The main therapeutic ingredient for someone who is grappling with childhood trauma, whether repressed or vivid memory, is SAFETY. The safety we refer to in psychotherapy is not only physical safety but emotional and psychological safety as well. People who have been abused or traumatized in childhood were helpless victims because they were young and did not have control over their environment or the relationship with the adults around them. In essence, their nervous systems were built around the trauma and this usually means that dissociation is a central defense mechanism the child used. For some people the dissociation was so strong (a great way to protect themselves!) that the memories of the trauma get lost in very depth of the mind.

Below I share a short case study of a woman who, over the course of psychotherapy, has started to uncover the lost memories and rebuild her life. The purpose here is to give clients insight into the importance of safety in treatment and some of the ways a client can work with a therapist to create a safe container.

CASE STUDY (This is a very condensed synopsis of work that took about a year)

'Freya' was referred to therapy by a local agency and complained that she feels "like something bad happened to me but I don't know what." I explained to Freya that whether or not we find out what happened to her or not, our intention in therapy is to help her deal with the impact of her traumatic past on her present-day life. The very first step in creating safety is stepping away from the trauma and focusing on creating a supportive therapeutic relationship.

After a number of sessions, Freya and I became more and more interested in what helped her feel safe in the therapy room. We discovered that it was helpful if she took 15 minutes before the session to prepare and ground herself in the waiting area and also 15 minutes after the session to reflect and transition back into her day. Extending the session time in this way on her own helped Freya to be ready to go deeper when she was with me.

In the beginning of each session I led a grounding exercise to help Freya connect with a feeling of safety and support. Her favorite one was mindfulness of her feet on the floor and back against the couch. We sat together for about 3 minutes focusing on these sensations and arriving into the session slowly.

We also found that Freya felt more comfortable in the therapy office when after the initial exercise, she lay down on the couch. Most of the time she did not make eye contact with me. Sometimes her eyes were closed when she spoke but other times they were not. She could speak more naturally and freely this way instead of sitting up across from me. Once she began laying down during the session, each session deepened in content.

One week Freya shared that she had been consumed all week with the feeling that there was a child screaming inside her. I interpreted this as the young child self that Freya had left behind. During this session I guided her to close her eyes and encounter the child. After she spent a few moments with the child, I asked her to see herself in a safe place. For Freya the safe place was at the ocean, listening to the ocean sounds and feeling the sun and sand. In our session she alternated between being with the screaming child and returning to the safe place. Eventually without my guidance, Freya felt the urge to return to be with the little girl. The child in her mind was upset and closed off. They did not speak very much since it was hard to communicate with such a child. I asked Freya what she might do to connect and comfort the child. She found herself sitting down next to the little girl and placing a hand on her shoulder. This was all the contact necessary. The two of them sat together in silence like this for a long time. 

A few weeks went by and Freya returned to session reporting that she was having memories of her childhood trauma come to the foreground in her memory. She told me this calmly, sitting up across from me as an adult. The memories she shared were very difficult and painful. I remarked to Freya how grounded she seemed to be as she spoke. She said that she herself was surprised by how well she has been doing even as the memories surfaced. She did not expect it to be like this. I explained to Freya that she had been doing a very good job creating safety for herself while connecting with the little traumatized girl inside of her. I reminded her that she is no longer that young girl. She is an adult who is no longer going through those experiences. Her ability to reflect and support herself is a real show of her strength and growing self-acceptance and self-love as an adult.

I believe that it was Freya's willingness to let go of the expectation that the memories would come up that helped free them. She spent most of the first year of therapy focusing on resourcing herself in her day to day life by finding creative activities, support groups and a stable living environment. In therapy she focused on learning tools to use in times of high anxiety and depression. The repressed memories were not the focus of her attention yet when they began to surface, she had access to a whole new set of coping skills she had been building.

Building safety in and out of the therapy room is a very important process for clients dealing with childhood trauma. It can be a lifelong process. It is so valuable because healing can feel like a deep dive; you've gotta have that oxygen tank with you down there. But once you've been to the bottom of the ocean of your mind and come back to the surface, you can take a long walk on the beach.

Yin Yoga is a passive style of yoga developed by Paulie Zink and taught by Sarah Powers and Paul Grilly that integrates yoga poses and knowledge of Chinese meridian theory. Meridians are lines of energy that run through the body and correspond to internal organs. These can be accessed through acupressure, acupuncture, hand-on-healing, and even by your own stretching to activate them. 
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The Stomach/Spleen meridian pair are the main meridians you can target for benefits relating to disordered eating.
"The stomach meridian is the yang meridian and is paired with the Spleen yin meridian. It helps support physical and emotional nourishment. It functions with the Spleen meridian in the assimilation of Qi from food through digestion and absorption. The Spleen supports self-esteem and open mindedness." (Taken from NaturalHealthZone)

The idea in Yin Yoga is to target the energy lines so it's not as important that you do the exact pose in the exact right way. As long as you feel a stretch, an opening of energy, a deepening of sensation - in the area you're working on. 
Here are some tips for your Yin practice:

• Give yourself ample time for the practice. Light a candle, play some gentle music, invite in a soothing atmosphere.
• Stay in each pose for a minimum of 3 minutes and up to 10 minutes or so.
• You don't need to exert any effort. Once you find a position that is effective, you should be able to fully relax into the stretch. Use props such as blankets, pillows, blocks or bolsters to create ease.
• Come out of each stretch very gently and slowly. Allow yourself time to lay flat in Savasana between poses and wait for the areas you were working on to feel pleasurable and flowing before moving to the next pose.

Here is a list of some poses that correspond to the Stomach/Spleen Meridian:

• Wide knee child pose (with or without a twist)
  
• Saddle pose (shown above)
• Dragon Pose (Low lunge)
• Swan Pose (aka Pigeon pose)
• Butterfly Pose
  
• And don't forget to do Savasana or Corpse Pose - laying flat and relaxing all muscles at the end of your practice 
  

Changing your thoughts about yourself may seem impossible. You have a very long term relationship with 'you' and it feels like you absolutely know and can rely on the view you have of yourself. When you hear yourself thinking "I hate myself" or "I can't do anything right" or any number of other self-defeating thoughts, you are actually abusing yourself emotionally. And as with any kind of abuse, it leaves a mark on your psyche. This internal negative self talk is very hard to break because it becomes a habit of the mind every time you are at all feeling insecure about yourself.

What you might not realize is that these negative thoughts are not true. They are a structure made up of many experiences you have had over the course of your life. More than likely, you have internalized messages that you received at a very young age from your care givers. It doesn't have to be the exact words they used that are going through your head now, but even passive ways they communicated to you that left you feeling unworthy. Your self-esteem is built on reflection you get from the world early on, so turning things around later in life is a daunting task. 

At the eating disorder recovery IOP where I work, we often come up against a big challenge with clients when it comes to self-esteem. A treatment program is fertile ground to examine your beliefs about yourself and weed through them. Then of course, comes the tricky part: planting new seeds of positive self-image.

This week in group, I brought in a song by India Arie called "Strength, Courage and Wisdom" and played it for the group. I asked each of the women to spend time reflecting on the song by journaling or drawing. We listened to the song 10 times in a row to really let it sink in. The song is groovy and fun. It's catchy too so it's easy to start humming along after the first time you hear it. Some of the women found themselves joining in under their breath as they journaled. 

When I asked them to share with me and the group what it was like to listen to this song each one of them said a version of, "Cool, song but I don't relate at all. I don't feel I have those qualities and I don't know how to get them." Although it was exactly what I expected to hear, their response made me sad. I looked around the room at these young women who had reached out for help in a world that sometimes makes it seem like having an eating disorder is par for the course to become pretty, successful and desired. I saw their strength. I saw them showing up here at the IOP day after day, riding the waves of up and down and picking themselves back up over and over when they fall. I saw their courage. I saw women who are choosing to look within for the answers. I saw women who, although they may waiver at times, they are beginning to build faith in their ability to change. I saw their wisdom. But they did not see these things in themselves.

I asked them what it feels like when someone gives them a compliment. Each in her own turn said that she can not accept a compliment and uncomfortably waits until it's over, then shakes it off. I asked each of them to think of one and sculpt two other women into the shapes of the person giving a compliment and herself when she is being complimented. For example, one woman sculpted a peer standing upright, chest and arms wide open in a welcoming gesture. Then she sculpted her peer in a stance that was slightly turned away, stooped over and averting her gaze. As we examined the sculpture we found that the person who was rejecting the compliment, was actually also rejecting the other person. She was making connection between the two impossible. And also, she was tense and holding tight, making things harder for herself than they have to be.

The points that came up in our discussion are very important to understanding what you are doing when you identify with the negative self-talk. Your whole body organizes around it. You are actually tensing up and holding on to the beliefs so strongly that your body tightens and is working hard to defend against any possibility that your thoughts might not be true. Your whole system is hunkering down. No wonder you feel trapped, alone and insecure. There is no space for anything else.

So how do you get from this place to a more open, fluid and self-accepting place?
There are a few important steps:
 
1) Recognize that this posture WILL change when the belief system changes. Whether you like it or not, your body will reflect the state of your mind. 

2) Becoming WILLING to allow it to change. This means you have accepted that you will change and you are curious about how.

3) Make a choice with your mind to influence your body posture. This is the rational step that we humans need to get "on board". You could call it a goal, an objective or a commitment. This choice will need to be made again and again until the new habit of mind and body become second nature.

4) Find tools to use to influence your body and make a little more space. The tools I am talking about here are already a part of your human body, but you may not be using them deliberately. The key here is to try a tool and track how it has affected you. Some tools might make you feel more open, others feel more grounded, some might help you feel safe. You will need to learn a few and adjust them to your needs in each moment. My favorite and most widely used tool is the breath. Breath as a tool is a subject in and of itself. Start with taking one deep full breath into the tension and see what happens.

5) Practice these tools when you are alone. It's important to practice when you are at ease and not in a triggering situation. This way you are giving your body cues that you will be able to use anytime. Practicing in the safety of your own space, when you are alone or with a therapist or other supportive person, takes away some pressure. Sometimes it's hard to do something different even when you're alone but at least no one else is there to be critical of you. You can work with your own inner critic and discover more about it.

6) Practice these tools when you are in different situations. Once you have practiced on your own, the tools will become more and more available in your day to day. You will find that using them throughout the day help you shift your inner world as needed.

Allowing yourself to be open to other possibilities besides self-defeating, self-loathing thoughts is a journey. It will not change overnight. But it will not change at all if you don't take some initiative. You have been a victim of circumstance for too long. You can choose not to continue being a victim of your own thoughts. With patience and determination, you will learn to heal your relationship with yourself.