The Need for Voice
An Interview with Vera Muller-Paisner on Treating Horse and Human Trauma
Posted Mar 05, 2016
In the course of the development of civilization man acquired a dominating position over his fellow-creatures in the animal kingdom. Not content with this supremacy, however, he began to place a gulf between his nature and theirs. He denied the possession of reason to them, and to himself he attributed an immortal soul. - Sigmund Freud
As part of the series on exploring trauma and trauma recovery across species, this interview turns toward psychoanalysis and the Eye Movement Desensitization and Reprocessing (EMDR) protocol as practiced by Vera Muller-Paisner. A psychoanalyst with a master’s degree in social work, Vera has spent the last three decades studying the chronicity and transmission of trauma. In 1996, she served as a research consultant for the International Study Group for Trauma at Yale University, and in 1996 received an appointment in the Department of Psychiatry, Yale University School of Medicine.
Vera has conducted extensive research with clinical experience working with Children of Holocaust survivors and is the author of Broken Chain: Catholics Uncover the Holocaust’s Hidden Legacy and Discover Their Jewish Roots. Much of her clinical work focuses on helping those who suffer from Post-Traumatic Stress Disorder (PTSD) including dogs and horses with whom she has modified EMDR to create Bilateral Equine Tapping (BET).
Vera, there are many different kinds of psychology and subsequently, comparably different approaches and philosophies concerning trauma and its treatment. You bring your training as a Psychoanalyst and insights from neurobiology to your work. Can you first describe the psychoanalysis tradition and how it differs from a straightforward cognitive psychological approach?
VMP: Psychoanalysis was an approach and concept developed by Austrian neurologist and doctor of medicine, Sigmund Freud. A number of other neurologists and psychologists including C.G. Jung developed and incorporated their own theories of psychoanalytic treatment. Students from these two related, but different fields, are referred to as “Freudians” or Jungians.” The key tenet of psychoanalysis, and what distinguishes it and that of Jung’s from other approaches and sub-fields in psychology, is its inclusion of the unconscious, processes—thoughts, memories, and feelings of which we are not aware or conscious of.
The study of the unconscious is referred to as depth psychology. In practice, psychoanalysis is a collaboration between the analyst (or therapist) and patient to explore his/her unconscious thoughts and conflicts through talk. While other kinds of psychotherapy now include its consideration, the use of dreams, symbols, and associations was originally connected to psychoanalysis as means to reveal what lay in the unconscious. For example, during a session this might entail the patient’s free association – communicating about anything and everything, wandering freely and saying anything that comes to mind.
Traditionally, patient and analyst meet several times weekly. Often, the frequency of these sessions increases and treatment intensifies. This is something else that distinguishes psychoanalysis from most other therapies that meet much less often and for shorter durations. Patients often spend their sessions lying on a couch which is intended to help the individual relax and enhance their ability to access and express unconscious material. Unlike cognitive psychological approaches, the focus of psychoanalysis is not on a specific problem of conscious memory. Rather, the analyst and patient discover unconscious conflicts that underlie conscious issues at hand. These “hidden” conflicts can create negative feelings and emotions such as anxiety, depression or unhappiness.
There is much greater awareness concerning psychological health and trauma effects over the past decade or so. At time, Post-traumatic stress disorder (PTSD) and trauma are confused or used interchangeably but they are not the same. Can you clarify the difference between trauma and PTSD?
VMP: Trauma results when the psychological and physiological capacity of an individual cannot accommodate a stressor. Stress is part of everyday life but when it becomes too great in magnitude or chronic, its effects are deleterious. An exposure to the possibility of death or that of a family member or friend, a serious injury, combat or sexual violence all qualify as trauma. Trauma is different from other diagnoses in that causes of trauma are acknowledged to come from outside the mind of the traumatized individual. In contrast, most diagnoses are conventionally regarded as intra- versus inter-psychic.
PTSD is a diagnosis developed by the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with a specific set of criteria and symptoms. PTSD is unresolved trauma. It is important to understand that it is not the trauma that someone has experienced that needs to be defined; it is the emotional reaction to it.
Can you say a little more about “the emotional reaction”?
VMP: Yes. Following exposure to a traumatic event, individual emotional responses differ. While some individuals may experience a temporary preoccupation with the event, such as intense fear and intrusive thoughts regarding the traumatic event, they are nonetheless able to integrate the past trauma into the narrative of their lives as “something terrible that happened.” In other words, the experience was extraordinary, but they are able to tie it in to their sense of self and present reality. However, many others can be triggered whereupon they are immediately transported back to the past and experience a replay of the event as if it were happening all over again. These intrusive memories, referred to as “flashbacks”, and the experience cannot be integrated or woven into a coherent narrative. The memories continue to roam, take a life of their own and disrupt everyday life with patterns of hyperarousal and uncontrollable emotional and physical distress. These are the conditions for PTSD.
You have included here “physical.” Do you mean to say that trauma is more than a psychological response?
VMP: Yes. There is a very complex neurobiological response to trauma. Stress hormones such as adrenalin and cortisol that are released during trauma are meant to mobilize the brain to help the body survive. However, if their activation continues – in other words, the individual cannot escape or mediate the psychophysical assault and there is sustained neuroendocrinal release—then the long term stress can cause long term changes in the brain. These, in turn, can entrench maladaptive behavior – what I mean by maladaptive is that ways of thinking, feeling, and responding that are not healthful for the individual.
Unintegrated memories that emerge as in the case of flashbacks are essentially engrained in neuroendocrinal pathways. Profound trauma changes the limbic system of our brain—what is often referred to as the “emotional center” of the brain—which leads us to respond similar to what when seeing a frightened or traumatized dog – he is unable to use words to describe the terror, is readily triggered by sounds or smells, and becomes basically frozen in place while desperately trying to stay alive. This was the way that Dr. Bessel van der Kolk described such a heightened state of arousal in a recent talk.
I think we can all relate to and visualize a dog “scared to death”, with his/her heart pounding, frozen in the moment, trying to do anything to survive. A part of the brain called the thalamus breaks down, leaving the images of “what happened to you” (the traumatic event) fragmented in the brain as un-integrated images floating outside of your “normal” narrative living a separate existence. These radically unexpected “flashbacks”, are the out of normal, the unprepared for, of “what happened to you” that constitute the agent of trauma. Even if, as in the case of war, a person is aware that she or he may be wounded or even killed, it is impossible to prepare for the conditions to which the mind and body are not evolved. This defines trauma – an overwhelming physical and psychological experience.
What do you think are some of the most effective aspects of psychotherapy in helping those who have been traumatized?
VMP: As a Psychoanalyst, I have learned to listen carefully in order to hear what is really being said or asked. Many who live with the experience of massive trauma don’t feel heard. Their voice, both internal and external, is suppressed, repressed, hidden, or silent. Their sense of self is so fragile that the manner in which they approach asking for or accepting something that they need is so subtle, they virtually cannot be heard. Their voice is often overridden by those trying to help. So while it may not be the intent of the person offering help, the trauma survivor feels that their own wishes and needs go unheard or misunderstood.
What is “not being heard” and why does that happen?
VMP: “Not being heard” means feeling silenced whether explicitly, when someone doesn’t show interest quietly in a traumatized individual’s story, or implicitly by judging the level of trauma experienced. A comparison of another’s trauma may feel like a denial of the trauma survived and can break any sense of a circle of safety, leaving the survivor in a state of enhanced vulnerability. In a sense, their real experience feels “capped off.”
Can you describe in more detail what is entailed in being heard?
VMP: At all times, it is important to honor the slightest discomfort of the traumatized being. It is essential for the person to feel that s/he is in safe surroundings, a space that, above all, gives them a sense of security, and secondarily, the therapist’s. I will give a recent example. A woman who had been severely traumatized as a child and made to feel “invisible” called to request a therapy session on Christmas Day which happened to fall on a Thursday, her usual day for a session. She mentioned that she didn’t seem to have “enough words” to “fill” for a full session but felt that she needed the connection. I responded by suggesting that we meet for thirty minutes. She agreed and we met. A few days later she told me that she didn’t realize that I had half hour sessions available. I replied that I did not. She then asked me why I had offered the half session and I told her it was clear that she needed it. That short amount of time and my recognition of her need was very important. She felt heard.
Being heard also includes seeing that the basics of life are met even before engaging in dialogue—this means being in a safe and warm place, provided with food, water and quiet, and being recognized and acknowledged respectfully. All of this entails calibrating to the traumatized individual—meeting them “where they are at” and not demanding them to be one way or another. This is the first critical step on the path of healing.
VMP: Yes, actually quite similar and transparently so. A psychological and traumatological approach does a great service by understanding “voice” in a much broader way. I’ll give you an example. A young Thoroughbred had been kicked and sustained a bruised rib injury which prevented him from walking easily and freely. The trainer was told by the veterinarian to keep him walking so the trainer took a lead line and attached it to the Horse’s halter, as was the customary way of walking Horses. However, he was reticent to move much more than fifteen feet. I suggested that she remove the lead line and instead, ask the Horse to follow her. It took a few minutes, as neither were accustomed to that way of relating, but very soon, the Horse followed her at a distance much greater than what a lead line allowed.
They did this together for several days and over time, he relaxed more and more and therefore was able to begin his healing. From the outside it may appear a minor adjustment but it made a huge difference to the Horse. You could see his attitude and demeanor transformed. Instead of resisting, he looked forward to his daily walks and even hesitated to come back to the barn. He was not forced l to live up to the expectations of a rigid prescription, but allowed to literally “go at his own pace” and this included not being led along. This latter arrangement very much reflects the kinds of settings created in therapy to foster a sense of safety, respect, and listening. This brings up another point.
Trauma brings out the primal fears to which we are all vulnerable. Trauma recovery starts with assisting the traumatized individual to cope with daily life. Treating trauma is a flowing process needing full attention and vigilance by the therapist to be able to manage the degree of emotional stimulation expressed as well as listening to the patient in a way that they may feel heard. When truly being heard, an individual is encouraged to use their voice.
You have used EMDR (Eye Movement Desensitization and Reprocessing)—often employed for human trauma survivors—for traumatized Horses. Can you describe this technique and give an example?
VMP: The exact neurobiological mechanisms involved in EMDR are not well understood. But what is known, is that EMDR has proven to be a very effective method in trauma recovery. Basically, it is a protocol that allows the re-experiencing of parts of the traumatic event on both the left and right sides of the brain simultaneously crossing the corpus callosum, allowing for the possibility of experiencing the traumatic event differently, and reinstating it into a manageable narrative.
What is the significance of the left and right hemisphere of brain “reintegration”?
VMP: Our hemispheres work well when coordinated. To say it in the simplest way, the left hemisphere is very logical and the right is more emotional. We need the use of both sides to be balanced. When experiencing a trauma, for example, the subcortical sections of the right brain, the amygdala and entire limbic area, take in the fear and horror of the traumatic experience, becoming “the frightened dog” without words. The traumatic experience needs to have working access with the left hemisphere in order to be able to name, explain and tame the traumatic experience into a narrative that can be managed. When this doesn’t happen naturally over time, the triggers may continue to flood an individual who can become overwhelmed, creating the possibility of PTSD. EMDR is one of several protocols that can be helpful in helping to balance the hemispheres.
The Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol 17:140.
Muller-Paisner, V. 2005. Broken Chain: Catholics Uncover the Holocaust's Hidden Legacy and Discover Their Jewish Roots. Pitchstone Publishing.
Muller-Paisner, V., & G. A. Bradshaw. 2010. Freud and the family horse: exploration into equine psychotherapy. Spring Journal, 83, 211-235.