Levels of Awareness (Therapy Theory)

 It would be best to read this article after reading “How to Measure Progress”, found here. 

This article takes us a step further in understanding what different psychological states look like, thus helping us understand how to interact effectively with people in various states. As a review, we recall that there are 6 common emotional states for people to be in, as seen in the U-Model: 

1. Dissociated Logic: A functional state where people can remain productive as long as they can avoid certain triggering stimuli. Though people in this state seem “ok”, they are actually in survival mode, have limited access to empathy, and are engaging in at least some behavior detrimental to their health to help them stay in this state (e.g., addictions to caffeine, gaming, sugar, excessive humor, etc.). This is a common state for those with personality disorders. See the post “Covert Depression” for more about this state.

2. Dissociated Fight/Flight: A state of intense anxiety or anger that seems disproportionate to the current situation. People in Dissociated Logic often get triggered into this state, or will enter it when they don’t have access to distraction or self-medicating.

3. Dissociated Freeze: A state of shut-down, exhaustion, poor appetite, and disconnection from logical thinking. If there are emotions, they are shame, hopelessness, self-loathing, or anything else dark, disturbing, or heavy.

4. Mindful Freeze: Also a state of exhaustion, heaviness, and pain, but also a state of recovery. There is less non rational thinking and more compassion for oneself. This state calls for rest, rather than ceasing to exist. The main emotions are grief or guilt, which are different from shame.

5. Mindful Fight/Flight: A state of fear or anger that seems proportional to the situation. People take responsibility for their actions, and allow others to be responsible for theirs. They can reason out cause and effect. They can formulate action to address stressors.

6. Mindful Logic: A state of calm, logic, hope, and contentment. This person is able to think rationally, receive new information and challenges, and ready to take effective action to solve their problems and achieve goals.

There are no defined lines between these states; someone might be feeling something between two of them at the same time, or describing “parts” of themselves in different states. For example:

-“I made it through work this week just fine (Dissociated Logic),  but I can feel some anxiety stirring inside me and I’m afraid of what I’ll find (Dissociated Fight/Flight).

-“Part of me knows that everything will be ok (Mindful Logic), but part of me just wants to crawl into a hole and die (Dissociated Freeze)”.

We must remember the sequence of transition between states to determine if someone is increasing dissociation, making them less emotional and connected (but more vulnerable to triggering) or decreasing dissociation, making them more emotional and connected (but more likely to recover and grow from stress). It follows the arrows on the diagram. Examples:

-Reducing Dissociation: “I feel really depressed and sad now that I let myself think about what’s really happening in my marriage, and I might have to call in tomorrow from work, but at least I know what I can do to improve my relationship now.” (From Logical Dissociation to Mindful Freeze)

-Increasing Dissociation: “I feel so much better when I don’t let myself think about what happened with Mom.”

A typical therapy course involves reducing dissociation, but sometimes increasing dissociation is necessary to cope with difficult circumstances. (See post on “Suppressing vs Compartmentalizing” and “Levels of Coping”)

Lastly, we recall that there is a spectrum of these different states. We may go through several loops with a particular fear or trauma before it doesn’t trigger significant dissociation. This means that, even though we processed a trigger once and feel better about it, there may be more work to do with it. Or, though we may have processed a particular trigger out of dissociation, there may be other triggers still hidden deep down. The process never ends, and that’s ok. The River Model shows this concept. 

The following is a sequential spectrum of what level of stimulus people can handle without becoming too dysregulated or overwhelmed. They roughly map on to the different emotional states. Listed are different interventions a therapist or other helper might use to facilitate a healing experience while in this state.

Connect to a fictional stimulus. This is the lowest level of mindfulness. Folks with severe psychosis or personality disorders often find themselves in a state where they can only accept false realities in order to feel calm and safe. Others may require temporary connection to fictional stimuli to rest from the extremely painful realities they are processing. Interventions:

-Meditate to “find a happy place”. Imagine yourself in that place, imagine the details, and picture yourself feeling calm and safe there.

-Create some other new image, idea, or story in your mind.

Connect to a real remote stimulus. Some people have a hard time being here and now, but can easily think or talk about things from far away or from the past. Interventions:

-Imagine yourself and the details of a real safe place.

-Imagine a happy memory, or a safe person.

-Recall a story you have heard, or a song you enjoy.

Connect to a real proximal stimulus. Some people are not ready to be mindful of themselves, but they can stay in the present without too much distress. Interventions:

-5 Senses mindfulness

-Perform a simple task like a puzzle, chore, or interact with a person nearby

Connect to your somatic motor functions. Some people can pay attention to their body functions, without tuning in to sensations yet. Interventions:

-Perform deliberate guided movements (yoga, stretching, tai chi)

-Breathing exercises

Connect to somatic sensation. This is where things can get really tough for the severely traumatized. Unhealed emotional injuries still hurt, and they have built up over time. Tuning in to these sensations can be extremely uncomfortable, and should be done in controlled doses if possible. Interventions:

-Compassionate touch. This is an active, validating experience of self touch intended to produce an oxytocin release just as a hug from a loved one might. You might mindfully hold your own hand, rest a hand on a knee, give yourself a hug, wrap yourself in a blanket, or put your hands on your cheeks.

-Describe a sensation of muscles or organs where emotions are felt.

-Induce other somatic sensations with tastes, textures, temperatures.

Connect to emotion. This requires some simultaneous awareness of the body and cognition. Someone in this state can identify emotion words. Interventions:

-Emotion Wheel: List every emotion word from the list/chart that resonates with you right now. Some may seem contradictory, but that’s ok. 

-The 6's Questions Interview (manager/protector dialogue from Internal Family Systems).

This is a powerful intervention best housed in a track all about parts and working with our unhealed hurts. 

Connect to sources of emotion. With a bit more cognitive awareness, the mind can be drawn to experiences that the emotion associates with. These might be experiences that appear to have caused the current emotion, or those that evoked a similar emotion when they happened

-List reasons why you may be feeling emotions you have identified.

-Socratic Questioning. An intervention often used to help a client identify a core fear. You continuously ask “Why?” until you reach a core fear–often something related to shame, rejection, abandonment, or death.

Connect to Self-Compassion. The next level of awareness comes with connection to the universal truth of one’s worth and inherent goodness. It involves a rationale for why the experience and emotion happened that does not blame or criticize the person. Interventions:

-Emotion Validation: “Emotions happen beyond our conscious control. We don’t need to decide if they are good or bad. They just are. And they always happen for a reason that makes sense. Can you identify why your emotions make sense?”

-Inner Child. Write a letter or imagine a conversation with your younger self that felt these emotions. What would you say? How could you meet this child’s needs? What message do you want to send to your younger self?

Connect to Compassion for Others (Highest Level). True compassion for others only comes after validation oneself. If someone is apparently only judging themselves and not others (especially in cases where they blame themselves, not their perpetrator of abuse), then they are actually on the dissociated end of awareness. They will have to process some suppressed emotions before they can really feel compassion for themselves, then others. Intervention

-The Other’s Shoes. Write down how you imagine another’s experience might be regarding the emotions you have felt.

-The Other’s Inner Child. What was happening with the other person’s inner child as this happened?