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Guide IV-106

NeuroAffective Relational Model (NARM)

Laurence Heller2012
A 34 · L 36 · M 3017 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the NARM Therapeutic Model as published by Laurence Heller and Brad Kammer in The Practical Guide for Healing Developmental Trauma (2022): four pillars, plus the Emotional Completion, Relational and Personality Spectrum models. The five Adaptive Survival Styles come from Heller & LaPierre, Healing Developmental Trauma (2012). Heller's own spoken account (Shrink Rap Radio interview, 2013) is used for stance and session process. The 2022 book's chapter text and its Appendix A ("NARM Protocol") are not drawn on; only its table of contents and short quotes are used. Where the guide goes past what those sources say, it is marked. [source: Practical Guide TOC; Heller 2013 interview]

The NeuroAffective Relational Model (NARM) was developed by Laurence Heller, PhD. Heller is also senior faculty in Somatic Experiencing, and he co-wrote Crash Course. NARM is a here-and-now, non-pathologising and non-cathartic psychotherapy for developmental, relational and complex trauma (C-PTSD). It is mainly a talk therapy that uses somatic mindfulness. It is not a hands-on bodywork method, although Heller says bottom-up work "may or may not involve touch". [source: Heller 2013 interview]

Core idea of change. We cannot change what happened. We can change the ways a person adapted in order to survive it. [source: Kammer, in Kushner 2022] Early attachment and environmental failures lead to five Adaptive Survival Styles: Connection, Attunement, Trust, Autonomy and Love-Sexuality. Each style is held in place by:

  • shame-based and pride-based identifications (a top-down identity distortion), and
  • nervous-system dysregulation (bottom-up).

These two run in a continuous feedback loop, which Heller calls the distress cycle. [source: Heller 2013] Change happens in four ways:

  • The client becomes aware, in the present moment, of how they are disconnecting from themselves. This includes automatic self-shame, self-rejection and self-hatred.
  • The client recognises their own agency in that process. In Heller's words, "we are actors in our own story."
  • The client feels the psychobiological shifts that follow, which loosens long-standing identifications. [source: Heller 2013; Kammer in Kushner 2022]
  • The client's "organismic impulse" towards connection and aliveness is supported. Heller and Kammer call this impulse "the fuel of the NARM approach". [source: Heller & Kammer 2022, via Goodreads quotes]

2. Framework

NARM is not a phase-based protocol with fixed session counts. Its structure is the four pillars, which run inside each session and across the whole course of therapy. [source: Practical Guide TOC; Goodreads quote 12226438]

The four pillars (Heller & Kammer 2022, ch. 3–6):

  1. Clarifying the Therapeutic Contract. Goal: a shared, explicit sense of what the client wants, both from the therapy overall and from today's session. Heller says therapy starts from "a clear understanding of what it is at least that the client is wanting." [source: Heller 2013]
  2. Asking Exploratory Questions. Goal: with curiosity, find out what gets in the way of what the client says they want. From this, a "working hypothesis" forms about how the client organises their inner world against their own wish. [source: Goodreads quote 12226438]
  3. Reinforcing Agency. Goal: help the client see how they take part, now, in keeping the old adaptation going, so that change becomes possible. [source: Heller 2013; Kammer in Kushner 2022]
  4. Reflecting Psychobiological Shifts. Goal: notice and name shifts in body, emotion and self-perception as they happen, so the client can register and integrate them. [source: Practical Guide TOC; Heller 2013 on tracking] [uncertain: the chapter's procedure]

Supporting models used alongside the pillars (2022 book, ch. 7–9):

  • Emotional Completion Model. Containing and deepening affect rather than discharging it.
  • Relational Model. The therapeutic relationship, including the therapist's own patterns.
  • Personality Spectrum Model. A map of where a client's self-organisation sits; the book includes a worksheet as Appendix B.

[uncertain: these were known from chapter titles and Heller's interview statements only]

Format and length. Individual talk therapy with somatic mindfulness. Heller says a course "could be as short as three months, or as long as several years." [source: Heller 2013] Weekly sessions are typical of the clinicians described in the sources, but no session frequency is specified there. [uncertain]

Moving between pillars.

  • The pillars are a sequence within a session: contract, then exploration, then agency, then shifts.
  • They are also recursive. When exploration loses direction, return to the contract.
  • The sources do not give formal criteria for moving on. [synthesis] Working criteria:
    • Move from Pillar 1 to Pillar 2 once a want is stated in the client's own words, is about themselves (not about changing someone else), and is something the session can work towards.
    • Move to Pillar 3 once a pattern of self-disconnection is visible in the here and now.
    • Use Pillar 4 whenever a shift appears, including early in the session.

Overall arc. A secondary practice source describes flexible stages: stabilisation and resources; exploring survival styles; core developmental issues; integration; consolidation and ending. This is not found in Heller's own sources. [source: Get Therapy Birmingham; uncertain]

When to choose NARM.

  • Heller presents NARM for relational and developmental trauma.
  • For single-incident shock trauma, he points to bottom-up Somatic Experiencing work that completes fight-flight responses.
  • With relational trauma, completing fight-flight is "not so easy", because the child had to protect the attachment bond.

[source: Heller 2013]

3. Guiding principles

[source for this section: Heller 2013 interview unless marked]

  • Here and now, not archaeology. History is not ignored, but sessions focus on how old adaptations operate today. It "doesn't become like what I call an archeological dig." Practically: ask how the pattern is happening now, not just why it began.
  • Non-pathologising. Survival styles were life-saving adaptations, not disorders. Practically: frame symptoms as solutions that once worked.
  • Symptoms as road maps. Symptoms point to "areas of disconnection." Practically: use a presenting symptom to locate which capacity (connection, attunement, trust, autonomy, love) is compromised.
  • Non-cathartic. "I define NARM as a non-cathartic oriented therapy." Practically: help the client contain and deepen feeling; never push for discharge. Heller notes "there's no pillow abuse in NARM."
  • No regression or reliving. Inviting clients to relive childhood scenes can be retraumatising. Practically: keep the client in their adult present while touching old feelings.
  • Top-down and bottom-up together. Work on both the identity distortions and the nervous-system dysregulation. Practically: alternate between inquiry into beliefs and identifications, and attention to felt sense.
  • Somatic mindfulness, titrated. Long silent mindfulness without movement can be "too overwhelming" for some clients. Practically: use short moments of sensing, "one little piece at a time", and pendulate between organised and disorganised states.
  • Agency. Help clients see how they participate in their own experience. Practically: shift from "what happened to me" to "what I do now with what happened". Agency means participation, not blame. [synthesis on the blame distinction]
  • Resource and strength orientation. Emphasise "the strengths, the inner wisdom" the client already has. Practically: track and name capacities, not only deficits.
  • Contract and consent first. Obtain consent before beginning the work. [source: Thompson & Horne 2023 (TPN listing)] Practically: ask permission before exploring a sensitive pattern or bringing in the body.
  • Do not collude; protect the client's agency. Therapists can collude with a client's survival strategies, and well-intentioned interventions can interfere with the client's agency. [source: Thompson & Horne 2023] Practically: notice when you are rescuing, over-working or advising.
  • Curiosity and kindness instead of "resistance". What other models call resistance is met with curiosity, which the presenters call "heartfulness." [source: Thompson & Horne 2023] Practically: treat the protective pattern as something to understand, not something to overcome.
  • Slow everything down. NARM practitioners describe contracting, consent, intentionality, curiosity, inquiry and slowing down as central. [source: Vasquez 2024] Practically: slow down before something charged and after any shift.
  • The R is the relationship. "The R in NARM is about the therapeutic relationship, which includes both client and therapist." [source: Heller & Kammer 2022, via Goodreads] Practically: track your own reactions as part of the field.
  • Careful with transference. "A premature focus on the transference relationship can actually be retraumatising" if basic self-regulation is missing. Practically: explore survival styles in the relationship only once the client can stay regulated while doing so.
  • Compassion as the change agent for shame. Authentic empathy, acceptance and compassion reduce internal self-objectification and can extend to family and culture. This includes intergenerational and collective trauma. [source: Kammer in Kushner 2022] Practically: model a non-judging stance towards the client's harshest parts.

4. Intervention inventory

NARM's interventions are mainly conversational inquiry plus somatic mindfulness. There are no scripted exercises or homework in the sources. The full in-session procedure is set out in Heller & Kammer (2022) ch. 3–9 and Appendix A ("NARM Protocol"), which is not drawn on here. The steps below are built from the pillar structure and Heller's described practice. Step detail beyond those sources is marked [synthesis]. All example language is illustrative unless quoted.

4.1 Clarifying the therapeutic contract (Pillar 1)

  • Purpose / when: At the start of therapy and of every session, and whenever the work drifts. It establishes what the client wants and gives every later question its direction. [source: Heller 2013; Goodreads quote 12226438]
  • Steps: [synthesis on sequencing]
    1. Ask what the client wants from today's session.
    2. Reflect the want back in the client's own words.
    3. If the want is about changing someone else, or is vague ("to feel better"), ask what it would be like for them to have it.
    4. Ask how they would know, in themselves, that it was happening.
    5. Check whether this is something they want to work on now (consent).
    6. Keep the contract in mind as the reference point. Return to it when the session wanders, and near the end.
  • Example language (illustrative): "What would you like for yourself from our time today?" / "If that were true for you, what would be different inside you?" / "Is that something you want to explore with me now?"
  • Watch for:
    • The want shifts from "them" to "me".
    • The client's energy or interest picks up when the contract lands.
    • Repeated failure to name a want. This is itself information, often about Attunement- or Autonomy-style patterns. [synthesis]

4.2 Exploratory questions and the working hypothesis (Pillar 2)

  • Purpose / when: Once a contract exists. The aim is to explore, with curiosity, what gets in the way of what the client wants. This builds a working hypothesis about the client's self-organisation: how they organise their inner world towards connection or disconnection. [source: Goodreads quote 12226438; Kammer in Kushner 2022]
  • Steps: [synthesis]
    1. Ask about the obstacle between the client and their want.
    2. Prefer "how" and "what" questions over "why".
    3. Follow the client's answers into present experience: thoughts, feelings, sensations, self-judgements.
    4. Note which shame- or pride-based identifications and which survival-style themes appear (see 4.9).
    5. Hold the hypothesis lightly and test it with further questions. Do not announce it as a diagnosis.
    6. Ask before going into sensitive areas.
  • Example language (illustrative): "What gets in the way of that?" / "When you imagine having it, what happens inside?" / "What do you tell yourself about wanting that?"
  • Watch for:
    • Answers that turn from story to present experience. That is a sign of good inquiry.
    • Intellectualising or a flood of history. Gently bring the client back to now.
    • The therapist interrogating rather than being curious. Slow down.

4.3 Reinforcing agency (Pillar 3)

  • Purpose / when: When a pattern of self-disconnection becomes visible in session, for example self-criticism, collapse, pleasing or withdrawing. The aim is to help the client see their own present participation in it. Heller: helping clients see their role is "agency in NARM". [source: Heller 2013; Kammer in Kushner 2022]
  • Steps: [synthesis]
    1. Name the pattern descriptively and without judgement as it happens.
    2. Invite the client to notice how they are doing it right now, in words, posture, breath or attention.
    3. Acknowledge why it made sense originally, as a survival strategy.
    4. Invite curiosity about what happens if they notice it without needing to change it.
    5. Separate agency from blame explicitly.
  • Example language (illustrative): "I notice that as you started talking about what you want, you began explaining why you don't deserve it. Did you notice that?" / "How are you doing that right now?" / "That isn't a fault. It's something you learned to do, and you're the one doing it now, which means you can notice it."
  • Watch for:
    • Recognition, often with a shift in breath or tone. That is a sign it is working.
    • Agency heard as accusation, leading to more shame. If so, slow down and stress the protective function.
    • Do not supply the answer yourself. Well-meant interventions can take agency away. [source: Thompson & Horne 2023]

4.4 Reflecting psychobiological shifts (Pillar 4)

  • Purpose / when: Whenever a change appears: softening, a deeper breath, warmth, tears, a new thought about oneself, more presence. The aim is to help the client register and integrate it. [source: Practical Guide TOC; Heller 2013 on tracking emotional experience and sensations] [uncertain: chapter procedure]
  • Steps: [synthesis]
    1. Notice the shift: voice, posture, colour, eyes, breath, word choice.
    2. Name it briefly and tentatively.
    3. Invite the client to sense it in the body and describe it.
    4. Give it time. Slow down rather than moving on.
    5. Link it lightly back to the contract.
    6. If the shift brings anxiety (for example, "feeling good is dangerous"), treat that as new material for exploration.
  • Example language (illustrative): "Something just changed in your voice. What are you noticing?" / "Take a moment with that. Where do you feel it?" / "How is this connected to what you wanted today?"
  • Watch for:
    • The client can stay with a positive or new state for a few moments longer than before.
    • Quick dismissal ("it's nothing") can be a pride- or shame-based identification at work. Explore it gently.

4.5 Somatic mindfulness (tracking sensations and emotions)

  • Purpose / when: Throughout. It brings the bottom-up level into the session. Clients learn to "track your experience, both emotional experience and the sensations in your body." [source: Heller 2013]
  • Steps: [synthesis except where cited]
    • Starting position: seated, eyes open or closed as the client prefers. No special posture is required.
    • Client: briefly turns attention inward to sensation (temperature, tension, movement, breath) and emotion, and describes it. Moments are short. Heller contrasts this with long Vipassana sitting, which can be "too overwhelming". [source: Heller 2013]
    • Therapist: asks open sensory questions, does not interpret, and keeps the client oriented to the room. No touch.
    • Closing: return attention to the room and to contact with the therapist, then ask what the client noticed.
  • Example language (illustrative): "As you say that, what do you notice in your body?" / "Is it more in your chest or your belly?" / "Let yourself look around the room for a moment."
  • Watch for:
    • Rising activation, blankness or numbing indicate dissociation. Shorten the sensing and orient outward.
    • Sensations becoming more nuanced over time is a sign the work is taking hold.

4.6 Titration

  • Purpose / when: With any charged material. The aim is to approach it "one little piece at a time" so the nervous system is not overwhelmed. [source: Heller 2013]
  • Steps: [synthesis]
    1. Choose a small slice: one sentence, one image, one sensation.
    2. Touch it briefly.
    3. Pause and check arousal.
    4. Return to stability.
    5. Approach the next small piece only if the client is regulated.
  • Example language (illustrative): "Let's just touch the edge of that and then come back."
  • Watch for: Speeding up, flooding, or a sudden flatness. Each signals too big a piece.

4.7 Pendulation

  • Purpose / when: When the client is near dysregulation or stuck in it. Move between organised and disorganised states, building the capacity to move between them. [source: Heller 2013; the concept comes from Somatic Experiencing]
  • Steps: [synthesis]
    1. Identify a place of relative ease in the body, or an experience of being organised.
    2. Move attention to the difficult state for a moment.
    3. Return to ease.
    4. Repeat, letting the client notice the movement itself.
  • Example language (illustrative): "Is there anywhere that feels a bit more settled right now? Stay there a moment… now notice the tightness again, briefly… and back."
  • Watch for:
    • The client finds the way back to ease more quickly. That shows growing capacity.
    • No place of ease can be found. Use outward orienting and relational contact instead.

4.8 Resourcing and strength-orientation

  • Purpose / when: Throughout, especially early on and after difficult moments. Highlight "the strengths, the inner wisdom" the client already has. [source: Heller 2013]
  • Steps: [synthesis]
    1. Notice capacities as they appear: for example, saying no, staying present, or having survived.
    2. Name them.
    3. Invite the client to sense what it is like to have that capacity.
    4. Frame survival styles as evidence of resourcefulness.
  • Example language (illustrative): "You just disagreed with me. What was that like?"
  • Watch for: The client deflecting praise. That is often an Attunement- or Love-Sexuality-type pattern. [synthesis]

4.9 Mapping the five Adaptive Survival Styles (symptoms as road maps)

  • Purpose / when: To guide the working hypothesis: which core need went unmet and which capacity is compromised. Use it as a lens, not a label. [source: Heller & LaPierre 2012 TOC; Heller 2013]
  • The five styles:
    • Connection. The person disconnects from bodily and emotional experience and from others. [Heller 2013] Shame-based identifications: shame at existing, feeling a burden, not belonging. Pride-based identifications: being a loner, not needing anyone, not being emotional. [Rankin, citing Heller]
    • Attunement. Often "very good at attuning to other people's needs" while less attuned to one's own. [Heller 2013]
    • Trust. Rewarded as a child "for not paying attention to their own needs", for example as a parent's confidant or by fulfilling a parent's dreams. [Heller 2013]
    • Autonomy. Difficulty to "set limits, to say 'no' directly." Often placating, with hidden resentment. [Heller 2013]
    • Love-Sexuality. The challenge is to "integrate an open heart with a vital sexuality." [Heller 2013]
    • The full shame- and pride-based identification tables for styles 2–5, and each style's "core dilemma", are in Heller & LaPierre (2012) and Heller & Kammer (2022). They are not drawn on here. [uncertain]
  • Steps: [synthesis]
    1. Start from the presenting symptom. Ask which capacity it suggests is missing: being in contact, knowing and meeting one's needs, healthy reliance, saying no, or an open heart with vitality.
    2. Listen for the matching shame and pride identifications.
    3. Expect mixtures. Most people show more than one style.
    4. Keep the map private as a hypothesis. Share it only if it helps the client's agency.
  • Example language (illustrative): "It sounds like, very early, you learned to take care of others' needs before your own. Does that fit?"
  • Watch for: The client using the style as a new fixed identity ("I'm a Trust type"). That is the opposite of the aim.

4.10 Working with shame-based and pride-based identifications (disidentification)

  • Purpose / when: When an identification shows up as a statement about who the client is ("I'm too much", "I don't need anyone"). It helps the client relate to the identification as an adaptation rather than as the truth. Heller treats these identifications as the top-down half of the distress cycle. [source: Heller 2013; "Disidentifying from Trauma Adaptations" is a NARM video title; uncertain]
  • Steps: [synthesis]
    1. Hear the identification.
    2. Reflect it as a belief or experience the client has, rather than a fact: "a part of you believes…".
    3. Explore how it feels in the body to hold it.
    4. Ask what it protects against. Pride identifications often defend against shame.
    5. Invite noticing who is aware of the belief. This builds distance between the observing self and the identification.
    6. Track any shift (Pillar 4).
  • Example language (illustrative): "When you say 'I'm a burden', what happens in your body?" / "Who would you be if you didn't have to be the strong one for a moment?"
  • Watch for:
    • Softening, or surprise at hearing the belief out loud.
    • Collapse into deeper shame. Titrate, and go back to resources.

4.11 Emotional completion (containing and deepening affect)

  • Purpose / when: When emotion arises, for example grief, anger or fear. NARM aims at "learning how to contain and deepen affect" rather than catharsis or reliving. [source: Heller 2013; Practical Guide ch. 7 title] The 2022 Emotional Completion Model, including any distinction between primary and defensive emotions, is not drawn on. [uncertain]
  • Steps: [synthesis]
    1. Slow down when emotion appears.
    2. Invite the client to feel it in the body while staying in the present, as their adult self.
    3. Help them stay in contact with you while feeling it.
    4. Let the feeling run its course in small waves. Do not amplify it with cathartic techniques such as hitting, shouting or pillow work.
    5. Afterwards, ask what has changed in how they experience themselves.
  • Example language (illustrative): "Let the sadness be here; you don't need to push it out or hold it back. Can you feel me here with you?"
  • Watch for:
    • Emotion that deepens and then settles, often with relief or new self-perception. A sign it is working.
    • Escalation without settling, or switching into age-regression. Orient to the present and titrate.
    • Practitioners report clients becoming more able to access anger and grief. [source: Vasquez 2024]

4.12 Using the therapeutic relationship (Relational Model)

  • Purpose / when: Throughout. The relationship "includes both client and therapist". [Heller & Kammer 2022, via Goodreads] Survival styles show up in the relationship, and exploring transference is "one of the ways" to see them. It should come only after self-regulation is established. [source: Heller 2013] The Relational Model chapter is not drawn on. [uncertain]
  • Steps: [synthesis]
    1. Track your own reactions, such as wanting to rescue, feeling bored or pressured. Treat them as information, and check whether they come from your own survival style.
    2. Notice relational patterns happening live, such as pleasing you, testing you or withdrawing.
    3. Name them only when the client is regulated, and ask permission first.
    4. Explore them as here-and-now patterns rather than interpreting the past.
    5. Relate adult to adult. Avoid taking responsibility for the client's process. [source: Thompson & Horne 2023 on collusion]
  • Example language (illustrative): "I notice you check my face after you speak. Is it all right if we look at that together?"
  • Watch for: The client can tolerate being seen in the pattern without collapse. Premature transference work can retraumatise. [Heller 2013]

4.13 Personality Spectrum mapping

  • Purpose / when: To place a client's self-organisation on a spectrum, as an aid to pacing and choice of intervention. Heller & Kammer (2022) give a chapter and a worksheet (Appendix B). [source: TOC] The content is not drawn on. Do not use without the book or training. [uncertain]

4.14 Compassion work with intergenerational, cultural and collective trauma

  • Purpose / when: When shame and self-objectification are tied to family or cultural history, or to oppression. NARM fosters authentic empathy, acceptance and compassion, which can extend to family and cultural systems. [source: Kammer in Kushner 2022] Relational trauma also "emerges out of the oppression of communities, cultures, and nations." [Heller & Kammer 2022, via Goodreads]
  • Steps: [synthesis]
    1. Name the wider context without reducing the client to it.
    2. Explore how the client has taken in judgements from that context.
    3. Invite compassion for the younger self and, where the client chooses, for the family's own adaptations.
    4. Never require forgiveness.
  • Example language (illustrative): "That harshness you turn on yourself: whose voice does it echo, and how has it protected you?"
  • Watch for: Compassion pushed too early, which can feel like invalidation of anger.

4.15 Bottom-up completion of defensive responses (Somatic Experiencing adjunct)

  • Purpose / when: Mainly for shock trauma. Completing "flight-fight responses" through body-oriented work is Somatic Experiencing's approach, which NARM partly integrates. For relational trauma, Heller says this is "not so easy". [source: Heller 2013]
  • Steps: Not described in NARM sources. Use only with Somatic Experiencing training. [uncertain]

4.16 Touch

  • Heller says bottom-up work "may or may not involve touch". [Heller 2013] Heller & LaPierre (2012) ch. 11 discusses NARM together with NeuroAffective Touch, which is Aline LaPierre's separately trained method, in long-term treatment. [source: TOC] The procedures are not drawn on. [uncertain]
  • Standard NARM practice as described in the sources is talk plus somatic mindfulness without touch.
  • If touch is used: it requires specific training (for example in NeuroAffective Touch), supervision, and a check of what your licence and jurisdiction allow.
  • Consent steps [synthesis]:
    1. Explain the purpose and the exact placement first (for example, a hand on the upper back or shoulder blade).
    2. Ask explicitly, and accept a no without pressure.
    3. Offer a no-touch alternative, such as the client's own hand or attention.
    4. Agree a stop word or gesture.
    5. Check in during and after.
    6. Document it.
  • Never sexual or genital touch.

4.17 Ending a session

  • Steps: [synthesis]
    1. Return to the contract.
    2. Ask what the client is taking with them.
    3. Reflect one or two shifts.
    4. Orient them to the room and the time.
    5. Check that they are regulated enough to leave.
  • NARM sources describe no homework. [uncertain] The Workbook for Healing Developmental Trauma (NARM workbook; authors and year not verified), which is not drawn on, may offer between-session exercises.

5. Handling problems

NARM sources reframe "resistance" and warn against collusion and premature transference work. [source: Thompson & Horne 2023; Heller 2013] Most of the concrete responses below are my own synthesis from NARM's stated principles and are marked as such.

  • Client cannot say what they want (no contract). [synthesis]
    • Treat this as material, not failure.
    • Explore what happens when they try to want something, for example blankness, guilt or fear of being too much.
    • Offer a minimal contract ("to understand what makes wanting hard").
    • Never supply the want for them.
  • The contract is about changing someone else. [synthesis] Acknowledge the wish. Then ask what having it would give them inside, and contract for that.
  • Stuck or circling in history. Heller warns against an "archeological dig". [Heller 2013] [synthesis on response]
    • Bring the client back to how the story is affecting them as they tell it now.
    • Return to the contract, and ask whether the current direction serves it.
  • "Resistance" or protective patterns. Meet them with curiosity and kindness, not confrontation. [Thompson & Horne 2023] [synthesis on response]
    • Name the protection and ask what it guards against.
    • Respect it as a once-necessary survival strategy.
    • Ask consent before going further.
  • Agency heard as blame ("so it's my fault"). [synthesis]
    • Slow down.
    • Say clearly that what happened was not their doing. Agency is about noticing what they do now, which is where their power to change lies.
    • Return to resources before continuing.
  • Client stays in victim or external-locus language. [synthesis] Without arguing, reflect small moments of choice in session, for example choosing to come or choosing to speak.
  • Overwhelm, flooding or dissociation. NARM's tools here are titration, pendulation and short somatic mindfulness. [Heller 2013] [synthesis on steps]
    1. Stop deepening.
    2. Orient to the room: eyes open, look around, feel the chair, feet on the floor.
    3. Increase relational contact.
    4. Go back to a resource.
    5. Resume only in smaller pieces.
    6. If it recurs often, spend more sessions on regulation before identity-level inquiry.
  • Client wants catharsis, or another therapist used it. NARM is non-cathartic. [Heller 2013] [synthesis on response]
    • Explain that the aim is to hold and deepen feeling so it can complete, not to discharge it.
    • Do not use hitting, screaming or pillow work.
  • Age regression in session. Heller avoids reliving childhood situations. [Heller 2013] [synthesis on response]
    • Gently orient to the adult self and the present: name the date and place, and the client's current age and resources.
    • Then feel the old emotion from the adult position.
  • Positive shifts trigger anxiety or are dismissed. [synthesis]
    • Explore what makes feeling good unsafe, often loyalty, guilt or fear of loss.
    • Titrate the positive state as you would a difficult one.
  • Intense transference or premature focus on the relationship. Premature transference work can retraumatise. [Heller 2013] [synthesis on response]
    • Stabilise first.
    • Name relational patterns only when the client is regulated, and only with permission.
  • Therapist collusion or rescuing. Therapists can collude with strategies that block progress. [Thompson & Horne 2023] [synthesis on response]
    • Notice signs in yourself: working harder than the client, advising, comforting too early, or avoiding challenge.
    • Check whether your own survival style is driving it.
    • Take it to supervision or NARM consultation.
  • Ruptures. [synthesis]
    • Name the shift in the relationship non-defensively.
    • Invite the client's experience.
    • Own your part.
    • Treat the repair itself as a live relational experience, without forcing it.
  • Non-adherence. NARM sources describe no homework. [uncertain] Non-attendance or late cancellations can be explored as relational patterns, with curiosity, and linked back to the contract. [synthesis]
  • Shock trauma, or acute PTSD symptoms dominating. Heller links single-incident shock trauma to bottom-up completion work. [Heller 2013] [synthesis on response] Consider combining with, or referring to, Somatic Experiencing or another trauma-focused treatment.
  • Suicidality, self-harm, active psychosis, severe dissociative disorder or crisis. Not addressed in the sources. [synthesis]
    • Follow standard risk assessment and safety planning, including lethal-means counselling (safe storage and removal).
    • Prioritise stabilisation.
    • Arrange psychiatric or crisis care as indicated.
    • Defer deep identity-level inquiry until the client is safe.
    • NARM's non-cathartic, titrated stance fits this, but it is not a crisis protocol.
  • Therapist vicarious trauma. NARM therapists report sustaining themselves through consultation groups, community and NARM's emphasis on supporting the therapist. [Vasquez 2024] Practically: maintain regular consultation. [synthesis]
  • Use of touch. See 4.16. Do not touch without training, explicit consent and licence clearance. Stop at once if the client freezes, goes quiet or pulls back. [synthesis]

Sources

Sources:

Books cited (not drawn on beyond the TOC, quotes and publisher pages):

  • Heller, L., & LaPierre, A. (2012). Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship. North Atlantic Books.
  • Heller, L., & Kammer, B. J. (2022). The Practical Guide for Healing Developmental Trauma: Using the NeuroAffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma. North Atlantic Books.
  • The Workbook for Healing Developmental Trauma: Tools and Techniques from the NeuroAffective Relational Model. North Atlantic Books (authors and year not verified).
  • LaPierre, A. (2015). Relational Body Psychotherapy (cited by a secondary source).
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