The Story Without
Retraumatization: Skills and
Strategies for Trauma
Resolution
Jane Webber & J. Barry Mascari, Kean University Carol Smith, Marshall University
www.kean.edu/~jmascari
´
Jane Webber
[email protected]
´
J. Barry Mascari
[email protected]
´
Carol Smith
[email protected]
´
FOR PPT:
www.kean.edu/~jmascari
Building & Maintaining
THERAPEUTIC RELATIONSHIP Relaxation/
Self-Regulation
Constructing & Sharing
NARRATIVES
Gentry & Baranowsky (2010)
Trauma Recovery?
WHY TRAUMA THERAPY CAN
BE RETRAUMATIZING
If I wanted to heal, I was told, I would
have to confront my past and face
down my traumatic memories.
This process proved to be so terrifying
and overwhelming for me for that I
TRAUMA RECOVERY
“I don’t think psychotherapy is done by
having people tell stories. Psychotherapy is
about
people finding a way of getting
along with their own internal systems
,
“Those clients who are not able to tolerate
memory-oriented trauma treatment may still
benefit from therapy geared to relieve symptoms, increase coping skills, and improve daily
functioning.” (Rothschild, p. 78)
§ Living safely and comfortably in your body
Living Within Your Body
“
One of the first things I do when I see people is I look at whether they are actually able to: livewithin their rib cages. “
“I may spend the first hour with a new patient helping them to just open up their rib cage, and to breathe, because as long as that primitive
When Trauma Therapy Becomes
Traumatizing
“When the therapy process accelerates faster than he can contain…when more memories are pressed or elicited into consciousness–images, facts, and/or body sensations than can be integrated at one
time….
it produces more arousal in the client’s autonomic nervous system (ANS) than he has the physical ad psychological resources to handle.
It is like an automobile speeding out of control, the driver unable to find and/or apply the brakes.”
The Body Speaks
Close your eyes and think about the last
time you felt really stressed.
´
Open your eyes and mark the picture
to show how and where your body is
reacting.
´
Now tell me (person next to you) how
Building & Maintaining
THERAPEUTIC RELATIONSHIP
The body speaks
what the
mind cannot.
A Comparison
Somatic Therapies
´Eliminate symptoms
´Develop self regulation,
intentionality
´Live inside your body ´A process
´
Interoception-bodifulness
Traditional Therapies
´Eliminate symptoms ´Correct faulty thinking ´Use logic and abstract
thinking
´Seek the end
Constructing & Sharing
NARRATIVES
HOW TO RE-STORY
WITHOUT RETRAUMATIZATION
§
Learn to pull arousal back into state of
tolerance
§
“..be safe in their bodies more and
Trap: Client’s Need to Rush Story for
Relief
“Often, people who have a history of trauma want to move quickly into the details of the trauma to gain
relief. I understand this desire, but my concern for you at the moment is to help you establish a sense of
safety and support before moving into the traumatic experiences.
We want to avoid retraumatization, that means we want to establish resources that weren’t available to you at the time of the trauma before delving into
Trap: Therapist’s Need to Know the
Details
§
Too much too fast: Just the facts!
§
Our own anxiety for details
Trap: Push into Overwhelm
“I was consistently retraumatizing because I was doing what I was trained to do which is go for the painful material like a heat-seeking missile. And when you find it, It will come to the surface and it will be a catharsis and all will be well…
I started teaching her self regulations skills just to get her back to a place where she was before I started helping her”
Remembering NOT Re-living or
Re-experiencing
Survivors don’t have to choose
resolution of trauma memory.
They can choose trauma
Techniques for Restorying
´
Processing trauma memory with
minimal words
´
One line or one word chapters
´
Start with the least-worst(safest) part
TRAUMA STORY CHAPTER TITLES
1. Creepy2. No
3. Afraid for mom
4. Worst
5. My friends hate me
6. Must die
7. Hospital
1. Escape
2. Fake-out
3. Fake-out
4. Journal secret
5. Friends
6. Told mom
7. My new counselor
8. New apartment
9. New Group
Trap: Telling the Story Only with Words
´Tell the story with other
senses
´Multiple story telling
modalities
Technique: Deconstructing Problem Story & Reconstructing a New Narrative
§
You are not the problem. The problem is the
problem.
§
You can
separate/escape from the problem.
§
You can
change your relationship to the
problem. We can deconstruct the dominant
(perpetrator’s) story together and create your
story.
HOW TO SLAM ON THE
Relaxation/
Trap: Going Outside Window of Tolerance
´Back into “Trauma Time” (van der Hart)
Outside window of tolerance, nobody to trust
1) Just outside window of tolerance: Use relationship to bring their focus to the present
2) Way outside window of tolerance: can’t focus: Use Somatic approach with
Technique: Bring Back into Window of
Tolerance
“What’s happening right now? Can you feel your legs.
Let’s stand up you and me. Walk around. Feel your feet on the ground.” (Ogden)
´Walk around room, outside, walk
together
´Grounding: See, hear, touch
Technique: Broaden Window of Tolerance
The centrality of the relationship in
holding people and in healing
trauma is recognizing that
Technique: Braking
“The purpose of hitting the brakes and dropping
the level of arousal is not just to give a pause and
a sense of safety. It also…enables the therapy to
proceed at a reduced level of arousal. Without
hitting the brakes, arousal will just build and build.”
(Rothschild, p. 115).
Anchor and Safe Place: SAFETY
´Concrete, observable resource providing bodily
and emotional relief and lowering hyperarousal
´Person, site, activity, object
´Lets just stop this for a moment. Tell me about
_________.”
´Safe Place is a specialized anchor site of
protection
´Easily accessible, multiple sensory memories, very
Technique: Continually Monitor Arousal
“I don’t want to propel any process that
I don’t know that my client can stop”
(Rothschild)
´Emotionometer/Scale
´Feelings Faces
´Take Your Trauma Temperature
Staying in the Present
“We do not need to excavate the past to
eliminate triggers and forever free ourselves form the insidious effects of stress….Instead, we can simply learn to recognize when we’ve been triggered and then respond by relaxing our bodies (pp. 89-90)
´Don’t wait to process trauma memories to feel
better.
Simple Techniques
•
Tongue touch
•
Stress ball squeezing (with 2
hands)
•
Tapping (thigh, foot,
shoulders)
Sympathetic Dominance
• Fight/flight/freeze
• Stressed
• Compromised Cognitive and Motor Functioning
• Reactive
• Repeating Same Mistakes • Hypervigilance
Parasympathetic Dominance
• Calm
• Maximal Cognitive & Motor Functioning
• Intentional
A Top-Down Approach
TRIUNE BRAIN MODEL
Three levels of
functioning
•
Surviving Brain
(old
brain)
•
Feeling Brain
(mid
brain)
•
Thinking Brain
(new
brain)
44
Thinking Brain Goes “Offline”
´Triggered Amygdalae ´Fight-Flight-Freeze-Faint
´Cortex goes “offline”
´Broca’s area especially sensitive ´Emotions blunted for survival
´Time slows down
´Blood moves from core to limbs
for escape
Image taken from Pacific Standard https://psmag.com/social-justice/brain-wiring-affects-dont-get-ptsd-87551
Broca’s area. Taken from Neuroscientifically challenged.
Telling Can Be Retraumatizing
´Engages Broca’s Area about a “gap time”
´Triggers Amygdalae/fear response ´Reactivates and reinforces trauma
neural networks
´Triggers flashbacks & survival system ´Reinforces trauma emotions via
repetition
´Clients do not want to talk about their trauma
Image taken from Institute of Regenerative and Cellular Medicine:
Trap: Bringing the Upper Brain Back too
Quickly
´
Stop talking about trauma if client cannot
describe what’s going on
´
Survivor can be retraumatized when
thinking brain goes back on line without
understanding
´
Combine bottom up and top down
Technique: Acknowledge/Affirm Distress
(Lower Brain & Upper Brain Connected)
´
Pushing it away makes it worse: distress
increases, gets more intense
´
Modify body scan to be less
overwhelming; “Notice your distress;
acknowledge it”
´
Accept the present but you don’t have
Trap: Misreading Spaciness
´Hypoarousal–Not moving or talking, dazed, dissociated, fearful
´Part of parasympathetic system that helps slow it down
Technique: Help to return to present and get out of dissociative state
q Broaden window of tolerance q Not in the here and now
q Help to move, walk
“Can you look at me?” ”Can you sense this moment?” (Ogden)
Trap: Miss Arousal Shifts/Dysregulating
Hyperarousal
´Talk faster, higher
pitch
´Breathe faster, hyperventilate
´Move suddenly, fast ´Sweat
´Fidget, Shake
´Shift attention
Hypoarousal
´Talk slower
´Breath slower
´Slow/Stop moving
´Lose attention ´Not present
´Eyes locked or not
“
Those clients who are not able to
tolerate memory-oriented
trauma treatment may still
benefit from
therapy geared to
relieve symptoms, increase
Building & Maintaining
THERAPEUTIC RELATIONSHIP
Relaxation/
Self-Regulation
Constructing & Sharing
NARRATIVES
Gentry & Baranowsky (2010)
Trauma Recovery?
´Jane Webber [email protected]
´J. Barry Mascari [email protected]
´Carol Smith [email protected]
´FOR PPT
´www.kean.edu/~jmascari
´Click on RESOURCES at the top. Look for date and
