Deep Brain Reorienting (DBR) and the Path Back to Connection

Susan Love: It is a shock-based model of therapy. We’re working specifically with a sequence that happens at the brainstem level, in their survival brain — that this sequence shows up when trauma happens, when things feel similar to the trauma that they experienced. So, you know, what we kind of talk about is triggers for people. When there’s upset in relationships, if they maybe didn’t get the response that they were expecting, and how they respond to that — we’re going to be working with a very specific sequence in their brainstem where it’s gonna really focus on shock and affect.

The shock is what drives and amplifies the affect. If we can really slow the sequence down, and pick up every little piece of it, be really thorough — it’s a little bit of a slower processing that we’re doing, with the sensations that start to present in their body — we’re gonna clear that shock out. And then we’re gonna have time to clear some of those affects out at the brainstem level.

So that day-to-day, what they start to see is that they’re not having the same reactions. They’re showing up differently — maybe they’re setting boundaries that they’ve really struggled to set, and they’re not having to think about it and mull it over. It’s just happening in the moment. And they’re not gonna second-guess themselves afterwards, or they’re not having some of the same sensory sensitivities to things, tones of voices, loud noises — things of that nature, where they have startle responses that come up. So we’re just cleaning house, so to speak, in the basement. Just getting all the cobwebs out.

And mopping the floors and getting it all sparkly as best as we can.

Dr. Amanda Fialk: I love that analogy. That’s a great analogy. 

Susan Love: What initially drew me to DBR was it came on a recommendation from one of my long-standing mentor and consultants. I was an EMDR-trained clinician prior, did a lot of parts work through a structural dissociation lens, and got into Stephen Porges’s work with the Safe and Sound Protocol and Polyvagal Theory. Just in my work with her, she looked at me one day, and she was like, Susan, I really think that you should take this training, Deep Brain Reorienting, and anything that she tells me to do, I just kind of jump on. I’m not — I blindly trust her, but I’ve got such a good relationship with her that it’s like, okay, yeah, cool, sure, we’ll see what it’s about.

I remember so distinctly, and I had no idea what it was. It was, hey, it’s something about shock, how it’s in our body, and our brainstem. I think that it’s something that we’re missing with our clients. I’m like, okay, yeah, let me go take the training.

That first day of the training was so profound for me, because it started answering these questions that I feel like I have had about certain clients — like, why am I not getting to this certain point with them? I can’t seem to get to and get healing around these pieces, and I keep running into these parts, and I’m doing all the parts work, and have been doing it for years, and we’re still just creeping along, or there’s such significant setbacks sometimes — or not setbacks, but, you know, clients can decompensate at times with the trauma work.

I remember being in the training and listening to Dr. Corrigan, and just — as brilliant as he is, and as dense as some of the material is — it’s like, yeah, there’s something more going on at the brainstem level, and what we’re not reaching with the modalities that we currently have.

Then I was so very fortunate to get to do a demo with Dr. Corrigan in that Level 1 training, and that’s where I knew that this is different. I have not felt this in any of my own therapy that I’ve done, and I’ve done a lot of therapy and everything that I’m trained in. So it was so profound in terms of what I experienced during that demo with him in the training that it hooked me immediately. Here I am, you know, 4 years later, and it’s pretty much the only modality that I use at this point.

Dr. Amanda Fialk: Wow. Wow. That’s powerful.

Susan Love: It’s been a very big shift in my own practice, and because of the deep healing that I’m seeing with people, I kind of try to — not that I try to talk them into it, so to speak, but I just give them that opportunity of, hey, here’s the different modalities that you have available to you when working with me, and here’s what I think would be really good. And from a DBR perspective, this is why I think maybe DBR is a good fit for what you’ve experienced.

A lot of the people that I work with have significant attachment wounding, they have significant neglect, significant trauma histories. Working with complex trauma and dissociation. So I’ve seen it shift my practice in terms of — I can get into their deep brain, and I can do what we would look at from a trauma processing and a trauma healing model. I can do trauma healing with them much sooner than I would be able to, using the modalities that I was previously trained in.

I’ve seen it be a lot less destabilizing for my clients in between sessions. Not that there’s not discomfort that comes up for them, not that there’s not an aftermath, so to speak, that can happen after sessions. It’s because DBR is not a memory processing model — it’s really a brainstem sequencing-based model. I’ve seen it be a lot less dysregulating for my clients in between.

If they’re self-harming, which would indicate that, hey, I need to do some more stabilization with them, I oftentimes can address the self-harm with the deep brain reorienting, which actually helps to shift the behavior for them, and tone down the distress that’s happening in between sessions. It’s ultimately increasing their ability to tolerate distress in between sessions as well.

So what people often are reporting to me, after some time doing DBR, is that they feel more integrated in themselves. They’re really able to hold their experiences with a lot more compassion, and they also are able to stay present with their experience. If I’ve got people that have really high levels of dissociation, they’ve got a lot of depersonalization and derealization, and they kind of pop out and go offline when they get distressed — they’re reporting to me, going, I can notice that there’s this option trying to come in to help me, and it doesn’t just take over anymore. That I’m really present and aware with what’s going on, and it’s really uncomfortable, and I’m doing it. I’m not using some of the old coping that I’ve used in the past. I’m feeling more centered, more calm, more able to connect with people.

I’ve got a mom that I worked with — and actually, she’s part of the case study that I’ll be presenting as well — where she was so dissatisfied at being a mother, or she was so overstimulated in her home, so overstimulated by the kids and all the demands of motherhood, and her complex developmental trauma that she had growing up, that it was all compounding. At the end of our time together, she looked at me and she was like, this has changed my life — that I can just be present with my kids. I actually enjoy being around them. I actually can play with them now, and just be present with them, and not be concerned about what I’m doing, what do I look like while I’m doing it, what’s my body doing. Just so present — where play actually finally comes online, and she can just enjoy her life. Where she was really, really miserable when she first came to see me.

Susan Love: Just like any modality, DBR is not gonna be for everyone. What phase of trauma healing am I in? There’s a lot of stabilization that needs to occur with this person, where they just don’t really have any skills at all. So I’m gonna start with giving them skills.

Maybe I’m starting with — and again, I’ll present a case study where I started with a Safe and Sound Protocol — with them, to really help build in some safe connection, to build in some emotion regulation, to build in some body awareness. And that was clinically necessary for that person. Once we completed that, then I moved to DBR.

Susan Love: People that I’ve experienced that maybe aren’t quite ready for DBR — what that’s looked like is, if somebody is actively suicidal you know, again, I look at it from a phases-of-trauma-healing lens. We gotta get you a little bit more stable before maybe we even start doing this. So safety concerns — that’s going to be something that I’m looking at. People that are really in active addiction — they probably need to go and do some detox and all of that before. It’s not that it wouldn’t be beneficial to the whole nervous system to be clearing some of this stuff out, to help support their sobriety — but if they’re just active in addiction, it’s gonna be really challenging, as we know, to do any work with anybody that’s in active addiction.

It’s very similar, from my perspective, to how I would conceptualize somebody’s readiness for any type of trauma work, in some ways. And DBR in and of itself can help with stabilization.

So it’s very case-by-case. What are the supports that somebody has in place?

I might be a lot more bold, so to speak, to start earlier in a residential setting, because they’re contained.

Dr. Amanda Fialk: Correct. I was just gonna say that — I was literally —

Susan Love: They’re not going anywhere!

Dr. Amanda Fialk: I was gonna say the same exact thing — like, if they’re working with you on an inpatient residential basis, it’s very different than on an outpatient basis. You’re able to be a little bit more — I don’t even want to call it risky, because that’s not the right word, but, in terms of being able to be more, I guess, aggressive in terms of approach, knowing that they are safe, right?

Susan Love: Yeah. And it’s gonna be — what I’m thinking about when I’m working with people, I’m not gonna go towards their biggest, baddest, nastiest trauma right off the bat. I have no idea what their process is going to look like.

And neither do they. They’ve never done DBR before. So I really am starting with — and I explain it to people — you’re probably going to get a little frustrated with me about what I’m going to suggest we work on. I want you to think about the silly, seemingly innocuous, stupid thing that you get frustrated about, or that you have a reaction to, that has nothing to do with any of your trauma, basically.

And because it’s gonna set us up for the easiest intro — that’s what I let my clients know. And we’re gonna start working towards building up a capacity for DBR. I’ve got some people that might only be able to tolerate about 10 minutes of processing, because their intensity and a lot of different things vary — their ability to just be in that space of being in, ultimately, really being in their body.

And being present with what’s going on — they might have a small capacity to do that.

And yet, with more DBR, they get more of a capacity to be with it. So again, it’s more stabilization that occurs, even with doing DBR around these seemingly ridiculous things that I’m asking them to work on. And they want to go towards the bigger stuff, and eventually we might get there. Oftentimes, at least in a residential setting, we’re not really going towards the bigger things, because I don’t have them for very long.

Susan Love: I’m not mixing modalities, where I’m gonna do DBR this session, and then the next session do EMDR, or parts work. I’m not weaving things in and out like that.

Dr. Amanda Fialk: Right, right.

Susan Love: It’s really — again, once somebody’s ready for DBR — that’s really the modality that I stick with, and we’re making very collaborative decisions with the client of, hey, you’ve tried EMDR, you’ve tried DBR, do you have a sense, maybe, of what direction you’re going to want to go in? Because once we get started — and I explain this to them — we’re not going to be flip-flopping back and forth, because of the different areas of the brain involved with each therapy. I don’t want to be working in DBR, and then do something that’s in a higher level of the brain that could disrupt the healing that is happening with the DBR.

So that’s my experience, and that’s been kind of an evolving thing within the DBR community, because it is a newer model of therapy. We’re still learning a lot. A lot of it is we’re learning as we go — we have researchers that are doing a lot for the DBR community right now, so that we’re getting research backing, and that we’re understanding what’s going on in the structures of the brain to support the theory that we have, and why we wouldn’t be recommending that somebody be flip-flopping modalities.

Dr. Amanda Fialk: Right. Yeah.

Susan Love: And even in — you know, I work in outpatient within a private practice, and then I also am in residential, where there’s a lot of different things that are happening. So I’m helping them build a plan and making recommendations on, okay, if we’re gonna do DBR, then here’s what I’m going to be recommending for you, to support that work — so that we’re not kind of cutting it off short with some other modalities. Versus if you really want to get that full experience of a lot of different modalities while you’re here, then we’re gonna talk about that, and maybe DBR is gonna be something that you could look at down the road. 

Susan Love: I feel like DBR has the impact that it does because we’re working at where the core of the traumatic wounding happened in the brain.

And the reason why people are not getting as destabilized — again, this is my experience with it, what they’ve reported to me, what I’ve seen — is that because we’re not focusing so much on the memory piece of it, there’s not all of the overwhelm of emotion that gets brought in. And it has to do with the area of the brain that we’re working in. Some of the other modalities out there right now are going to be much more focused in the limbic system, where DBR is really a brainstem-based therapy.

We’re working with a sequence that presents when traumatic incidences, attachment wounding, or the sensitized reminders that we have of our experiences get brought up. So, by addressing this sequencing that’s at the deep brain level — the orienting response that occurs, the shock that then starts to occur, then the emotional responses that start to occur — it’s all brainstem-based responses in a sequence, so that I don’t have to get into their story, really, at all. They don’t have to share — you know, the moment that we start talking about what it is, either some people are having to dissociate in order to even tell me what happened to them, or they’re so flooded by the emotion, because the shock is driving the intensity of the emotion.

So with DBR, what we’re doing is we’re decreasing the shock that’s at the brainstem level. And that shock is amplifying those emotional responses. So even if I spend a session with somebody, and the only thing that we’re getting to in that session is shock, there’s still benefit to the entire person in doing that, because clearing that shock out is going to reduce — and these are just my words — that emotional reactivity that they have on a day-to-day basis, where maybe they’re getting set off in the car, with road rage. Maybe they’re just really fearful because there’s a lot going on, or the grocery store is so overwhelming for them that by the time they get to the checkout line, they’re ready to bite the person’s head off — or they can’t even make eye contact with them because they’re so overwhelmed.

So it’s clearing out the stuff that’s driving the overwhelm, so to speak. It’s a really basic way to say it.

Susan Love: My hope for the future of DBR — and it is a growing modality, and I feel like the impact on the trauma healing world, the trauma therapy world, is really — and in my experience already, just so profound — I feel like it’s kind of starting to spread a little bit like wildfire. We can’t keep up with the demand of the training requests right now, which is a really cool thing to be a part of.

So where I can see it going — I think we’re in really the early stages, kind of like where EMDR was back in the early 90s, where eventually I can see it as having a really large presence in the trauma community. There’s just such a — I hate to continue to use the word profound, but it really is — and this comes from not just what I’ve seen with clients, but it’s come from my own experience as a client doing DBR — that the shifts that people see, the shifts in terms of even how I show up with my clients, is so different, because of the work that I do with it.

And there’s gonna be more — there’s so much that we don’t know about the brain that we’re still learning. This has ignited more research into brainstem-level activity, and areas that maybe we haven’t quite fully explored, to really see what is happening at those levels of the brain and how they’re impacting us, and how trauma impacts them. So we’re learning a lot right now from it.

I mean, I feel like the sky is the limit, kind of — away with this. And I don’t want to sell, you know, this — like, false hope for people or anything like that, that this is the end-all, be-all of therapy. It’s just that, in my experience, it’s been a lot more palpable and tolerable for people to do the healing that they really have needed to do, and just haven’t quite been able to get to. So that they can get to a higher level of functioning and presence, and really just enjoyment of themselves, and the people that they’re in relationship with — that I’ve seen with some of the other stuff that’s out there.

Susan Love: We have 3 levels of training with DBR: Level 1, Level 2, and Level 3. They are various days, each training — 2 to 3 days, depending on the level. We have trainings that occur based off of UK-based times, and trainings that occur based off of US — or just North American — time zones. And deepbrainreorienting.com is the best resource for people to find what trainings are available.

There are even additional trainings that help people really learn some of the concepts that are discussed in each level, because DBR is a very neuroscience-heavy model of therapy. There is a need to understand the anatomy of the midbrain and the brainstem in order to really hold the client’s experience during the processing.

So the other really important piece, for anybody that is considering getting trained in DBR, is consultation after training — that is something that is so needed, because it’s a growing model. We’re learning more as we go because it’s new, and there’s things — even from when I got trained, the way that the training is done now versus when I took it 4 years ago is so different. There’s so much more information in it that was not there. Level 3 is 3 days now, and I took Level 2 and 3 in 2 days together. It was a two-day training for Level 2 and Level 3. And so it just speaks to everything that has evolved and what we’re learning, and really making sure that you, as clinician, are being held and supported in the work that you’re doing with clients by a consultant. Oftentimes consultants are working directly with, you know, Dr. Corrigan or some of the higher-up people in the DBR organization that have been doing this for a while — they’re giving their information, and they’re getting consultation from them, and it’s trickling down to all of us.

So that’s one of the most important pieces that I would suggest for anybody — if you’re going to get trained, be ready to do some consultation after you get trained, because it really is needed to make sure that you’re understanding what’s happening, and really supporting the clients as best as you can.

There are practicums in the trainings that occur where you’ve got somebody being client and somebody being therapist, and there’s training assistants that are coming through, helping support the practicum work, so that you really can have that embodied experience of learning the model. Because there’s just something — even for me, in my own process, I don’t know if I would be the DBR clinician that I am without all the DBR therapy I’ve received. So, in addition to the consultation that I’ve had there’s just things about it where there’s not words, because we’re working in the brainstem, that’s not a language center of our brain. So there oftentimes just aren’t words for what’s going on. And to be able to identify it when it’s happening, I feel like, for me, I can see it very clearly because I’ve felt it myself.