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Transcript

Transference

Countertransference

Q&A and Case Consultation

Treating Trauma with a Focus on EMDR

Erin P. Hwasta, M.A., MFT

erin@erinhwasta.com

Treatment Stages

Restore Self & Connection to Community

Client will need to find a new sense of self

  • New perceptions & boundaries
  • New belief system

Client will need to find new ways to connect to their community and surroundings

  • Learn how to NOT be hypervigilent
  • Learn to connect to others
  • Learn to live in the present

Treatment Methods

History of Treating Trauma

  • The Talking Cure

Termed by one of Janet’s patients.

The act of speaking the unspoken and bringing light to the dark.

  • Exposure/Testimony
  • EMDR

Mechanism:

Replicates the natural way the brain processes experiences and information.

  • Assess for fit
  • Establish safety
  • Strengthen internal resources - Tapping In (Laurel Parnell, PhD)
  • Create a map of trauma
  • Systematically target trauma
  • Events: All memory chains and body scan
  • Check SUD and VOC
  • Triggers: All triggers, future templates and body scan
  • Check SUD and VOC
  • Reevaluation

  • Neurofeedback

EEG feedback to teach the brain to coordinate brain waves

  • Yoga

Teaches body awareness and meditation

Safety and Stability

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

The Healing Relationship

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

Nature of Trauma

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.

The Diagnoses of Trauma

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

  • PTSD
  • Children 6 and under
  • Subtypes
  • Acute Stress Disorder
  • Adjustment Disorder
  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder

Amygdala - senses danger

Thalamus - puts together sensory information

Vegus Nerve:

PTSD Dx

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.

“Complex PTSD”

A prolonged period (months to years) of chronic victimization and total control by another may experience the following:

  • Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  • Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes/body
  • Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  • Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
  • One's System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

Exposure/Testimony

Testimony

Exposure

  • Teach relaxation techniques
  • Prepare a written script
  • Read out-loud

  • Sessions recorded, written
  • Testimony revisted
  • Read out-loud
  • Signed by therapist and client

Neocortex:

Involved in higher functions such as sensory perception, generation of motor commands, spatial reasoning, conscious thought and language.

Reptilian Brain:

Sleeping, eating, breathing, etc.

Narrative Memory

Traumatic Memory

  • Raw sensory information tied together

  • When triggered it is re-experienced.

  • Normal memory

  • Experienced as a memory from the past, not happening in the moment.

Presentation Overview

History of Treating Trauma

Diagnosis and Classification

PTSD

Complex PTSD

The Traumatized Brain

Treatment Stages and Methods

EMDR

Exposure:

  • Teach relaxation techniques
  • Prepare written script
  • Read out-loud

Testimony:

  • Sessions recorded, transcribed
  • Testimony revised
  • Read out-loud
  • Signed by therapist and client

Lymbic System

Perception, emotion, memory of relevance, relations between organisms and surroundings.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is an approach for treating trauma, addictions, phobia, chronic pain, etc.

Developed by Francine Shapiro, Ph.D

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