Trauma & Attachment Therapy

Trauma Lecture

I'll be giving a lecture about trauma, PTSD, Structural Dissociation, the Polyvagal theory and the use of EMDR to impact PTSD on Saturday morning, May 17 from 9:30 to 12. Frank Kokorowsk will copresent with a dynamite multi-modal trauma treatment that he's been using with homeless people. There are 2 CE's for everyone and it's sponsored by the WA State Coalition of Mental Health Professionals and Consumers our main advocacy group with the legislature.

Register at wacolition@verizon.net (email your name and phone).

May 17, 9:30 -12 Good Shepherd Center 4649 Sunnyside N, Seattle

More Therapeuitic Aphorisms

Jonathan Kandell sent me these aphorisms. And I can't seem to change the formatting, though I've tried, several times:

"In my office I have some variation of ACT up

"Accept the reality of the moment
Choose to do something meaningful
Take action!"

I vary this depending on my mood...

sometimes it's "Accept all feelings and thoughts . . .
or the middle is sometimes it's "Commit to a direction. . .
sometimes it's "Choose a direction. . .

This week it's

"Accept all internal experience
Know your purpose     [from Morita in Japan in the 20s]
Take action!"

Then there's a client favorite:

"Screw you _and_ your inner child!"

Why Book Editing Is Like Doing Psychotherapy

The Book has a title now: EMDR Solutions II, for Depression, Eating Disorders, Performance and More. It has a cover photograph, too. and the photo has a story. (Full disclosure--the photographer is my husband.) See it and read it at http://www.dougplummer.com/archives/ireland2/fall9.html

I'm in full-blown editing mode: going through each chapter, attaching a header, reformatting it, and reading for sense, structure, and grammar. All the writers are talented psychotherapists. Some of them are good writers. Some had lousy English teachers. In an attempt to solve the he/she dilemma, a few of my writers have turned "they" into a singular pronoun. "When I talk to a client, I tell them . . ."  Some, even without using "they" can't keep their subjects and verbs in agreement. Or the verb tense in agreement in one sentence. Some of the sentences are like puzzles. I work hard to understand what the writer means and to make it cogent and "correct". Mostly, I like the process. Sometimes, I whine about it.

Editing seems natural to me because, as a therapist, I listen intently to people. I notice tone, meaning, coherence of narrative, posture, breathing, and monitor my own human reaction to all of it. When I see a discrepancy between, for instance, affect and content, I might intervene. "What do you feel, inside, when you're talking about the bad thing?" Or "I notice you look kind of hunkered down while you're talking about something good that happened. What's going on?" Therapists, the good ones, anyway, sift through a pile of complex information every moment and help bring clarity to murky responses. Through questions and other techniques we help clients create coherent narratives, acknowledge and process affect, and build the neural networks that come only from human response. In the mean time, we see the clients through the eyes of our editors' brains.

Jim Marshall on Psychotherapy and Religion

This is from an email sent by Jim Marshall, a great psychotherapist, deep thinker, and good soul:

"I was delighted to see that there will be a section in your book on EMDR and Spiritual Issues. Back in 1992, Francine asked me and a clinician from California to lead the EMDR and Spirituality Special Interest Group starting at the 2nd annual conference that year. That same year I had presented a paper to the second annual conference of the American Association of Christian Couselors entitled "EMDR--A Godsend in the Healing Process".  The cool outcome was that eventually the Christian therapy community got hip to EMDR and a few folks out at Fuller did PhD dissertations on it, but my own grad school, Wheaton College hasn't done squat (per the irony of being a faith-based program that overvalues well-designed studies yielding scientific evidence before fully exploring a new treatment). That was a long time ago. Anyhow the topic continues to be a very conscious daily focus for me and i will look forward to any chapters devoted to it.

An observation: I have NEVER observed EMDR to prompt change or cognitive shifting away from or contradictory to the person's spiritual orientation, meaning both their affective bond with God and their theology (i.e., their view of the nature of God, the Person of Christ, and the nature of the relationship He desires) UNLESS these were both distorted and contaminated by transferences (e.g., Heavenly Father/earth dad). With the clearing of those transferences, their theology did shift, i.e., it became more accurate/attuned to an orthodox Christian theology centering on a Gospel of love versus a conditional, punitive, shaming theology. Also, it has always been fascinating (per Paul Vitz, NYU) to observe how clients' theological formation through early adulthood (with shifts and changes, embracing/abandoning certain faith traditions) is powerfully influenced by the nature of their early attachments, and reinforced or reshaped by later attachment experiences."

Jim Marshall
http://www.mastercare.net

A Neuroscientist Explains Her Stroke

Check out this amazing 18 minute video suggested by Kelli Sherine:

http://well.blogs.nytimes.com/2008/03/13/when-a-brain-scientist-suffers-a-stroke/

Soldiers Project NW II

I went to an organizational meeting for the Soldiers Project NW(SP)last night. Forty-two people were there. Therapists from all over the Puget Sound region, one from Yakima, and even one from California. About 10 were veterans. Several had worked for the VA. The rest were people who heard about it and wanted to help. Several expressed despair or shame at the current level of services available for soldiers and veterans and excitement at the possibility of righting the situation.

Trisha Pearce and Lisa Weinberg convened the meeting. They've been working since October to connect with the LA-based project, a 501C3, which started the first chapter. They invited Michelle (whose last name I didn't get), a social worker from the Seattle VA to talk about the interface with VA. SP volunteers will work with people who either don't qualify for, or don't want to interact with VA and the military for mental health needs. We'll work with active duty, honorably and dishonorably discharged soldiers and their families and friends. We can refer appropriate people to the VA for services, if they want to be referred.

There are seven simple rules for SPNW volunteers:

1. You agree to provide one hour a week of mental health support or tx at no charge.
2. You agree not to accept donations, insurance payment or barter for services provided.
3. You agree to educate yourself on the effects of trauma, war and the treatment of combat PTSD and how to refer for veteran's benefits. If you work with families, children, or women you will educate yourself on their special needs.
4. You agree to screen referrals to determine whether they are appropriate your scope of training, and, if not, refer them back to the SPNW referral system.
5. You agree to conduct this pro bono work with the same high ethical and professioanl standards as in your general practice.
6. You agree to keep in touch with SPNW about your availability and practice info.
7. You agree to maintain appropriate malpractice insurance that covers your work with clients (including those seen at no cost through this project) in private practice.

These are the most simple and elegant membership rules I've ever seen. They all make sense, and they don't dictate how to do the therapy. The only other rules I heard were about the neccessity to be licensed or on the licensure track.

There are plans for support and training of we therapists. I requested information on Traumatic Brain Injury, about which I know little. I offered to do a basic traumatology workshop. The conveners gave us piles of paper full of information, including many information-filled websites for clinicians and active duty people, veterans, and their families. I think that EMDR HAP could get involved, since it's a non-profit, and will be contacting the main office soon, to find out.

If you want to join, volunteer in some other capacity or want more information, contact Trisha Pearce at  soldiersprojectnw@yahoo.com .

Dan Siegel's Parenting From the Inside Out

The Reading Group (Brena Lever and I) met last week to discuss Parenting from the Inside Out by Daniel Siegel and Mary Hartzell. At that moment Seigel happened to be meeting with the Dalai Lama, Dan Goleman, and some other child psychology types, about a mile from my house, to discuss how to grow compassionate children. We were lucky enough to be able to watch the discussion on cable. You can watch it yourself on your computer (and most of the 15 Dalai Lama events) at http://www.seedsofcompassion.org/ .

We had time to discuss the book. We were both surprised by it. I had expected Dan-Siegel "light", a book I could hand to any literate parent, for step-by-step attachment instructions. It was Dan-Siegel "medium". The book is not an easy read, except in contrast to Siegel's other books. I would give it to well-educated, analytical parents. Or I would assign specific readings, with possibility of reading more.

Siegel and Hartzell recognize this. Each chapter has 3 parts. An explanation of an idea, with one or more case examples. A brief list of "Inside-Out" exercises for the parent to do. And a longer section "Spotlight on Science" for people who want to know about the mechanisms of trauma and attachment. A hurried or less educated person could read the first part and work with the exercises. A motivated, less hurried, and more scientifically oriented person could read every word, as we did.

It's a good book for understanding how our own traumas and attachment styles can impact our ability to see and respond to our children, and that we need to do our own work to develop a "dual awareness" of our old stuff and our real here-and-now kids. It's a good book "Seigel-medium" from which to learn about attachment styles, attachment research, and the impact of parental attachment patterns on their kids' attachment styles.

My favorite concept from the book is "earned secure attachment", the getting of a healthy attachment style from therapy, mindfulness, and/or good later attachments. "Earned secure attachment" is what we want for our clients, and, in many cases, ourselves.

Here's what our two-person group thought: Therapists should read this book, because it's the easiest book that Siegel has written. Inside Out has covers all the regular Siegel topics, but less academically. Then they should explain the concepts to their clients, and work their clients (using many possible therapies) through their traumas and into earned attachment (if needed) and into an awareness of the necessity to mirror, support, and share joy with their children. They can suggest this book to bright, educated, curious parents. They should avoid giving it to people for whom it would be too frustrating.

The Soldiers Project, Washington

Nicole Brodeur featured "The Soldiers Project"  in her Friday Seattle Times column.  This some of what she said:

" Trisha Pearce, who lives in Stanwood, is starting a Northwest chapter of The Soldiers Project, a network of licensed mental-health counselors who offer free psychological treatment to active-duty soldiers, National Guard members, reserves, veterans and their families.

The nonprofit Soldiers Project was founded in 2004 by Los Angeles psychiatrist Judith Broder, who was moved to act after seeing a performance of monologues written by an active-duty Marine and featuring Iraq veterans.

Some 35 percent of Iraq War veterans seek counseling in the year they return. This year, the U.S. Department of Veterans Affairs will spend $3 billion providing mental-health care to about 1 million veterans.

That helps, Pearce said, but the VA's culture of bureaucracy alienates some veterans.

Others don't want to get in any deeper with the military. Or they don't want mental-health issues to be on their records. Or they were dishonorably discharged and aren't eligible for benefits.

Then there's the National Guard: "They're not coming back to a military base," Pearce said. "They're in Baghdad one day, and then they get off the plane and they're home in Bellevue and their wives want them to clean the gutters.

"They are not going to come back and be who they were."

Before she can help them, Pearce must first build a network of psychotherapists willing to volunteer at least one hour a week to soldiers in need.

Once that's done, clients could call or e-mail and, within 24 hours, receive a response from a clinician who will gauge their needs, then search the database of therapists.

On April 28, she will hold an informational session for therapists from 7 to 9 p.m. at University Lutheran Church in Seattle. (RSVP to soldiersprojectnw@yahoo.com).

The project has given Pearce a new purpose and forced her to abandon the antiwar sentiment she embraced in the 1960s. "We should all be saying, 'We're here for you,' and support veterans by making it simple for them to get psychiatric care," Pearce said. "It should be our responsibility, like paying taxes, to go out of our way and do something."

The Soldiers Project started in Los Angeles and has offshoots in Chicago and New York, and of course, Seattle. Check out the LA website at  http://www.thesoldiersproject.org/ for more information, or better yet, if you'd like to start your own chapter in your town.

Writing a book

I've finished three and a half chapters. I'm giving myself until late April to finish three and a half more. The act of writing is getting easier as my mind slides easily into the "groove"; the neural avenues of "writing behavior" lengthen and widen and make thousands more connections.

I no longer wake up at five a.m. with my brain saying "Write this, right now!" My brain seems to trust that I have 3-4 days each week for writing. It's mostly willing to wait for a writing day. When the day comes I sit down and read what I've written so far, tweaking and editing as I go. Then the words come and I find out what I know about the topic at hand. Then I read it over, tweaking some more, and adding more as the neurons connect to other information.

Most of my writing is taking dictation. (No, I don't think it's Ramtha telling me what to write. And I don't think I've got a dissociative disorder.) It's the writing voice that holds the information and the right words until I need them. It's the same voice that comes out during the 4-6 hours of consulting I do each week. Someone asks me, "How do you do EMDR with this client with this problem." And the answer, if I know it, flows out in spoken paragraphs. I redirect the voice to my fingers and the paragraphs appear.

After thirty years in practice, it's fun to find out what I know about things. I'm in the middle of the chapter about Medically-based traumas. I sat down and wrote a list of cancer-related EMDR targets, from pre to post cancer treatment. I'd never thought of the list before, but I've done these things with people over the years, and my brain made a coherent organization, that I'd never consciously thought. I love how we can program ourselves to do these complex things, and just get out our own way and do them.

My mother writes fiction. My husband is a photographer. Both of them organize complex data from an unconscious space. Mom drags her writing out of her guts. Doug "shoots from the heart". I think my writing is from the brain, though my motivation to do it is from my brain and from my heart. Writing is fun for my brain in the way my crossword puzzle addiction is fun. I find the word that fits, and am more likely to find the word if I don't try very hard. If I can't find the crossword or the right word in a sentence, I go to Dictionary.com's thesaurus and look it up. The heart part drives the motivation. I want to reach as many therapists,and their clients, as I can, with the information I have amassed over the years. I want to relieve as much suffering as I can with the skills that I've been given. And I want to give other skilled therapists the venue to do the same.

As I write, I think of the other writers sitting at their computers, getting out of the way of their internal writers; letting the words flow; chasing down citations; tweaking sentences; and providing new ways for therapists to help their clients heal.

PTSD Has Genetic Aspects

http://arstechnica.com/journals/science.ars/2008/03/18/study-identifies-gene-x-environment-link-to-ptsd  is a link to a website that discusses the connection between a stress-related gene and the likelihood of developing PTSD.

The new issue of the Journal of the American Medical Association features an article by Dr. Kerry  Ressler and several co-authors found that specific variations in the gene appeared to be influenced by child abuse. That interaction strongly increased the chances for adult survivors of abuse to develp signs of PTSD. The worse the abuse, the stronger the risk in people with the gene. (Though that might be true in any population.) From the Seattle Times: "The results of the new study suggest there are critical periods in childhood when the brain is vulnerable to 'outside influences that can shape the developing stress-response system'. . .Dr. Thomas Insel, director of the NIMH, said the study is valuable for the light it sheds on military veterans. He said the results help explain differences in how two people see the same radside bomb blast. One simply experiences it as a bad day and goes back to functioning. The later develops paralyzing stress symptoms." See below for the Seattle Times link: http://seattletimes.nwsource.com/html/health/2004291429_ptsdgene19.html