Sensorimotor Psychotherapy for Trauma Workshop
The Sensorimotor Psychotherapy Institute presented "The Art and Science of Trauma Treatment: Implications for Clinical Practice" on Sept 21st 07 in Marino Institute of Education in Dublin. This workshop was facilitated by Pat Ogden, PhD and Dr. Ruth Lanius. Seven psychotherapists from CCST attended the conference.
Sensorimotor Psychotherapy, founded by Pat Ogden in the 1980s is an approach that builds on traditional psychotherapeutic understanding but includes the body as central in the therapeutic field of awareness. This therapy draws on the worlds of psychodynamic psychotherapy, cognitive behavioural psychotherapy and includes neuroscience, the theory of attachment and dissociation.
The presentations included the neuroscience of the impact of trauma on the central nervous system, with graphic views of the brain from the latest research using scanning technology. This science including the technology is contributing hugely to the continuous development and clinical practice of therapists working with traumatised individuals. Best practice in trauma care occurs not only when therapists are able to recognise what clinical approach to implement, but what is potentially retraumatising for the individual.
Understanding Trauma
While many individuals are exposed to traumatic experiences, it does not necessarily follow that the individual will be traumatised. A useful way to categorise trauma includes: shock trauma and developmental trauma. Shock trauma is defined as an event or situation which is often perceived to be life threatening (such as an accident, a mugging, rape and torture), where a person's nervous system is suddenly overwhelmed. Whether or not the incident of stress will result in shock trauma depends on the individuals own resources. These resources can be internal or external, such as being a very healthy, secure individual with good nurturing support of family and friends.
Developmental trauma is often associated with a long history of prolonged and severe abuse and/or neglect which interrupts the so called 'normal' psychological developmental stages of the individuals growth.
Shock trauma occurs when a persons active survival defenses (fight and flight) have been rendered useless and the individual enters into a state of shock and frozen helplessness. Traumatic experience disrupts a person's normal ability to regulate their emotional and physiological states. This is often the reason why the traumatised individual experiences sudden panic, numbing, intrusive images and thoughts and enters a state of fear and acute anxiety. They might swing between two opposing and contradictory directions: in one instant suffering intense feeling causing the heart to beat faster and the pulse to increase and in the next instant having no feelings or sensations. This state only adds to the individual's helplessness and confusion where they often feel "insane" and "hopeless" and feel reluctant to seek help.
Complex Post Traumatic Stress Disorder
There was a lot of emphasis in this workshop on the treatment of Complex Post Traumatic Stress Disorder. This disorder usually develops when the individual is not able to process or integrate the trauma experienced. This results in the trauma experience being stored in the brain and body. When a current event occurs, that reminds the individual of the traumatic incident, it can evoke the full recording of the event with all the terror, fear and shock as it occurred in the original traumatic incident.
For any trauma survivor, the obvious supportive structures such as family, friends, and community and daily activities play a vital role in the individual's recovery. Sometimes there is a need for professional care such as medical doctor and counselling support. This all helps to alleviate the trauma to some degree and helps to keep the mind occupied.
Dr Ruth Linus emphasised the need for 'appropriate professional specialist' assessment in order to diagnose properly, so that the most appropriate therapeutic approach may be implemented to meet the individual's needs. She outlined the role of a multidisciplinary team in treating and caring for the individual suffering Complex PTSD. This ensures that the most appropriate intervention may be implemented including psychiatric, medical, nursing and psychotherapeutic individualised care.
The 3 phase treatment approach outlined in the workshop is familiar to all of our therapists:
Phase 1: Stabilization of the Client with Symptom Reduction.
This phase deals with the safety and stabilization of the individual. The traumatised individual needs to gain some control over the frightening and often terrifying array of symptoms associated with PTSD. This process may take quite a considerable length of time to achieve. It includes all the elements of any therapeutic relationship: building a safe and trusting relationship, learning about boundaries, psychoeducation about PTSD and reassurance that it can get be managed. It also helps the client to become aware of the present, avoiding retraumatization and empowering him/her as the symptoms of PTSD are slowly and therapeutically addressed.
Phase 1 of treatment helps the client to learn new skills to regain a sense of control before moving on to the second phase. For the asylum seeker who has not yet been granted refugee status, it is unlikely that he/she will be able to progress to phase 2 since their vulnerability is too great.
Phase 2: Treatment of the Traumatic Memory
This phase deals with the individual's story of the trauma. Only when the client is well resourced and has the ability to face the awful terror of the trauma can they initiate this phase. This involves the telling the story in detail including the embodied version with all its 'felt' experiences. It includes reconstructing the story so that they client can distinguish between the past event and the present. A lot of grief and loss is dealt with in this phase where often for the first time the client can mourn the losses including what the client describes as 'loss of self'.
Phase 3: Helping the individual to reintegrate and rehabilitate personally and with the world.
Having come to terms with the trauma the survivor now faces the task of developing a new life after the trauma. This involves the work of integration and reclaiming ordinary and pleasurable experiences. The client not only faces reconnecting with 'a new self', but will be challenged to learn to trust other people and develop new relationships. The therapeutic relationship helps to form a template for this process, whereby the client learns to trust and to establish new safe boundaries in a secure and professional context.
This workshop was not only informative and exciting, but it affirmed the ethos of the psychotherapeutic team in CCST, where we aspire to working with a multidisciplinary model of care. The body oriented therapies which include our full range of complementary therapies in CCST were all mentioned as essential in the approach to healing trauma.
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