In the midst of covid, many therapists are reporting an increase in clients feeling numb. Their motivation is low and they describe themselves as going through the motions and just existing. It’s almost as if they have shut down and are on autopilot.
How do we help clients who are showing up this way?
In this article we will cover:
- understanding nervous system responses
- the unique reason their numbness makes sense
- how to create long term healing
By the end of this article, you will have a clear idea of what is going on for your clients and how to help them.
Nervous system responses
Discovering polyvagal theory was a major step forward for how I work as a therapist. It helped me become more observant of responses that are driven by changes in the autonomic nervous system.
Autonomic is another word for involuntary. So the autonomic nervous system takes care of those functions that happen without our conscious say-so. For instance, I don’t issue an order to digest my food or beat my heart. It just happens.
The nervous system’s response to a shortfall of safety is also involuntary. Think of the last time you watched a gripping thriller and there was a sudden fright. Did you choose to jump? Or did your nervous system just do it?
It is helpful to pay special attention to client responses that are driven by the nervous system. For instance, an increased heartbeat, butterflies in the stomach and redness in the face are all signs of a nervous system moving into fight or flight.
Fight or flight is not the only nervous system response to a lack of safety. When a problem feels too overwhelming, we move into a state of shut down. If you’ve ever felt scared stiff, then you have experienced the freeze of shut down. This nervous system state is our oldest defence mechanism against danger.
Little wonder that many of our clients are experiencing indications of this nervous system state. Numbing is a classic sign of it. After all, evolutionarily, a purpose of shutdown was to numb us against the pain of capture by a predator animal.
If your client is feeling numb and disengaged, it is a sign that their nervous system is not feeling sufficient safety. That this should be happening more in the midst of a pandemic makes sense.
For short term support, it can be helpful to talk about safety and what helps them feel safe. The nervous system is desperate for cues of safety at such times. You can use the five senses as a checklist: sight, sound, touch, taste, smell.
What makes them feel safer to look at, to hear, to feel, to taste or to smell? Likewise, what can bring a gentle return to energy to this numb, scared body? If they were to build a playlist of music that would be helpful in this state, what would it be?
Deb Dana refers to these kinds of interventions as “befriending the nervous system.” Of course, the best way to help the nervous system recover a sense of safety is to be with others who feel safe for us. This is harder in times of pandemic of course. But it may still be possible. This includes pets too.
The key noticing is that the numbness is a nervous system response to a lack of safety. So it makes sense. In the next section, we will explore how else it might make sense.
For more reading on polyvagal theory:
The unique reason that the numbness makes sense
We have seen that a numbing response makes sense as a nervous system reaction to a lack of safety. In a pandemic, it figures that people feel less safe than usual.
Yet you will notice that not everyone is responding to the pandemic with numbness. Some clients are feeling anxious and jittery. Others are doing pretty well.
This suggests that there are more specialised reasons why this client’s nervous system responds to threat in this particular way. The pandemic may be the current reason why the client has slipped into this state of numb autopilot. Yet there is a reasonable chance that this is a response that predates the current situation.
When exploring further, the client may notice that it is a familiar experience when faced with a shortfall in safety. If so, this is an opportunity to help create lasting change for your client.
I like to repurpose a technique from Motivational Interviewing to get to the core reason why the numbness makes sense for them in particular.
Explore the benefits of feeling numb. It seems a daft question, but there are likely some ways that feeling numb serves them. Is it helpful in some way? Work with them to build a list of reasons why this numbing is of benefit somehow.
Likewise, you can explore the costs of change. If you waved a magic wand and they suddenly became a person who feels everything fully, what are the downsides of that? What price do they pay for becoming that person who experiences it all? What discomforts emerge when they imagine themself that way?
Typically, you can help make sense of the client’s struggle with a single sentence that encapsulates their answers. (You can see a fuller explanation of this method here.)
If I allow myself to feel everything fully
Then [bad thing that is taken from their answers above]
So I numb myself
Even though I long to be fully engaged with life
Because anything is better than [that bad thing]
You can try a few ideas out together with the client. Ask them which aspects from their lists feel most risky, scary or emotionally heavy. Insert them into the above sentence and try it on.
You will emerge with a sentence that doesn’t just describe their numbed response to the pandemic. Instead, it will likely land for them more generally.
It is unique to each client of course, but let’s illustrate with a fictional client:
If I allow myself to feel everything fully
Then I will be overwhelmed and suffer a breakdown like Dad did
So I numb myself
Even though I long to be fully engaged with life
Because anything is better than suffering a breakdown like Dad did
This man’s father suffered a series of breakdowns when the client was a child. He realises that his nervous system shuts down in order to defend himself from the same fate. His fear is that if he lets himself feel fully, he will break down too. This terrifies him and so his nervous system steps in to protect him.
Now you both know what he is defending against, you can engage in work to erase it for good.
How to create long term healing
There is only one known brain mechanism that produces lasting, effortless change. It is called memory reconsolidation. Through the use of mismatch, the brain is able to erase old trauma responses and replace them with something new and more resourceful.
The client still remembers what happened. Memory reconsolidation only alters implicit memory – which includes feelings and autonomic nervous system responses.
Now that you know what the numbness defends against for this particular client, you can explore how they may have learned this.
In the example above, it is already clear. The client has already spoken of scenes where he witnesses his father’s suffering and decides that anything is better than that.
He has decided that fully experiencing feelings leads to overwhelm and breakdown. Yet he is also aware of the costs of this defence mechanism and would like it to change.
Depending on your client’s sentence, it may be that some more exploration is needed to find the “target learning”.
Once found, you can follow the steps of memory reconsolidation in order to help trigger the brain mechanism that leads to change. This can be done conversationally by helping the client collect information that disconfirms the core belief.
For instance, this client believes that fully experiencing one’s feelings leads to breakdown. What specific people are a good example of how he would like to be once this problem is overcome? Identifying those who feel fully and yet avoid breakdown is an example of mismatch knowledge.
Of course, simply collecting mismatch knowledge is not sufficient to trigger memory reconsolidation. Nonetheless, it is the raw material for the steps that do.
Another way to help trigger memory reconsolidation is to use imaginal work in order to make it happen. I have provided an overview of this kind of imaginal work here.
SUMMARY
In this post we have covered:
- understanding nervous system responses
- the unique reason their numbness makes sense
- how to create long term healing
We saw how the numbing that your clients are reporting is a nervous system response to a sense of safety shortfall. A short term intervention can be to help the client learn how to befriend their nervous system.
This involves building a resource pack of senses-inspired cues to safety, as well as co-regulation with safe persons (including animals).
It may also involve doing other things with the body to invite a gentle return to energy, such as breathwork, light exercise or listening to music.
Yet the client may notice that numbing is a defence that gets in the way of life more generally. They realise that it is a familiar response that occurs more than is useful, and they would like to change it.
You can use the single sentence technique to discover how this response makes sense for them.
From there, if lasting change is the goal, then your aim is to trigger memory reconsolidation. Note that this is a brain mechanism, not a model. You may decide to tweak how you work to trigger it more reliably, but the likelihood is that you can continue with your preferred modality.
As such, this becomes an opportunity for transformational change. When achieved, it allows the client’s nervous system to respond to present circumstances rather than from traumatic events in their history.
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