Showing posts with label cathy malchiodi. Show all posts
Showing posts with label cathy malchiodi. Show all posts

Thursday, October 27, 2022

The Four "Fs" of Trauma Response...Fight, Flight, Freeze, Feign

We have likely heard of "fight" or "flight" as a typical response to being in danger or a stressful situation, and in recent years, many have included the "freeze" response.  However, there is a fourth term that has been included in the stress response, which is usually referred to as "fawn." However, I like the term "feign" that Dr. Cathy Malchiodi puts forth as another way people manage their way through precarious situations.  Read her article further and think about what you might incorporate into your terminology and treatment approach.

https://www.psychologytoday.com/us/blog/arts-and-health/202106/understanding-fight-flight-freeze-and-the-feign-response

TRAUMA

Understanding Fight, Flight, Freeze, and the Feign Response

“Fawn” is a disempowering term when it comes to trauma.

Posted June 13, 2021 |  Reviewed by Gary Drevitch


© 2020 Courtesy of Cathy Malchiodi, PhD

"Self-Preservation," collage from the visual journals of Cathy Malchiodi, PhD 

Responses to danger are physiological reactions traditionally known as fight, flight and freeze (sometimes called collapse) (Cannon, 1932). Trauma specialists define these reactions as neurobiological responses to threat. One widely accepted concept is that the thinking brain (neo-cortex) is often automatically dominated by the mid-brain (in particular, the amygdala) during moments of fear. This means that the mid-brain goes on high alert and signals the sympathetic nervous system to release chemicals to prepare the body for fight or flight. If it is not possible to escape or fight, the limbic system then engages the parasympathetic nervous system to initiate a freeze or collapse response in the body, resulting in immobilization, restricted breathing, and decreased metabolism. In humans, freeze reactions may include psychological dissociation. Threat and danger signals may include real threats such as possible assault or physical harm, but they can also be as simple as humming fluorescent lights, the whir of a fan, or the popping sound coming from a car engine, causing individuals to automatically feel unsafe.

The Fawn Response

In 2000 (Taylor et al), “tend-and-befriend” was proposed as a stress response in females. Researchers proposed that “tending” related to nurturing designed to protect the self and offspring and befriending involved the establishment and maintenance of social networks. The assumption was that females have a greater role as caregivers and use tend-and-befriend to create safety and reduce stress. For various reasons, the researchers found that the flight response to stress may be inhibited in females and that other responses related to caregiving and social survival are used for under conditions of stress.

A few years later, a fourth possible response emerged in trauma discussions: the fawn response. This terminology is often credited to Walker (2003) who attributed it to “codependent defense” and followed a tradition in English-speaking trauma terminology of using a word starting with the letter “f.” Walker described fawn types as those seeking safety by merging their needs, wishes, and demands with others. These individuals respond to distress by forfeiting rights and boundaries, becoming compliant and helpful, somewhat like the children described by Alice Miller’s The Drama of the Gifted Child (1979). According to Walker this response may become part of other trauma reactions, combining with fight, flight, or freeze depending on what is encountered.

Fawn ubiquitously appears without question in just about every current meme, chart, or infographic defining core trauma responses. But it is now time to take a step back and revisit this descriptor and the connotations that accompany it. It certainly is no longer defined as a "defensive" strategy as originally described by Walker. In particular, the use of this term subjectively feels directed at women, perhaps because of its original definition as a female “tend-and-befriend” response more than 20 years ago. To fawn is also described as having a lack of identity and boundaries and a general sense of being so overwhelmed one cannot act in one’s behalf. Used to describe “people-pleasing” or “passivity” when confronted by possible assault, terror, or atrocity, the negative connotations of “fawning” are depreciative, pejorative, shame-based, and perhaps, culturally or gender-biased.

A Reframe of Fawn to Feign

In working with individuals with traumatic stress for several decades, I have listened to many stories explaining impressive adaptive coping skills when faced with threat or danger. These often include complex strategies like negotiation and improvisation to consciously protect themselves from harm. Children and adults have reported that they “faked” responses to those who intended assault to stay safe in the moment. For example, one survivor of a hostage situation clearly conveyed to me the value of consciously fooling her kidnapper. She knew she could not “fight or flee,” and instead developed a relationship with her captor over time, using very convincing appeasement as a strategy. As it turned out, it was successful in preventing physical assault until she could actually escape her imprisonment (Malchiodi, 2020).

In decades of work with survivors of assault and terror, I have used what I believe is a less shame-based term—to feign, a purposeful action taken in order to escape danger and defuse threat. By definition, feign implies a more artful invention than just mere pretending. As a trauma response, an individual may simulate befriending, deferring, negotiating, and/or bargaining in service of self-preservation or saving another. Feigning may also be part of the other three trauma responses (fight, flight, freeze). For example, some individuals report consciously pretending to be immobile, as animals automatically do to distract predators. In these cases, it is not just the body’s dissociative response; for these individuals, it is a deliberate and decisive action when in danger.

Feigning is an assertive action that supports survival in the moment. However, one outcome of repeated feign responses is that these actions may become a natural part of how we interact with others and the environment when stressed. So yes, when people-pleasing, bargaining, deferring, or other befriending behaviors in service of survival are repeated over time they may become a dominant and problematic narrative. Eventually one may come to value others over self, find it difficult to describe feelings or communicate, fear abandonment, or sense an exaggerated responsibility for other individuals. It then becomes important to recognize how these adaptive responses helped in the moment for survival, but may no longer be helping in the long term, impacting mental health and quality of life. This recognition is particularly important in eliminating the shame that many survivors experience, blaming themselves for not fighting or fleeing an assaultive, abusive, or terrorizing situation.

Broadening the Discussion

In trauma-informed practice, I believe there is a more empowering way to frame these responses that may not necessarily be solely the domain of co-dependency or instinctual responses to please others. Reframing fawn as feign is just one more way of broadening this discussion and refining our language and definitions

“To fawn” continues normalized as a valid trauma response in literature and social media. I am simply advocating for a lane change to a different descriptor that acknowledges the action-oriented, self-preservation-based capacity of individuals to survive. Using the word “feign” will not magically erase the shame or guilt one may feel when forced to pretend, ingratiate, or bargain with a perpetrator, even when it is to save one’s own life or the life of another. But it does respect that the individual was able to defuse threat through personal adaptive survival skills and acknowledges the context of danger that existed in the moment. As trauma specialists know, healing comes not only from acknowledging what happened to us, but also that what we did what was right in the moment to survive and ultimately thrive.

References

Cannon, Walter (1932). Wisdom of the body. New York: W.W. Norton & Company.

Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process. New York: Guilford Publications.

Miller, A. (1979). The drama of the gifted child. New York: Basic Books.

Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411–429. https://doi.org/10.1037/0033-295X.107.3.411 

Walker, (2003). The 4Fs: A trauma typology in complex PTSD. Retrieved at http://www.pete-walker.com/fourFs_TraumaTypologyComplexPTSD.htm.


Cathy Malchiodi, Ph.D., is a psychologist, expressive arts therapist, trauma specialist, and author of 20 books, including Trauma and Expressive Arts Therapy: Brain, Body, and Imagination in the Healing Process.

Online:

 Cathy Malchiodi, PhDFacebookLinkedInTwitter


Thursday, February 11, 2010

Coolest Top 10 Art Therapy Interventions

Cathy Malchiodi is doing a series with her "Healing Arts" blog on Psychology Today, and is listing the coolest Top 10 art therapy interventions. I wanted to repost it here for everyone's benefit.

The Ten Coolest Art Therapy Interventions
By Cathy Malchiodi
Created Feb 11 2010 - 1:42pm

For my next series of posts, I am taking a cue from PT colleague Ryan Howes who is just finishing up a fascinating series called The Ten Coolest Therapy Interventions. Howes' mission in his blog and his popular postings is to demystify the elements and process of psychotherapy for the public. Like Howes, I feel that when potential clients understand what therapy entails, they are more likely to find the internal courage to seek help from a qualified professional. They also become more educated consumers, capable of "co-creating" [no art therapy pun intended] the course of their therapy and more invested in the process of healing.

No doubt some colleagues will cringe at the idea of making public some of the more common techniques used in the field of art therapy. However, "what is art therapy" is one of the best-kept secrets in the field of mental health. You might be surprised that on some days I wake up wondering what the heck art therapy is because so much misinformation about it abounds on a Google search. Art therapy is the brunt of jokes by Dr. House and some embarrassing therapeutic moments on Dr. Drew's Celebrity Rehab; Tiger is apparently getting some art therapy, too and I can't wait to hear about that on the Joy Behar Show some night. To counteract the media, my intention is to both help you understand what art therapy is about and why it complements and enhances traditional verbal therapy approaches to treatment.

All helping professionals know that no one intervention can be applied to all clients; they know that the best interventions are those that are tailored to clients' needs and their presenting situations. As an art therapist, I can say from experience that this challenge is the "coolest" part of my work with clients--to invent a creative strategy to promote change, insight, and well-being. A good art therapist, like a good psychologist, counselor, or family therapist, is adept at innovation and creative adaptation. A good art therapist also knows that for many clients, no technique is needed if the client is capable of creative expression without a directive or gimmick.

My criteria for determining the "coolest" art therapy interventions include:

Historical Tradition: Interventions commonly taught to therapists-in-training in the field of art therapy and related mental health professions;
Innovation: Use of a specific art material or visual media to address clients' presenting problems or for the health and well-being of clients;
Adaptation: Development of a specific intervention based on a psychotherapeutic approach such as psychoanalysis, CBT, or other model;
Popularity: Consistent appearance in literature, conferences, or workshops, whether it's the actual intervention or a variation of the intervention.

For the most part, I'll be focusing on interventions used with adults, but some will also apply to work with children, groups, couples, or families. I'll try to give you a brief history of each intervention through the lens of art therapy and the influences of psychology, counseling, marriage and family therapy, art, and culture on that intervention. I'll will also be explaining a little bit of how an intervention might be adapted to suit individual needs and situations in the spirit of "one size does not fit all."

Like Howes, I am not going to talk about evidence-based approaches or outcomes. I am also not going talk about the use of art to evaluate or assess emotional or other disorders; that is a topic both fascinating and controversial and a subject for another blog series.

Finally, to paraphrase Howes, reading these brief posts is no substitute for the education it takes to understand how to effectively and ethically apply them to practice. Competent therapists always get adequate training before applying any intervention. And consumers or potential clients, if you have a mental health challenge or disorder, please contact a therapist with appropriate credentials and education rather than attempting to apply these interventions to yourself.

So here they are: The Ten Coolest Art Therapy Interventions.
Click the link to read each post [links will go live as each blog is posted]:

10.February 16th, 2010 - Magazine Photo Collage


















1. October 31, 2010 - The Art Therapist's Third Hand

PS: I don't expect that everyone who reads these posts will agree with my choices, but that is part of the rationale for this series, too. If you are an art therapist or a therapist who uses art or visually-based methods in your practice, let me know your thoughts; in fact I welcome your opinion right now [if you know me, you know it won't influence me in the least, but you also know I always love a good dialogue]. And thank you, Ryan, for the inspiration.

@ 2010 Cathy Malchiodi, PhD, LPAT, LPCC
www.cathymalchiodi.com

Join the growing community of art therapists from around the world at the International Art Therapy Organization [IATO]. One world, many visions...working together to create an inclusive and sustainable future for art therapy.

Subscribe to my Twitter and get the latest art therapy news at
http://twitter.com/arttherapynews.