These days I have real difficulty in trying to separate or differentiate my counseling from my coaching work.
At what point do I step back from a subject my client presents and suggest we are moving into different professional territory? My client is totally disinterested by that. All he knows is he has issues, often complex and multi layered, which are standing between how he is, and how he would like to be.
I now regard my work as being on a 'the continuum of wellbeing.' Sometimes life is good. We are in the 'ok 'zone. At those times, people might seek out the services of a coach.
At other times, life is less than perfect. People or events cause worry and concern. This has an effect on our sense of wellbeing and we are in the 'not ok' zone. We might then consider it most appropriate to work with a counsellor. Or, we might move from 'ok' to 'not ok' moment to moment, reacting rather than responding to life events. Affect regulation might then be the focus of therapeutic work.
The fully integrated practitioner will have the appropriate tools to deal with whatever their client presents.
There is no more dramatic example of the 'not ok' client than those that present with trauma. The skill set needed to deal with such a wide range of presenting issues, is something I now think of as extreme integration.
I believe 'extreme integrated practitioners' hold the key to the future of holistic wellbeing support. They will challenge our interpretation of where counselling stops and coaching begins, underpinned by our better understanding of the mechanics of the human brain.
The silent right hemisphere
Recent research has indicated that insight, sometimes referred to as the 'aha moment' occurs in the right temporal lobe, in an area situated just above the ear. (1)
This hemisphere is generally connected with emotion, an older part of the evolved brain. This silent hemisphere has no language and perceives the world in a completely different way to the lateral, logical, linear left hemisphere. It interprets the world through instinct, concept, shape, colour, dimension, image and metaphor.
In recognition of the emerging significance of this hemisphere, I have increasingly used guided visualisation in my work and noticed much improved clinical outcomes as a result.
For many years I have been using a particular guided imagery technique called 'Rewind' for resolution of Post Traumatic Stress Disorder. (2) The process involves engaging parasympathetic breathing and relaxation before guiding the client to visualize the traumatic episode on an imagined screen.
The client is encouraged to fast forward and rewind the traumatic episode until they are calm whilst recalling the event. This intervention has become a welcome addition to my therapeutic tool box and something I wrote about in detail in my book 'PTSD Resolution.'
A tool for the resolution of trauma
In my role as coaching and counseling supervisor, I try to both support and inform those I work with.
Having passed on the details of the Rewind technique to one supervisee, he greeted me eagerly at our next appointment.
'I've tried it twice since we talked about it last time,' he said 'and I am amazed at the results.' One client had been caught up in an OCD cycle of high anxiety and checking. It was starting to dominate his life and was developing into agoraphobia.
He'd become less and less inclined to leave the house to go to work. Once he was at work, charged with making sure the building was secure before exiting, he felt compelled to return to check and re-check that doors were shut, lights were off and all electrical appliances switched off a source.'
It turned out the origins of the client's OCD were rooted in a single event when he had left an iron plugged in which caused a subsequent fire. A Rewind of this first incident was enough to break the pattern and give reassurance to his brain's emotional centres that they could switch off thehyper-vigilant mechanisms keeping him on red alert.
On this occasion my supervisee used the intervention for the first time and wondered if it would be effective. When his client returned two weeks later, not one incident of checking had taken place. Both practitioner and client were really pleased.
'What happened with the second client?' I asked.
My supervisee smiled. 'She phoned to say the visualisation had sorted the problem out and she didn't need further therapy!'
Memory is malleable
To understand why Rewind and techniques like Eye Movement Desensitization and Reprocessing or EMDR (4) work, we need to appreciate the implications of neuroplasticity and malleability of memory.
'False memory syndrome' (4), although not listed as a recognised disorder in the DSM V (5), is understood by therapeutic practitioners as significant in the context of suggestion, distortion and fabrication. The phenomena is a clear example of how memory is encoded within the neural networks of the brain and, in recollection, can become re-encoded.
Although perceived as a negative manifestation off the phenomena, 'false memory syndrome' gives positive hope and reassurance to both clients and practitioners that the nightmares and flashbacks of PTSD can be resolved by the re-encoding of traumatic memory and the creation of a new and calm narrative around the trigger event.
If the client can be encouraged to feel safe, comfortable and relaxed whilst retrieving previously negative or traumatic memories, with appropriate practitioner guidance, the memory can be integrated by the hippocampus.
The Freudian link
Restructuring memory was something referred to by Freud as Nachtraglichkeit or the ability to re-conceptualize childhood memory from the maturity of the adult. (6)
I try to pass on effective skills, including the Rewind technique, to as many professional practitioners as possible in a way that was easy to understand. (7)
Yet, I find generally that, even when they have the competence to use these simple techniques, similar to those used by trauma focused CBT practitioners and approved by NICE under the heading 'imaginal exposure (8), they do not necessarily have the confidence to do so and need ongoing training, encouragement and support in supervision to implement them.
The roots of Rewind
The technique known as 'Rewind' can trace it roots to the work of Milton Erickson, (9) an American psychiatrist specializing in medical hypnosis and family therapy, who was noted for his creative approach to mental health. It was Erickson who first coined the term brief therapy.
After many years of studying Erickson's therapeutic work, Richard Bandler, originator of Neuro Linguistic Programming, wrote about the technique in his book ‘Using your Brain for a Change’. (9)
calling it the 'fast phobia cure'. He said:
'I discovered that the human mind does not learn slowly. It learns quickly. Teaching someone how, and when, to associate or dissociate from thoughts or emotions is one of the most profound and pervasive ways to change the quality of a person's experience, and the behavior that results from it. Dissociation is particularly useful for intensely unpleasant memories.'. (10)
The technique, sometimes referred to as visual kinaesthetic dissociation (VKD), was developed further as a treatment for PTSD by Dr David Muss who described it in his book 'The Trauma Trap'. (11) It was later adapted by Joe Griffen and Ivan Tyrell who added an imagined TV and remote control rather than a cinema screen. (12)
So, what is the Rewind technique?
Whichever version you use, the key to fast resolution seems to be in how memory is stored in the brain and the unique human ability to step back into its observing self.(13)
If you imagine an area like passport control in your brain, ordinary and every day memories are waved through and put into a filing cabinet. This is where they stay unless you decide to look around in the filing cabinet and retrieve the document. Memories with emotional significance, like birthdays for instance, are easier to retrieve.
However, if an incident occurs which is perceived as a possible life or death situation or is a significant traumatic event, the memory is not waved through by passport control and is kept in a kind of holding bay.
The amygdala, an almond shaped organ within the limbic system or emotional centre of the human brain has the job of protecting the human body. If something occurs which is perceived as threatening, sufficient emotion is attached to the memory by the amygdala to ensure it stays in the holding bay.
The brain will then scan the environment for anything similar to that event and will press the panic button if it perceives a threat is present. Your amygdala is always trying to protect you and, if feels it has information which must not be filed away, it stays alert on your behalf.
The human brain is also a pattern matching organism and has to be so, to safely navigate the world.
If you walk into a room and see a chair, although you have not seen that specific chair before, you know it is a chair because it loosely matches the pattern of a chair with a back, seat, and four legs. This pattern matching mechanism has to be quite loose otherwise every time you saw a new chair you would have to work out what it was all over again.
This loose pattern matching mechanism means that any thing in the future which is similar enough to an original trauma may produce the fight, flight or freeze response.
But, encouraged to view a traumatic episode in a safe environment, from further away and from the outside looking in, the client is moved into their observing self. The amygdala receives the message that this incident is not still current and the client is now safely out of that situation.
The client’s internal soldiers who have been scanning the environment for danger are given permission to stand down. Emotion is unhooked from the memory and it can now be processed, contextualised and integrated into memory. It is waved through passport control and filed away with other memories.
The traumatic memory will not be forgotten but can be retrieved much as other memories can be retrieved at will but not now tagged with the high emotion of the original memory.
Describing the technique
The client can be guided to imagine either watching a TV or being in a cinema watching a film of the traumatic incident from before there was a problem until the memory fades. In some circumstances, the client may be encouraged to end the film in a relaxed place, for instance on a beach if that is appropriate for that client.
Having watched the film the client is then encouraged to move into the film screen and experience the incident in reverse, very fast as they rewind back to the moment before the event occurred.
Rewind for pattern breaking
The technique is also helpful for pattern breaking. An Impact of Events Scale (14) or other outcome measure can be used to monitor improvement pre and post intervention. The second measure can be completed on the client’s next appointment and any changes noticed and reflected back to the client.
So even if a client does not appear to meet the criteria for Post Traumatic Stress Disorder, Rewind may still be appropriate for breaking old patterns, by integrating or putting old memories to bed.
As the human brain pattern matches, events in the here and now may be similar enough to incidents from the past that a match occurs. This is something counsellors generally refer to as transference. (15)
Any reaction to an incident in the present time which appears to be over the top may be due to pattern matching to past events.
A traumatic incident
Client M had developed issues about learning to drive. Aged 17, he had been taking driving lessons quite happily until an incident occurred when he mounted the pavement.
Although the incident had been quite minor, in his imagination he had played a film of the possible consequences of losing control of the car. He had imagined a major accident in which he had been the cause. ‘If a car had been coming the other way or had been travelling close behind, there could have been injuries or death’, he thought..
Although this incident did not meet the criteria for post traumatic stress disorder, it had been tagged as significant by the amygdala. Pattern matching was now occurring every time he got into the car for a driving lesson. He was edgy nervous and upset and was at the point of giving up learning to drive.
I explained to the client how memory is stored, how pattern matching occurs and then completed the Rewind technique three times with this particular client as he seemed uncertain he had done it correctly.
This was a one-off session. The client's mother happily reported afterwards that the session had been successful and there was now no further negative reactions in driving lessons.
Rewind for a client with Aspergers syndrome
Clients with Aspergers syndrome will sometimes seek the help of a therapeutic practitioner to help process or integrate emotional content and high anxiety. My client, Mary has regular 'Rewind sessions' when her life becomes overwhelming and she needs to calm down.
Mary attended a session complaining of a song which had been going round in her head for days and was really annoying her. Significantly, the song was called ‘Runaway.’ She told me she'd been replaying regrets about recent incidents over and over to the point where she now could not sleep. The Impact of Events Scale was very high in all areas
It turned out that Mary had fallen out with a group of people when she had made some social mistakes and had then been isolated by the group. She was now full of regret and was tormenting herself by replaying a film of those events in her head.
I reframed the experience for Mary:
‘It sounds like you have regrets about the things you said and the actions you took. Yet human beings are hardwired to learn from mistakes so what new knowledge and wisdom or new understanding and insight you take from this event?’
Mary was able to see that, given the same set of circumstances she would, in the future, act differently.
‘It’s like you've got caught up in a repeating memory just like the repeating song in your head and that you now need to learn from the experience and let go of that particular memory.’
Rewind was successful in allowing Mary to integrate the traumatic memory having taken some new learning from it.
Helping our veterans
The possible 'domino effect' for the traumatised Veteran is significant. Returning from war, distressed by nightmares, flashbacks and scanning the environment for possible danger can result in constant over vigilance and hyper arousal.
Intense emotional discomfort can lead to behavioural and personality change which can impact the whole family. The Veteran may turn to drugs or alcohol to alleviate the symptoms, self medicating to help with sleep or avoid nightmares.
Anger outbursts are not uncommon. Drug or alcohol addiction may lead to break up of the family, loss of employment and subsequent loss of status. Many of the Veteran’s innate emotional needs (15) are now unmet by his lifestyle.
This domino effect can then impact further on a trajectory into homelessness, violence or crime.
Whole brain therapy
One of the foremost researchers of neuroplasticity, Michael Merzenich's (16) work has shown that the brain retains its ability to alter itself well into adulthood, suggesting that brains with injuries, illness or embedded functioning styles might be able to change and recover, even later in life.
He has also explored the way the senses are mapped in regions of the brain and the way sensations teach the brain to recognize new patterns. This research is significant for the evolving world of coach-counselling.
Imagination is a powerful mechanism. Our growing understanding through neuroscience and research is providing the rationale for ever more creative interventions which access a uniquely human resource, one which can be both the source of our distress and the key to resolution and healing.
I believe the previously hidden power of the fully integrated brain is now mirroring and providing a parallel for the new move into truly integrated well being support for humanity.
It seems to me it's not a question of if, but when, extreme integration will be the norm.
Are we ready?
'Frances Masters is principal of the Integrated Coaching Academy. The Fusion Therapeutic Coaching Diploma runs again October 2014. See www.integratedcoachingacademy.com'
Refs:
1. The Creative Brain: How insight works. Episode 8: Thurs 27th June 2013 http://www.bbc.co.uk/programmes/b01rbynt
1. Zhang, Q., Qiu, J., Cao, G. (2004) "A review and hypothesis about the cognitive mechanism of insight." Psychology Science 27, 1435–1437
2. Muss, D.C., 1991, BJCP, 30, 91-92, A new technique for treating post-traumatic stress disorder: a report on the treatment of West Midlands Police officers with PTSD,
3.http://www.amazon.co.uk/PTSD-Resolution-Defeating-Panic-Reclaiming-ebook/dp/B00A9FOD36Masters,
4. Shapiro, F. & Silk-Forrest, M. (1997). EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma. Basic Books .
5. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing.
6. Cozolino, L. (2010) The Neuroscience of Psychotherapy: Healing the Social Brain. Norton Press
7. F.A. Masters, 2012. The NCFE accredited Fusion Therapeutic Coaching Diploma
8. www.nice.org.uk/download.aspx?o=CG026NICEguidelineword
9. Bandler, R. 1985. Using your Brain for a Change. http://www.citehr.com/117434-books-richard-bandler-rarest-collection.html
10. Bandler, R. 1993. Time for a change. http://cdmotivasi.files.wordpress.com/2008/06/richard-bandler-time-for-a-change-ocr-v100.pdf
11. Muss. D. 1991 The Trauma trap. Transworld. London.
12. www.hgi.org.uk
13. Deikman, A.J. 1982.The Observing Self. Beacon Press. Boston.
14. * Impact of Events Scale. http://www.octc.co.uk/resources.
15. http://www.oxforddictionaries.com/definition/english/transference
16. Merzenich, M. 2013. Soft-Wired: How the New Science of Brain Plasticity can Change your Life. Parnassus. San Fransisco