Is there an element of shutdown here? I think so. Pretty strongly with the Identity Pathological Personality trait. Whenever there is an issue in identity, I go to shutdown Disconnect from the environment, from others, from the present moment and from the self Numbness and dissociation may be part of someone’s shutdown The present moment and the self Again, we have to be in the present moment to be our true or truer self Through tx, the client might look back and say “that wasn’t me.” and now that they are in the present moment, they are more fully their true self. The narcissist is not their true self, they are what others define them as; they are not in their own body, they are very much in their thoughts and out of the present moment Part of being in the present moment is to be within your body Like borderline, the narcissistic person is using others But it’s to define who they are - which may help them to regulate their sense of self-worth, to give themselves a new story and maintain the sympathetic energy, which prevents them from going into shutdown; the borderline used their connection with others to maintain their sympathetic energy and avoid shutdown This is not an actual ventral vagal moment or actual co-regulation from another - this would require real connection and result in empathy, compassion, connection, calm and being in the present moment, which all lack for the narcissist Probably more of an avenue for stuck freeze sympathetic energy or returning fight energy For the borderline individual, the relationship or perceived connection with the other person was their avenue for the freeze energy, to regulate themselves and avoid the misery of rejection - the opposite of rejection was what they sought For the narcissistic individual, the opinion or approval of the other person might be their avenue for regulation. Not connection with the other person, but opinion. Or maybe the other’s positive opinion of them brings them a distorted sense of connection, but the opinion or approval is sought, which is the opposite of the deflated self-esteem which comes from shutdown Story follows state - They are placing the intense freeze energy or returning fight energy into an exaggeration of the worth of the self (this is a sympathetic story) Countered by the complete deflation of the worth of the self, with the absence of the energy (this is a shutdown story) Parallels BPD with their judgment of the other person as all good or all bad, the narcissist is directing that energy inward BPD is outward, narcissistic is inward b. Self-direction : Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations. Is there safety here? No. Is there flight energy here? I don’t think so. Is there fight? Yes Goal-setting means there is some motivation and motivation requires sympathetic energy Creating something like a business = self belief, energy, ability to tolerate the sympathetic activation along with risk - all from safety system along with fight sympathetic because we’re directing the energy toward something, not away from it Remember, being in these defensive systems doesn’t mean we’re actually being defensive. It just means that circuitry is activated. But it’s activated along with the social engagement system. When the ventral vagal circuitry evolved, it sort of dampened the intensity of these defensive circuits, while also repurposing them when combined for pro-social interaction. But this person lacks the safety system necessary for motivation and I think it turns into something else. That sympathetic, aggressive energy to get things done is used for the end of getting approval from others Not for improving the lives of others Not for providing for loved ones But for admiration or approval In the safety state, you don’t really need the admiration and approval of others You can appreciate it, but it’s not the goal of using sympathetic energy “Unaware of own motivations” corroborates this - not a conscious awareness of the thing they are after, which is the approval of others Is there shutdown present here? Not more than I have already said Disconnect from the self and needing others to define the self AND 2. Impairments in interpersonal functioning (a or b): a. Empathy : Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others. Empathy requires access to the safety and social engagement system If we’re in danger, we’re not going to have empathy This is a nervous system in a state of danger Leading to “impaired ability to identify with the feelings and needs of others” Excessively attuned to the reactions of others Excessive attunement requires some energy; this is not attunement to the polyvagal state of another, matching their state Could this be a shutdown to fight climb? Cutoff from the self is shutdown and the excessive needing reactions from others to affirm their existence or their worth is from fight? Shutdown brings a big disconnection from the world; going up into the fight energy might be where the energy to excessively attune comes from Doesn’t feel like flight and definitely not actual safety and social engagement But this could also be an avenue for stuck freeze energy Reactions of others if relevant to the self Energy required to attune to the reactions is not guided by the social engagement system; is not safe and connected The social interactions are very much directed toward the self and from the self From relevance to the self and searching for reactions of others This energy put into finding relevance to the self may be an avenue for staying out of a more disconnected and shutdown state... If you take away the approval of others… what is this person left with? Very lonely, disconnected, sad existence b. Intimacy : Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain Superficial relationships/selfishness/little interest No social engagement circuitry activated Selfishness vs self-interest Selfishness is benefit to the self at the expense of others Self-interest is benefit to the self along with others or not at their expense I give my time for interviews and editing and loads of stuff I am giving away. But I benefit from it also along with all of you, hopefully. I’m acting out of my self-interest and that’s okay, so are you… you’re listening and benefitting, but not at my expense. There’s a mutuality - the more I give, the more people listen, which increases the rankings of my podcast on the chart and maybe garners more attention for other things I want to line up. Even Steven. My Polyvagal Patrons are acting out of their self-interest by giving $5/mo for my members’ content… we both win. I get the money for my efforts and they get more content for their $5… there’s benefit along with each other. B. Pathological personality traits in the following domain: 1. Antagonism (this is the higher order structure with traits under it) , characterized by: “In two studies, antagonism was negatively associated with the ability to identify the emotional states of others.” - https://www.sciencedirect.com/science/article/abs/pii/S0092656618300461 a. Grandiosity : Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others. All about the self again Entitlement is like something is owed to you even if it’s not Self-centeredness is obviously all about the self One is better than the other is about the self, inflated along with the energy of fight probably Condescension probably comes from fight energy, there’s an aggression to it Shutdown disconnect from the self Inaccurate view of the self Being better than others is not accurate; definitely no safety in there We can be better or worse at some things or activities, like we can outperform or underperform each other But none of us is inherently better than the other, we’re just mammals on the same planet, born without value b. Attention seeking : Excessive attempts to attract and be the focus of the attention of others; admiration seeking. Is there safety here? No. Is there flight here? No. Is there fight here? I think so. Wanting to seek out and get closer to the attention, not avoid or hide from it The energy required in the “excessive attempts” is fight Is there shutdown here? Maybe, due to wanting to avoid it through the inflated sense of self that comes along with the attention in this trait C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations. It’s chronic, not obviously temporary D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment. E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). Polyvagal Patrons , let me know what you thought of this episode and the Member’s episode in the Patreon comments. Where is the Freeze? With the Borderline dx, I thought Freeze might be more underlying a lot of what we were seeing… but with narcissistic, I don’t get that same feel. There were not any sx in the DSM criteria , that pertained to rage or panic, no overwhelm or frantic energy… it could still be there, but it also seems like someone could have this dx without that outward presentation. Etiology suggests an over or under gratification of the desires and needs of a child, history of physical abuse, unpredictable or negligent parenting, being modeled manipulative bx from parents, which suggests some attachment issues to put it loosely… more of a chronic disruption of connectedness maybe C-PTSD than a forced immobilization shock trauma sort ANNOUNCEMENTS - Major one - members section has moved to Patreon . I’m calling it “Polyvagal Patrons.” And the best part is it comes with it’s own podcast! The Polyvagal Patrons podcast shows up in your podcast app just like this one. It’s updated with a mini episode or two every single week on Tuesday, just like this one. There’s a ton of audio content there already. Already over 7 hours of content that is not available here. That’s 7 hours more of all things Polyvagal and fun excerpts that didn’t make it into the podcast… for $5. You could literally binge 7 hours of this for $5 this month. And I am adding to it weekly. Current members, when you switch over, let me know and I will close the JustinLMT account so you aren’t being billed both places. I also sent out an email with more details. THANKS SO MUCH FOR LISTENING! Mayo Clinic article - https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463 Personality Functioning Criteria - https://onlinelibrary.wiley.com/doi/full/10.1002/pmh.1434 Definition of “pathology” from APA - https://dictionary.apa.org/pathology Polyvagal Patron access for $5/mo - www.patreon.com/justinlmft Polyvagal101 - https://www.justinlmft.com/polyvagal101 Mugs & more from Justin - https://society6.com/justinlmft Recommended reading - https://www.justinlmft.com/books Intro/Outro music & Transition Sounds by Benjo Beats - https://soundcloud.com/benjobeats

Put yourself first. I keep every episode as safe as I can, but just by the nature of the topics, you may experience some stuff come up. Take a break if you need to. And these are my personal conceptualizations about how the PVT connects to the DSM. I’m not suggesting you think the same way. This is how I am viewing them in general. As a starting point. This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of CPTSD, consult with a mental health or medical professional. I am speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. COMPLEX PTSD Polyvagal Ladder review CPTSD was initially proposed by Judith Herman ( 1992 ), who stated that “In contrast to the circumscribed traumatic event, prolonged, repeated trauma can occur only when the victim is in a state of captivity, unable to flee, and under control of the perpetrators” (p. 337). Shutdown = can’t run or fight Neuroception of life threat Herman is describing childhood - prolonged, repeated trauma where they cannot escape and under the control of the perpetrators due to childhood dependence on others CPTSD is typically begun during childhood when major developments are happening and when self-regulation is supposed to be happening But self-regulation is entirely dependent on co-regulation early on in life Need co-regulation from safe others, especially parents and people in the home Without self-regulation, life becomes a lot more difficult as the individual is always in a stuck state The diagnostic criteria for C-PTSD include: 1. E xperiencing anxiety -producing visual or emotional flashbacks, and vivid memories of trauma in response to triggering events Same with PTSD Triggering events are a neuroception of danger, passing through any sort of conscious processing and subjective to that individual Triggering the stuck freeze energy or going from safe to flight/fight that are accompanied by the visualizations of the event and the emotions of it Emotions and visualization are connected to the polyvagal state, which is probably connected to the traumatic event Those details of the event get imprinted to the person as cues of danger for the future 2. Going to extreme lengths to avoid environments or situations that are believed likely to provoke flashbacks or unpleasant memories Same with PTSD Going to extreme lengths in and of itself is using some sympathetic energy Behavioral adaptation to avoiding the sympathetic energy Sympathetic energy without the safety system is too much Obviously not just the memory, but what is tied to it; and the memory is a reflection of the state, a visualization of the danger cues 3. Chronic feelings of being unsafe or vulnerable to threats, even when external circumstances show no obvious signs of danger Potentially different than PTSD due to a chronic unsafe feeling Could be any of the stuck defensive states This is outside of being triggered by a vague thing; it’s chronic , it’s always there Due to lack of self-regulation, which is due to lack of co-regulation and betrayal of trusted caregivers, not just a lack of co-regulation Lack of safety in this person’s life Lack of trust Lack of vulnerability If anything, other dysregulated people are the norm for this individual Sounds like a pretty unsafe existence 4. A pattern of participating in unstable, dysfunctional, and unsustainable relationships Like I said in 3, dysregulated others become the norm Like attracts like People in their safety state will keep their distance from unsafe others Dysregulated people will keep their distance from safe individuals because it feels uncomfortable or they feel like they don’t deserve it or they lack the skills necessary for these safer relationships In more detail... Polyvagal theory explains that neuroception is healthy or unhealthy When we exist more down the ladder, we perceive danger everywhere and miss the cues of safety; our autonomic nervous system is prepared for danger, not social engagement This person has great difficulty in detecting safety or risk in others due to #3, the chronic feelings of not being safe, which is the stuck defensive state You’re left with dysregulated states attracting each other to get basic needs met, to seek protection, to seek companionship, but finding other dysregulated nervous systems that might compliment or exploit that The social engagement system of this individual is underdeveloped due to their chronic traumatic life, leaving this type of external relationship pattern. But this lack of safety also reflects on their internal relationship pattern... 5. Negative self-concept defined by feelings of deep shame, guilt, and unworthiness Very limited access to the social engagement system, where feelings of positivity woud live Remember, CPTSD is a reaction to “prolonged, repeated trauma… in a state of captivity, unable to flee, and under control of perpetrators.” If you can’t run, if you can’t fight, you shutdown These #5 feelings are all feelings of being in a shutdown state - the impulse to become smaller, to curl up; this is the bodily impulse of shutdown and the emotions that come along with it Per Peter Levine, shame is a biosocial thing, it serves a purpose on the social level and is felt in the biology; not just a state of mind Like with registries for sexual offenders - it’s for public safety, but also serves a function of public shaming Or being de-friended due to cheating The community can use shame as a way of stopping behavior But for the shame to be effective, it needs to be repaired The shaming of children through abuse is obviously a misuse of shame and is inflicted upon the child from the abuser’s own shame Shame needs safety to be undone, but the cptsd individual potentially did not have actual safety, so the shame persists along with the shutdown from the traumas If one were to listen to the bodily feelings under the shame, it might lead them toward completing the bodily impulse of becoming smaller, then coming out of that posture with the sympathetic energy as they climb the polyvagal ladder Wanting to disappear - becoming physically smaller, tucking head in, curling shoulders inward, a hunched look Feeling inferior, worthless, self-loathing, loneliness, emptiness Posture of collapse, aversion of gaze, wanting to hide and being smaller, lowered capacity to think, problems orienting to the moment and environmental safety Story follows state as well - these are thoughts that are directed toward the self and reinforcing of the state; we focus on the thoughts and not what is underneath them 6. Poor emotional control that leaves sufferers vulnerable to fits of rage and frustration and bouts of paralyzing anxiety Sounds like stuck freeze energy to me - rage, paralyzing anxiety; paralysis is the stiff muscles along with immobilization Rage is the uncontrolled sympathetic fight energy that gets triggered Weaker vagal brake, which is entirely dependent on the strength of the social engagement system Influence on the heart Makes sense since the lack of co-regulation in early childhood would have left with with a very underdeveloped social engagement system This dx is kind of all over the place, representing a very dysregulated body Stuck freeze energy and a severe shutdown state possibly at the same time All six symptoms must be detected before a complex PTSD diagnosis can be made. Because C-PTSD is often complicated by depression , anxiety disorders, borderline personality disorder , and substance abuse (all common co-occurring conditions with C-PTSD), mental health professionals will screen for such conditions once the symptoms of complex PTSD have been identified. We can see how this dx can end up looking many different ways when one adapts their behavior to the defensive state This has a lot in common with borderline personality disorder, which might be a behavioral adaptation to the cptsd; i can also see narcissistic being an adaptation to the cptsd But where is the dissociative sx? Polyvagal Patrons, let me know what you thought of this episode and the Member’s episode in the Patreon comments. ANNOUNCEMENTS - This completes the first year’s worth of weekly episodes. There’s actually more than that. Polyvagal Patrons ! 2 mini episodes per week for the next couple weeks at least. Listen to them right after this in the same podcast player. Double check your subscriptions, Narcissistic Personality episode didn’t upload correctly HOMEWORK - Remind yourself that you’re safe Maybe now, maybe when you’re at home, maybe when you’re on a walk, look around and remind yourself you’re safe Peter Levine and Shame Interview - https://www.youtube.com/watch?v=i2CN5nhmfxk Intro/Outro music & Transition Sounds by Benjo Beats - https://soundcloud.com/benjobeats

There are a handful of individuals that really intrigue me and I feel compelled to speak with and learn more from. And Karena Heyward is one of those individuals. She is teaching psychology online and incorporating the polyvagal theory into her classwork and her online therapy practice with hopes of using it in her research and scholarship as well. She's not only the definition of a #traumanerd and a #polyvagalnerd, but she's also a Super Fan to put it mildly. Oh and she also calls herself a "drama-trauma nerd" because she was on the high school stage crew. I'm extremely happy to present to you my chat with Karena Heyward. We talk about some polyvagal implications in teaching online and off as well as providing therapy online. Find her on Instagram - www.instagram.com/headtoheartllc If you're as much of a polyvagal and trauma nerd as Karena and I are, you might be interested in joining the Polyvagal Patrons where I have a whole separate podcast for only $5/mo. And Karena just so happens to be one of those Polyvagal Patrons. Karena, thank you so much for joining me. I know you're listening to this and I really want you to know how much you're appreciated. I look forward to talking with you again!

In English - https://www.justinlmft.com/post/parental_self-control Spanish translation by Sara Sandoval Trota ( para más en español - https://www.christianpsicologo.com ) Hola Justin. Mis hijos se suelen pasar el día chillando, chillan incluso por la noche, lo cual me activa el estado de huida. Cada vez que pasa me entra mucha ansiedad, y cuando pasa varias veces seguidas me enfado. ¿Qué puedo hacer respecto a este estado? Hola. Antes que nada —y es triste que tenga que decirlo, pero lo quiero hacer— gracias por no ser un padre que pega a sus hijos. Dicho esto, como padres, hay que hacer algo para tratar con nuestro estado a la hora de interactuar con nuestros hijos. Si te encuentras en un estado no seguro/social crónicamente, recomiendo hacer alguna actividad física en familia en momentos en los que no haya ninguna crisis. A decir verdad, hay muchas cosas diferentes que podemos hacer, así que no hay una sola respuesta. He aquí lo que hago yo. Ser consciente de mi propio estado Detenerme Recordar mis valores como padre Entender el estado de mis hijos Darles señales de que están a salvo Solucionar el problema con ellos 1. SER CONSCIENTE DE NUESTRO ESTADO Todos los días llevo la consciencia a mi estado y a mi respiración, lo cual se ha convertido en un hábito para mí. Suelo escanear en varios momentos del día diferentes partes de mi cuerpo (¿¡por qué casi siempre tengo la parte de detrás de las orejas tan tensa!?). Conozco las señales de mi cuerpo lo suficientemente bien como para pillarlas antes de que me lleven a comportarme de alguna manera de la que acabaría arrepintiéndome. Osea, cuando me siento muy frustrado, me doy cuenta de ello y enseguida hago algo distinto para no acabar chillando. Por ejemplo, si vuestro hijo se despierta a medianoche chillando, ¿cómo os sentís? ¿Os entran ganas de correr? ¿Os invaden pensamientos de peligro? Si vuestro hijo adolescente se pone rebelde, ¿qué hace vuestro cuerpo? ¿Tenéis una subida de acidez en el estómago? ¿Os encontráis apretando los dientes? Hacer los escaneos diarios, ya sea en cualquier momento o no, nos lleva la consciencia a nuestro cuerpo, y con consciencia —siendo capaces de describir las sensaciones de nuestro cuerpo y nuestros pensamientos— aumenta nuestro control a la hora de elegir cómo reaccionamos a las situaciones más difíciles. 2. DETENERSE En serio, simplemente deteneos . Si esto es una idea totalmente nueva para vosotros y soléis llenaros de furia o queréis salir corriendo, esta recomendación os resultará absurda y totalmente inasequible. Y lo entiendo. Todavía es un reto para mí si no me encuentro en el estado seguro/social. Dejar pasar la frustración es más fácil y hace sentir mucho mejor que intentar hablarle con calma a un niño chillando, pero hace más daño a corto y a largo plazo. Yo simplemente he aceptado que pararme me da la oportunidad de avanzar al siguiente paso. Es como un momento de transición para mí, no una solución al problema. Pero antes de eso, mi objetivo singular en este paso es no empeorar la situación . Si mi hijo está enfadado y yo también me enfado, probablemente la situación va a empeorar, y a más largo plazo, también estoy empeorando la relación con mi familia, y eso no va conmigo. Si vuestros hijos están chillando en medio de la noche, no empeoréis la situación. Estamos hablando de un niño aterrorizado que ha caído en su propia excitación simpática. Dar señales de seguridad será más efectivo y tendrá un impacto positivo más duradero en el niño y en su capacidad de tolerar su propio estado la próxima vez . No lo empeoréis esta vez actuando por impulsos y siendo más agresivos. Tenéis una oportunidad para mejorar ahora de cara a la siguiente ocasión. 3. RESPIRACIÓN PROFUNDA Lo sé, está recomendación suena estúpida y nada práctica, pero es muy efectiva para volver en vosotros mismos. Respiro tantas veces como me haga falta, sin moverme y yendo un poco hacia dentro. Mis hijos se darán cuenta de lo que estoy haciendo, lo cual les dará un tiempo de pausa. Normalmente una buena inspiración profunda seguida de una exhalación larga me basta para poder concentrarme en el siguiente paso, pero si necesitáis hacerlo más de una vez, adelante. Este es un bueno momento para recordar alguna experiencia del pasado que os hiciera sentir a salvo. Yo recomiendo pensar en alguna vez en que tomasteis en brazos a ese niño cuando todavía era un bebé, o en la primera vez que os agarraron el pulgar, o la primera vez que jugaron a algo. Cualquier cosa que os haga recordar cuánto los queréis, porque es verdad que los queréis, aunque no sea lo que sintáis en ese momento de agitación. Sin duda, deberíais practicar la respiración profunda a lo largo del día. Yo no hago meditación ni yoga; no es lo que me va. Sin embargo, controlar la respiración de manera consciente de vez en cuando me entrena para ser capaz de actuar de manera más acertada más rápido. 4. RECORDAR NUESTROS VALORES COMO PADRES En momentos de mucho enfado o frustración, me es de ayuda recordar cuáles son mis valores como padre. Por nada del mundo pegaría jamás a mis hijos, lo cual me resulta bastante fácil, y siendo honesto, no tengo ningún deseo de pegarles. Si este tema es algo que necesitáis priorizar, por favor hacedlo inmediatamente. Por favor. He aquí algunos otros posibles valores: Educo a mis hijos partiendo del amor, por encima de todo Tengo que ser una persona que dé seguridad y señales de que no hay peligro Seré una persona con quien puedan sentirse a salvo, sabiendo que soy un modelo para el futuro Estos valores normalmente me bastan para ir al siguiente paso. No, no es super fácil al principio. Sí, con práctica, cada vez se hace más fácil. Han habido veces en que he tenido un poco de debate interno sobre cómo llevar una situación, porque aunque sabía que el camino seguro/social es el correcto, también sabía que dejarme llevar por la energía de lucha huida me daría un resultado más rápido. Normalmente, este diálogo interno acaba con el sistema seguro/social diciéndole al sistema lucha huida ≪ vete a otra parte ≫. Si lo que quiero es que mis hijos se encuentren en el estado seguro/social, yo tengo que estar en él también . 5. ENTENDER EL ESTADO DE NUESTRO HIJO El otro beneficio de ser conscientes de nuestro propio estado es usarlo como señal para dar información de nuestra toma de decisiones. Si nos sentimos en pánico cuando nuestro hijo está chillando, he ahí una pista de dónde se encuentra nuestro hijo. Seguramente está sintiendo algo parecido, y ahora nosotros también lo estamos sintiendo. Imaginad que estáis en un centro comercial y sentís a un bebé chillando. ¿Qué sucede? ¿Vuestras alarmas internas se apagan, verdad? Esas alarmas están ahí por algo. Respetadlas, escuchadlas, y entonces actuad . Surgen de vuestro amor por vuestros hijos. Cuando estamos más calmados, podemos ser más conscientes y elegir cómo actuar. 6. DAR SEÑALES A NUESTRO HIJO DE QUE ESTÁ A SALVO Esto significa darles señales de seguridad de manera directa, por ejemplo, estando con ellos, tomándolos en brazos, cantando, sonriendo, usando la prosodia o levantándonos y moviéndonos con ellos. Para los adolescentes, vamos a centrarnos más en lo facial, como el contacto visual, o mostrando curiosidad por ellos y que nos importan. Para el niño que se ha despertado en medio de la noche y está chillando, puede que tengamos que usar una voz má prosódica mientras los tomamos en brazos y lo mecemos. No tengo una guía exacta para cada caso, y cada niño es diferente, eso está claro. Para mi hijo (de 4 años), cuando abro los brazos como para darle un abrazo, normalmente viene a mi sin poder resistirse, incluso cuando está muy abajo en la escalera polivagal. Para mi hija (de 9 años), suele funcionar mejor escucharla y darle tiempo, y entonces volver a preguntarle cómo está, y cuando se haya regulado, le doy un poco de amor y positividad. 7. SOLUCIONAR EL PROBLEMA Una vez hayamos ganado el control sobre nosotros mismos, entendamos mejor en qué estado se encuentra nuestro hijo y estemos concentrados en dar señales de seguridad, ahora ya podemos intentar solucionar el problema. ¿Por qué estos niños están chillando en medio de la noche? Obviamente, no se sienten a salvo, lo cual puede ser por diferentes motivos, pero una vez se sientan suficientemente seguros, es la hora de procesar lo que está pasando. Podríamos decir algo como: ≪Oye, he visto que te salían lágrimas de los ojos y te he oído chillar, pero veo que ahora estás respirando mejor. Has pasado mucho miedo, ¿no? ¿Qué te ocurre?≫ Una vez nos hayan dado una respuesta, podemos intentar buscar una solución con ellos. Solucionad el problema juntos, como cerrando la puerta del armario con el niño que tiene miedo. Para un adolescente, podría ser organizar un horario para hacer los deberes. Trabajar con ellos los ayudará a entrenarse para quedarse o volver al estado seguro/social la próxima vez. A largo plazo, esto mejora la regulación de uno mismo. El mayor problema que nos encontramos es que no podemos esperar hasta el momento de la crisis para preocuparnos de nuestra propia regulación. Tenemos que hacerlo más a menudo. Si esperamos hasta el momento en que oímos chillidos, y entonces decimos ¿¿¡¡Qué hago ahora!!??, será más difícil implementar estas soluciones. Así que hay que practicar estas cosas con antelación para que no sea tan abrumador cuando nos encontremos en la situación real. Creedme, he estado en vuestro lugar y ya lo he pasado (casi del todo). Sí queréis saber más sobre este tema, os recomiendo leer (enlaces de Amazon de donde recibo parte del beneficio de las ventas sin que os cueste nada extra a vosotros) Tus hijos a prueba de traumas de Peter Levine, el curador de traumas de ≪Somatic Experiencing≫.

Yes , there needs to be a goal (or goals) in therapy. OMG, yes. I discuss things like Bad Therapy on the podcast as well as in my Patreon podcast . But here I'll go through some main points in considering this question: Therapy is not a paid friendship. It's a professional service. A service just like any other. The client pays the agreed upon amount; the provider gives the agreed upon professional service. These two things (and more) would be included in an informed consent. And there is an agreed upon goal of the service . Maybe an end date. Maybe a number of sessions. Either way, it ends when one of these conditions is met, but my focus is on a measurable change goal. And a measurable goal should be there no matter what the end condition is. If I hire a plumber, it's for a set price for a set service and ends when my plumbing need is alleviated. The plumber doesn't just keep finding things to fix. Or wander around the house aimlessly. No. We agree ahead of time on what the plumber will do. They will work until the leak under the sink is fixed. For therapists, we provide a service around something less obvious, but still measurable. Like until the feelings of anxiety have alleviated from a severity of 9/10 to 3/10. Or the nightmares have reduced to once a week versus nightly. Or the moments of noticeable "glimmers" with family members increases to 3x/day. Something like that, typically with a baseline and an identified stretch of time to see the change maintain as well (like for one month). Friendships don't have goals. Or cut off points. Or a limited number of meetings. Friendship does not involve being paid. It's not a professional service. It's friendship. Friends can get together and just talk. They can kill time with no specific end goal in mind. It's about the company of the friend, not what you want out of the friend. Therapy is different. There's something a client wants out of the therapist. Something that the client is not able to do alone at that point in their life. So they hire someone they perceive can help them get to the next step. If you're coming in week after week and doing basic chit chat or venting, that's not therapy. Chit chat can have its place in building rapport with a client and oftentimes a session begins with chit chat. And there might be a week where the client tells me, "I just need to vent and for you to listen." But the heart of therapy is much more than this. Again, it's a service and not a friendship. We are supposed to provide something different that a friend or other support cannot. And part of that is having a clear goal to collaborate on. I personally do not feel comfortable whatsoever with accepting money from someone to simply talk. Or chit chat. Or vent. That's something they can get elsewhere. If a therapist is taking payment from you week after week without a goal, then I don't know what they're doing. It seems they are charging you for talking with no end in sight. How do you know if this is helpful or not? How do you know if you're making progress? How is that being measured? Is the therapist a part of that discussion on progress? If they aren't discussing or measuring progress, what are they doing? And I know, the client is still receiving co-regulation and simply connecting with another human being is important and helpful. But helpful towards what ? What does my co-regulation have to do with the client unless they have a goal that they are working towards? If you want co-regulation, that's what friends are for. You can get co-regulation in the form of friendly support. Or a mentor. Or a family member. Or a spiritual leader. But what if I don't have these things and just need someone to talk to? Then a goal of therapy is to increase your support network. Not for the therapist to be your support network. Therapy is temporary! Not ongoing with no end in sight. Yes, some clients might be in therapy for years and years. This isn't a discussion on how long therapy should take. Only on whether there is a goal or not. Even for those clients in therapy for years, there should still be regular measuring of progress toward a specific goal. Goals can change over time, by the way. The goal of the first few months of therapy might not be the same as the last few months. As one thing improves in therapy, then it might be time to change the goal to something else. But this needs to be a verbally discussed and then written agreement between client and therapist. Not meandering in and out of session, discussing whatever is the problem currently. Not only should the goals be clearly discussed and agreed upon, but they should also be revisited regularly . I typically check in with my clients about their progress on goals every session. "How did the homework go?" "How's your progress on the overall goal?" "Do you feel like you're still making progress on the goal or do we need to re-discuss it?" Stuff like that. I also regularly check in with them about myself as a service provider. Every session. "How did this session go for you?" "Did I do an okay job for you today?" "How was I as a listener for you?" "Is there anything I can do better for you next time?" Stuff like that. A goal is something that is agreed upon and collaborated on . So getting feedback about myself as the provider involves the client in the collaborative aspect. They design the goal with me. They discuss what's working and not working with me. We change what needs to be changed as therapy progresses. The collaboration is central to building autonomy for the client. Otherwise, without the transparent collaboration, we're left with an expert/client dichotomy. It's a strong power differential. When you collaborate, it begins to neutralize the impact of the power differential and eliminates the dichotomy. Therapists are the experts on psychology in the room. The client is the expert on their life in the room. The two meet in the middle and collaborate. The client is viewed as a fundamental part of therapy and not the recipient of therapy. Therapy is done with the client and not to the client. Without a goal, the collaboration is lost. Not having a goal in therapy and simply meandering week after week builds dependence from the client to the therapist (although I also wonder about the therapist to the client as well). A relationship of weekly venting can emerge. One of a weekly reset. This weekly reset is helpful for the week maybe, but what about long term? What about that client's larger ability to gain more emotional independence? If there is no larger goal being addressed, the client might be relying on the therapist for their weekly grounding. If the client has no one else in their life for support, this creates a significant problem. A therapist can't be offering only weekly venting. This is a guaranteed regular bill for a service that has no end in sight and may have also built dependency on the therapist. This is the exact opposite of what therapy is supposed to provide. Goals build autonomy and success. Meeting goals is important in life; they are foundational in building confidence, healthy boundaries, bravery and autonomy. In feeling value in yourself and your capacity to meet challenges. But you cannot meet a goal if you have not set a goal. Same applies for therapy. To help clients build their autonomy and confidence, they need to experience feelings of success and pride in what they have achieved. To be able to see where they were and where they are. When you begin treatment with a licensed therapist, creating a treatment plan is expected. It's taught to us in "therapy school" (as Mercedes would say) and is part of the basic structure of therapy. Therapeers - if you don't set goals with your clients, what are you working on? Are you providing anything distinct from what others can give to your clients? How do you know? If you have some means of knowing that you're working on a goal... is your client aware of it also? Do they know that you have a goal for them? Has it been discussed with them? Have they signed off on it in writing? Does your informed consent say that goals aren't going to be developed if they're not? I think at it's best, not having a treatment goal is an attempt to provide co-regulation, opportunities for venting and be a support for the client. At it's worst, it's a way to take advantage of someone's desperation and give them a weekly bill with no end in sight. And both of these can look the same way. How would you know the difference? We have to do better. We have to provide a unique collaborative experience and professional relationship for our clients that they cannot get elsewhere. And part of that is a goal for our time with our clients.