Integrating Trauma Memory using Lifespan Integration©
By Natasha Sephton
In this case study I describe how I worked with a woman in her early forties to heal the trauma surrounding her infant daughter’s illness and death, fourteen years prior to therapy. This bereavement left her with a level of PTSD (Post Traumatic Stress Disorder) symptoms, which had a detrimental effect on her relationship with her partner. Andrea (pseudonym), sought Lifespan Integration therapy with me upon hearing about its effectiveness at healing trauma. This paper will focus on assessment and evaluation; treatment planning; building required core-resilience; and in particular focuses on clearing Andrea’s PTSD symptoms using a specific Lifespan Integration timeline covering her daughter’s life and death. I will offer a brief understanding as to how this therapy works to clear trauma, including the neuro-science which underpins it.
Lifespan Integration therapy (LI) originated in the USA in 2002 by Peggy Pace (Pace, 2015), who discovered the healing and regulatory effects of repeatedly using a timeline of memory cues to integrate trauma in clients. Since her discovery, Pace and her colleagues (Thorpe, 2012) have developed LI into a modality that incorporates a number of protocols that heal different kinds of trauma and which occur at different developmental stages. LI is now used by therapists in a number of countries across the world, who champion considerable anecdotal and in-practice evidence. At this stage there are small studies (Balkus B. 2012) (Hu M. 2014) and at the time of writing a Swedish research project is in process, however, any substantial research into the efficacy of the model is yet to be published. LI is underpinned by the growing neuro-psychology field and developmental psychology. It is based on the premise that the body/mind has an innate capacity to move towards self-healing and the hypothesis that ‘psychological dysfunction results from insufficient neural organisation’ (Pace P. 2020). I am sharing some of my clinical experience with the kind generosity of my former client’s permission.
On arriving in my therapy room, Andrea shared how she had recently begun a new relationship but was highly anxious that she was in some way inherently toxic, fearing that the extent of her loving feelings for her partner could somehow cause his death. This irrational fear was at odds with the otherwise high-functioning woman in front of me. Andrea recognised that her experience of mothering a very poorly baby, who died before her second birthday, continued to impact her life over a decade later. I began to suspect Andrea may be experiencing some level of PTSD.
Andrea’s daughter, whom I shall call Beth, was diagnosed with Myenteric Hypo-Ganglionosis within the first weeks of life. This motility disorder was a condition caused by a disfunction with the nerves on the bowel. Andrea and her husband spent the entirety of their daughter’s short life (nearly two years) in and out of hospitals, learning how to give the specialist treatment their daughter required in order for her to live at home. She eventually died of multi-organ failure as a result of sepsis just before her second birthday, in 2005. Andrea and her husband went on to have two more children before their marriage broke down in 2013.
As part of the assessment process, Andrea completed the IES-R questionnaire (Impact of Events Scale – Revised) in which she scored a total of 30, indicating that PTSD is a clinical concern. According to the IES-R (Weiss & Marmar, 1996) a total score of 33 or more represents ‘the best cut off for a probable diagnosis of PTSD’.
These recognisable impacts are the symptoms of the trauma; the legacy of trying to survive the original trauma (Fisher, 2017). The IES-R divides the difficulties experienced following trauma, and scores into 3 categories of Avoidance, Intrusions and Hyperarousal. Andrea’s score for these categories was highest at 12 for intrusions, 10 for hyperarousal and 8 for avoidance. These results gave me indications as to the ways in which her body-mind system were responding to manage her trauma.
After therapy, during evaluation, Andrea completed a second IES score in which she scored a total of 4. Here, the highest score Andrea gave to any one question was ‘1’, indicating that the impact from the trauma was experienced as ‘a little bit’. All the other scores reduced to zero.
Creating a focus for therapy
Creating a therapy goal or focus in Lifespan Integration offers a ‘road map’ for both the therapist and client. I encouraged Andrea to focus on what needed healing and what she wanted this to look like; countering what she didn’t want, with what she did want.
Andrea’s focus for therapy was ‘To heal my loss of Beth’. In order to help her to fully assimilate this focus, I asked her to consider the changes she anticipated on her way to actualising her goal. These were:
- I’ll gain calm acceptance of how I managed the ending of her life;
- I’ll feel more compassion for myself;
- I’ll know, and feel a sureness, about what we [Andrea and her husband] did was right for then;
- The anniversary of Beth’s death will feel sad and be OK, remembering the time she passed;
- I’ll feel acceptance and compassion towards [ex-husband].
I understood that in order for Andrea to proceed, she needed to increase her self-acceptance, compassion and self-love. By asking her: What will you notice changing as you see yourself healing? she was able to speak of what was missing. This helped me create a treatment plan which included:
- Supporting stabilisation through building emotional resilience and connection to her core self;
- Clearing the trauma of her daughter’s illness and death.
In order for Andrea to integrate her trauma, she needed to be able to tolerate hearing her timeline of memory cues over her lifespan which she created in session. This timeline incorporates pleasant, neutral and painful memories so the therapist can moderate the level of activation when reading it to the client. This is with the aim to engage the trauma just enough to provide live therapeutic material, but not so activating that it would overwhelm the client, taking her out of her Window of Tolerance (WoT) (Ogden, Minton, & Pain, 2006). The term Window of Tolerance describes the hyper- and hypo-arousal responses to threat perceived by the body/mind system. If our arousal escalates, we become overwhelmed, moving out of our WoT and significantly restricting our capacity to integrate new experience.
For people with a history of trauma, hearing their timeline of memory cues can be very activating. On a neuro-biological level the Autonomic Nervous System (ANS) is triggered to respond to threat, even if the threat is associated with a past experience recalled momentarily. Porges’s research into the ANS (Porges, 2011), culminating in the Polyvagal Theory, has offered the field of psychotherapy a neurobiological lens in which to observe our client’s experience in therapy. The ANS has two main functions: regulating the core organs as well as the social engagement nervous system. The ANS supports normal functioning when we are engaged in ‘safe’ social interaction, however, when threat is perceived the ANS will either go into Sympathetic Nervous System arousal (fight/flight), or Parasympathetic Nervous System arousal (freeze/collapse). Our basic human drive is to seek connection to others, however, if we perceive risks or threat, we automatically (biologically and psychologically) move into self-protection (Cozolino, 2006).
The Lifespan Integration therapist focuses closely on the client’s body and mind, tracking their neuro-biological responses to their timeline as their nervous system responds to past experiences of threat, or trauma. The repetition of timelines allows the client’s brain and body to understand that the threat existed in the past and releases the client from any implicit conditions of threat arousal in the present. It is supposed that this creates neural organisation which in turn fosters neural integration.
Starting LI therapy and preparing the ground
Andrea’s LI therapy began by repeating her whole-lifespan timeline to her at quite a fast pace, encouraging her to stay as present and grounded as possible. Andrea’s system activated into her parasympathetic system, which was signaled by her yawning, reporting feeling tired, and her attention drifting, beginning to shut down. This, if left to continue, can lead to numbing and dissociation. To shift Andrea away from dissociative states, I used somatic interventions to help her to stay present and varied the pace reading her timeline. Working in this way supported her to tolerate her self-connection through her lifespan and stay engaged in the present time.
From these initial sessions I identified that Andrea had some resiliency but there was a need to increase this to help her to stay connected to herself with compassion. To successfully integrate trauma memories, we are significantly advantaged by having a solid sense of our core, or secure self-connection (Pace, 2015). If circumstances in our early (perinatal) life caused developmental or attachment disruption, a strong core-self doesn’t get ‘built in’. In terms of healing trauma, this strong core can be viewed as an important anchor to a secure base from which we can integrate later life traumas.
I attended to Andrea’s attachment development through protocols in which I invited her to engage imaginatively with her very young self-states. One of these protocols involves the client to imagine themselves being their two-week-old self-state, who then, imagining being held by the therapist (who holds a doll representing the client’s baby-self), gradually accesses the therapist’s loving gaze and compassionate attention. This intervention provides an opening for the client to evoke their early-life implicit memory. Through repetitions of the timeline, opportunity for healing trauma, or what was lacking at the time, is created through re-wiring the neural networks associated with the early trauma. Over nine weeks of core-building sessions, Andrea’s self-connectedness and self-love expanded, and I considered her sufficiently solid enough to return our focus to her therapy goal.
Clearing the original trauma and PTSD symptoms
To clear Andrea’s trauma around Beth’s illness and death, I used a protocol (‘PTSD Protocol’) which involves creating a specific timeline covering Andrea’s memories of her daughter’s birth, through her life, death, and up to the present over 11 sessions. We worked to clear manageable ‘chunks’ (for Andrea) of this time frame, initially starting with the time around the end of Beth’s death to the present, adding more cues as the sessions progressed until we were using a complete timeline that ran from late pregnancy through to the present time.
During the first trauma clearing session we used 10 iterations of this timeline. As Andrea was activated into her Parasympathetic Nervous System (PSNS), yawning and disconnecting, I encouraged her to use somatic exercises, engaging her body. Andrea then reported experiencing more affect, engaging with the pain of her daughter’s death. This brought her into her Sympathetic Nervous System (SNS) as she began to feel sensations in her limbs and was more engaged with her anger. This was an encouraging sign, as the benefit of the sympathetic, over the parasympathetic branch, is the capacity to mobilize. This is significant regarding the impact of trauma, as Van Der Kolk (2015) describes, ‘if we can mobilize ourselves out of the way of trauma (through fight or flight) the damaging effects of it are significantly lessened’. During the seventh repetition of the timeline, integration was occurring as Andrea’s pre-frontal cortex began to engage more fully, perceiving herself from an observer self, questioning ‘Why am I always trying to get away?’. In the last three iterations of the timeline the pain progressively lessened to a more tolerable level. Andrea shared that ‘it’s quite a bad story’ and that ‘it felt like I was watching the unfolding of a slow-moving car crash’.
Throughout her therapy, I was always curious as to how Andrea was responding in between sessions. For example, following the session described above, she reported her nervous system feeling somewhat dysregulated, however she was also going through her divorce (from the father of her children) hence finding it hard to know what to attribute it to. Andrea is interested in understanding how her body and brain operate around trauma and readily absorbed the neuropsychological education I shared with her. It is my opinion that having this knowledge about how we function makes healing trauma all the quicker, with most people reporting that it lessens their shame as they recognise it as an evolved biological function. By her third PTSD Protocol session, Andrea reported that she had had a consistently good week and this continued with a general upwards curve towards feeling more solid in herself, sleeping better and feeling closer to her partner.
Andrea spoke of how, in the early stages of the PTSD protocol, she was concerned about being ‘de-sensitized’ and ‘feeling disconnected’ to Beth. Instead, what she found was greater sensory awareness and a deeper sense of connection to her deceased daughter and her memory of her. As we continued integrating memory and the accompanying affect, Andrea found that many new memories were coming back to her. Memories were ‘fleshing out’ and ‘expanding’. Sensory memory was also expanding: Andrea found she began to recall smells, and was seeing more detail of clothes and hospital rooms from the time.
Another aspect of memory recall that we see happen through using LI, is memory ordering. Often, (implicit) memories are initially recalled in a haphazard way, with a lack of certainty around when they occurred, and are often partially formed. As we progress through iterations of the timeline, the brain seems to re-organize, allowing narrative functioning (explicit memory), informing us that a specific event actually happened before, not after another. This re-organisation of narrative shaped the later stages of Andrea’s process as more aspects of her life surfaced and it began to feel more like she was hearing a more fully expanded story of her life including aspects such as her relationship with her husband, family members, friendships, and having to leave her training course and career.
Andrea also recalled long forgotten happy memories of when Beth was playful, full of laughter and getting up to the things that babies do. Eventually, we had a timeline that included memories from late pregnancy to the here-and-now. Andrea was now able to hear her timeline ‘with all ears’. She could stay present, connected to herself in the here-and-now and listen to the story of this part of her life. When evaluating Andrea’s experience at the end of therapy, she reported an openness to experiencing loving feelings and found a new capacity to remain steady, even when anxiety rose, allowing her to step back from unhealthy relational patterns she had engaged in over a life-time.
Andrea attended Lifespan Integration sessions to help her with her fear of relational connection, and the impact of the trauma of losing her infant daughter to a life-long illness. This case study has attempted to illustrate how Lifespan Integration therapy can help to clear trauma and the impacts of trauma through the repetition of a timeline of memory cues. Through various LI protocols Andrea’s therapy helped her to develop a stronger core-self. This coherency and self-compassion enabled her to stay present whilst engaging with her trauma surrounding her daughter’s premature death. Through tracking Andrea’s Autonomic Nervous System and making timely body-mind interventions to keep her in her Window of Tolerance, using Lifespan Integration I was able to help her to process her past experiences, integrating fragmented trauma into associated memory.
Pace P., (2015) Lifespan Integration: Connecting Ego State Through Time. Eirene Imprint. USA
Thorpe C., (2012) The Success and Strategies of Lifespan Integration. TimeLine Press, LLC. USA
Weiss, D. S., & Marmar, C. R. (1996) The Impact of Event Scale - Revised. In J. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford.
Fisher, J., (2017) Healing the Fragmented Selves of Truama Survivors: Overcoming Internal Self-Alienation. Routledge. NY & London.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W. W. Norton & Company, Inc.
Porges S., (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. Norton. USA
Cozolino, L., (2006) The Neuroscience of Human Relationships: Attachment and the Developing Brain. Norton. NY
Pace P., (2015) Lifespan Integration: Connecting Ego State Through Time. Eirene Imprint. USA
Van Der Kolk B., (2015) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. Penguin. USA
Balkus B. (2012) https://lifespanintegration.com/balkus-lifespan-integration-research/
Hu M. (2014) https://lifespanintegration.com/monica-hus-lifespan-integration-efficacy-research-study/
Pace P. (2020) https://lifespanintegration.com/neuroscience-lifespan-integration-therapy/