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Stabilizing the Unstable: Working with the Academy of Therapy Wisdom
Self-Destructive Behavior, Addiction, Eating February 25, 2021

Disorders, and Suicidality
Stabilizing the Unstable:

Working with Self-Destructive and
Addictive Behavior, Eating Disorders,
and Suicidality
Presented by the Academy of Therapy Wisdom

Thursday, 25 February 2021
Janina Fisher, Ph.D.
Trauma and violence

are inseparable
“The roots of violence-related
problems . . . can be found in the
adaptive responses to threat
present during violent
experiences.”
Perry, 2001
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without Permission 1
Threat cues keep the nervous

system “on guard”
•It is an evolutionary advantage for mammals to be
sensitive to cues or “triggers” reminiscent of the original
event OR its context. But, unfortunately:
•T riggers =
•R emembering
•A ll
•U n-needed
•M emories
•A t once
[George Boyd, age 16]
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Each Part of the Personality

Contributes
“I can’t afford to feel
a Defensive Strategy
overwhelmed. I have to
function!”
“Going on with Normal Emotional Part of the

Life” Part Personality
Fight: Flight: Freeze: Submit: Attach:

Protector Distancer Terrified Ashamed Needy
Fight holds out Flight to the The Freeze Shame, self- The heartbroken
‘the suicide loathing, and Attach part
rescue! Flight part is terrified desperately
card’ as the uses addictive and alarms passivity of
alternative if Submit feeds seeks help,
behavior to get the body
drugs don’t quick relief, to helplessness, increasing sense
work ‘turn off’ the body hopelessness of vulnerability
Fisher, 2009
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The Parts Remain Ready to Defend
“What [once] began as a

necessary defense in the face
of a real threat becomes a
pervasive, unrelenting
reaction to the anticipation of
a threat.”
Ogden, Minton & Pain, 2006
Core Assumptions in a Trauma

Model of Aggressive Behavior
•For trauma patients, violence toward self or other is a
post-traumatic reaction triggered by trauma-related
cues that stimulate animal survival defenses
•With the prefrontal cortex inhibited, clients cannot
manage their destructive impulses or exercise good
judgment. The animal defense responses over-ride the
client’s commitment to safety
•After an incident, clients have little perspective and
sometimes little memory. They may not recognize that
they were triggered and felt threatened or realize the
risks they are taking Fisher, 2009
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To Address Aggressive Behavior, the

Window of Tolerance Must Expand
Hyperarousal: over-activation
creates chronic de-stabilization and
desperate craving for relief
Original Window Expanded

of Tolerance Window of
Tolerance
Hypoarousal: numbing, ‘deadness’ and

passivity contribute to need for substances
to either shift or maintain this state
Ogden and Minton (2000)
Connect Symptoms to Parts

In the context of client’s having cut herself, therapist tries to evoke
curiosity:
Was Fight upset So, you want to
I hear you Let’s think trust people, and
about the
cut last about this: Fight wants you to
phone call? Or
night—what was it Flight? just trying to mistrust them?
part do you Was it Fight?
protect you?
think it was?
“Yeah, Fight
thinks
“Of course I
“I don’t [Looking at I’m
was upset! I
know—I diagram] “Well, a fool
can never trust
just hate I guess it was for trusting
anyone. But
myself” Fight” him”
that sucks,
too”
Fisher, 2006
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Connect Symptoms to Parts, cont.

Therapist continues to ask mindfulness questions:
Everyone needs a
Well, maybe you can
Fight part, so
work with Fight and
hold onto it—it
So, Fight help it see that you are
Yes, if Fight had gives us courage
keeps trying an adult now who
its way, you and backbone.
to protect knows whom to trust.
wouldn’t trust But we need our
you that way.
anyone, huh? Fight parts to let
us decide who to
trust and how to
react.
“But it “I won’t reject
“It’s safer
backfires— my Fight part,
that way—
because then though—it
then you I can’t get saved me in
don’t get “I do trust a lot
help” the of people here”
hurt”
orphanage”
Fisher, 2006
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Mindfully tracking connections between

symptoms, triggers, and parts
Client just broke his sobriety: That’s a pretty
How could you big trigger!
I’m so glad People who don’t
tell people were
you could tell What was do their jobs, so
getting to you?
me you used going on just That they had you have to carry
last night— before you all the load
‘no respect’?
what triggered used?
you?
“Yeah, just like

“None of them
“I don’t “People were I have
were doing
know—I getting to me— their jobs—I
my whole
just hate they have no can’t rely on life. . .”
my job” respect” anyone!”
Fisher, 2008
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Connecting symptoms to
triggers, cont.
We have to figure
Well, drinking does out a way for you
calm the nervous to know you’re
triggered before
So the system—he was just
trying to help out, to the addict takes
When you got trauma action. People
triggered, what trigger make the feelings
disappear are going to be
feelings came triggered the
assholes
up? addict part! sometimes—you
don’t want to
relapse over
“But now I’m them!
“I just “F--- it! I feeling stupid, and
wanted a don’t have my head is killing
burger me, and I don’t “That’s for sure.
to feel this
and a want to lose my They’re not
shit”
beer” career” worth it”
Fisher, 2008
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What the Parts Try to Accomplish

Generally, these behaviors reflect unconscious, instinctive
efforts to regulate autonomic arousal:
•Suicidalality: “You found a way to live by always having a way
out, a bail-out plan, that gave you some control over your fate”
•Cutting or self-injury: “Hurting the body is an ingenious way to
get relief because it triggers your body to produce adrenaline and
endorphins…..”
•Mistrust and paranoia: “You learned the hard way that it was
safer to assume the worst in people . . .”
•Eating disorders and addictive behavior: “You found that
alcohol took away the fear of being around people. . .” “When you
restrict, you can’t feel … your body is numb.” Fisher, 2008
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Responding to Fight and Flight
Befriend the
Patient
Mindful active
symptoms Validation
Curiosity defense and
or (Re-framing) ally with it
crisis
Therapist: “Not Therapist: “You

Therapist: “It’s
Patient: “I’m wanting to live is a way and Fight both want
that bad, isn’t it?
done—what’s to take control, a relief. I wonder if
I’m curious about
the point? bailout plan. When you could work
what the trigger
There’s too much none of the other parts together . . . If
was—something
pain. I can’t go could take the pain Fight could put the
must have
on” anymore, Fight was plan on hold for
triggered you”
always there for them. ” just a bit…”
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Stabilizing the Unstable. . .

Curious, compassionate, clear,
creative, calm, courageous,
confident, connected
“Going On with Traumatized Part of

Normal Life” Part the Personality
Fight Flight Freeze Submit Attachment

Part Part Part Part Part
The Going on with Normal
I’ll take care of Life self is charged with
the little parts-- the responsibility for
-they are safe
with me”
soothing and supporting
the vulnerable parts
14
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For further information:

Center for Integrative Healing
23 Main Street
Watertown, MA 02472 USA
DrJJFisher@aol.com
www.janinafisher.com
Sensorimotor Psychotherapy Institute

www.sensorimotor.org
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Stabilizing the Unstable: Working with the Academy of Therapy Wisdom

Self-Destructive Behavior, Addiction, Eating February 25, 2021

Stabilizing the Unstable:

Presented by the Academy of Therapy Wisdom

Janina Fisher, Ph.D.

Trauma and violence

Threat cues keep the nervous

Each Part of the Personality

“Going on with Normal Emotional Part of the

Fight: Flight: Freeze: Submit: Attach:

The Parts Remain Ready to Defend

“What [once] began as a

Core Assumptions in a Trauma

To Address Aggressive Behavior, the

Original Window Expanded

Hypoarousal: numbing, ‘deadness’ and

Connect Symptoms to Parts

Connect Symptoms to Parts, cont.

Mindfully tracking connections between

“Yeah, just like

What the Parts Try to Accomplish

Responding to Fight and Flight

Therapist: “Not Therapist: “You

Stabilizing the Unstable. . .

“Going On with Traumatized Part of

Fight Flight Freeze Submit Attachment

For further information:

Janina Fisher, Ph.D.

Sensorimotor Psychotherapy Institute

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