INTEGRATIVE TRAUMA RECOVERY GROUP
10/13/2016
INTEGRATIVE TRAUMA RECOVERY GROUP Anita Mandley, MS, LCPC
Introduction • How ITR came into being • Presenting ITR to prompt curiosity and spark a conversation • Hope to share with participants a “felt sense” of ITR • Consolidate with the observations of clients and myself
1
10/13/2016
3
Four Levels of Stress Reactivity
Anita Mandley, LCPC, Center for Contextual Change
Fundamental Elements of Trauma
Powerless Disconnected Devalued Out of Control
2
10/13/2016
Complexity of Trauma Impact • Affect • Cognition • Neurobiology • Somatic • Attachment
Characteristics of PED
• • • • • •
Excess of aversive emotional experiences Inability to regulate intense physiological arousal Problems turning attention away from emotional stimuli Cognitive distortions Failures in information processing Insufficient control of impulsive behaviors
3
10/13/2016
PED Characteristics cont'd
• • •
Difficulties organizing and coordinating activities to achieve non‐mood‐dependent goals when emotionally aroused Tendency to freeze or dissociate under very high stress Occurs across the entire emotional system, including the behavioral, physiological, cognitive, and experiential subsystems of emotional responding
PSYCHOLOGICAL COMPLEXITY • The focus of psychological science has been predominantly reductionist, based on the understanding of the mind in terms of relatively independent components. No other branch of science is in more desperate need of complex systems models and ideas than psychology. No other branch of science is quite so fragmented as psychology. Different aspects of mental function: memory, perception, action, learning, affect, are seen in terms of almost completely different concepts, when in the brain/body/mind, these components operate in an unified and synergistic way. Cognitive psychologists construct models of mental processes’ behaviorists do not attend to the abstract mental processes; and neuropsychologists use information about neurochemistry and neuro‐anatomy to construct their theories. Psychology struggles to have a unifying paradigm. This is especially true in the arena of trauma therapy. The focus of a complex systems view, is not whether one is looking at a network of neurons or a network or thoughts or emotions; it is the emergent properties of the network or system. The mind can be easily conceived as a collection of emergent properties of the brain. A paradigm of complex systems, focuses on the emergent properties of the mind.
4
10/13/2016
FOUR ASPECTS OF COMPLEXITY Underlying neural networks ‐ Abstract psychological phenomena Analysis of experimental data Clarifying philosophical foundations Working on these four levels at once can be transformative and bring together all the components of the mind into the process of healing.
Complexity and Self‐Organization • A complex system is said to regulate its own emergence. This means that the system itself has certain properties that determine how it unfolds over time. This self‐organizational process, the way the system shapes its own unfolding, is built from the mathematics of complex systems. We are capable of self‐ organization. It seemed to me that our triangle of well‐being, the system of mind, brain, and relationships, might be more fully understood in complex terms and we might be able to apply the principles of complexity and integration to creating health across each of these aspects of our lives. •
Daniel Siegel
5
10/13/2016
STATES OF MIND PARADIGM THOUGHTS
Sense Of
URGES
Self
Emotion INTERNAL MODEL OF OTHERS AND THE WORLD
BEHAVIORS
Somatic Experiences
States of Mind • Rational Mind Dominated by reason, logic • • Emotion Mind Dominated by emotional experiencing • Intuitive Mind Perceptions in the absence of perceptible cues, non‐verbal encoding and decoding . • Trauma Mind Extreme distress, high emotional reactivity • Wise Mind Dominated by intrapersonal coherence and internal attunement
6
10/13/2016
Audre Lorde • “We recognize that all knowledge is mediated through the body and that feeling is a profound source of information about our lives.”
Traumatized people need to have physical & sensory experiences to: • Unlock their bodies, • Activate effective fight/flight • Tolerate their sensations, • Befriend their inner experiences • Cultivate new activation management patterns.
7
10/13/2016
Antonio R. Damasio The Feeling of What Happens: Body and Emotion in the Making of Consciousness
• “We use our minds not to discover facts but to hide them. One of the things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.”
Antonio R. Damasio The Feeling of What Happens: Body and Emotion in the Making of Consciousness
• “…I sense that stepping into the light is also a powerful metaphor for consciousness, for the birth of the knowing mind, for the simple and yet momentous coming of the sense of self into the world of the mental.”
8
10/13/2016
Organizational Models ▫ The Collaborative Change Model ▫ Judith Herman’s Trauma Recovery Group Model ▫ Bruce Ecker’s Therapeutic Reconsolidation Process ▫ John Briere’s Model of Trauma Counter‐Conditioning
Therapeutic Modalities • • • •
Somatic Experiencing Dialectical Behavior Therapy Yoga Settling the Body and activating the frontal lobes
9
10/13/2016
The Collaborative Change Model • Stage 1 ▫ Safety, relationship, vulnerabilities and resources, psycho‐education, positive and negative consequences of change, acknowledgement
• Stage 2 ▫ Expanding reality, creating new possibilities, challenging patterns
• Stage 3 ▫ Integration, generalization and consolidation
Therapeutic Reconsolidation Process • Creating experiences of juxtaposition of old experiences, memories and learning with new contradictory experiences • Steps of TRP ▫ Accessing sequence ▫ Transformation sequence ▫ Verification phase
10
10/13/2016
John Briere’s Trauma Counter‐conditioning Process • Exposure • Activation • Disparity • Counter‐conditioning • Extinction
The SE Transformative Process 1. Safety and Stabilization ▫
Building Body Awareness
2. Stabilization ▫ ▫
Establish cycles of activation and settling Trauma Mind Vortex •
Increase capacity and trust to exit by noticing resources, building mastery, stabilizing the nervous system
3. Re‐working Specific Moments of Life ▫ ▫ ▫ ▫
Using activation of threat to access nervous system Observe traumatic patterns Observe disparity Contract and notice impact of new experience
11
10/13/2016
Types of Transformational Interventions • • • • • • • • • •
Accelerated Experiential Dynamic Psychotherapy Coherence Therapy EMDR Emotion‐Focused Therapy Somatic Experiencing Gestalt Therapy Hakomi Internal Family Systems Interpersonal Neurobiology Neuro‐Linquistic Programming
Anita Mandley, LCPC, Center for Contextual Change
Judith Hermann ,MD. Trauma and Recovery • “Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people control, connection, and meaning.”
12
10/13/2016
Pre and Post Assessments • • • • •
PCL Civilian (PTSD Checklist) Dissociative Experiences Scale Difficulties in Emotional Regulation Scale 5 Facet Mindfulness CES‐D (Center for Epidemiological Studies Depression Scale)
Group Format • Stage 1 ▫ Orient to the theme ▫ Mindfulness ▫ Journal review opening round
• Stage 2 ▫ Psycho‐education ▫ Experiment and discussion
• Stage 3 ▫ Journal ▫ Closing Mindfulness
13
10/13/2016
ITR‐ Stage 1 (Six Weeks) • • • • • •
Orientation and Group Norms Inside vs Outside/Trauma and the Nervous System/Resources States of Mind and Pendulation States of Mind Awareness of the Body Weight on your shoulders
Stage 2 Topics (Eleven Weeks) • • • • • • • • •
Intention‐ Moving Towards vs Moving Away Positive and Negative Consequences of Change How Change Happens: Expansion and Contraction Obstacles to Change: Willingness vs Willfulness Boundaries Is It Happening Now? Inside vs Outside Threat Sensation as Sensation My Body Belongs to Me: Reclaiming the body and building a container
14
10/13/2016
Stage 2 Topics (cont’d) • Dissociation • Acknowledging the Impact of the Trauma
Stage 3 (Seven Weeks) • • • • • • •
Radical Acceptance Moving Towards Safe Connection Safe Attachment Belonging Impact of the Group Consolidation: Moving from the Group to the World Saying Goodbye/Party/Certificate of Completion
15
10/13/2016
Primary Resources • Enlightened Witness ▫ Well informed, open and broad minded, educated, wise ▫ Able to give greater understanding about a subject ▫ See, observe, notice, spot
• Competent Protector Capable, acceptable, reasonable, fair, decent Guard, champion, watchdog
• Compassionate and Warm Comforter ▫ Understanding, caring, sensitive, warm with a strong desire to alleviate suffering ▫ Providing consolation
16
INTEGRATIVE TRAUMA RECOVERY GROUP Anita Mandley, MS, LCPC
Introduction • How ITR came into being • Presenting ITR to prompt curiosity and spark a conversation • Hope to share with participants a “felt sense” of ITR • Consolidate with the observations of clients and myself
1
10/13/2016
3
Four Levels of Stress Reactivity
Anita Mandley, LCPC, Center for Contextual Change
Fundamental Elements of Trauma
Powerless Disconnected Devalued Out of Control
2
10/13/2016
Complexity of Trauma Impact • Affect • Cognition • Neurobiology • Somatic • Attachment
Characteristics of PED
• • • • • •
Excess of aversive emotional experiences Inability to regulate intense physiological arousal Problems turning attention away from emotional stimuli Cognitive distortions Failures in information processing Insufficient control of impulsive behaviors
3
10/13/2016
PED Characteristics cont'd
• • •
Difficulties organizing and coordinating activities to achieve non‐mood‐dependent goals when emotionally aroused Tendency to freeze or dissociate under very high stress Occurs across the entire emotional system, including the behavioral, physiological, cognitive, and experiential subsystems of emotional responding
PSYCHOLOGICAL COMPLEXITY • The focus of psychological science has been predominantly reductionist, based on the understanding of the mind in terms of relatively independent components. No other branch of science is in more desperate need of complex systems models and ideas than psychology. No other branch of science is quite so fragmented as psychology. Different aspects of mental function: memory, perception, action, learning, affect, are seen in terms of almost completely different concepts, when in the brain/body/mind, these components operate in an unified and synergistic way. Cognitive psychologists construct models of mental processes’ behaviorists do not attend to the abstract mental processes; and neuropsychologists use information about neurochemistry and neuro‐anatomy to construct their theories. Psychology struggles to have a unifying paradigm. This is especially true in the arena of trauma therapy. The focus of a complex systems view, is not whether one is looking at a network of neurons or a network or thoughts or emotions; it is the emergent properties of the network or system. The mind can be easily conceived as a collection of emergent properties of the brain. A paradigm of complex systems, focuses on the emergent properties of the mind.
4
10/13/2016
FOUR ASPECTS OF COMPLEXITY Underlying neural networks ‐ Abstract psychological phenomena Analysis of experimental data Clarifying philosophical foundations Working on these four levels at once can be transformative and bring together all the components of the mind into the process of healing.
Complexity and Self‐Organization • A complex system is said to regulate its own emergence. This means that the system itself has certain properties that determine how it unfolds over time. This self‐organizational process, the way the system shapes its own unfolding, is built from the mathematics of complex systems. We are capable of self‐ organization. It seemed to me that our triangle of well‐being, the system of mind, brain, and relationships, might be more fully understood in complex terms and we might be able to apply the principles of complexity and integration to creating health across each of these aspects of our lives. •
Daniel Siegel
5
10/13/2016
STATES OF MIND PARADIGM THOUGHTS
Sense Of
URGES
Self
Emotion INTERNAL MODEL OF OTHERS AND THE WORLD
BEHAVIORS
Somatic Experiences
States of Mind • Rational Mind Dominated by reason, logic • • Emotion Mind Dominated by emotional experiencing • Intuitive Mind Perceptions in the absence of perceptible cues, non‐verbal encoding and decoding . • Trauma Mind Extreme distress, high emotional reactivity • Wise Mind Dominated by intrapersonal coherence and internal attunement
6
10/13/2016
Audre Lorde • “We recognize that all knowledge is mediated through the body and that feeling is a profound source of information about our lives.”
Traumatized people need to have physical & sensory experiences to: • Unlock their bodies, • Activate effective fight/flight • Tolerate their sensations, • Befriend their inner experiences • Cultivate new activation management patterns.
7
10/13/2016
Antonio R. Damasio The Feeling of What Happens: Body and Emotion in the Making of Consciousness
• “We use our minds not to discover facts but to hide them. One of the things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.”
Antonio R. Damasio The Feeling of What Happens: Body and Emotion in the Making of Consciousness
• “…I sense that stepping into the light is also a powerful metaphor for consciousness, for the birth of the knowing mind, for the simple and yet momentous coming of the sense of self into the world of the mental.”
8
10/13/2016
Organizational Models ▫ The Collaborative Change Model ▫ Judith Herman’s Trauma Recovery Group Model ▫ Bruce Ecker’s Therapeutic Reconsolidation Process ▫ John Briere’s Model of Trauma Counter‐Conditioning
Therapeutic Modalities • • • •
Somatic Experiencing Dialectical Behavior Therapy Yoga Settling the Body and activating the frontal lobes
9
10/13/2016
The Collaborative Change Model • Stage 1 ▫ Safety, relationship, vulnerabilities and resources, psycho‐education, positive and negative consequences of change, acknowledgement
• Stage 2 ▫ Expanding reality, creating new possibilities, challenging patterns
• Stage 3 ▫ Integration, generalization and consolidation
Therapeutic Reconsolidation Process • Creating experiences of juxtaposition of old experiences, memories and learning with new contradictory experiences • Steps of TRP ▫ Accessing sequence ▫ Transformation sequence ▫ Verification phase
10
10/13/2016
John Briere’s Trauma Counter‐conditioning Process • Exposure • Activation • Disparity • Counter‐conditioning • Extinction
The SE Transformative Process 1. Safety and Stabilization ▫
Building Body Awareness
2. Stabilization ▫ ▫
Establish cycles of activation and settling Trauma Mind Vortex •
Increase capacity and trust to exit by noticing resources, building mastery, stabilizing the nervous system
3. Re‐working Specific Moments of Life ▫ ▫ ▫ ▫
Using activation of threat to access nervous system Observe traumatic patterns Observe disparity Contract and notice impact of new experience
11
10/13/2016
Types of Transformational Interventions • • • • • • • • • •
Accelerated Experiential Dynamic Psychotherapy Coherence Therapy EMDR Emotion‐Focused Therapy Somatic Experiencing Gestalt Therapy Hakomi Internal Family Systems Interpersonal Neurobiology Neuro‐Linquistic Programming
Anita Mandley, LCPC, Center for Contextual Change
Judith Hermann ,MD. Trauma and Recovery • “Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people control, connection, and meaning.”
12
10/13/2016
Pre and Post Assessments • • • • •
PCL Civilian (PTSD Checklist) Dissociative Experiences Scale Difficulties in Emotional Regulation Scale 5 Facet Mindfulness CES‐D (Center for Epidemiological Studies Depression Scale)
Group Format • Stage 1 ▫ Orient to the theme ▫ Mindfulness ▫ Journal review opening round
• Stage 2 ▫ Psycho‐education ▫ Experiment and discussion
• Stage 3 ▫ Journal ▫ Closing Mindfulness
13
10/13/2016
ITR‐ Stage 1 (Six Weeks) • • • • • •
Orientation and Group Norms Inside vs Outside/Trauma and the Nervous System/Resources States of Mind and Pendulation States of Mind Awareness of the Body Weight on your shoulders
Stage 2 Topics (Eleven Weeks) • • • • • • • • •
Intention‐ Moving Towards vs Moving Away Positive and Negative Consequences of Change How Change Happens: Expansion and Contraction Obstacles to Change: Willingness vs Willfulness Boundaries Is It Happening Now? Inside vs Outside Threat Sensation as Sensation My Body Belongs to Me: Reclaiming the body and building a container
14
10/13/2016
Stage 2 Topics (cont’d) • Dissociation • Acknowledging the Impact of the Trauma
Stage 3 (Seven Weeks) • • • • • • •
Radical Acceptance Moving Towards Safe Connection Safe Attachment Belonging Impact of the Group Consolidation: Moving from the Group to the World Saying Goodbye/Party/Certificate of Completion
15
10/13/2016
Primary Resources • Enlightened Witness ▫ Well informed, open and broad minded, educated, wise ▫ Able to give greater understanding about a subject ▫ See, observe, notice, spot
• Competent Protector Capable, acceptable, reasonable, fair, decent Guard, champion, watchdog
• Compassionate and Warm Comforter ▫ Understanding, caring, sensitive, warm with a strong desire to alleviate suffering ▫ Providing consolation
16
