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Transference
Countertransference
Erin P. Hwasta, M.A., MFT
erin@erinhwasta.com
Treatment Stages
Client will need to find a new sense of self
Client will need to find new ways to connect to their community and surroundings
Termed by one of Janet’s patients.
The act of speaking the unspoken and bringing light to the dark.
Mechanism:
Replicates the natural way the brain processes experiences and information.
EEG feedback to teach the brain to coordinate brain waves
Teaches body awareness and meditation
Client must feel safe and in control in order to begin the process
Therapist must balance safety with need to face the past
Putting on the brakes
Slow down the process even more if addiction is suspected
Feminist movement in Europe and US – Sexual Assault and Domestic Violence
Most common form of traumatization is not from men at war, but from civilian women in everyday life.
Rape Trauma Syndrome and Rape Crisis Centers
End of WWI, through WWII and after Vietnam –
Shell Shock or Combat Neurosis
Late Nineteenth Century France – Charcot studied Hysteria. Freud and Janet later joined
Freud published The Aetiology of Hysteria, was shunned for his conclusions. He recanted and retreated from his patients.
Clinical outline of PTSD was developed. 200-240 days of combat would give any soldier PTSD
Janet never gave up his ideas, but saw them forgotten
The first principle of recover is empowerment
Clients may turn to therapists as omnipotent rescuers that they wished would have protected them.
Client may invite revictimization.
Therapists may feel as helpless as clients and take on the rescuer role.
Therapists must tolerate uncertainty.
Traumatized Brain
No one wants to talk about it, no one wants to acknowledge it, no one wants to take responsibility for it or admit that we allow it.
Frontal Lobe - planning, anticipating
Pre-frontal Cortex- puts things in a timeline to make sense of it. Creates past, present and future.
Insula - registers the sensations in our body.
Broca's Area - creates speech
DSM V – New Chapter Trauma- and Stressor- Related Disorders
Amygdala - senses danger
Thalamus - puts together sensory information
Vegus Nerve:
Criterion A: Stressor
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required)
1. Direct exposure.
2. Witnessing, in person.
3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.
Criterion B: Intrusion Symptoms
The traumatic event is persistently re-experienced in the following way(s): (1 required)
1. Recurrent, involuntary, and intrusive memories. Note: Children older than 6 may express this symptom in repetitive play.
2. Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
4. Intense or prolonged distress after exposure to traumatic reminders.
5. Marked physiologic reactivity after exposure to trauma-related stimuli.
Criterion C: Avoidance
Persistent effortful avoidance of distressing trauma-related stimuli after the event: (1 required)
1. Trauma-related thoughts or feelings.
2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).
Criterion D: Negative Alterations in Cognitions and Mood
Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required)
1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs).
2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous.").
3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame).
5. Markedly diminished interest in (pre-traumatic) significant activities.
6. Feeling alienated from others (e.g., detachment or estrangement).
7. Constricted affect: persistent inability to experience positive emotions.
Criterion E: Alterations in Arousal and Reactivity
Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required)
1. Irritable or aggressive behavior.
2. Self-destructive or reckless behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems in concentration.
6. Sleep disturbance.
Criterion F: Duration
Persistence of symptoms (in Criteria B, C, D and E) for more than one month.
Criterion G: Functional Significance
Significant symptom-related distress or functional impairment (e.g., social, occupational).
Criterion H: Exclusion
Disturbance is not due to medication, substance use, or other illness.
Specify if: With Dissociative Symptoms.
In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").
Specify if: With Delayed Expression.
Full diagnosis is not met until at least 6 months after the trauma(s), although onset of symptoms may occur immediately.
A prolonged period (months to years) of chronic victimization and total control by another may experience the following:
Testimony
Exposure
Neocortex:
Involved in higher functions such as sensory perception, generation of motor commands, spatial reasoning, conscious thought and language.
Sleeping, eating, breathing, etc.
Narrative Memory
Traumatic Memory
History of Treating Trauma
Diagnosis and Classification
PTSD
Complex PTSD
The Traumatized Brain
Treatment Stages and Methods
EMDR
Exposure:
Testimony:
Perception, emotion, memory of relevance, relations between organisms and surroundings.
EMDR is an approach for treating trauma, addictions, phobia, chronic pain, etc.
Developed by Francine Shapiro, Ph.D