Trauma & Attachment Therapy

Easy Ego State Intervention Workshops

Dear Readers,

Ego state work has been around since before Freud, and in latter years, has been the main stay of many practices. Interventions can range from "How old did you feel when you were yelling at your wife?" to "Let's identify those dissociative states that take over your body." I've been working with this stuff since I became a therapist, 38 years ago, and have read, been taught, taught, and written about it, extensively. It's one of the most versatile tools and lenses through which to see clients that I have.

In January, I expanded my 2-day Ego State training to 3 days and presented it in near London, England. there was time for practice, demonstrations, and some case consultations. Participants raved about the workshop, saying things like "I know MY parts now!" "I know exactly what to do with many of my clients!" "This is the most practical workshop I've taken!" There is special info for EMDR practitioners, but you don't have to know EMDR to take the workshop and get credit. EMDR practitioners get 12 hours for EMDRIA and 12 for their profession. Others get it for their profession.

I'm  giving it several times this year. 

• 4 days in Milan,Italy.  May 10 -13 https://www.international-isc.com/wp-content/uploads/2017/12/brochure-shapiro-ing.pdf
• 3 days in Seattle, WA, June 8 - 10 https://www.eventbrite.com/e/easy-ego-state-interventions-seattle-tickets-44375863402  
• 2 days in Des Moines, Iowa October 20 and 21st, link to follow
• 3 days in Boston November 9-11, link to follow

Here is what I cover:

• Distinguishing Healthy/Flexible and Dissociative Ego States (and map your own)
• Overview of Ego State Interventions
• Identify Vagal States
• Use Embodied Ego State Interventions (includes practice)
• Clearing Trauma (includes practice)
• Theory of Structural Dissociation
• For EMDR practitioners, distinguish when EMDR, when EMDR and when both are the treatments of choice
• Tools to work with sexual abuse, and then bring back healthy current sexuality
• Work with Attachment Issues, including April Steele’s Building a Secure Self (practice)
• Couples Therapy
• Calming Over-Active Immune Systems, Multiple-Chemical Sensitivity (possible demo, if someone has one)
• Pain Protocol
• Shame (practice)
• Suicidal clients
• Resourcing (including installing your own “team”)
• Healing Personality Disorders
• Working with Dissociative Identity Disorder

If you can't get to a workshop, you might read Easy Ego State Interventions or sign up for one of the many good trainings on this subject. It's good stuff to know!

Trauma Treatment Handbook: Protocols Across the Spectrum

My copy of the new book arrived today. Here is what Diana Fosha says about it:

"This is a thorough, accessible, and very practical book, filled with resources and sound ideas, filtered through the intelligence and experience of a savvy, compassionate, down-to-earth, and very experienced clinician. It is like a travel guide to the land of trauma and trauma treatment: if you are new to it, it will orient you to all there is to do and see; if you're a frequent traveler, it is a worthwhile reminder of all that is out there, above and beyond the familiar places you always visit. Once could ask for a better guide. I highly recommend it."

I explain trauma, complex trauma, dissociation and how to assess them and prepare for treatment, and all the kinds of treatment that I know about from the main-stream to the obscure. I talk about working with military, sexually-abused, and relationally traumatized people, and how to take care of yourself while doing the work.

 Some of my heroes comment on it. Dan Siegel wrote the introduction, despite my lack of research. Diana Fosha, Stephen Porges, Kathy Steele, and Onno van der Hart wrote very nice blurbs on the back. I'm humbled by their support.

This is the first book written completely by me. I'm amazed to be responsible for synthesizing so many people's therapies in one book. The design is great, and the photos, by Doug Plummer (my beloved) are gorgeous.

GPS-Directed Socially-Engaged States

Two years ago. My husband and I drove up the California coast after the Lifespan Learning conference. We did it again after this year’s conference, with a remarkable difference, my skinny-nervous husband was rarely in hypermobilized vagal states on this trip. I blogged about the last trip, here: http://traumatherapy.typepad.com/trauma_attachment_therapy/2007/03/mobilization.html

In 2007, every time we came into a town, he’d get anxious, incapable of social connection, and constantly scanning for danger. He couldn’t problem-solve very well or negotiate with me about restaurants, hotels, etc. (When relaxed, Doug is a well-connected, loving, sweetheart.) This time he could chat, problem-solve, laugh, play, and negotiate. What’s the difference? We have a GPS device.

Doug has been navigating foreign terrain with his GPS for over a year. (He travels a lot for his photography work.) "Emily" tells him where to go and how to get there. She locates food and shelter. She usually keeps him on the path. Her calm British voice directed us through our five-day trip. Yesterday, she got us around San Francisco, where the traffic can be mobilizing for anyone. Today, she will again.

Because of Emily, I don’t need to back way up to allow Doug time to reset to a meyelenated ventral vagal state, capable of socializing, thinking, and shooting pictures. He spent less time in shut down, dorsal vagal immobilized states, too. His body didn’t need to shut down to recuperate from the mobilization.

As you can imagine, this trip was more fun. We stayed engaged much more of the time. There were less occasions or need for repair. Doug fell into his birding swoons or photograpy swoons much more easily, both highly engaged states. (104 species before we hit San Francisco. But who’s counting?)

We both talk to Emily. And we allowed her to lead us astray, a few times on purpose. (That’s how we saw the White-Tailed Kite, a beautiful hawk that "treads water", Kestral-like, in mid-air while searching for little rodents and reptiles.) If you are or travel with a "born to be anxious" person, I recommend a GPS system for your car. It took the unfun kind of mobilization out of our trip.

UCLA Trauma Conference Synthesis

I escaped the conference yesterday, and am typing in the dark this morning beside my snoring husband. I can’t see my notes, so let me tell you my impression of the conference:

Trauma impacts the right hemisphere of the brain. Helpful trauma therapy targets the right brain. Left brain cognitions and interpretations don’t have much impact on the right brain. (So said Alan Schore in 500 quotes, yesterday.)

How do we, as therapists, help traumatized people heal? We use our attuned relationship with them to keep them present and socially engaged. If they are socially engaged, now, they’re in a meyelenated ventral vagal state and can’t go dorsal/shut down /immobilized or too ventral/ mobilized/ hypervigilant. Connect. Attune. Not just with your words: "I hear you say that you’re scared." Attune with your body. "I feel your fear in the room." Then help your clients locate that sensation. "Where is it in your body?" Then stay connected with them as they mindfully explore what it’s like to be scared, while connected to you, and tracing the affect through their body. If you’re Pat Ogden, you will have your clients try out the movement that they didn’t get to do when the bad thing happened. (I have a movement tx background and incorporate this in what I do.) If you’re Diana Fosha, you’ll use the power of your connection and your brilliant countertransferential language to do hold the clients in your therapeutic embrace while they move through the trauma. (I use her language all the time – in the moment self-disclosure as containment and dual attention, cool stuff.) If you’re Francine Shapiro, you will make sure that client have a deep, attuned connection with you, while bringing cognitions, affect, and sensations into consciousness, applying periodic eye movements, and deeply connecting during the breaks between, while the clients watch their minds clear the trauma. If you’re Dan Siegel, you’ll teach your clients mindfulness, so that they can get fully present, so that they can socially engage, be present with the trauma, and let it move through with whatever techniques you use. If you’re Bessel van der Kolk, you might do any of the above, and you’ll send them to Yoga class, to become re-embodied.

What are the threads that run through this varied work?

1. Presence. Getting into the here and now experience of body, affect, and thought. That includes clients being inside the Window of Tolerance: not overstimulated, not immobilized (dorsal vagal), not over-mobilized (unmeyelenated ventral vagal). Present and capable of connection so that the work can move through them.

2. Dual Attention: In EMDR, it’s the bilateral stimulation. In Yoga and in Ogden’s work it’s the attention to bodily experience. In Fosha and good relational analytic work it’s the relationship that keeps one mind on the present and the other on the traumatic past.

3. Affect while in relationship: In all of this work, clients have affective experiences while "held" inside the window of tolerance and a therapeutic relationship. It’s not that the affect is "discharged", though it might be. It’s that it is felt; not avoided; witnessed; survived; and transformed into a memory, no longer a developmental catastrophe.

4. Relationship with self and the other: Tolerance for one’s own affect and history. Capacity for relating to others.

You have just read the thesis of my next book, Trauma Therapies. I already had it, and was validated and heartened by what I heard, every moment. The next wave of therapy is Right Brain, Mindful, Affective, Embodied, and Relational.

The husband is up and it's time to go. I'm on vacation for the rest of the week. Imagine me bird and scenery-watching on the California coast, self-regulating with no set schedule. I want to see a Condor, this time.

UCLA Trauma Conference Day 2: Dan Siegel, Mindfulness

Daniel Siegel: A System's View of Disintegration & Integration

(He's still cute, he's still brilliant, he speaks in easy-to-remember aphorisms and he's still heartful. What's not to like?)

"Integration is the linking of differentiated parts. The concept is useful for assessment, tx planning and therapy. . .Presence is absent in trauma survivors. Presence begins with us as therapists."

P.A.R.T.T.T.T  
when fully
Present we can
Attune to the client or others and
Resonate with others and develop
Trust which is important because it activates the smart ventral vagus so the social engagement system turns on so that we can
Track what's going on in moment to moment experience which allows the
Truth to come out and creates
Transformation/healing.

We help clients become open systems: self-organized: chaotic moving toward complexity, flexibility and adaptable: energized and coherent. System acheives complexity by linkiing differentiated parts. Coherence comes from integration. (Thank God for systems theory in social work school in 1979! I understand this stuff!) When not integrated we move toward rigidity (avoidance), chaos (flooding) or both.  It's all about the mind regulating the energy and information flow. "The mind is in the whole body and among people: it's embedded socially/relationally and embodied." "What I am is a process of regulating energy and information flow, not limited to our bodies and right now and this relationship. The ripple effects after we leave or die are also who we are." (My woo-woo teacher says the same thing. So does Hillel, sort of.)

Calming exercise: Put one hand on your heart, the other on your abdomen. Hold them there for a while. Try switching hands to see if you prefer one over the other. Most people do.

Your right hemisphere contains the storage of autobiographical information. PTSD is impaired integration. Long story about how a past trauma impeded on the present and how mindfulness allowed him to integrate the past event and stop reacting to the trigger.

"There's a distinction between awareness and mental activity: Awareness is the infinite possibility of neural firings."

In trauma, mental activies get locked into rigidity and chaos and pull humans into limited possibility. With unresolved trauma, rigidity and chaos imprison the person's possibilities. Good therapy transforms the brain of the the client to totally shift their center of attention and stay present to the self and watch self and make sense of it. The labeling of the internal state downregulates the limbic system. The client knows that "this" is not "that". Integration is the capacity to sit with core awareness and sit with anything that comes in. You can use mindfulness practice to help people distinguish between mental activity and true awareness. Ventral integration--being touch with the bodily state: Track it and you transform. Supress it and it screws you up.

"Liberate the innate drive of a complex system to integrate. Interpersonal integration: We are designed to be interdependent and interconnected. There's hope for we as humans to move from chaotic & rigid states to integration, kindness, and peace.

(Thank you, Rebbe Dan.)

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After Dan, Martha Stark, a child psychiatrist spoke about Optimal vs Traumatic Stress. Traumatic Stress overwhelms and disrupts. Optimal Stress provides the impetus for transformation and growth. Optimal Stress--you need enough to stimulate adaptation and growth but not enough to overwhelm the system. In therapy, challenge when possible and support when necessary. (My brain was full and I took a walk.)

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The Question and Answer period at the end of the day was worth the price of admission:

Dan Siegel: Txist attunement helps clients widen their ability to be with emotions and curiosity; integrates the experience; brings openess; widens the window of affect tolerance and acceptance and love, and moves away from rigidity and chaos. Be safe but not too safe: push the limits of the window of tolerance.

Francine Shapiro: Schizophrenia is sometimes misdiagnosed. Not all psychosis is genetic. Some is trauma-based, early and not-so-early childhood. If you target the negative experience, set up information processing. If they have positive networks to go to, the trauma will clear. Do processing if the client can stay present during processing (maintaining a dual awareness) and have positive experiences to call on. Otherwise spend as much time as you need to set up those positive networks. Truly schizophrenic people can be traumatized by their disease or by abuse, or disrupted attachment. Go after those targets if the client is resourced enough.

Pat Ogden, to Dan: Too much attention to mindfulness doesn't develop relational capacities. Dan to Pat: If you improve mindfulness, people have the capacity to connect. Capacity for the parent to be with his/her own self and material predicts the kid's secure attachment.  Teach people to harness the social capacity of their brains.

Steve Porges: We've developed to deal with humans, but school teaches/rewards dealing with objects. Psychiatry depersonalizes relationships. We need to teach social interaction: develop exercises. Play tempers mobilization states. We need more exercise that is face-to-face. Treadmill running teaches mobilization, badly. (I disagree.)

Bessel van der Kolk: Med school kills empathy in trainees. (Cited research)

Francine: EMDR and Dreams. Same brain process. (Robert Stickgold) Customize sets by attuning to clients needs. Goal is to take the REM state further than it goes in sleep. Images change in each set as new positive information comes in. . . Early therapeutic intervention for early humiliation would help people immensely. We need to teach parents and educators the impact of humiliation. (Jim Knipe and I wrote chapters about using EMDR on these issues to clear depressionin Solutions II.) The window of tolerance closes because of these childhood negative experiences.

Bessel: EMDR is hypnagogic, like sleep with very rapid associative processing. . . But people need to move, to play. EMDR has no movement. People need to complete the movement. But, research shows that EMDR clears 83% of the trauma. Movement-based treatment doesn't have the same success.

Martha Stark: Did EMDR with an insomniac client over a suicide attempt. In processing she remembered that at the last minute she saved herself, and the meaning about self changed for the better. Her insomnia disappeared and she started to remember her dreams.

Skipping some -- too tired.

Dan: Mindfulness creates secure attachment to the self. It's a way of being. Mindful awareness is brain hygiene, not a religion, should teach it in schools, to doctors, and create empathetic practitioners.

More in the next few days. Steve Porges read this blog and told the other presenters about it. I got some interesting attention today.

 

 

UCLA Trauma Conference 3/7/09 Day2: Porges

Stephen Porges, Demystifying the Mechanisms of Trauma: Maladaptive Consequences of Adapative Bio-Behavioral Reactions to Life Threat 

Stephen Porges knows how to connect. I could listen to him talk all day.  I explain his Poly-vagal theory to every trauma client and every consultee. Today, after he answered a difficult question, in a most kind way, my friend Barbara said, "Now, I'm in love with him."

Here's a post from exactly 2 years ago on Porges and his work. It might help to read it first. http://traumatherapy.typepad.com/trauma_attachment_therapy/2007/03/ucla_attachment.html

Here is the quick and dirty explanation of the Polyvagal (PV) Theory: "Neuroception of danger and safety or life threat trigger 3 neurological circuits." They developed at different evolutionary times. The newest one (Green Traffic light) occurs when we understand that we are in a safe environment. When it's on, we have the capacity to be socially engaged, to think, to hear and understand other humans, eat and to play. The second oldest (Yellow light) is engaged when we perceive danger, but we don't think it will kill us. In this mobilized state, we attend only to cues about danger and safety. We can't connect well, we can't even really hear people. We are scanning for danger and predators. The third state and evolutionarily oldest state (Red light) is immobilization in the face of life threat. We shut down completely, can't connect, feign death, and can't/don't have protective reflexes. (Can you say "dissociation?) 

Today, Porges said that "our nervous system reacts differently to the same stimulus, depending on our psychological state." The Polyvagal theory is about our biological quest for safety. He bemoans that these states aren't better recognized and then explained to clients, medical patients and all trauma survivors. Here are some but not all of the gems from his presentation:

People are different. The same stimuli can create different states in different people depending on a host of factors: genetics, attachment, and history. He talked about voodoo death--when people are literally scared to death, they aren't hyper-mobilized, but immobilized. Their hearts and respiration slow down to nothing and they just die, when cursed or after having broken an "unbreakable rule" and they have no ability to escape, no options, or are being held tightly.

"Immobilization with fear is a missing concept in psychology and psychiatry and medicine."

Vagal Paradox: Slow heart rate is mediated by the vagus. Sometimes too much (see voodoo death.) Heart rate variability (a good thing) is primarily mediated by the vagus and is a protective factor. "If the face is flat, the heart rate is flat. If the face is lit up, there's heart rate variability."

Singing, listening and chanting: when we feel safe and tuned into the tones we hear best, the human voice, we can't hear the low tones, the predator frequency. . . New brain circuits damp or control the old ones. We lose the adaptive urge in immobilization, pain threshholds are raised, we conserve metabolic resources and are prepared to die. (Imagine chronically abused people who live in this state, over and over.)

Yoga students with abuse history get a higherheart rate after mild exercise. No abuse hx, makes for a lower heart rate. Abuse supressed vagal regulation and lowered the threshold to be defensively reactive. Tell clients: "Your threshold to react changes and this is what happens."

Since "social behavior is a regulator of our physiology", use your self to help your clients regulate. Make the office safe. Make it quiet. Muffle the low traffic noises. Have face to face interactions that are safe.

"Face to face is play with reciprocity." What could be aggression without face to face contact becomes play. Puppies and kitties look at each other when playing. So do kids. So do people in consensual sex. People can be in a mobilized state, without fear, in play. They can be in an immobilized state without fear in play or rest. (Baby in mom's arms).

The nervous system continuously evaluates risk. Reactions to life threat is not easily reversed. These reactions can bring up rage if a client misreads the clues. (Think borderline or DID clients.)

Auditory pathways (music, voice, and song) invites proximity. It's the first route in to change the nervous system. Music therapy in the frequency of the human voice and social engagement help traumatized clients regulate themselves. So does Prana Yana breathing, with slow exhalation.

(Stephen, if you care to correct, edit, or add anything, I'd be honored. Links to articles or websites would be great, too.)

More tomorrow.

 

UCLA 2009 Trauma Conference Day 1, van der Kolk & Shapiro

Day 1: Bessel van der Kolk is lovely. He's humble, he's funny, and he is the premiere researcher on the neurobiology and/or efficacy of trauma treatments in the world. And cute and brilliant, of course.

Here are nearly random gems from 3 hours of notes:

With trauma, there are no stories, only sensory experience: images, affect, and tactile, olfactory, and auditory experience. Bleure (1920): People can't hold the memory of the trauma--can't tell the story. The solution is taking action against the person who hurt you or telling the story over and over. (Prolonged exposure). Bessel says "No. Telling the story is not enough!" Later: "When people are into their trauma, they cannot talk about it. They become dumbfounded." Because Broca's area in the brain shuts down. "When the left brain shuts down, we must shift to right brain processing."

"Our job as trauma therapists is to bring the frontal lobe on line." (He said that GW Bush showed himself to be a "limbic" president with his "Let's kill them all" speech after 9/11. "A dangerous limbic-run man.")

The body relives and reinstates the initial trauma state, even the stress hormones.

Exposure therapy "blasts people's brains with the trauma and drives them crazy. That's supposed to be good for people?" And said the CBT literature is full of the treatment triggering suicide attempts, substance abuse, and worse symptoms.

He talked about his amazing EMDR vs Prozac study. 80% of adult onset trauma completely cleared PTSD & Depression after 8 weeks of tx. Prozac people felt better until they stopped taking the drugs. EMDR folks got better and better for months after tx and stayed that way. Cool study and he had trouble getting published despite 3X the success of CBT. Politics.) http://www.emdr.dk/artikler/07_kolk.pdf

Bessel and many of the top child psychiatrists and psychologists are lobbying for an new DSM 5 diagnosis: Developmental Trauma Disorder:  http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf 

It's much needed. I have so many clients who need this diagnosis! (gai

Developmental Trauma Disorder

A. Exposure

1. Multiple or chronic exposure to one or more forms of developmentally adverse

interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to

bodily integrity, coercive practices, emotional abuse, witnessing violence and death).

2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

B. Triggered pattern of repeated dysregulation in response to trauma cues

Dysregulation (high or low) in presence of cues. Changes persist and do not return to

baseline; not reduced in intensity by conscious awareness.

•Affective

•Somatic (physiological, motoric, medical)

•Behavioral (e.g. re-enactment, cutting)

•Cognitive (thinking that it is happening again, confusion, dissociation,

depersonalization).

•Relational (clinging, oppositional, distrustful, compliant).

• Self-attribution (self-hate and blame).

C. Persistently Altered Attributions and Expectancies

•Negative self-attribution

•Distrust protective caretaker

•Loss of expectancy of protection by others

•Loss of trust in social agencies to protect

•Lack of recourse to social justice/retribution

•Inevitability of future victimization

15

D. Functional Impairment

•Educational

•Family

•Peer

•Legal

•Vocational

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Bessel talked about vagal nerves (see Porges--later) and said that you can change the way you feel by changing the state of your body (thus our affinity for alcohol, drugs, and sugar.) Drugs, tai chi, karate, yoga, meditation and exercise manipulate the vagus nerves. Do yoga, etc. to affect the state of your body.

"Emotional Regulation is the most important issue in psychotherapy."

Cloitre 2007: '"If treatment relationship lead to affect regulation, the patient gets better."

In a study with chronically traumatized clients: 8 weeks of Yoga class beet 8 weeks of CBT with 28 hours of homework.

In PTSD, the thalamus goes offline. The thalamus orients you to where and when you are in a autobiographical context. Much of the brain goes offline when immobilized and there are no available receptors for attachment or problem-solving.

"Thinking has no avenues of access to the emotional brain. (You can't talk yourself into loving Dick Cheney, whatever the incentive.) . . . Traumatized people don't have a sense of being deeply present because the anterior singulate is off-line. . . Keep clients oriented to 'now' in themselves: 'How does your body experience that feeling?' . . .Help clients process what's inside of their here and now consciousness."

Trauma survivors see the trauma or the "bad thing" as outside of themselves, not as their own response to something that happened. "Bring attention to the body, to internal landscape: What's the sensation? Where do you feel it? What happens if you try something? Take a deep breath, right now. Do TFT tapping on the collarbone spot. . . Notice what comes up and remember how it will come to an end. How can we give the miserable, alone, frightened part of you some company? . . . Tell her you know how terribly lonely it was."

"You can't do trauma work without people deeply observing their own level of consciousness and then deeply connecting on the outside with you."

"The emotional brain runs the show." Feelings should be guides rather than a source of terror.

Bessel spoke of the importance of EMDR and Somatic therapies in working with trauma and showed a moving video of a formerly DID client who was "organized" by neurofeedback. "EMDR is the opening for understanding trauma. You can't do trauma treatment without EMDR or something else that knits the sensory experiences together."

Part II: Francine Shapiro, the brilliant maven of EMDR, looking well and energetic.

Much of what Francine said was material you can find at emdria.com or the EMDR Institute website: The Adaptive Information Processing model and the steps of EMDR treatment. Today I heard her say some different things: The importance of targeting the "small t" traumas. Much of the trauma that can severely impact a life does not fit the criteria for PTSD. She gave many examples of people who developmentally stopped at some distressing, non-life threatening event, until an EMDR session, years later, released them. (It happens. I've seen it many times.)

"Neurophysiology does not equal destiny." There is neuroplasticity in adult brains. Shrunken hippocampi grow again, after the trauma is resolved. Don't give up! A study: 8 sessions of EMDR, 20% increase in hippocampal growth.

Beliefs are a manifestation of trauma. CBT/Exposure = extinction. EMDR = reconsolidation. In prolonged exposure, the memory of the rape doesn't change, but get a competing new memory. But the clients relapse when around a trigger, because the old memory is still there. EMDR reconsolidates memory changes, so the initial triggers won't work.

"Processing dysfunctional and positive memories are the focus of EMDR treatment. Process the negative and integrate the positive. Every positive attunment or modeling by the therapist links the positive information in. . . You need to have positive adaptive memory networks for tx to work."

Process: Family of origin issues, memories that are encoded; Defenses, i.d. the earliest childhood event that caused that pathway to develop; cognition, process the memories that created the cognition--the cause is the encoded earlier event; Somatic/Emotive, "When's the 1st time you felt that way?"; Developmental, "What events derailed attachment?"

(I'm getting too tired to give you all the rest, so I'll hit a few highlights:)

ADHD: some of it is PTSD, some real ADHD.

Body dysmorphia: usually from childhood humiliation, sometimes just one comment. Clears with a few sessions. (There's a chapter in Solutions II about this.)

Small t traumas cause more pathologies than PTSD.

Axis II (personality dx's) are a constellation of attributes, each rooted in earlier events.

Borderline Personality Dx: Cool stuff-- too much to write. But Axis II is moveable and cureable if you go after the childhood antecedents. (I know because I have ex-borderline clients and ex-narcissists.)

If you are treating kids, treat the parents attachment issues and the kids get better. Include in this: targeting the non-bonding event with the child, then make a story about an easy pregnancy, each trimester, an easy delivery, the first breath, first hours, coming home -- better than real life, and install it.

In family systems, you can treat the family of origin issues in every one, all the behavior. Teach skills after the trauma is gone, when it can sink in.

Depression. Yes, See the first 5 chapters in Solutions II.

Phantom Limb Pain. Yes. See the PLP chapter in Solutions I--Wilson

Grief: "There is more positive recall of the loved one after EMDR (for traumatic grief) than after CBT. (Sprang, 2001)

EMDR increases resilency and engenders a new sense of self.

 

 

Babette Rothschild: The Body Remembers

The name of the workshop was "The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment".  The main point was: therapists do too much trauma therapy too early and should do much more preparation before they do the "memory processing" and should often do no trauma processing at all. She talked alot about helping people regulate their physiology by 1. "Talking about recipes or baseball" 2. Tracking their sympathetic and parasympathetic responses 3. Using cognitive techniques to separate past trauma, experienced as flashbacks, from here and now reality  4. Using some simple toning techniques to ground and feel the body. 5. Noticing external and internal resources.   Then she left out "making the experience of trauma go away."  The physiology was old hat: sympathetic and parasympathetic instead of vagal nerve tone, wrong information about the hypothalamus, etc.

I like trainings in which the presenter turns the fire hose of information on me and I have to swallow all that I can. This wasn't one, by design.  Rothschild says that she wants people to get the theory and then extrapolate what to do, out of that. She wants to go slow so that people can take in what she's saying. I agree with her suggestion that clinicians learn at least 3 trauma techniques and then figure out which ones will work with which clients. And I felt that we could have learned what she had to say in about a third the time, so I'm still disappointed. She is in private practice and doesn't take insurance. She seems to do therapy as if there is all the time in the world and that her clients must be ever protected from their distress.

As someone trained in about 10 kinds of trauma processing, I agree with having many techniques. And I think you should have enough technique and interpersonal containment to halp your clients move through the trauma, not just learn to calm down when you have it. Yes, you may need a long preparation phase and you need to have a stable client before you start. And the processing phase is important. Done well, it makes the trauma go away, a good thing.

EMDR and Depression poster

I applied to the EMDR International Conference to lead a 3-hour workshop on Treating Depression with EMDR. I wrote four chapters about it in the new book, EMDR Solutions II, for Depression, Eating Disorders, Performance, & More. Instead of a workshop, I was invited to do a poster. I know how to write. I know how to talk. I never had to put four chapters in an understandable form that fills an 8 foot X 4 foot poster and can be seen at 5 yards away. It took about 20 hours, including half-learning a new program (Power Point), formatting nightmares (why did the text size keep changing?), and pruning all my case examples, wit, and nuance from the basic information. It’s still too crowded, but understandable. If you want to see the content of the poster on EMDR and Trauma-Based Depression, Mood-Disorders, and Attachment-Based Depression go here:

Download DepressionPoster-1.pdf

Here are the other chapters. They’re in to Norton, the last laggards have sent in the “artwork” for their charts. And Norton’s copy editor is ready to find 1,000 errors that I missed in 3 edits, and still won’t find them all.

Unit I: TREATING Depression

1.Introduction to Assessment and Treatment of Depression, Robin Shapiro

2.Trauma-Based Depression, Robin Shapiro

3.Endogenous Depression and Mood Disorders, Robin Shapiro

4.“Shame is my Safe Place”: Adaptive Information Processing methods of resolving chronic shame-based depression, Jim Knipe

5.Attachment-Based Depression: Healing the “Hunkered-Down”, Robin Shapiro

UNIT II: TREATING EATING DISORDERS

6.The Why of Eating Disorders, Andrew Seubert

7.Integrating Eating Disorders Treatment into the Early Phases of the EMDR Protocol, Janis Scholom

8.The Neurobiology of Eating Disorders, Affect Regulation Skills, and EMDR in the Treatment of Eating Disorders, Linda J. Cooke & Celia Grand

9.Treating Bulimia Nervosa with EMDR, DaLene Forester

10.Image is Everything: The EMDR Protocol in the Treatment of Body Dysmorphia and Poor Body Image, DaLene Forester

11.Addressing Retraumatization and Relapse When Using EMDR with Eating Disorder Patients, Janet McGee

12.Desensitizing Desire: Non-Verbal Memory and Body Sensations In the EMDR Treatment of Eating Disorders, Catherine Lidov

13.The Case of Mistaken Identity: Ego States and Eating Disorders, Andrew Seubert & Judy Lightstone

UNIT III: PERFORMANCE, COACHING, AND POSITIVE PSYCHOLOGY

14.EMDR and Performance, David Grand

15.EMDR and Positive Psychology, Ann Marie McKelvey

16.EMDR and Coaching, Ann Marie McKelvey

UNIT IV: Solutions for Complex Trauma

17.EMDR Friendly Preparation Methods for Adults and Children, Katie O’Shea

18.The EMDR Early Trauma Protocol, Katie O’Shea

19.Towards an Embodied Self: Integrating EMDR with Somatic and Ego State Interventions, Sandra Paulsen & Ulrich Lanius

20.Direct Targeting of Intrusive Images: A Tale of Three Soldiers, Elizabeth Massiah

21.Attachment, Affect Tolerance, and Avoidance Targets in Obsessive Compulsive Personality Disorder, Robin Shapiro

UNIT V: TREATING MEDICALLY-BASED TRAUMA

22.Clearing Medical Trauma, Robin Shapiro

23.Treating Birth Related Post Traumatic Stress, Katherine Davis

24.Treating Multiple Chemical Sensitivities with EMDR, Robin Shapiro 

UNIT VI: MORE EMDR SOLUTIONS

25.EMDR With Sex Offenders in Treatment, Ronald J. Ricci & Cheryl Clayton

26.Using EMDR with Religious and Spiritually Attuned clients, Martha S. Jacobi

MYSHRINK.COM

myshrink.com is a fantastic website/blog full of information about therapy, bodymind connection, anxiety, and depression. It has some of the most cogent explainations I've seen. It's a great resource for clients as well as therapists. It's written and overseen by Suzanne LaCombe, a therapist in Vancouver, BC. She writes clearly, has a sense of humor, and doesn't fall back on academic-speak. If she did EMDR, I'd be soliciting her for a chapter, about anything she wanted. Check it out here.

The Neuroscience of Psychotherapy

The book group discussed The Neuroscience of Psychotherapy by Louis Cozolino (W.W. Norton & Co. 2002). We liked it. Cozolino's book is easy to understand and moves along nicely. It is packed with information about the brain. Its case examples were great, though too few.

Cozolino writes about brain structures--the triune brain (lizard, mammalian, human), the left-right split, the effect of good attachment on brain growth, and the effect of trauma or poor attachment on brain pathology. He refers extensively from 2 out of 3 of my favorite "brain geeks": Seigel and Schore. He calls on theorists from the analytic traditions (Winnicott, Alice Miller, Freud) to discuss developmental and pathological processes. He talks about "neural plasticity", the ability of the brain to grow and adapt long after early "sensitive periods" or developmental windows. (That's why psychotherapy or new life experiences can change the brain.)  He quotes good research to discuss good therapy, which he says (and I agree) is neural growth and integration which is enhanced by:

"1. The establishment of a safe and trusting relationship. 2. Gaining new information and experiences across the domains of cognition, emotion, sensation, and behavior. 3. The simultaneous or alternating activation of neural networks that are inadequately integrated or dissociated. 4. Moderate levels of stress or emotional arousal alternating with periods of calm and safety. 5. The integration of conceptual knowledge with emotional and bodily experience through narratives that are co-constructed with the therapist. 6. Developing a method of processing and organizing new experiences so as to continue ongoing growth and integration outside of therapy." (p.27)

We liked it, and everyone thought there was a lot missing. The title: The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, has very little discussion of psychotherapy. I was hoping that it would reiterate how Exposure therapy dampens amygdalur function, while EMDR integrates it. I wanted to get the scoop on Stephen Porges's Polyvagal theory and how looking into someone's eyes is a different for them when they're mobilized, immobilized, or in a myelinated ventral-vagal relational state, and how to move them from one to another. I wanted to get the lowdown on which therapy modality might best fit which disorder. (Yeah, Yeah, Cozolino does say that it's the relationship, more than the modality, which I know and say. And I still want to know what to do.)

EMDR has a nice one paragraph mention near the end of the book. Our group of 4 contained 3 EMDR/Brainspotters and 1 cognitive behaviorist/ Brainspotter. We could see EMDR fixing many of the manifestations of brain dysfunction, throughout the book. Cozolino had a great description of what's happening in the brains of people with Borderline Personality Disorder (p. 282-3) without talking about Dialectical Behavior Therapy. We all wanted him to know more about more therapies than he did when he wrote the book. And he didn't.

Read this book to get an easy-to-read rundown on brain function that pertains to therapy. Then read more. Look up Stephen Porges and Polyvagal theory, there are lots of articles online. Read Dan Siegel. Go to Dan Siegel & Marion Solomon's attachment conference at UCLA/Lifespan Learning Center every March. (I think of it as the brain geeks-with-hearts meet hearts-with-big-brains conference.) And remember, that everytime you interact with clients, you're truly messing with their brains.

The Neuroscience of Photographers' Artistic Process

My husband, Doug Plummer, who is a wonderful professional photographer, interviewed me for a podcast about the neuroscience of "being in the zone" of taking good pictures. Given our interests, it's an ongoing discussion. Here's the podcast. It's about 15 minutes long, boiled down from about an hour. If you'd like to visit Doug's blogs go to http://dougplummer.blogs.com/daily/  to see his picture of the day, taken that day. Go to http://dougplummer.blogs.com/dispatches/ to read his blog about photography, birds, and contradance. (Today's post includes a picture of me holding a brain.)