Fear in the Therapy Room with Michael Guilding

Welcome to the Business of Psychology podcast. My guest today is Michael Guilding, a retired psychotherapist with 30 years of clinical experience, including over a decade working within NHS psychological therapies as head of counseling. Michael spent the past 10 years studying the human fear system, building on attachment theory and polyvagal theory to understand complex trauma and depression. He teaches workshops for the Complex Trauma Institute and has just released his book, Fear in the Therapy Room.

Full show notes and a transcript of this episode are available at The Business of Psychology

Links for Michael:

https://michaelguilding.com/

Book: Fear in the Therapy Room:

https://michaelguilding.com/book/

Amazon: https://amzn.eu/d/00rg0AWB

Waterstones: https://www.waterstones.com/book/fear-in-the-therapy-room/michael-guilding/9781781612903

Links for Rosie:

Substack: substack.com/@drrosie

Rosie on Instagram:

@rosiegilderthorp

@drrosiegilderthorp

The highlights

• Michael tells us about who his book, Fear in the Therapy Room, is written for 01:37
• Michael talks about the fear system draining Energy 5:45
• We discuss burnout and our awareness 9:44
• I ask Michael about fear alert, fear arousal, and fear collapse 13:33
• Michael explains about the link between fear collapse and depression 20:59
• We look at the role of cognition 28:28
• Michael talks about rethinking therapeutic touch 32:20
• Michael looks at resistance to change 37:08
• I ask about supporting clients through chronic stress 43:15
• We discuss how to support therapists 50:35
• Michael tells us where we can buy his book 52:19

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Speakers:

Rosie Gilderthorp

Michael Guilding

Hello, and welcome to the Business of Psychology. My guest today is Michael Guilding, a retired psychotherapist with 30 years of clinical experience, including over a decade working within NHS psychological therapies as head of counseling. Michael spent the past 10 years studying the human fear system, building on attachment theory and polyvagal theory to understand complex trauma and depression. He teaches workshops for the Complex Trauma Institute and has just released his book, Fear in the Therapy Room. So welcome to the podcast, Michael. It's lovely to have you.

Thank you, Rosie.

So can you start by telling us a bit about who Fear in the Therapy Room is written for?

Right. It's written for all therapists basically. But I think it also applies to all people who are caregivers for a major part of their life, because so much of it is the dynamics of what happens when someone is seeking care and what happens for the person from whom care is sought, the caregiver. And it's about... Well, it's about the impact of that on the caregiver or the, or the therapist, because what I discovered over a period of time working on this... This has, this has taken me about 12 years, something like that, to actually bring this to fruition and write it up. And in the process, I've done a whole series of workshops entitled Fear and the Therapist. And I found that therapists were actually quite concerned about their fear responses. They were thinking that there was something, there was something wrong with them. You know, they were, they thought, you know, they weren't strong enough or whatever because they were having these fear responses. And I was really struck by the relief that people felt in the workshops when I said, "This is just the work. This is ordinary." We get, we get emotionally battered in this work because we're like two, two stringed instruments, that we, we're hugely responsive organisms, you know? And we vibrate in sympathy with someone else. So if someone comes and their fear system is activated, and actually just about every single client who comes to see us comes with an activated fear system, and it kicks off our fear system. And if we're afraid of that and afraid of what it does to us, it drives us further into fear. And one of the big things about fear is it shuts down reflective thinking, and it also shuts down the part of the brain that controls social engagement. So we become unsocial and unthinking, which of course completely undermines us as therapists, which of course then alarms us even more. And the moment you can actually realize this is normal, and it's just like, "Oh my God, my fear system is triggered again," or, "My mind's going blank," or something like that, and not get alarmed about it, but just think, "Okay, I need to take a moment," you know? "I need to j- ooh, let's just get my posture right. Let's just take a breath. Let's just get myself..." And then your thinking comes back online, and then, and then you're back into the business. But I was really struck by how many therapists were, were actually getting disabled by their fear of their fear.

Oh, I think that's so powerful, and I really like the link you make there with caregiving in general because I have two client groups, basically. I work with families and parents who, you know, their children are really struggling, and I work with them on their mental health. And I also work with psychologists and therapists who are building independent practices. And as you can imagine, there's an awful lot of overlap there. And what I, what I see a lot in my psychologists and therapists is shame, that they don't feel able to do the level of complex trauma work that they've done for the rest of their career. And when I dig into it, they're, you know, they're at home with a child who is really struggling. And when you think about how, you know, some ... if we sort of resonate like a musical instrument, I love that, with somebody who's in deep fear. If we're dealing with our children who are deeply fearful, very activated, we're gonna be in that state a lot of the time. And then we're going into the therapy room and getting into that state again. Of course, at some point the body is gonna scream, "Enough. I can't manage this."

Yes. There's a massive energy thing here, that the fear system utterly drains us of energy. There's a fantastic bit in Sapolsky's book, Why Zebras Don't Get Ulcers, and it's looking at- just what it takes out of us energy-wise to be in a fear state. And it, and it isn't so much about, about the running and the fighting involved in a fight/flight response. It's about the amount of energy it takes to break out glucose and nutrients from storage cells throughout the body, get them into the bloodstream so that the muscles are, are far stronger, faster, more powerful. And then when that's no longer needed, for that to actually put them back into, into storage. I mean, I realized this as I got older, and just had less available energy, and also I realized it the moment I got properly in touch with my body and I started to notice the battering that this, that this work gives us, just what a huge energy drain it is. And then as I... I think I was, I was still working just about full time in private practice, but I was getting on a bit, and my mother lived very close by, and she started to get very frail and needed more and more of my time, and I really just felt that two-way pull. And actually, there's a bit, there's a bit I put in the book about it when having had a day's work with a couple of really quite difficult sessions which had really drained me, and I was just desperate to get to the end of the day and just get a big glass of wine and sit down in front of some mindless television, and just as I'm finishing and wrapping up the work, I notice I've got a message from my mother, her oven's stopped working. She hasn't been able to get her dinner. Can I help out? And my heart just sinks. It's like, "Oh, my God." And I walked round, it's about just a four-minute walk round, you know, to a parallel street to see what I can do, and I had this thing in my imagination that I just imagined that there's just a newborn baby by the side of the road, and I imagined it just kicking it into the gutter as I walked past. And it's like a really shocking image to have, and it, and it just made me think, "Oh my God, I am utterly depleted. I have got absolutely no, no energy left for anyone," you know? And my imagination is telling me this is, this is the scale of it. And from that point, I started really scaling back on my work, and I cut out evening work. I cut down the number of my clients to no more than four a day. Then I gradually increased my holidays, so actually by the time I got to retirement, I was working two days a week, and my holiday schedule was in the summer I would work for five weeks, and then I would take two weeks off. In the winter, I would work for four weeks, I would take one week off. And actually, it was very good preparation for my clients as I came up to retirement. Just sort of, you know, taking away from the just every week all the way, all the way . But it's just a matter, it's a matter of survival. The brain takes up, I think it's about 25% of the energy of your body when you are in a inactive, calm state. The moment you start to have emotional turmoil in on top of that, it's huge the energy drain. And I just didn't understand that in the early days of my work.

And what I wonder about is, is it that that was a crisis point for you where you became aware of it because you were dealing with more emotional turmoil than you had done before? Or could it have been that this was equally happening other points in your life but, but you wouldn't have been so aware of it? Because what I hear a lot, and I think, you know, I've said this, this is also how I would describe my career, is that when I was in my 20s, I used to be able to see, you know, seven complex cases back to back, and I'd feel fine, and I'd go out with my friends, and I'd be all right. Whereas now, I, you know, I have to limit my clients to three a day. And I wonder now how much of that is my awareness improving, and how much is a genuine change?

Do you know, I think that's both, because I think in my earlier years, well, I didn't, I didn't actually start training as a therapist until my late 30s. And before that, I'd been working in Royal Mail in senior management for some years. And I've had one patch where I just burnt out completely just because of overload. I was actually working as the area manager, where I was in charge of deliveries for the whole region. And I would have to be up from, at 4:00 in the morning, you know, to go out and visit delivery offices and that sort of thing. But they'd also devolved all personnel work to us, so I had all the major disciplinary hearings to do and industrial tribunals and that sort of thing. So sometimes it was after 5:00, and I was then driving back from Hull to York with my eyes just sort of, just sort of going. And six months of that, I just burnt out completely, and that was the thing that made me think, "I need another string to my bow. What else could I do?" And then I thought, "Oh, yes, reading Jung back at university. What a fascinating thing that would be, that would be to do." But I don't think I had the awareness at all of what was going on. And I think when I started training as a therapist, I think I worked very much in terms of, from an intellectual point of view. You know, my mind was, was working really hard because actually I didn't have much feeling in my body. I think one of my basic defenses back from the past is a freeze, which is the brain releases numbing, painkillers. So you don't actually feel what happened, what's happening in your body. You don't actually know what you're, what you're feeling. And it's taken me decades to actually get more and more in touch with my body and be able to notice it. But I also do think that our capacity for work and energy simply declines. I mean, in my late 30s when I was training and then, and then just into my early 40s, I was working sometimes 80 hours a day. You know, I had a big project setting up a new mail center where I was the project manager and also had to negotiate the whole of the movement of the entire operation from one place to another place with one of the stroppiest unions around in the, in the country. You know, and that, at the same time, I was doing my counseling training, I was having clinical supervision, I was going to see a therapist twice a week, and when I look back now, I just think, it's mind-blowing. So youth, you can get away with a huge amount in youth, and you really, really have to look after yourself as you get older.

Yeah, that's really interesting, and you kind of naturally there started talking about the terminology that you use in the book to describe the kind of fear system. And I think it's different, slightly different to the way that many of us have talked about the threat system before. So you, you talk about fear alert, fear arousal, and fear collapse. So can you sort of explain those terms for us, and maybe how they might map onto terminology like fight, flight, freeze, and flop that we might have heard before?

Right. Well, the fear alert is what would probably be known as the orienting response. So that's when there's a sort of perception of a threat but you're not sure where it is, or the threat is at quite a distance. So the biological changes that, that happen in the body are your, your hearing, your sense of smell, and your eyesight actually become more acute, so you become better able to sense danger at a distance. And at the same time, your startle response is activated, and it... there's two bits to that. The signal to the nerves that control the movement of the muscles is increased, and at the same time, the signal on the ventral vagus nerve that is actually inhibiting heart rate is withdrawn. So the first one is a bit like you've got a car and you're revving the engine, and the second one is you've taken the brake off and now, bang, you can go straight into a fear arousal response if that's needed. But there's very little energy expended, so you can go right back into calm quite quickly. And I think fear alert is a crucial factor in complex trauma, because in complex trauma, we're sort of stuck in fear alert all the time. And because you've got this startle response thing going on and the awareness of danger, you're in a volatile state, and therefore, you very easily will go into a fear arousal or a fear collapse. So that's the-

That makes loads of sense ...

that's the first bit. The fear alert, the orienting response. The fear arousal, I mean, the main bit of it, fighting and running, it's a massive change in the body. A huge burst of energy where cortisol based hormones are released, and they break out the glucose and the other nutrients into the bloodstream, as well as, you know, triggering the, both the speed of the heart, and the volume of the chambers of the heart. So you're getting a faster flow and a greater volume flow, which is also enriched at the same time. So there's that bit that everyone's known about for, for ages, the fight flight response. But as part of it, there's also a freeze part, and that's when there's no immediate escape route available, or you're not sure what to do, or there's no genetic information as to how to deal with that threat. Like a rabbit in a car's headlights. You know, the rabbit doesn't, doesn't have the genetic information as to what to do about car's headlights. It's too recent.

Do you know, that is so interesting, 'cause this is something my kids asked me about the other day. Why do badgers and rabbits and deers not learn to not be hit by cars? And I said, "Do you know, I think something must, must get passed down genetically to warn you about certain threats," 'cause they would run away from a fox or something, but they don't run away from a car. It's exactly what they were asking me. That's fascinating. Thank you.

And of course, something might be happening with the lights, the dazzling of the light. Who knows what's happening in the brain that's screwing up the circuits. But whenever there's something where we're not sure what's the best way to survive, or let's say our body isn't sure what the best way to survive, 'cause this all happens faster than cognitive thinking, we lock. So it's like the, what is it, the agonist and antagonist muscles that go in different directions both just fire like that, and you're stuck in that. And that can switch back into fight or flight, or it goes into fright, which is like the real peak in terms of the heart rate going up. And at a certain stage, I think there's a cardioprotective stuff, so this becomes a tipping point, and then you get a... then you get the collapse. So that's the fear arousal bit. I'll come back to the freeze bit because it's part of the complicated mess of what's written about this, and then fear collapse is the parasympathetic system that just shuts us down completely. So this is the thing that when an animal is being chased by a predator and the predator gets the claws in, so that's it, at that point, the animal just goes into a massive flop, and it's, it's a combination of two things. One is there's a huge release of opioid painkillers into the body. So you don't feel pain, and there's a huge drowsiness that goes with it. And at the same time, the blood vessels throughout the body are widened, and that means the pressure on the blood flow just drops. So it's a bit like, you know, in your central heating, when you lose water pressure, the heating stops working. So when you lose blood pressure, then the oxygen and the glucose isn't getting to every single cell of the body. You know, so muscle cells, skin cells, immune system cells, the brain cells, everything. So it just shuts down. And we feel it. Like, eyelids just go really heavy, face droops, you know, shoulders droop. Muscles feel really, really heavy as lead. Thinking starts slowing right down. At a certain stage, it just switches off completely. And that was the bit that, you know, in the first years of my work as a therapist I knew absolutely nothing about. So in terms of working with complex trauma, I was dealing with people, who now I would say they were in a state of fear collapse. And I hadn't, I hadn't any framework of understanding of that. And in terms of the resonating between what happens, I would sometimes be sitting with a client, and I would be overwhelmed by a huge wave of exhaustion, and my eyelids would go really heavy, and I'd ju- my thinking would start to go. So of course, you know, as it starts to go, you also start to get into a, an anxious panic as well, 'cause it's, "Oh, my God, I'm losing the plot. I've forgotten what all this is about, I don't know what to do." And I had no idea what that was, what that was at all.

I was just trying to think about when I became aware of this kind of fear collapse, and I don't think it was, I don't think it was early on. I think it's something I've only really been aware of maybe in the last 10 years. But I was thinking about when I felt it most acutely, as I was reading the book and reading about this. I was like, "When have I really felt this most strongly? And it was actually with the clients who at the time would have been given the label treatment resistant depression. So you then go on to make that link. So can you explain a little bit about that link between fear collapse and depression?

Can I just make another little diversion here? And that's about treatment resistant, because I think there's something in that way of thinking about our client that's so absolutely unhelpful-

Oh, I hate it, I'm so glad you said that.

... to our clients. I think it's, "I'm cross with you 'cause you're not allowing me to be the best therapist here." And they are not resistant to treatment, but something is happening in their biology that we're not understanding. Okay, so I'll get back to the thing about depression. The dynamics of attachment, I was following that, and it was making a big difference for my clients, but there was just certain of my clients, it just, it was no use to them at all. And I would think, "There's something I'm missing." And it's to do with trauma, because this was about the most traumatized of my clients. So I thought, "I just really need to educate myself more about trauma." And started reading, and eventually came across Peter Levine and this parasympathetic collapse. And it was like, "Oh my God, this is really, really important." And I knew nothing about it. And it seemed that in the USA, they were years ahead of us, and, you know, in the UK we just hadn't started understanding it. So I started writing a paper for the sort of community that Una McCluskey was working with, updating our notion of the fear system. And I mean, that was one really important thing for me, that she'd introduced me to the idea of the fear system, as it'd been formulated by LeDoux to sort of fight, flight, and freeze. And I'd found that very powerful, and was trying to understand, was trying to understand that better. So I was reading about, you know, animals collapsing when they were caught, and in the process of writing my paper, I was about... This was about a week before the conference, I went down with food poisoning, and I had an awful attack of diarrhea. And this was, this was very early in the, very early in the morning, so I'd felt the thing coming on for a few hours. And anyway, I had to grab my dressing gown, race downstairs. And in the few minutes afterwards, all of a sudden I just felt really faint. I thought, "I'm gonna fall off the toilet." So I threw my dressing gown onto the floor and just collapsed onto it. And it was a very strange experience. My mind's like having Radio 4 on all the time, or Radio 3 or something like that. There's something going on all the time. There's little tunes going on, or I'm thinking about what I'm going to eat next, or what I'm going to do, or thinking back over a conversation that I've had. And it was like click, complete radio silence. Nothing was happening whatsoever. I was lying on my side. I could see the pedestal of the... so I'm sort of on the floor, and there's a pedestal of the, the basin there. So I'm aware of it, but I'm not thinking about it. There was absolutely no thinking going on. The part of my bare legs were on cold tiles and it, they didn't feel cold. There was a very slight difference between being on the dressing gown and not on the dressing gown, but my feeling wasn't working properly. So they're just this blank. And then all of a sudden, oh, just got back again. Back up again. Went back to bed, and looking at the alarm clock, I realized I'd been lying on the floor for 30 minutes. And I had this visceral sense of what this collapse felt like, which I carried for several weeks afterwards. I mean, at first I thought ... I didn't link it at all to what I was trying to write about until 3:00 in the morning the next day, and I just sat bolt upright in bed and said, "Oh my God, that was a, that was parasympathetic collapse. That's what I'm writing about." You know? I got really excited about it. And then I thought, "Oh, it's nothing to do with fear." And then I got to the bit in the book about, that it's exactly the same mechanism that is triggered by massive liquid loss, which is what had happened, toxins, bacterial infection, viral infection, exhaustion. So I thought, "Ah, right. Okay. This one wasn't triggered by fear, but this is it. This is what it feels like." So I carried that sensation for some weeks afterwards, and because of that I was sort of sensitive to changes in mood. So low mood, it was like, "Ooh, this feels like a not quite so powerful same thing," as I was, as I was experiencing. And that, that sort of clicked while I was still at the conference. I'd delivered my paper, and I was at the conference and I just thought, "The mechanism behind depression is this parasympathetic collapse." And I'd never knew ... I, I'd never known what depression was, and no one else around me seemed to know what depression was. And I just ... I was with a group of people just talking after dinner I think it was, and I said, "Hey, I think, I think depression is this mechanism." And there was a general, "Oh, yes. That makes real sense." And it was like, it was like the moment you said it, it just fell into place. So then there was a long period of trying to understand that and trying to understand, okay, the ... You know, with animals there's this sudden collapse, and you're just laid out, you know, as they are after a chase, or as I was on the toilet floor, you know. What about depression where you can sort of still keep going, but, you know. So it was like there's got to be some sort of intermediate stage. What's going on there? And it, and it took some time, and actually a correspondence with Stephen Porges before he alerted me to the fact that when you are in a state of fear alert, when fear continues for too long, the signal on the ventral vagus nerve that's actually inhibiting the heart rate becomes weakened. You know, just as if you don't use your legs for six months, you can't walk for a bit. But the same sort of thing was happening within our, within our nervous system. I thought, ah, so we have these intermediate stages where you have a fear collapse triggered by some sort of threat, you know, be it something in the present or some remembrance of the past, or whatever. But you still have some regulation of the heart rate via the ventral vagus nerve, so you get the clash of these in different degrees, making the difference between just low mood at one end or severe depression at the other, and at a certain stage that your legs are cut under you and, you know, you can't even, you can't even move around.

I wonder if the role of cognition comes in somewhere there as well. That, you know, if you're on that pathway, but you've got... You can still see purpose and meaning in life, then you can kind of hold yourself. But if something happens which then removes that and you can no longer see kind of meaning in what you're doing, you know activities are, aren't valued anymore, then that could completely, you know, cut the knees off you. And you go straight into a proper collapse. Just thinking about how people have that capacity to carry on, carry on, carry on, and then will sometimes properly slide.

Yes. I tend to think that the body and the biological processes are absolutely primary, and that cognition is secondary. But the danger is that you can get a feedback loop from cognition. So, I mean, a bit like can happen when you're a, when you're a therapist. And if you start to go into a collapse and your mind starts to, your mind starts to be less effective, and when your body drains of energy, what your body is actually saying is, "Oh, I can't. I can't anymore." And of course, that then gets picked up by the mind as, "Oh, I can't. I don't know what I'm doing. I'm, I'm useless. I'm..." And of course, if you then elaborate on that, what you're doing is you're increasing a fear response, which is then collapsing you even more. So in a sense, the cognitive therapies have a real use in actually catching the way that you're thinking and trying to cut that feedback loop so that you're not alarming yourself even more.

Yeah, that makes loads of sense.

But they have a drawback, you see, that if you're relying purely on that, the moment the fear system gets too powerful, either in arousal or collapse, your cognition wipes. That in fear arousal, what happens is if you just think there's a spectrum of your cognition where you can look at all sorts of things, you can be reflective, you can take stuff in from every angle, think about it and incorporate it. In fear arousal, it just narrows, and the only thing you focus on is you can use your cognitive mind to detect danger and fight danger and escape danger and nothing else. And when you're in fear collapse, the brain cells within the processes for cognitive thinking are actually just starting to, to switch off completely. So you get this sense of just slowing thinking. It's a bit like trying to wade through treacle. You know, and it's like, "I could think better than that. I should be able to think, but n- nothing, nothing's happening." And then after a bit, blank, you know, a bit like when I'm lying on the floor and, and there's a residual sense of surrounding and nothing else. No cognitive processing whatsoever.

Yeah, so obviously cognitive therapy is a pretty useless when we've got into that point.

Absolutely, and that's why you need, with complex trauma, you need this range.

Yeah.

You know, the cognitive approaches and therapies have a very useful part to play in terms of this loop between body and mind. But the moment the mind has gone, you have to be into the body, the body therapies, and the being with the body. And sometimes just the being there as a person and meeting as a person because that's the thing that can bring you around. I mean, really simple things like there's a beautiful illustration in Peter Levine's book, um, and what is it? Oh, yes, he's been knocked around, down by a car, and he's by the side of the road, and he's sort of dissociating. So he's sort of going in and out of fear collapse, and there's a paramedic comes and asks a load of very intrusive questions. And of course the, your mind isn't working, so actually it just, it just shuts you down even more, and he dissociates even more. And then there's a, there's a young female doctor who's off duty comes past. She sits and she just holds his hand, and he just has this sensation of coming back into, into his own body. You know, so just human touch is one of the most powerful things.

Wow, that's such a powerful story, but when we think about our own lives, I'm sure it's also a very relatable one, and yet that isn't something that we're trained even to really be okay with as therapists. Thinking back to the horror that would have been met in my early career if I'd been like, "Oh, yeah, I held their hand."

Absolutely. I mean my core training was psychodynamic. You had no physical touch. You know, it was, it was frowned on to shake a client's hand when they came in and presented their hand to you. I mean, I got rid of that stuff in the end because it just, just plain impolite, and it just... it's actually not helpful. And there's very good reasons why you have to be really careful with touch. You're dealing with people who have been traumatized either by intrusive touch or by the complete withdrawal of touch. And you have a power dynamic, and you have issues if you're a male therapist and there's a female client, and that sort of power dynamic. So there's a huge amount of things to be talked about. But yet, all of that is, it is based on an understanding that actually, that actually didn't bring in this parasympathetic collapse. And certainly when a client has completely lost it and has, and has completely slumped in the therapy room, you know, maybe you're coming to the end of the session, and they're gonna have to go out into the world, and it's like, "Ugh, how can I send someone out into the world who's actually not capable of looking after themselves?" At that stage, just a handholding for a few minutes can actually just reconnect them and bring them back into the body. So I think we now, in our training, need to look at this touch thing really carefully. And I suppose the way that I've thought about it is that when you start work with a client and you know there's a history of trauma, then you actually understand, you explain to them something about the way trauma works and what might happen in the therapy to help with it, and you explain, "I don't usually use touch, you know, for very good reasons, but there are times where if someone goes into a complete slump, and they've just lost that connection, just a gentle handholding can really help, you know. Are you, would you consent to that if that's, if that happens?" So there's something about the preparatory stuff and people knowing what it's about, and in that case it can be used. But it's a bit of a minefield. It's a bit of a minefield, and it needs thinking about carefully. But I think that having learnt about parasympathetic collapse, we have to rethink therapeutic touch.

Yeah, I think so. I think potentially the fear around it sort of derives from this old model of the mind and the body being completely separate, and we were free to intervene with the mind, didn't wanna have anything to do with the body, that was a, you know, unpredictable, for someone else to deal with. Whereas, you know, if that's not our model anymore, and it, you know, it isn't, then we have to start thinking in a more holistic sense of how we work with a real whole person. And it can be... We can do very intrusive and potentially dangerous things with words. We've worked out ways of, we think, doing that in a boundaried and safe way, so I don't see why this should be any different. But you're right. Because we've come from this place of it being totally taboo, you know, not even shaking hands. I was trained the same way, and not even from a psychodynamic perspective, but absolutely you're not gonna shake the hand of a client. Kind of easier for me as a woman, actually, probably than it was for you. But we can't go from that to suddenly feeling, like, comfortable with it. We need training. And we need to think about how as a profession we change our, our attitude to this for people coming through.

Yes. But I think you see this, introducing the thing about parasympathetic collapse as part of the trauma response is an absolute paradigm shift in the work. And we haven't really properly got on top of that. And, you know, I think in the UK there's still a bit of a, of a resistance to it. I tried on three occasions, once I'd realized this and started to formulate my thoughts on it, I really wanted to have feedback from my colleagues. So I wrote articles for the BACP Therapy TODAY on three occasions, and they were turned back on each occasion. They were writing stuff in the journal about depression in terms of, oh, this bit of the brain and that bit of the brain, which actually didn't relate to anything we use in therapy at all. But they didn't want, they didn't want to know that.

That's interesting. What do you think that resistance is about?

I think that, I think people get a bit ingrained in their way of doing therapy and their way of doing therapy is the right way. And they see... Well, because I think this is a paradigm shift, it's seen as a threat. Because, you know, we talk about the fear system. The fear system is deeply, deeply embedded in the therapeutic professions. You know, of whatever orientation. I was in a support group with a group, some of whom were supervisors and tutors of mine from the past, but they had previously been in a sort of psychoanalytic association, which was deeply damaging. It was deeply shaming that, that if you presented a paper to this, you could be absolutely ripped apart by your colleagues. And it's like, "What's going on?" And in a sense, it's part of the, it was part of the hierarchies. There was a very old, you know, psychoanalytic thing about we are the people that really know it, you know, and the psychotherapists are, they're not that good, and the counselors, puh, you know. They're, they're insignificant. And hierarchies are about fear. I found when I was doing my, my workshops, my Fear in the Therapist workshops, there was a couple of ones where people sort of got into a spat. I think there was a quite high-ranking mental health nurse getting into a spat with a counsellor about, you know, who was the real therapist. It was like, "Ah." So from that point on, when I was doing live ones, and I have a training room in my own house, so I'd have groups of eight people come into my house to do that, and they were completely banned, if they were in the kitchen having a cup of tea before or if they were in the, the group room waiting, they were completely banned from mentioning anything about the profession they were, the length of time that they'd been practicing, the type of training that they had, anything like that, that would actually present these, these hierarchies.

I love that. That's such a good idea. There's so much kind of politics around it, isn't there? And I guess I'm also wondering if part of the reason it feels threatening is that if you become aware of this, you then have to change your practice in order to incorporate this knowledge. Like, the thing that was so clear to me from reading the book was that with this knowledge, we know that we should be attending to what's going on in us, the fear response that might be present in the client, and pausing and regulating, dealing with that in the moment, and then going back. And I think some defensiveness comes from a place of people feeling that they're not capable of that, either because of the restraints of their service, so they know, "I don't have time to do that, I'm gonna miss my targets. I'm not gonna tick this box if I do this, so it's threatening to me." Or that they doubt their own capability to deal with what that is bringing up for them, because they don't have good enough clinical supervision. They maybe aren't getting personal therapy to help them process the vicarious trauma that they've dealt with for possibly 25 years plus. Is that your sense too?

Yes, absolutely, I think that's the case. I think, you know, I talked to you about when I, when I started training as a therapist, that I was sort of almost a bit numb from the, from the neck down, and therefore having to do everything in my head. I think if myself then had read some of the stuff that I was then coming to write, I think I would have been defensive and resistant of it, at that stage. And I think the thing about, the thing about the therapy is a really, really big issue, because if you are to be aware of what's going on in your body and be able to regulate it, you need to have processed the trauma that you've gone through. And I have come across, you know, some people who actually said, "Oh yes, there's this trauma here, but it, but it's okay. It doesn't, it doesn't impinge." Which is nonsense. There are no dividing lines in the brain. If you had any sort of trauma, it's going to be touched on at some stage in the work you do, and it does need to be addressed. And it's a scary thing, you know, it's a scary thing addressing that. You can never say to anyone, "Oh, you should be, you should be doing this." Each person just has to do what they're able to do at a, a particular place. So you know, back in the day I would've been resistant to these ideas, so I completely understand anyone that's resistant to them, and people just have to find their way in their own time.

And I think what's really helpful, and where I think a lot of other books that I've read on this, this topic haven't gone so far, is you give practical examples of what you can do in those moments where you've recognized something in yourself and in the client and you want to stop and intervene. I think that's really useful, and I think those of us that, you know, might use CBT, CFT, ACT, EMDR, there's a lot in that, that will be familiar around that kind of, you know, grounding, using breathwork and sort of dealing with the in-the-moment fear response. But what I read in your book that I haven't read about anywhere else, I've seen it on Instagram oddly, but I haven't read any other credible sources on, so it was really helpful for me, was the stuff about the more chronic, that persistent sort of chronic stress held in the body, and what we might do to support clients through that. So can you say a bit about that? 'Cause that might be new to a few other people as well.

Well I suppose that, yes, it's the way when, when our fear system is aroused for too long, then actually it, we get stuck. So the fear system can't switch off anymore. I think our fear responses were evolved in circumstances where the threats didn't go on too long. Because in terms of a prey animal, you either got away within a short space of time or you were dead. It was as simple as that. So fear going on and on and on and on, and no, no place of safety we weren't designed for. And what happens when fear goes on and on with no place of safety is that the biological mechanisms that actually switch off the fear system stop working, and the way the whole body habituates, gets in the way of fear turning off. I mean, one of those, one of those things is chronic tension. That if you're in fear all the time, then you're in a state of high tension, and after a bit you don't even notice that. But, you know, your muscles are just tense. I mean, so you go for a massage and oh my God, this is rock solid. So you're carrying rock solid muscles there. One of the ways that you switch off the fear system when you're not actually running and fighting is that you get big, deep breaths and then a trembling of the body which dissipates the energy of fear arousal. When you are chronically tense, that, that doesn't happen. You, you can't do the shaking. Also, you can't do the deep breathing because your diaphragm is, is absolutely tight. So that's where shallow breathing, you can only breathe as far as the diaphragm lets you. You don't get breathe right down into the, to the abdomen.

So what I thought was really interesting in the book is that you do give some places that we can look for advice about how we might deal with that if we know, 'cause I think as therapists we're starting to get better at recognizing when a client in front of us is carrying that kind of chronic tension. But what most of us don't know is what we could safely do about that and where we could safely send people to do more work on that.

Yes. I mean, one of the things that I realized is there's, there's a lot of the work in helping to heal trauma doesn't belong to us. You know? That it actually belongs to physios and coaches and people that do massage, and that yoga and meditation are incredibly useful in terms of getting rid of this chronic tension. But also there are some ways of working. I think in terms of dealing with trauma, my two big favorite ways that I found were EMDR, which I learnt quite early on, so, you know, I practiced EMDR for about two decades and found it really fascinating. But the other one was, was focusing oriented therapy, which is weirdly like Vipassana Meditation, but done as a couple rather than done as an individual. So what happens there is, someone might be talking about their, a trauma story, and the moment they note they mention something that, that might be telling what the body sensation is, or sometimes I would say, "What sensations do you notice in your body when you're saying this?" So it might be, "Oh my God, this real knot right, right in the pit of my stomach." You just sort of stop and slow down, and I would say, "Okay, just close your eyes and focus all of your attention on that knot." And, just try to describe it to me in the simplest possible terms. And there's a whole thing about clean language, how you ask questions where you're not actually putting therapist's assumptions into it. So you might ask, you know, sort of, "What shape is it? Do you imagine, do you imagine a colour? You know, is it tense or is it, is it relaxed?" So they might describe a really tight knot that's livid purple in color, and it might be throbbing or something like that. And you just say, "Give it your entire attention." And what I'm doing at the same time, I'm closing my eyes too, and I'm imagining in the same part of my body exactly what I'm hearing them describe in their part of the body. And it's amazing work actually. But so this might go on 10, 15 minutes, something. Every now and then I'll just say, "Are you noticing anything else?" Or, "What are you noticing?" And just invite them just to simply describe, and just keep your attention on that, nothing else. And what the, what very often happens is it sort of gradually changes, so the, the knot might just loosen, or it just goes from a livid purple down to a sort of more light pink colour. It stops throbbing. And then sometimes, bang, it just dissipates. And when it dissipates, you usually just get a relaxation of tension in the body. And very often, where it's associated with a trauma story, you've almost picked up the part of the body that the trauma is trapped in the body, and you've just loosened gradually. In Vipassana meditation, you do this, you're constantly going through the body and noticing every part of it, and you're noticing what it's like and tension, relaxation, that. But with that, you just, once you've noticed, you move on. So you keep on moving on. With this one, you just stay, and you just stay with someone else. And it's strange. You know, you come out of 20 minutes of this, it's almost like emerging from a, a trance-like state that the two of you are, are in together. But the amazing sort of healing that sometimes happens there, you know, and the trauma symptoms can, can dissipate. People are left without anxiety, and they start to do things differently in, in their life. So I absolutely love that way of working, and it actually came-

That sounds amazing. I think, you know, I'm aware of your time, and I know we need to, to wrap up, but just, you know, what I've really taken from this is that there is so much opportunity for deeper healing and better therapeutic work, but that to do it, I think therapists need to feel safer themselves.

Absolutely. That possibly might even be the core message of the book because it ends up with a section on supporting the therapist. Because we can only, we can only help other people when we are relatively fear-free. In other words, when we've actually caught our fear and actually been able to regulate it. But this isn't something about the individual. This is something about the whole of the context of our lives, not just the past context, like the therapy that we've gone through to regulate our trauma, but it's what sort of is our, in our intimate relationships, are we in a supportive relationship? Do we have really supportive friends? Do we have a supportive workplace, or is our workplace fear-driven, which actually is the majority of workplaces, and it certainly is the NHS at the moment.

I was thinking when I was reading the book, I could almost split services that I'd worked in into services that would, as a fear response, label the client treatment resistant, and ooh, weirdly, we get loads of those. Or services that would go the other way and would label the therapist as incompetent. And again, you know, you can see how those are both fear responses.

Absolutely.

But neither of those is gonna make you feel safe enough to do this kind of work.

Yes. One of my big things in it is, is it doesn't matter if you're in a fear-driven context like the NHS or you're in private practice or you're in an agency that's fairly supportive, every one of us needs a really good support network of professionals that understand this same thing as we do, that know what the work is like. So, for the last few years until my retirement, I had set up a local support group where we simply had the... I laid on lunch every Friday, every Friday at lunchtime. I would provide a soup, and then people would bring and, bring and share on top of that. And it was, you know, when crises come, sometimes you might not see a supervisor for a few weeks. Or you might have no one to talk to. So, so there was always a place fairly soon that people could just come and talk. So we would just share a lunch together, and then we'd have an hour and a half just in group, just checking out where we were, what was happening, what was battering us in that week with the... and just supporting each other in that. And my message is find somewhere like that, and if it's not there, create a network like that and, and you can't do it by yourself, so find someone else, and the two of you then create it together and draw people in. And don't make it too big because then it starts to get, then it starts to get scary. But we absolutely need a high level of support, not just when you're just out of training. This was for me in my last years. You know, I've been, been sort of a therapist for close on 30 years. I needed that just as much as someone who was, who was starting out. So yeah, support is central.

Oh, I think that's brilliant advice. I love that, and I think lots of people listening to this are gonna want to go and buy the book. So I know I can direct them to your website, which I'll put in the show notes of this episode.

Thank you, Rosie.

Is the book now available to buy in bookshops, Amazon, that kind of place?

It is. It's available on Amazon. It's available in Waterstones. It should be available in any major bookshops.

Wonderful. So I'll make sure all the links are in the show notes for this episode so you can go off and get your copy, 'cause I really have got a lot out of reading it myself, so it is one that I recommend highly to the listeners.

Oh, thank you for saying that, Rosie. Really appreciate that.

Well, thank you so much for joining us today. I've really enjoyed the interview. And, yeah, thank you so much for your time.

Thank you, Rosie. Thank you so much.