diane heller interviews bob scaer – somatic experiencing

Diane Heller interviews Bob Scaer – Why Healing Early Attachment Wounds is a Must in Recovery from PTSD

© Diane Poole Heller, Bob Scaer 2014 1

Diane: Hi, I am Diane, and today we are going to look into why Somatic strategies are so important in helping trauma heal, as well as Attachment… and I am very excited today to have my friend – good friend – Bob Scaer here… he is also a neighbor, we live in the same town and we’ve been working together for… gosh, I don’t know, a couple of decades now?

Bob Scaer: over that …

Diane: maybe three decades … and it’s been a joy – Bob was the reason I got a chance to teach trauma at the Boulder Community Hospital, and we are here today to explore this exciting topic. So Bob, I’d like to introduce you… Bob has written several great books, we will talk about it later … “The Body Bears the Burden” is one of them, and he is an expert in Dissociative disorder as well as healing Trauma… and many, many other things.

So, I think we are going to look very closely today at Attunement and its role in healthy Attachment; and also we will address mis-‐attunement, which becomes the underpinning for complex trauma possibly later, at least helps it manifest. So I’ll turn that over to you…and what would you like to start us off with, Bob?

Bob Scaer: Well, we could talk about ourselves in the history and how we got acquainted, and we could also talk about the phenomenology of Trauma that we both evolved over the years, because… we’ve changed.

Diane: We’ve changed a lot over these 30 years together; the whole field has changed a lot, right? But you are still on the cutting edge, so I am excited to hear what you’ve discovered.

Bob: Well, I am on the “liberal fringe” maybe…

Diane: Well, one of the things I’m intrigued to hear is why don’t you believe in PTSD, so …except for a very small part of our field, because it is such a buzz word that everybody throws around now – and we will get to that, at least if you don’t start there.

Bob: Sure, well… let’s go way back to the beginning, which was when I started my career in rehab, where I was treating patients with whiplash…

Diane: 1980s.

Bob: …and minor brain injury – and I calculated, over a 30-‐year span I saw probably 5000 whiplashes – I used to get 3 or 4 new patients a week, because these were the patients who inexplicably had symptoms that involved all systems and all manifesting the same way: they all had the same syndrome, but it was both neurological (brain injury) and physical (pain, neck pain, and many of them had Fibromyalgia, and Irritable Bowel (IBS)…all sorts of what is called by the medical profession “Somatization disorders”, disorders of the body but that are really inexplicable – and so these people were often treated as being hysterical by physicians.

Diane: Yeah… it was a delight to teach at your facility, at the hospital… and also I think you were sending me so many people, I got a really good training working with whiplash, and auto accident injury, and head injury… and that’s how I ended up writing a book about that, because you got me focused in that direction, so I thank you for that.

Bob: Well, I have to give my appreciation to Peter Levine, who lived very closely to me… and one of our therapists, Marcus Cure, gave me one of his articles… I read the article, and I realized he was describing all of my whiplash victims.



Diane: Yeah, he is a genius.

Bob: So I brought him into Mapleton (location of Bob’s practice) to do a workshop and I sent him a few patients… these were patients who were two or three years down the line, and being treated with Somatic Experiencing – his technique – they recovered form their physical symptoms from the auto accident …and that was something that was way out of proportion from what I ever thought in clinical medicine.

Diane: When I first saw Peter work – I think we met in 1989 – it would just seem like magic, I had no idea what he was doing, but I could see these incredible results. So, I think I was with him for 4 hours when I decided I’d be with him for about 20 years… that was a little “telegram from God” or something, telling me that I really needed to learn his work – and he has really, deeply, impacted my life and the lives of all of my clients that followed, so…

Bob: Then I realized whiplash was a clinical syndrome that had medical implications and it was an experience, not an injury. It was not an injury, it was an experience, which changed the brain – and it changed the brain because as I saw these people, I started to do histories of their life and I found that I’d say 90 percent of my female patients – and they were almost all females – had experienced child abuse… and I realized that child abuse was a common ground for the development of this particular bizarre syndrome. So this goes way back to the childhood, and infancy, even… and at about that time I met Allan Schore, this was in the early 1980s…

Diane: Before Allan Schore was Allan Schore, right.

Bob: Right… and we – a colleague of mine, Carol Schneider and I – met him at the APA in Denver and he gave a talk and we met… I went up to him afterwards and said “I’d like to ask you a few questions” and we ended up spending two hours talking.

Diane: Not surprised… not surprised. He has made such a huge contribution. Really understands the Attachment underpinnings and the “Attachment theory is regulation theory” terms of understanding that all ties together. And I think a lot of people hadn’t made that connection before he really brought it to the surface for all of us.

Bob: And actually Mal-‐attachment… or even abuse in childhood, is the root of these Somatic syndromes later in life – which explains most of the visits to doctors’ offices.

Diane: Right! And the ACE studies really support that in a really big way, I brought that into my understanding in the last couple of years.

Bob: So Attachment disorder is at the beginning for all of this.

Diane: Right, and ACE – if anybody is unfamiliar with it, it is “Adverse Childhood Experience” that Felitti and a few other doctors put together… you can get a lot more information about it online, maybe on YouTube – but I wanted to really go back to this, because it’s the Attachment under-‐pinning… I think it’s important for people to really understand it, and how that impacts trauma and all these symptoms and syndromes that arise later. Really important to get to the bottom of it, because if we can start to influence that, it’s like working on the foundation of a building: if we can manage to help repair happen, it starts to shift the whole structure towards health again.

Bob: I was taught in medical school that children were incredibly resilient. Infants were incredibly resilient because they didn’t feel pain and it wasn’t until much later that this concept was challenged in the medical profession.



Diane: I know! Where did they get that idea?? It seems so crazy, but that was really a part of our training, it seems so hard to imagine that you would not see pain in an infant.

Bob: Well I knew that, I knew they could feel pain because when I stuck an infant with a needle in medical school, they exhibited the Moro reflex – which was the startle response – and so I knew that.

Diane: A lot to deny, isn’t it?

Bob: It took a lot of denial – but we’re good at that.

Diane: Yes, unfortunately.

Bob: So that’s, you know… we went back to the childhood roots, back at the start of the work, that idea… and that’s what we are talking about, the Attachment disorder and its results down the line.

Diane: Right, so you were talking a bit earlier about procedural memory… and some of that implies implicit, but I think it might be nice to expand that idea of how procedural memory really IS the way the body learns – and also encodes – a lot of these patterns, how we learn – but also encodes into these patterns that become problematic later, so I would like to expand on that a little bit.

Bob: Yeah… I know a lot of people have emphasized this – and procedural memory is basically a memory of procedures, which is what the body learns to do… and so we’re learning athletics skills, musical skills, dance skills, you name it… any of these things we do to increase the function of our physical body, our motor system, in order to perform or to survive is procedural memory, which is implicit, it’s unconscious, otherwise we would be…

Diane: …It would drive us crazy, we’d try to ride our bike and we’d have to go, “Okay, now I’ll have to do this, now I’ll have to do that”… sending all those messages for every little thing we did, it would be impossible.

Bob: Yeah, so it involves what the body does, what the body learns, what the motor part of the brain learns about how to run the body. It also is the process by which classical conditioning is done – in other words, Pavlovian conditioning is based on installation of procedural memories and it is our major survival tool. So procedural memory is closely linked to survival and as a result, in threats to survival, it is the engine that stores memory for future reference, to save you from a similar event.

Diane: So it’s all mixed together.

Bob: It’s all mixed together.

Diane: So even the way you move, and doing a certain action: if that also happened earlier and you hit a high arousal for something scary, that then becomes a package deal.

Bob: …Which also basically says that in trauma, if your procedural memory has established links to the event but hasn’t extinguished them, then that is the engine of trauma: it’s fear extinction, it’s fear conditioning.

Diane: Fear conditioning that helpfully later we can interfere with a little bit, and calm it down.

Bob: And of course fear conditioning involves the body – and that’s how the soma, the body, comes into the picture of understanding trauma – and therefore healing it – because we need to use techniques involving fear extinction.



Diane: Right – and you make it sound very clarifying, you know, because if we really look at that then, it really emphasizes the importance of – first of all – being able to calm the Autonomic Nervous System (ANS), being able to do a little “Amygdala whispering,” right? With Amygdala whispering we can calm that part of the brain, that sort of alarm that we can’t help responding to, because it’s in our bones and muscles and tissues and brain and nervous system.

So I am so excited that our field is finally more and more embracing the Somatic strategies that are so important for healing Attachment, the underpinnings of trauma, and then also coming back to really understanding how to move someone through a traumatic response, if we can manage some fear extinction… then focus to something calm and soothing, and back and forth… and really noticing what the physiology is telling us, as we are even talking about something, really watching what the body is doing or not doing, right? To really be able to start to see where those symptoms are, where the roots of them are.

Bob: Right, and that goes back to the childhood… the ACE studies shows that this theory of procedural memory basically is based on that. Childhood is the time when the brain becomes more resilient through the learning process of enhancement of Attachment and bonding – and structurally and physically is changed by that, in order to help the part of the brain that produces homeostasis to expand and grow.

Diane: When we have the right nurturing and the right support and the right contact, the right bonding, prosody in the voice, eye contact, skin-‐to-‐skin touch, and the right kind of attunement in the relational field – hopefully – between caregivers and children, that is a gift that you give to a child, and to their brain, and to their future experience. That is irreplaceable.

Bob: Yeah, Allan Schore talks about this… and of course the area that he attributes to this is the right lobe of the frontal cortex, the part of the frontal cortex that overlies the orbit of the eye on the right side, which is the modulator of homeostasis and balance of the Autonomic Nervous system, and the Limbic emotional system – and balances arousal and threat and the Amygdala therefore, rather than letting it go half-‐cocked with every negative threat… and so that part of the body results in our being balanced throughout life; and in the absence of that, we are unbalanced and likely to overreact to traumatic events such as an auto accident.

Diane: Right! And then we have to work clinically, right brain-‐to-‐right brain, to try to bring that back in focus – and hopefully, caregivers that have some emotional attunement, they are actually feeding or nourishing that right brain-‐to-‐right brain connection, so that… I mean, in some way you get a lot of food for the right brain, so that it has that limbic access and that resilience… and I think that some of these different Attachment insecurities really interfere with the right brain, because there isn’t somebody present enough. Or because the child is experiencing a certain degree of neglect – or maybe even rejection – but because there is not enough contact with significant others, they actually aren’t getting a sense of strong foundation for the limbic, and if they don’t have that… hopefully, later we are going to help that develop clinically, but it’s much easier if we have that foundation in childhood.

Bob: It’s very important for that, and in fact if one doesn’t have that, one has a great difficulty for the entire lifespan with attunement with peers, with other people – whether in their family or in their work or whatever – they can’t relate to that person in a way that’s productive or at least as productive as they should be able to; and so, a personality disorder that involves this estrangement of contact may result from that process as well – and so we are talking about something that lays the foundation for the entire cultural heritage, and how we interface with other people.



Diane: And it’s an interesting development in so many cultures worldwide now… because of the economics stress, so often both parents are needing to hold down jobs, and moms aren’t getting enough time – and maybe dads aren’t either – with early infants, so it’s something that we really have to look at. I think, seriously, as a culture, if we really want peace and harmony in the world, a lot of it has to start with moms and babies, and with dads and babies.

Bob: That’s it, we got to look at how we birth babies, how we bring them into the world, who is there when they are infants, that there is a mother there, a constant figure there, that there is harmony within the family… because disharmony and rage… in other words, people who are traumatized will then traumatize their infants unwillingly, by virtue of their behavior.

Diane: It’s a very predictable and totally easy transmission of intergenerational trauma, and this is happening all the time. You think about just the regular stresses we have, but then you go to war to foreign countries and all the kinds of things they are dealing with internationally, we are setting things up for just a continual trauma re-‐enactment – if you will – through Attachment problems, you know, generation after generation… that’s why really, I think, both Bob and I are so committed and really focused on understanding Trauma and Attachment – because it has such a foundation for health and humanity, globally. If we look at the whole situation, if we could really get a lot of support in the beginning, it could mitigate so many other problems that follow. I love the idea of preventative; I just wish we could have a lot more support for that.

Bob: We need to look at that, and the way we birth and rear our children, and break the cycle.

Diane: I really love this understanding now, that when babies are born, first of all they are much more sympathetic in terms of their nervous systems, they don’t have as much Parasympathetic, so they can’t really calm themselves, right? Because so many times people ask me that… “Why do you say that interactive regulation is first and self-‐regulation comes later?” I get this question a lot. And partly it’s because of how we come in… I guess, if our parasympathetic was completely on board, our heads would be too big to make the journey… I don’t know exactly why we don’t have so much parasympathetic. And parasympathetic is the part of the Autonomic Nervous System that has a calming effect, a restoring support for resiliency, a resting kind of phase – when it’s in balance – that really helps us later in life; but when we first are born we are more sympathetically oriented, we can scream and cry and – you know – we can’t manage our own arousal so much, right? So we have to have a caregiver, we are completely dependent on having a caregiver that knows how to regulate us, hold us, soothe us, calm us. And the baby’s nervous system is literally learning implicitly from the parenting, from our caregiver’s nervous system. It’s a kind of transmission – so hopefully, in an ideal world, parents have this ability to calm and soothe and nurture and be present and/or get support… parents also need support, to be able to move into that space with their infants.

Bob: Yeah, the other side of that is the umm tendency of infants to freeze or – conservation is Schore’s definition of this…

Diane: conservation of energy?

Bob: …but the Freeze response of course is in response to an intense arousal; and if you’re helpless, then one will freeze. And the Freeze response is a Dorsal-‐vagal response – it’s autonomic but it’s a very primitive, reptilian autonomic state, not a Mammalian one, and it is a very dysfunctional state – it is a state of survival at times in animals, but in infants and in adults the Freeze response is very dysfunctional.



Diane: Doesn’t take us to a good place, we don’t want to stay there too long, in an ideal world.

Bob: Now, understand that we call it dissociation, but dissociation is the behavioral expression of the Freeze response – and if the infant is frozen over and over again because of dysfunction in the bonding and the attachment between the mother infant, they will be destined to freeze with minor arousal throughout their growth and adulthood.

Diane: Gets patterned in.

Bob: And of course that’s a stage that is very dysfunctional, because the Freeze state is a state of helplessness – and you cannot function through that state, and so that’s how trauma evolves. And infants who have been traumatized, or have mal-‐Attachment, Schore says they will be destined to undergo Freeze dissociation responses throughout their life in the face of threat; and that of course creates a very dysfunctional personality survival state, inhibiting health, because many of the syndromes of chronic trauma, late trauma, and complex trauma, have to do with the Freeze response.

Diane: Yes. Do you want to say a little about the Freeze response? Because I think that’s the core thing we are talking about here.

Bob: Well, yeah, the Freeze response… it is the core thing, it is the core thing that produces or expresses the pathology of the event. The Freeze response is what all animals do – in fact, reptiles do it, you know? In biology laboratory in college we would caress the stomach of the frog, and the frog didn’t try to escape, but would go limp… so we thought we were hypnotizing them – no! We were threatening them, and they froze – and therefore we could do our little experiments. And the Freeze response is a strange state, it is profoundly a parasympathetic state, that is, the heart slows, the gut in the intestinal tract gets very overactive… that’s why the soldiers in combat, who are helpless when being bombarded, will soil themselves and wet their pants.

Diane: Right – and there is no way not to do that, when you go to that physiological state that’s physiologically engineered.

Bob: And actually mammals can die in the Freeze state, because the heart rate drops way down – to the point where literally the body does not receive the flow of blood, and they die in the Freeze response.

Diane: You know, I was listening to a program – oh my gosh, it must be 10 years ago – where they were talking about some statistics on … they thought that people who were diagnosed with heart attacks, who died with heart attacks, they actually were passing from being too long in the Freeze response, and that’s because their heart rate went so low – and maybe their brain was reading it as “not there anymore,” or whatever – but that would take them into actual death.

Bob: They would actually die.

Diane: Yeah, it’s really a serious state we are talking about.

Bob: Yes it’s called “Voodoo death”. Walter Cannon wrote about it in the early 19th century, about the indigenous person who had broken the taboo – which means he threatened the whole tribe – the shaman would point a sacred bone at him, and he would go to this tent to lie down and die because …

Diane: He would go right into Freeze response.



Bob: Yeah… you need the tribe to survive. In that state of helplessness, he actually… the heart stopped in enlargement, the last thing was that it just stopped and filled with blood, which is the deep parasympathetic Dorsal-‐vagal state. So that’s not good for you.

Diane: Obviously.

Bob: And there are lots of physical syndromes related to that phenomenon; and most of them involve the gut and the heart.

Diane: So understanding physiology – and really the body is broadcasting its state all the time, we just have to learn the language of understanding what skin tone changes mean, and what pupil dilation means, and when the head turns to orient, or it gets stuck in a particular body posture – freezes in a particular position; and then, how to enter into that sequence with someone and gradually try to lower the arousal, or bring safety up, so they can actually move through a sequence that would’ve been there if they hadn’t frozen in the middle of it. It’s like stopping the interruption or helping the interruption complete.

Bob: Right. And as Peter Levine emphasized, in an animal coming out of Freeze response, their body goes into a pattern of movement; and if you really analyze it, that… what the body is doing is, it’s replicating what it did until it froze; and if it doesn’t go through that shaking, or replication of the movement (often it’s a running movement), then that movement pattern will be stored in procedural memory.

Diane: And keep them stuck.

Bob: And keep them stuck, and result in symptoms that involve those muscles that should have tried to protect you but didn’t.

Diane: It’s like, the brakes are on, and the tension pattern is actually – maybe – an inhibited movement related to defending oneself…

Bob: Exactly.

Diane: …in the moments of threat. And we start to understand the chronic pain patterns – and tension patterns and symptoms – and even other things such as sounds you don’t like to hear, or smells you don’t like to smell, and cause a strong reaction in you… but very often they are related, they are actually the body telling you exactly where the threat is. The way I think of it is, a little arousal spike that’s keeping the trauma in place and keeping you stuck in a lot of other ways – and usually related in a way that we wouldn’t have fully grasped until we had this piece of understanding.

Bob: And those muscles that try to protect you but didn’t, thereafter will go into deep contraction with any threat or any life event that reminds you unconsciously of that trauma.

Diane: And that’s an important thing, because you don’t even know… and people are saying, “Why are you so reactive to this?”…They think you’re high maintenance or something, and you are like, “I can’t help it!” and they say,“Just relax!” – I love this. So many people, my clients, will say, “You know, my husband, or my friends, say I should just relax – and I am like ‘Yeah right!’” …Well if you could you would, right? But it’s really the worst thing to say – in a way – to someone who is dealing with overarousal, and really it’s built-‐in… until we can maybe touch in and help it move through.



Bob: Well, I run a chronic pain program, and most chronic pain occurs in those muscles that failed to protect you; and in an auto accident, that’s the muscles in the neck.

Diane: Right, the whiplash.

Bob: And also the lower back. And so, those muscles will try, will go into tension – and painful tension – under any clue to that old event. And of course the clue may be something that’s not obvious at all. These are the commonest things for which doctors see patients, these pain patterns involving muscles that didn’t do what they were supposed to do and were thwarted by the Freeze.

Diane: And this is why the body is an incredible channel of wisdom… I am so happy to hear more and more people talk about it, and more and more therapy models talking about it. And we certainly bring it into the work with the Attachment, and working with Trauma… and Peter Levine brought so much of that into focus – and Allan Schore as well… and Bessel van der Kolk of course, who also began the Somatic understanding even when he was still at Howard, so there’s a lot of people on board now, and we are getting – I think – more and more skills therapeutically that we can actually use, which really make a huge difference with people.

Bob: Yeah. There are several other things: one is that women are predominantly involved in this more than men, because men are predators; and there is no such thing as whiplash in derby, crash derbies, you know – where they have those cars competing with each other until the last car moving wins – and there are studies on these guys who drive them, and none of them have whiplash.

Diane: That is really interesting.

Bob: Because they are predators, they are not helpless.

Diane: So they don’t feel the helplessness – that’s the key piece – and women are little bit more socialized or prone or…

Bob: They are prone to some extent – they lack the testosterone gene that the males have; which is protective, actually, of that kind of phenomenon.

Diane: Now that’s interesting.

Bob: Well, 90 percent of my whiplash victims are women and that’s partly that, but also…

Diane: The neck is less supportive muscularly in women, too, isn’t it?

Bob: It is.

Diane: Does that matter?

Bob: The procedural memory would be the same – but women are more prone to helplessness, by virtue of their genes, the chromosomes.

Diane: Hormonally and all of that, that’s interesting.

Bob: And that’s not to say that they are weaker, they … It’s just that their brains and their Autonomic Nervous Systems are different.



Diane: That’s a little bit of a different design. That really makes a difference though, in terms of who gets traumatized and who reacts to whiplash, for instance.

Bob: And of course what males do is… the traumatized male becomes violent and our jails are filled with boys, with men who as children were abused.

Diane: They don’t have that destabilization patterned in, then the testosterone probably pushes it to an overactivation and fight response.

Bob: So the male pattern of trauma often is aggressive, rather than Freeze.

Diane: So they get more anger outbursts, and acting out rage.

Bob: …And murder, and violence, and dysfunction in aggressive area… and it all goes back to attunement.

Diane: Yeah, let’s circle back to that again, that’s kind of a foundation for what we are talking about today – it’s so interesting. I wanted also to mention, while I was thinking about it, this other physiological piece that maybe not everybody is familiar with: that we are actually born with extra brain cells – “fat brains” if you want to call it that – and that based on our environment, which is largely our caregiver, our brain actually shapes and structures itself – in a way, to prepare and to be able to accommodate a scary environment – and then more of the structures of the brain that are related to threat and defending against threat will be enhanced, and others pruned away. If we are born into a pro-‐social behavior family, where there is a lot of love and nurturing and attunement and kindness and snuggling and safety and protection, then that part of our brain – limbic, pre-‐frontal cortex – starts to accumulate more support and more structure. And we actually are designed then, for the future, to have a much more relational brain.

Our brain is a social brain, but that part of our capacity is greatly enhanced, so that’s another really important thing. Because once your brain is really accommodated to that original environment – it can still, of course, have some neuroplasticity and make some shifts – but it’s going to be much more difficult for someone’s brain that originally adapted to threat and overwhelm: it could be they were raised in an addictive family, or parents that raged, or it can also just be that the parents have their own unresolved trauma… So they have frozen themselves, or their energy field is full of unresolved fear, and just even trying to bond with that could also be scary to the infant, right? So, it may not even be the parents actually doing anything really scary; it could be their own nervous system.

Bob: It isn’t abuse per se, it’s the absence of nurturing and connection between the mother and the infant – and it’s an emotional neglect – and that is traumatic in the long run too, that impairs Attachment, and of course by no intent or capacity of their mother under the circumstances.

Diane: Right – I mean, in so many ways of course their parents are doing the best they can; and I think it was Ed Tronick, and maybe Allan Schore also, who said that you needed to be in a high-‐quality attunement 20 to 30 percent of the time for Secure Attachment to really happen. I just want people to get this, that you don’t have to be perfect, right? but it also greatly enhances Secure Attachment when not only you have that 20 to 30 percent (of attunement), but you also have the capacity to repair, so as a parent you sort of “get it” when you are out of kilter with your kids, and you get a sense of apologizing or correcting whatever that “off-‐ness” is.



And I know that Ed Tronick – I like this! – he says that really, we are learning lot of relational resiliency when we get out of attunement but we also find a way back in, then we come out again and we find a way back in. So it’s a learning process between parents and children, or partners, or therapists and clients… but that coming back in is really important and it has a lot of benefit.

Bob: Yeah, and in that light I think it’s important never to blame the ill-‐nurturing or mal-‐nurturing mother, because they are simply reflecting their Attachment and their experience as an infant… and so one is to look at this for compassion and understanding, that this is something that is physiological – there is no negative intent on the part of the parent in this process, it’s just what their …

Diane: …what their experience was, and it’s showing up.

Bob: …what their heritage was for themselves.

Diane: Procedural memory through generations.

Bob: This mal-‐attachment is cultural and it is passed through generations, as we know a lot from many studies – including Holocaust studies – that this is a generational phenomenon.

Diane: …And a humanity phenomenon, so we have to understand it in a very broad sense for us to really impact a positive change.

Bob: Yeah, life is not simple.

Diane: No, life is not simple.

There is something that I heard you say at the recent lecture at the Caritas center, which I really want to highlight in our talk today – and as one of my friend says, to “let the rat out of the bag” – about the rat studies, and what happens and what they discovered from the study on the mothers (or the dams), how they interact with their pups… and what happened as a result. So I want you to share that story, I really thought that was fascinating.

Bob: Well, it has to do with maternal instinct and maternal behavior in rodents, in rats. Now rats certainly don’t have the same brain as we do. Mainly, their limbic system – the emotional brain – is just as well developed as ours, but the cogitative thinking, planning, intuitive brain, is not there very much. So rats are instinctual – and of course, human beings are just as instinctual in some of the things we do, one of which is this maternal infant bonding. This is deeply unconscious: one doesn’t plan to be this way; one is this way because our genes have made us this way, but we don’t plan on doing the things we do when we nurture a child; and this study shows how the behavior of the female mother rat, the dam, can affect the male only, the male pup, the child, who is nursing and being nurtured. And what they found is that dams, mother rats who have been traumatized in some way, spend much less time licking and grooming.

Diane: Right, much less contact.

Bob: Much less contact: licking and grooming behavior is the maternal behavior of the rat.

Diane: That’s the Attachment bond of the rat.

Bob: Exactly, it’s instinctual – and the dam who has not been licked and groomed is not a good licker and groomer.



Diane: Right, so there’s intergenerational transmission.

Bob: And the pup that is deficient in licking and grooming becomes a deficient licker and groomer, meaning that your maternal capacity is a heritage of your own birth (and your treatment, and your attunement and Attachment) and it’s more dramatic than that, even, because what happens is that it goes down generationally – because the pup who has not been licked and groomed doesn’t lick and groom, and their pup isn’t (licked and groomed) as well… this way we have this transmission of behavior – which is not by genes, it’s by behavior. The Autonomic Nervous System is much more over-‐reactive in the pup who has not been licked and groomed, they are very unstable.

Diane: Unstable, and do they show any aggressive behavior?

Bob: No, but they tend to freeze very easily.

Diane: They tend to freeze like the infants you talked about – Dorsal-‐vagal response again.

Bob: Yeah, and the female who has a mother who is not licking and grooming, becomes a poorly licking and grooming mother too.

Diane: Right! …the one that didn’t receive it.

Bob: Exactly.

Diane: It exhibits the same behavior with her children.

Bob: And all these pups who were deficient in licking and grooming have over-‐reactive Autonomic Nervous Systems: in the face of threat they go into an arousal response excessively, and they tend to freeze more and more than the pups who have been licked and groomed – in other words, they are less resilient in the face of threat and stress.

Diane: So that’s going to really affect their survival.

Bob: Exactly.

Diane: And resilience and rat life.

Bob: But it’s also generational, and that’s the scary key – because this is passed on down, and it’s not because you are a bad mother, it’s because you were not…didn’t perceive the nurturing, didn’t have the part of your brain that helps to promote that – the pro-‐social brain – and as a result, you are what you are. And this is applicable to human beings as well: all mammals have this capacity to be an effective or ineffective nurturer, and that creates the behavior that later on makes you more vulnerable to threat and trauma.

Diane: So how much wiggle room do you think there is later, when people go through the process of having therapy, or really addressing their wounds, or really working on a physical level as well as an emotional level and get good work? What’s your thought about that?

Bob: When you have a pup who’s been not licked and groomed enough, and you put him out on a running wheel and he runs and runs and runs, his capacity for licking and grooming increases – and probably that’s because what happens is, the Autonomic Nervous System is balanced by that. And you know, the Autonomic Nervous System



fluctuates between parasympathetic and sympathetic, it’s a sinuous sort of wave, all like…all of the systems of the universe have this sine wave – if you remember trigonometry – and that sine wave is much more balanced in the rat (or the human being) who has had a good nurturing and good Attachment, and not traumatized – less likely to be traumatized – much more stable than in the rat or the human being who has not been nurtured or has been traumatized… and they will tend to have an exaggerated cycling.

Diane: An oscillation that’s out of bounds.

Bob: Right, and so they over-‐react to threat stimuli, they immediately go into exaggerated fight-‐and-‐flight response, which then tends to trigger a Freeze response. And so it is generational, experiential, and it works on this autonomic level too, and everything is run by the Autonomic Nervous System therefore it doesn’t function as well; and you have diseases, which we call psychosomatic diseases, of the gut, the heart, and all of the organs that are governed by parasympathetic system. So this is generational, it is cyclical, and it has many manifestations down the line.

Diane: And it really speaks to how important it is clinically for therapists and physicians and any caregivers in a professional way, the need to understand how the Autonomic Nervous System works, how the brain is accommodating that, how the procedural memory is behind the scenes, navigating things… and then really have an interface with that, in a way, to really start to be sensitively bring people into more of a homeostasis, more of a stabilization in the way their brain and Autonomic Nervous System is working. So I think there is some hope in here – I want to make sure we get that message out, that there is some hope in here – but it’s really critical for people to understand the Somatic part of it.

Bob: It is, because this is all unconscious.

Diane: Exactly, people learning cannot come in and say, they can’t even report it as a presenting issue, because they don’t even have…there is not a mind there, to even tell them it is part of the problem. It’s not mental, it’s sub-‐psychological, that’s what I am trying to say, pre-‐verbal. It comes from those early times.

Bob: And a lot of this isn’t tried in training for being a psychotherapist.

Diane: Or medical.

Bob: Or medical, definitely not medical.

Diane: Alright, but now we have some great opportunities in our work to bring this knowledge in and combine it with the brilliance of Attachment theory or the brilliance of medical understanding of different physical disorders and if we could put all the pieces together we could start to have some amazing results that I never… When I started as a psychotherapist, there was no way I had any idea I would end up studying the Autonomic Nervous Systems, and – you know – brain functions, and how …what would be the underpinnings of the symptoms of so many of my clients were always struggling with.

Bob: Yeah, it’s one problem with Talk Therapy – which is necessary…

Diane: Right – well, there is narrative, we call it narrative, that’s a piece – and sometimes when you are talking, if someone is really present and listening to you, they are giving you attunement (thank God, right?) that they didn’t have originally… so maybe the talk is part of it, but maybe even more important – and my opinion would probably be biased towards “it’s more important”– is the relational field and the attunement you are bringing into it as a



therapist, regardless of what model you are using, right? But even better, if you understand the Autonomic and can read what the body is doing and how it’s responding from an Attachment point of view, and also from these trauma symptoms that express themselves…

Bob: …Which brings us into this process of attunement, between the therapist and the patient…

Diane: Yes, critical point here.

Bob: And there are mechanisms in the brain that help this attunement occur, that we rely on – in our interaction socially, as you and I are talking now, as you are talking in a cocktail party to a friend, as the mother and infant are bonding – there are systems within the brain that perpetuate and force this and facilitate it… and that’s Stephen Porges work.

Diane: I want to talk about Stephen, because I know both Bob and I are huge aficionados of Stephen Porges, really I feel like his research is so…pivotal, really. I don’t think there is a big enough word, so…important, as a foundation for really understanding why Somatic strategies really work, and also giving us a flashlight into the darkness, or helping us map out the labyrinth of how we can help find these Freeze responses and then help people move through them, so they can start do the fear extinction that Bob has been talking about. So I really want to have Mr. Stephen on center stage here for a while with us, because I know you know him and I know him as well, and we have a lot to say about Stephen so…

Bob: Well, Stephen Porges developed a theory called “Polyvagal theory”, poly meaning “many” and vagal meaning the Vagus nerve, which governs the Autonomic Nervous System; and he notes that in the Mammal we have a part of the Vagal system, which is different from the reptilian Vagal; and the Dorsal-‐vagal nucleus is in the reptilian brain (Amygdala), and it lies on the top of the brain; and it governs the gut and the Autonomic system, that governs the organ systems of the body – like blood pressure, pulse, digestion, heart rate – all of these things are governed by the Dorsal-‐vagal nucleus. There is another one called the Ventral-‐vagal nucleus, and when I was in medical school (which was a long time ago,’63 was when I graduated…)

Diane: And you’ve advanced the field a lot since then.

Bob: …Well, in those days we didn’t know what that nucleus was, it had been named the “nucleus ambiguous”.

Diane: I remember, yeah… that’s in fact a term I am very familiar with.

Bob: …They really didn’t know what this thing in the Amygdala did, but it was linked to the Dorsal-‐vagal, in fact the branches from these nuclei came out and were ensheathed, and came out as the Vagal nerve.

So we didn’t know what this Ventral-‐vagal did… well, Ventral-‐vagal is another governor mainly of the heart – not the gut, just the heart – and what it does is, it protects the heart and the response of the body to a threat by inhibiting and down-‐regulating it until the information as to the threat becomes clear; and so in a situation where an animal is threatened, they will often stop for a moment – some call it a Freeze, some call it a mini-‐freeze and some call it… – it’s related to the Freeze response, but it isn’t really the same thing.

Diane: It’s a stopping response, to sort of, like, “wait a minute, what’s…”



Bob: And then they will orient, they will check out the environment, mostly through the nose and the olfactory system – but also the visual system – looking for the threat. And if their heart rate is slowed slightly, and if there is no threat, they come out of it, they go back to their business.

Diane: They return to relaxation response and just continue grazing, or continue nuzzling, or whatever they were doing, right?

Bob: It’s an energy conservation system for mammals, because mammals would burn out without that.

Diane: Would be running around all the time.

Bob: If they were into a fight-‐and-‐flight with the least danger signal, they’d be exhausted, they would die from exhaustion – so this is energy conservation, which allows the mammal to survive.

Diane: Intelligence in our design.

Bob: Unconscious intelligence, but nevertheless… vagal intelligence. And if the threat becomes very severe, then the Dorsal-‐vagal will kick in, because that’s the engine of the Freeze response, – it would drive the body into the state of lowered heart-‐rate, immobility, flood it with endorphins, so pain is inhibited.

Diane: And which is compassionate, like you have an anesthesia built in.

Bob: Also it helps you to stay still, if you are wounded.

Diane: Right, so you don’t bleed out.

Bob: Yeah, so you don’t trigger the predator – and oftentimes the predator with the frozen animal will nose the animal and will lose its interest because they respond to movement cues.

Diane: Yeah, and also because they have probably a biological knowledge that if the animal is actually dead, it’s bad meat, so part of its own survival is to ignore a frozen animal.

Bob: And they’ll often go off to find their pups to feed, and of course during that period the animal may come out of it, and may then get up and shiver all over and escape.

So this complex system of homeostasis is really critical for this, and the part of that is what the Ventral-‐vagal does otherwise. Now the Ventral-‐vagal has attachments to all of the nuclei that govern the movement patterns of the head and neck, that means the pharynx, the throat, the tongue, the inner ear, the muscles that dampen the vibration of the bones, the ossicles of the middle ear and the facial muscles.

Diane: All the facial muscles and the skin on top of the facial muscles that help us with the expression.

Bob: And the throat and the ability to swallow, and the tongue, and the vocal cords.

Diane: And prosody, the way our tone of voice comes out, right? All of those things.

Bob: So these things actually have to do with affiliation, in the case of the muscles of the vocal cords the sound of the voice reflects the emotions of the individual and so that’s what’s called prosody – which is the emotional content of the speech – with the person who is hearing that, which will then create an empathic bonding through the vocal system.



Diane: The tone, the tone is so important.

Bob: Exactly. We have more muscles in our face than any other creature.

Diane: Like 52, or more maybe.

Bob: You know, maybe, something like that.

Diane: I can’t remember I think it’s about 52. Yeah, and all the little combinations, when you look at yourself in the mirror you can see this, by changing a few facial muscles, I think 500 different, probably – but who’s counting? – but 500 different facial expressions… we will have a quiz on that tomorrow.

Bob: Right. And of course this has to do with communication – affiliation – has to do the bonding with the person – and I can’t imagine, when they discovered Botox… it removes the capacity of the individual to communicate with facial muscles, which is as important as the words.

Diane: Right! And if you think about mothers having Botox who are also having babies, they are actually messing with the actual mechanism that gives them the capacity for attunement with the child. I mean people don’t generally know this, so it’s really important to highlight that.

Bob: So these muscles have to do with affiliation – and Porges calls it the Social Engagement System – they have to do with the Ventral-‐vagal nucleus and all of the muscles of the head, neck and face.

Diane: Even our ability to turn towards each other right now, these muscles that turn our neck, and being able to talk to a group or, you know, move in a direction, the orienting of the neck is part of the Ventral-‐vagal system.

Bob: Yeah. The orienting response: looking around for threat.

Diane: Looking around if you are with a lot of people, you are making contact that’s actually a part of your Ventral-‐vagal system.

Bob: So that’s an incredible contribution to the concept of interpersonal communication and bonding; or, detecting threat and initiating Avoidance.

Diane: And then back to Ed Tronick, with the Still Face studies, right? How distressing, you know… (Diane pauses to describe the content of the study) Basically – very briefly – that study was having mothers come in with their infants and then the researcher would tell them to change their affect: they’d be kind of engaged, and having their time with the baby, and then they’d be told to – just even for two or three seconds – go completely blank in the face, “Still Face”, and you could see how distressing that would be for the baby even for a very short period of time… they’d initially giggle and try to engage the mother back with the giggling, or they’d reach for the mother, or they would eventually start the Signal Cry, right? Crying – or maybe even getting angry and hitting anything to get that face back – because it’s so much a part of the Attachment bonding system… and of course the researchers would only let this happen for a short period of time, and then tell the mother to re-‐engage – which is a repair, right? – and then bring the baby back into that bonding, that reciprocal expression, and you could see the baby completely relieved… it might take a few minutes to work out the stress of that, but if they had Secure Attachment to begin with, they would recover relatively quickly.



Bob: Allan Schore calls that – the babies’ response to the still face turning away – he calls it “conservation withdrawal”, which is the first Freeze response. It’s as the physiology of the Freeze involved in the babies not being confused by the mother’s absence of attunement through the facial muscles, and therefore goes into a Freeze because it’s… they can’t manage it… they’re just threatened.

Diane: I can imagine it’s very stimulating, very scary.

Bob: So they freeze.

Diane: Like, “Where are you, where did you go? You are not here, I need you.”

Bob: So that’s… all of these systems that different people come up with, and then – but they are all melt together – and it’s like there’s an instinctual awareness that this was there and all of these researchers came up with the same concept and amplified on it.

Diane: Yeah, and maybe emphasized different parts of it, but they really do fit together like a perfect puzzle, beautiful. Stephen, I know, he talks about different levels of threat – and sometimes, you know, even at a certain level of threat we are still able to stay active, so you don’t go into the helplessness, so you can move into a fight-‐or-‐flight response. But if something, or… you’re patterned for it before, from your Attachment history, right? If there’s a certain stimulus, especially if you consider it – your body experiences it – as a life threat – like a car coming at you or something – where you just think of it as – your body reads the experience as, “I am not going to make it”, then it triggers that Dorsal-‐vagal shutdown, going into immobility. So one of the things we are trying to do clinically is go into these frozen, immobile states and help bring resources… help bring contact that maybe wasn’t originally there with others … with ourselves as a therapist, or if we are in a group, with other people – and trying to bring in resources that weren’t there originally, so that the Dorsal-‐vagal can begin to release. And we can become active in our defense and then move into our fight-‐or-‐flight responses… this is a big, huge contribution, that Peter Levine brought from his studies in ethology, study of animals and their reaction to threat, and how it translated into human behavior.

Bob: Because that part of our brain is the same, as in any other mammal.

Diane: So we are going from an over-‐activation of parasympathetic that took us to shut down and then trying to lift the break a bit, so we can find our sympathetic in a way, to move into action – and that’s usually fight-‐or-‐flight, but sometimes it’s seeking to connect, right? Some of it tends to befriend – and then that’s actually moving us up through a physiological, predictable physiological sequence from immobility to mobility – being able to act, feeling less helpless, and less shut-‐down, less frozen, right?, and less cold – even at a cold temperature – and then actually having access – more of that Ventral part of the brain that you were talking about, Ventral nucleus – and then actually accessing our Social Engagement System.

That brings us back, sometimes, first into contact with our self – because we’ve been, like you said, dissociated – and we start to feel ourselves… and then very often, moments after that, we experience an interest and a capacity to engage with someone else. Like, if you were a therapist sitting in a session with a client, you might go, “Oh yeah, they are back”… they are going into a deep internal process and all of a sudden they show up! …And you just feel like somebody entered the room that maybe was there before physically, but wasn’t there in a really contactful way.



The reason I want to really highlight this, and I want to hear more about it from you too, is… I think sometimes with some of our clients, they might feel themselves as being socially awkward, or as having a social phobia or something, but they actually have the equipment, right? They have the equipment, is akin to walking into a dark room, you just have to turn the light switch on… and you can’t really turn the light switch on of the Social Engagement System – I call it Ventral-‐vagal, right? And this whole apparatus you’ve been talking about – the eyes , the ears, the mouth, the throat, the turning, all of these social affiliative behaviors are there – unless we do the fear extinction, which you started to talk about in the beginning, because threat is actually conflictual with our ability to be socially engaged – in contact with ourselves deeply, and also in contact with someone else – or to even care to be really in contact with someone else… because when you are scared to death you tend to feel… you know, you’re only really focused on being able to survive the next moment! You are not so focused on relationship at that point, unless you are trying to grab on to somebody to be rescued or something, right?

Bob: Those procedural memories we talked about that are there all the time, interrupt the system, unconsciously. I had a patient who I referred to a therapist – and she went to the therapist once, and then she came back and said, “I don’t know what this is about… the woman was delightful, she is attractive, well groomed, she is really very nice and sweet … but I was terrified.” So I said, “What does she look like?” and she goes “She had long, blonde hair, and she had a beautiful dress on, and she had a lipstick…” – and as she said that, her eyes went wide – “and it was a very red, red lipstick.” Which took her back to her childhood… because the grandmother who abused her used to wear this scarlet lipstick, and she didn’t recognize that.

So when we are in the Social Engagement, we will pick up cues – and especially if you’ve been traumatized, you are very sensitive to that, because your Amygdala – which is the arousal system in the mammalian brain – is primed for threat. And so, if you are talking to somebody and you just can’t engage with them, or you are on a blind date and you’re meeting for coffee and the person really puts you off even if they’re really quite nice, it has to be with procedural memory, for these nuances of appearance or behavior that reflect old negative life experiences and trauma.

Diane: And it could be anything, it could be a sound, it can be a shift in the tone of voice, it can be the eyes narrowing a little bit or, like you said, the red lipstick…and you have no idea, because it’s an unconscious process.

Bob: Right, which is procedural memory – and your brain is just trying to protect you.

Diane: Yeah, it’s doing everything it can, but sometimes it’s actually getting in the way. The other thing I’ve noticed, in working people from immobility Freeze responses, is that they get their action back and then they might feel the impulse to run or to fight, or to just speak and have their voice about something… and you create safety, so that can actually happen, initiate, and complete. But sometimes, right as they finish the sympathetic part of this process, and they start to move into Ventral, they initially make contact but then something happens; and the old pattern of shame with their mother, or fear of the parent, or something that doesn’t fit what’s happening in the therapy session… but you just see it come out, it’s like a projection – it’s not there for a moment – and then that projection comes and they just collapse… or they just go in, and they are like “I can’t look at you, I can’t make eye contact”. And so, often I think the therapist might not understand, but that isn’t about them, probably not I mean, unless they are “Still-‐Facing” the client or something, right? In the psychoanalytic process it used to be that the neutral face was a really important part of the therapy – and for some reason, I understand the reasoning behind that, because then you are sort of a screen for the projection, and you can see more clearly really what’s the client’s history. But for some clients – maybe not for everybody, but certainly for some – that’s



going to be really difficult for them, if they had a parent in their past that was depressed or non-‐expressive, or from their own history… remember, this is not about blame, REALLY important to emphasize that – but they didn’t have the social engagement system very developed… the light switch wasn’t so turned on, then even that could trigger a transference, countertransference, the messy soup that people aren’t really understanding the full significance of.

Bob: Yeah, it’s a crucial part of it. And that’s the role of procedural memory in this whole process, it has to do with that part of the brain that’s trying to protect you through information, but it’s false information, it’s false because it’s procedural.

Diane: And you believe it 100%, and you feel it in your body as if it’s absolutely true.

Bob: Yeah, but it’s something that it’s over, it’s in the past and yet it’s brought back to the present by the procedural memory.

Diane: I think that a very important point for procedural memory is that when that surfaces – when that gets triggered, or excavated, or whatever the right word is for that – it doesn’t feel like the past at all. There’s no sense of time or place. It doesn’t feel like, “this happened with my mother in the blue bedroom,” this feels like it is happening NOW, and I feel the full sensational range, and emotional experience of it, as if it’s happening now. So it’s almost impossible, unless you’re really familiar with the tricks of procedural memory, that you don’t project it on your partner, or your therapist, or your client, or your child, or your dog, or whoever you are in relationship with… in that moment, it’s going to feel like it’s right now – “What do you mean it isn’t happening right now?” – it IS happening right now because for you, in procedural memory, it absolutely is.

Bob: It is, and that is a really good point, because it is reacting to the past as if we were in the present and that’s what trauma is, the negative past, the threat, all that stuff, is constantly brought up into the conscious memory through minor cues – watching a TV show, watching a movie, talking to somebody, someone in the grocery store looking negative – I mean, all of this things are just lurking there trying to protect you against the existential threat that actually is all gone and over, but not for your survival brain.

Diane: So there is a point I want to make, because I think it’s so important that we understand the Attachment underpinnings, and we understand Attachment theory and the Somatic parts of that, as well as understanding how to work with car accidents and surgeries and maybe some things that happen later in life – going to war, coming back as a Vet – and I think that linkage isn’t as fully understood as I would hope… I mean, I think it’s so important for all of us who are trying to treat people that had… we are dealing with trauma symptoms now, but how much of that – at least some of that – is influenced by those original patterns, I think that’s a newer understanding for all of us. And you know, I find it really fascinating to understand more and more of about that.

Bob: Well, Trauma work came out of… Trauma arose from the response of veterans to exposure to combat, that’s how it came out.

Diane: And eventually extended into sexual abuse.

Bob: That’s right. And actually brought in the Trauma of rape, right into the 80s and 90s.

And Vietnam was the pot, boiling pot that created awareness of this thing called PTSD, which was simply trying to describe the way these guys behaved, rather than really understanding what the brain was doing.



Diane: So it’s really understanding the symptom of behaviors, not really the genesis.

Bob: Right, nobody understood that soldiers who were mal-‐attuned in childhood would be more likely to get PTSD in combat and… so that was the start of it, it was in combat, and I talked about that a lot because I think most of the syndromes that have to do with trauma in warfare have to do with dissociation. These guys are dissociated, and when they commit suicide or when they kill a family member and kill themselves, they are in dissociative state, they are back in combat, and they are unconscious within the moment’s experience.

Diane: And just acting out what originally there was.

Bob: And they are probably reacting to cues in the environment to replicate some of the stuff that they experienced in warfare.

Diane: And that’s a huge thing that we really need to get handle on.

Bob: And the odds are they were traumatized as kids.

Diane: Which made them more susceptible to the post-‐traumatic symptoms, right?

Now, do you feel that really, if they have a strong Attachment system in the beginning – because the way the way the brain is shaped pro-‐socially and the resiliency that’s built up over, you know, a relatively healthy childhood (and I mean we’re not trying to talk about perfect, nobody has a perfect childhood) – but that resiliency can just mitigate, what? 100 percent, or 80 percent, who knows? But mitigates a lot against taking future stresses and pushing forth the trauma symptoms.

Bob: Oh yeah – that is the core of resiliency, or susceptibility. It’s that heritage of homeostatic development in their response to threat through nurturing as a child that creates their resiliency, versus their vulnerability to trauma all throughout the lifespan.

Diane: So later in therapy, let’s look at… okay, now, it maybe started out with not the best situation as a child – and of course many of us fall into that category on the planet, right? – and you are trying to build that resiliency later, and as a therapist you are trying to help somebody come back to discover that part of themselves… Do you hold to this idea that Bowlby put out, that biologically we do have Secure Attachment? …that it might be interfered with a lot, and we adapt away from it toward the insecure Attachment behaviors? And you know, we can go into Avoidant, Ambivalent, and Disorganized and how those insecurities organize, depending on the parenting style… But in terms of bringing it back, we are trying to excavate the Secure Attachment system, or emphasize when it shows up, you know… and of course, working with safety and fear extinction… What’s your sense about that, what do you feel really helps? Or, what’s your hope for that, in terms of people – clients themselves learning skills, and therapists learning skills to help their clients – can you speak a sort of “clinical” piece about this a little bit?

Bob: Well, again… I think the Attachment is based on the mother’s capacity. The infant arrives well-‐formed, ready for attunement, basically… now, there are incidents of inter-‐uterum trauma, I mean there is no question that when a mother is bearing a child for 9 months, (a mother) who is terribly disturbed and dis-‐regulated, that child is affected.

Diane: A mother who has violence at home, or something like that…



Bob: Yeah, that child is affected in the uterus.

Diane: That’s already happening, it’s already adapting.

Bob: And predominantly that’s because of the elevated cortisol levels that traumatized people have.

Diane: Which should get passed on to the infant in utero?

Bob: In utero the cortisol is actually very toxic to the brain, in adults or infants or in fetuses, elevated cortisol results in shrinkage of parts of the brain that contribute to the affiliation process, specially to the Hippocampus, which is the part of the brain that governs conscious memory, declarative memory… and that part of the brain atrophies.

Diane: So when people you know so often say to you when you are talking to them, “I just don’t remember any of my childhood” and they don’t really understand the significance of that, right? If there is an overload of cortisol or something that interferes with remembering a lot of what happened early on.

Bob: Therapists know that: when you don’t remember your childhood, it’s because bad things happened; and also if you do an MRI and compare the size of the Hippocampus to the mean (average size), it’s shrunken… and those studies in incest victims and children, young women, mainly show that the size of their Hippocampus is shrunken.

Diane: So if a client comes and they have that condition, they have had that history… maybe a parent that was neglectful or violent, or maybe it was a stranger that was responsible for sexual abuse – however that happened – or within the family, and they actually have a shrunken Hippocampus, right? Or maybe an overdose of cortisol running wild or whatever, the HPA access is off, what are some things that really, realistically, therapists can expect to…how can they help a person, what kind of progress or what kind of possibility does that person have?

Bob: Well, you have to enable the person’s homeostasis, balancer of their Autonomic Nervous System.

Diane: They are directing it in a way that the protector or the steward of the homeostasis, their body, has to learn it because it didn’t learn it originally.

Bob: Which means you need the capacity to create presence, and the exchange between the therapist and the patient. And producing that requires that you have healed your wound to the best you can and that you can now engage in the Social Engagement system using all of the resources of your head, neck, and all the muscles.

Diane: And they are appropriate; I think there is appropriateness and attunement.

Bob: In other words, you have the capacity to attune to the client just like the baby with the mom.

Diane: Alright, and that’s very reparative… that is something I really want therapists to hear: how much their presence, their capacity, their own healing journey, and many people really do so much work on themselves (thank God, right?) but they are bringing all of that, what they reaped for themselves personally, and that’s really their biggest gift to their clients.

Bob: It is, for better or worse, your efficacy as a therapist is depending on your capacity to establish… It’s your responsibility to be able to attune – the client can’t – but the client’s brain will respond to that just as the infant, and actually there will be repair of the patient’s kindled brain.



Diane: I totally agree with you, and I really want everybody to hear this, because it’s so important!

Bob: Through that process – and of course Daniel Siegel has emphasized that problem more than anybody, about the mindful presence of the therapist in the process – but that applies to mothers and children, that applies to interaction with anybody.

Diane: The marriage partner, you private partner, friends, your children, your dog, your therapist and your client.

Bob: Yeah, if you can establish that, you are in good connection then.

Diane: And if there is a way, there is an intelligent process of returning ourselves, or enhancing those capacities as a therapist, and then bringing our clients into that fresh phase as well. I think of it as a kind of “active mindfulness”, because sometimes I think mindfulness… I don’t exactly know what the definition is, but when I think about it, generally, it’s sort of your own ability to stay present in your body, and feel your sensations, and – you know – be there, right? But in therapy – as a therapist – or as a person I am trying to be in deep relationship with – I think of it like I’m “being with”– being with myself, but also at the same time having a capacity to be with another person’s process – therefore a “being with, being with” if that makes any sense. It’s kind of active relationally, there is a relational mindfulness that I think we are really highlighting. There is a personal one that you can do in meditation, isolated – which is wonderful, right? – but there is also another one – however we want to name that – that is really about what happens in a relational field, what happens in our relationship moment to moment… How are we connecting when our presence is there, when it glides out a little bit, or how do we repair, how do we attune… You started this about attunement, and I am making full circle coming back to that – that’s one of the most important possibilities, and we do have to do some homework, unless we hit the jackpot and came with Secure Attachment from the beginning.

Bob: And I think that’s exactly right. I think it’s the duty of the therapist to deal with their own issues satisfactorily to be able to establish their bond. So we need to recognize that we all have a piece of this. So this life is tough, and so we need to be aware of that, until we enhance the interaction through our own capacity to deal with threat, and to heal ourselves or to be healed.

Diane: One way to look at it might be that we … even if we get triggered, we know “Okay, this is the trigger for me”, that gradually we work, and we work with our arousal, and we work with our ability to do fear extinction, and we find a way to be able to recover more quickly, right? That doesn’t mean we never have the reaction, but maybe we are able to recover more quickly – and that’s a signal we are moving back into resiliency, and maybe when we feel less of that withdrawal – like you were talking about the babies, that one way they can conserve energy is to withdraw, maybe when we are able to approach a little bit more… certain things that I think we can actually practice and develop skills around – and I think that’s the hopeful part of this, even if our brain shaped in certain way. And even if we have a smaller hippocampus, and even if we had neglect or violence or, you know, inconsistent parenting as a child, there are ways we can move through it to come back into a “better Social Engagement System”, as Stephen Porges and we call it.

Bob: Yes, care for ourselves first.

Diane: Well thank you, this has been a delight, thank you so much for all the juicy stuff you shared with us today, really appreciate it.

Bob: Thank you, it’s been fun and a pleasure.



Diane: And we will make sure people have a chance to check out some of your wonderful books too, because I know you weave a lot of this material in as well, so it’s a rich resource for all of us.

Bob: Well, I have a plug: my third edition of “Body bears the burden” came out yesterday and I got my copy yesterday.

Diane: Kind of a birthday of sorts, right? Another birthday, right? Beautiful… and you have written something recently.

Bob: A year ago I wrote a book called “Eight keys to Brain, Body, Balance”. There is an Eight Keys series at Norton Press and I was asked by Babette Rothschild to write about the brain. So I wrote about the brain and some book for lay people. It’s the brain, and then how that evolves into negative life experiences and trauma and healing.

Diane: Well, thank you for your rich contributions.

Bob: Thank you.

diane heller interviews bob scaer – somatic experiencing

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