Trauma & Attachment Therapy

NYT's Article: Stimulants given to soldiers may increase PTSD.

Dr. Richard Friedman in "Why Are We Drugging Our Soldiers" shows the correlation between Ritalin and Adderall prescriptions and increased PTSD. He cites several studies showing that these drugs enhance the memory of fear-provoking events. Scary and makes all kinds of sense. Read it!

Traumatic Brain Injury

Traumatic Brain Injury (TBI) is in the news again. Robert Bales murdered 16 civilians in Afghanistan. He has TBI, drinks too much, and just saw a friend lose a leg. Why does TBI matter? 

Traumatic brain injuries are head injuries that can occur from a direct blow to the head, in an accident, sports, or assault (how most civilians get them), or from the shock waves of an explosion (how many military people get them). People who have strokes or brain aneurisms or too many steroids may have the same symptoms. 

Symptoms can include disorientation, memory loss, difficulty learning things, headaches, and confusion. Some people with TBI get right brain damage that makes them lose control of their emotions. They can have outbursts of rage, uncontrollable weeping, major depression that doesn't quit, and even laugh too long and too loudly. When traumatized or provoked, they don't have the normal "off" switch. If you add alcohol to TBI, you add more disinhibiton. If you add trauma, which amps up emotions, you can have the human equivalent of a bomb.  

I don't know Robert Bales, so I can't say more about what turned a nice guy into a mass murderer. However, I have worked with people with TBI. My clients all had memory loss, headaches, and wild emotions. They all had increased startle response, out-of-control anger, low frustration thresholds, and lives that were falling, or had fallen, apart. All these bright people needed help organizing basic things in their lives: finances, schedules, social lives, medical care. All felt dissociative, but weren't: one person when not filled with affect, but like a whole other person when showing emotion. 

With each one, I used EMDR, lots of support, and lots of cognitive work. We always targeted the accident with EMDR. With one person, who had had a tree-limb put a big dent in her skull, we were able to halve the pain, recover a fair amount of memory (2 years of graduate school), and cut back "out-of-her-mind" affect(emotion) in about 10 sessions. With others, it went more slowly, but was still helpful. The EMDR targets for most included the day of the accident, the losses that accrued from the head injury, the daily frustration, and the targets that would bring up much affect. We would imagine emotion rising and cognitively and physiologically calming it down. I taught basic relaxation, refocusing, grounding techniques, and how to deal with others. We brought in family and friends to teach time outs. Either the TBI survivor or the other person could call a timeout and the other one would have to back off, until the injured brain could cool out. I used the future template of EMDR for survivors to image using these techniques when needed. 

I've had a few clients that I didn't know had TBI, until nothing worked with them. After scratching my head, I would finally ask the question: "Have you ever been hit in the head?" In both cases, TBI answered my question, and I knew what to do. When people exhibit TBI symptoms, I always ask this questions at the intake. When people don't exhibit these questions, I try to remember to ask.

Back to military people. I have been hearing that many active duty military and veterans aren't getting proper care for TBI. Why? Poor screening and institutionally not wanting to pay for the cost of extensive, long-term treatment. In my opinion, it's a crime to ignore this devestating injury in the people that are taking the hits for the rest of us. If our country won't pay for the treatment, we will pay for it in traumatized families, increased suicides of military personnel, and more chaos in theaters of war and at home.

An op-ed in the NYTimes: War is Brain-Damaging

TBI Website: http://www.traumaticbraininjury.com/

 

Vets discharged with PTSD finally allowed benefits.

It took a law suit and it's about time!

http://www.washingtonpost.com/local/dc-politics/2011/08/02/gIQAEm8cqI_story.html?fb_ref=NetworkNews&fb_source=home_multiline

NYT's Article: A Typical Suicide of an American Soldier

James Risen writes about a soldier, Staff Sgt. David Senft, with PTSD who kills himself in Afghanistan. The article lists many things that predict successful suicide:

• Senft came from a distressed "broken" family.
• He had many attachment disruptions in childhood.
• He had been on multiple tours of duty.
• He had PTSD from a trauma early in his deployments
• He had attempted suicide before.
• He'd been hospitalized by the Army, because of former suicide attempts.
• The Army deployed him, anyway.

The military's mandate for suicide prevention completely failed this man. Read this sad story to know him and know the details.

Tricare Refuses to Pay for CRT & EMDR for Veterans

National Public Radio wrote and spoke about the "Battle Over the Science" of Tricare not paying for cognitive rehabilitation therapy (CRT) for Traumatic Brain Injury (TBI) "despite pressure from Congress and the recommendations of military and civilian experts, the Pentagon’s health plan for troops and many veterans does not to cover” cognitive rehabilitation therapy — a “limitation that could affect…tens of thousands of service members who have suffered brain damage while fighting in Iraq and Afghanistan.” See article in Veterans Today:  http://www.veteranstoday.com/2010/12/21/battle-over-science-money-blocks-widely-recommended-tbi-therapy/ and the NPR story: http://www.npr.org/2010/12/21/132203864/philanthropist-provides-care-that-the-pentagon-wont

It turns out that Tricare hired a research company that it knew (or maybe told to) would find this well-researched therapy to be "not scientific", despite unanimous by 50 clinicians and researchers on a special governmental commission. The reason: It didn't want to pay. CRT is expensive. And necessary. Thousands of military people are returning from Iraq and Afghanistan with TBI's from exposure to roadside bombs. The shock waves from these explosions move through brains, temporarily jellifying the tissue and causing lasting cognitive problems and difficulties with affect regulation. CRT helps people learn to cope and manage despite brain damage. It's necessary therapy.

This is reminding me of Tricare's refusal, until just this week, to pay for EMDR therapy for vets, despite EMDR's acceptance by the VA, the APA, and other entities as an "evidence-based practice". This was more about politics than money. Cognitive behaviorist and exposure people had colonized Tricare's committees, not allowing support for other effective therapies. I'm sorry that our active duty people and veterans have been victimized by the political and financial b.s. at Tricare. They deserve better.

In my experience, many "researchers" quote studies that support their beliefs and not the ones that support the facts. Or else cling to lab-based double-blind studies. Many effective therapies were not hatched or researched in labs. They work despite the lack of studies. Some, even after the "appropriate" research is complete are debunked because of the belief systems of the meta-researchers.  My belief: Do what works for the client in front of you.

 

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.

NYT's article and video about military women with PTSD.

Video of military woman with PTSD: Video

Article about military women with PTSD: Article

Check out Damien Cave's article in today's New York Times. Women are less likely to be granted disability on the grounds that they weren't in combat, even though they are seeing plenty of action in Iraq. Unrecognized, they feel shame about having the flashbacks and aggression that characterized PTSD and are even less likely to seek treatment than male soldiers.

 

Connie Sidles Interview: Grief, meaning, presence and bliss

Connie Sidles is a famous Seattle birder. Here is this week's KUOW radio interview with her about why she spends so many hours at the Montlake Fill. Connie gives a cogent discussion of dealing with grief, how to create/have meaning in life, how to get present, and why birding creates bliss in its more conscious adherents. Hear her here: http://kuow.org/program.php?id=17451

And if you want to see my husband's book of photographs of the Montlake Fill, go here: http://issuu.com/dougplummer/docs/at_the_fill . You don't have to buy the book to see the pictures. Click on the book then on the pages below. You can listen to Connie on one Explorer and look at the book on the other. Connie wrote the intro to the book.

Waltzing With Bashir

Ari Folman has made a beautiful and devastating movie about trauma, dissociation, and war. As a young Israeli soldier, he was in the 1982 Lebanon war. When a friend came to him with troubling memories of that war, Folman realized that he had no memories about being in Lebanon. A therapist friend told him to ask fellow veterans about what happened and Folman interviewed people until his own memories came back. The movie is animated. It flips between "talking head" interviews with middle-aged men at home, and their younger selves in Lebanon. The animation is amazing; the music, perfect; the characterization of the various soldiers/veterans makes them totally human.

You see the trauma and the men's attempts to cope with it. One man,was considered a genius as a teen. As an adult  he hides on his Dutch farm, constantly stoned.  Some seem untouched. Others still devastated.

As the movie unwinds, you see the event begin to come together--The assassination of Bashir, the Lebanese Christian Falangist leader, led his followers to slaughter men, women, and children in a Palestinian refugee camp. The Israelis, their allies, were supporting the Falangists to "find the terrorists". By the time the Israelis understood what was going on, and the word finally got to the Israeli leadership (slowed down by idiocy and disbelief), it was too late. The last few minutes of the movie are film footage of bodies and wailing women in the camps. There is no other resolution. Nothing to make us feel good.

The movie brilliantly portrays what trauma looks like. Its director also directed the original Israeli In Treatment , which portrays among other things, the therapy of a soldier who inadvertantly bombed an orphanage. I wonder if he was compelled to do In Treatment, before he remembered what he forgot about his own war experience. Here's a link to some "stills" from the movie, and an interview with Folman.  http://lukeford.net/blog/?p=4343 My favorite lines in the interview are, "Having made WALTZ WITH BASHIR from the point of view of a common soldier, I’ve come to one conclusion: war is so useless that it‘s unbelievable. It’s nothing like you’ve seen in American movies. No glam, no glory. Just very young men going nowhere, shooting at no one they know, getting shot by no one they know, then going home and trying to forget. Sometimes they can. Most of the time they cannot."

Evidently the movie brings two distinct responses from some Israelis: "Folman should be shot as a traitor for bringing up the incident."  Or "It's good, he's finally showing the world that it wasn't our fault." My response and the response of the two Israelis with whom I watched the film, was devastation and hopelessness. In the light of our despair over the recent attack on Gaza, we were stunned. We had to walk in the cold wind, swing on swings, and watch children play in order to bring ourselves back to here and now in our safe Seattle neighborhood. Today, I'm back to thinking that the little we do as trauma therapists makes a differences. As Hillel said, "If you save one person, you save the world." I need to keep this always in mind, or I get paralyzed by the trauma we humans create.

NYT's PTSD in Iraq Vets article: Counting the Walking Wounded

The New York Times published this article today. If you haven't starting gearing up to work with soldiers, get some training now. There are online trainings, in-person trainings, and books. You can even start by watching movies: In the Valley of the Elah is supposed to be a great one. Understand that, so far, EMDR has been statistically superior to any other training for PTSD in soldiers.

Counting the Walking Wounded

By LAWRENCE M. WEIN in the New York Times

Published: January 25, 2009

Stanford, Calif.

Related

Times Topics: Veterans and Post Traumatic Stress Disorder

THE American troops in Iraq daily face the risk of death or injury — to themselves or their fellow soldiers — by homemade bombs and suicide attackers. So it is not surprising that post-traumatic stress disorder is a common problem among returning soldiers. But how many, exactly, are affected?

This question is key to determining how large an investment the Department of Veterans Affairs needs to make in diagnosing and treating the problem. The United States Army's Mental Health Advisory Team, which conducted a survey of more than 1,000 soldiers and marines in September 2006, found that 17 percent suffered from P.T.S.D. Similarly, a Rand study put the number at 14 percent.

But these estimates do not take into account the many soldiers who will eventually suffer from P.T.S.D., because there is a lag between the time someone experiences trauma and the time he or she reports symptoms of post-traumatic stress. This can range from days to many years, and it is typically much longer while people are still in the military.

To get a better estimate of the rate of P.T.S.D. among Iraq war veterans, two graduate students, Michael Atkinson and Adam Guetz, and I constructed a mathematical model in which soldiers incur a random amount of stress during each month of deployment (based on monthly American casualty data), develop P.T.S.D. if their cumulative stress exceeds a certain threshold, and also develop symptoms of the disorder after an additional amount of time. We found that about 35 percent of soldiers and marines who deploy to Iraq will ultimately suffer from P.T.S.D. — about 300,000 people, with 20,000 new sufferers for each year the war lasts.

Consider that only 22 percent of recent veterans who may be at risk for P.T.S.D. (based on their answers to screening questions) were referred for a mental health evaluation. Less than 40 percent of service members who get a diagnosis of P.T.S.D. receive mental health services, and only slightly more than half of recent veterans who receive treatment get adequate care. Those who seek follow-up treatment run into delays of up to 90 days, which suggests there is a serious shortage of mental health professionals available to help them.

Proper P.T.S.D. care can lead to complete remission in 30 percent to 50 percent of cases, studies show. Thorough screening of every soldier upon departure from the military, immediately followed by three to six months of treatment for those who need it, would reduce the stigma that is attached to current mental health referrals. The Rand study estimates that treatment would pay for itself within two years, largely by reducing the loss of productivity. This is the least we can do for our veterans.

Lawrence M. Wein is a professor of management science at the Stanford Graduate School of Business.

 

 

EMDR for Veterans: Write a Letter

The EMDR International Association, (EMDRIA) is urging its members to write a letter supporting EMDR treatment for soldiers and veterans. The EMDR Humanitarian Assistance Program has been offering and doing volunteer-run, inexpensive Basic trainings to the military and the VA. EMDR has been accepted by the Department of Defense as one of two effective/allowed treatments.

What's the problem? There is hostility on some of the lower levels of bureaucracy towards EMDR. It's new. It's not what they've always done. And some think that anyone professing PTSD is a weenie slacker. Also, some of the people who have lucrative contracts teaching cognitive behavioral techniques to military and VA clinicians are threatened financially and ideologically by EMDR. HAP trainings are much cheaper then what they're doing for profit. And, according to them, EMDR is either woo-woo bullshit (despite all research) or just another form of exposure therapy.

What can you do? Write a letter to your national senators and congressperson. It's easy, because here's a link to a sample letter and the addresses and how you can do your own if you want to personalize the sample letter: http://www.emdria.org/associations/5581/files/Writing%20Letters%20To%20Congress%202009.pdf

And here's a link to an article germaine to the letter: “Providing EMDR Mental Health Services for the Military” . You can print it and send it with your letter, if you'd like.

This is a worthwhile endeavor. EMDR works with trauma and works with soldiers. I know. I've done sessions with Korean, Vietnam, and both Iraqi war vets.

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  [email protected] .

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 [email protected]).

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.

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

EMDR Humanitarian Assistance Program

I'm on the board of the Humanitarian Assistance Program of EMDR. We are a non-profit organization whose goal is to "expand access to effective mental health treatment for traumatized and underserved communities through direct service and training of local caregivers, anywhere in the world."

HAP's current projects include training therapists in Lebanon, the West Bank,India, Indonesia, and the Philippines. Domestically, it has a big project on the Gulf Coast (post-Katrina), and many projects training staff of community mental health centers, rape crisis centers, child treatment agencies, VA's, military counseling staff, and where ever a non-profit group, serving underserved populations asks them to go (given specific criteria, of course). It is often described as "Doctors Without Borders" for mental health. All trainers and facilitators are volunteers. Trainees are encouraged to become facilitators, and then trainers, so as to create a training infrastructure in each area. (This has happened in Israel, and is well on its way in both the West Bank, and India.)

HAP sends volunteer therapists to some disaster scenes. Many HAP volunteers assisted New Yorkers, post-911, and people in the Gulf Coast, post-hurricanes. In my town, Seattle, we've worked with people in the aftermath of a shooting incident, and with some Katrina transplants. HAP in the midst of formalizing our Trauma Recovery Network (TRN) to be able to connect volunteers to people who need them. Volunteers give 5 free stabilization and EMDR sessions to clients, and are not allowed to see the people, for fee, at anytime. If you are a certified EMDR-therapist, you can volunteer for the TRN here. If you'd like to know more about HAP or make a donation, click here. It's a great organization, well-managed, with most of the money going to direct service. For having a tiny staff, it does alot. HAP's goal for next year is to train 1200 people, who would not otherwise have its traumatology or EMDR trainings. I'm proud to be part of it.

Soldier with PTSD from War or Rape

PBS's Frontline has a new show about the psychological effects of the Iraq War on soldiers, including the culture of "suck it up" in the service that prohibits many soldiers from getting treatment, go here to read about it or watch it online.

The New York Times Magazine has a cover story about rape and sexual harassement in the military. Go here to read it.

Francine Shapiro replies

I had posted on my last thoughts on a private list and got a reply from Francine Shapiro, the founder and steward of EMDR. It was a bit daunting for me. She's smarter, more well-informed, and the inventor of what I do in much of my working hours. She has given me permission to post our discussion. Read the last entry to see what it refers to.

"Regarding a description of VR and EMDR, the actual explanation for the use of exposure therapy is that prolonged exposure is supposed to cause an extinction of the response.  Not a dissociation.  It is based upon animal models and has a long history in behavior therapy. 

Whatever other treatments achieve, I'd be careful about describing shared attributes.  That is, EMDR does not focus on increased affect, but rather the affect generated by the stored memory.  The dual attention is the attention to the manifestations of the elicited memory:image/thoughts/emotions/physical sensations/beliefs---which is an internal focus--and the bilateral stimulation which is external.  The here and now sensations are manifestations of the stored event.  So if that is what the other therapies are focusing on it is not dual attention. 

As we know in EMDR people can process with a primary attention on body OR thoughts Or images.  So none is mandatory as it is in other forms of therapy.  Nor do we coach a client to a coherent narrative as done in other therapies.  It merely evolves as a byproduct of the reprocessing.  As do the changes in affect, body sensation, thoughts, images, sense of self, etc."

My reply: I don't mind you jumping in and I think your comments are absolutely relevant.  I've worked with several people who had had exposure therapy for PTSD, and the experience created dissociation in all of them, not extinction. Of course, they all could have had underlying dissociative processes, before the exposure therapy.
        I went to rat-running behavioral undergrad school: U of Iowa. and cognitive-behavioral graduate school, U Washington. I love how, since then, the neuro-research shows us how it all works. The dampening of affect, with exposure, showing up in the midbrain--I can't remember if it was the amygdala or hippocampus in which the electrical response stops. With EMDR, the integrative process shows up in the left cortex, as more activity in the narrative part of the brain. All the trauma therapies that I like, especially EMDR, which is my "therapy of choice" appear to result in a coherent narrative. I think my language wasn't precise. EMDR brings up "the affect generated by the stored memory." I have witnessed about 20 hours of tapes of Diane Fosha working. I think she does a similar thing. I sat in a 5 day class she did last year. The 6 EMDR therapists who were there, could see the Standard Protocol at work, in what she did. It's all we talked about at lunch. She brings up the old state, the related cognition, the related affect, and the related body sensations. It appeared to us, that the switching of attention back and forth between internal states, related to the trauma, and the connection with the therapist worked much like EMDR. It had the same outcome. Or so it seemed to us.
        I like EMDR, better, because it's easier to teach and easier to keep track of. It's what I do. The Standard Protocol works, and it's not fuzzy. It can be measured. I've taught some not-very-bright therapists the protocol. They were able to do ok, but not stellar, therapy. I don't think they could do AEDP, because it's not as structured.
Thanks for your input, it's always welcome!
Warmly and with great respect, Robin

Her reply:  "It’s hard to know what outcomes really are, or are maintained, without follow up research.  I’d just say  that I’d be careful about the neuro research.  It’s all in it’s infancy.  There are various studies that show various things.  And you can’t link “left cortex” to “more coherent narrative.”  you can say that Broca’s area is off and then activated.  That has to do with language.  But things are a lot more complicated than that.  Exposure therapists claim the same thing (more coherent narrative) for their therapy."

"Virtual Reality" in tx of PTSD

Check out these links for looking at "Virtual Reality" videos for treatment of war-caused PTSD in soldiers.

http://www.msnbc.msn.com/id/14048170?GT1=8307

http://www.defense-update.com/products/v/VR-PTSD.htm

Virtual Reality? It sounds like old fashioned exposure therapy that teaches dissociation, not healed presence.  There are non-EMDR treatments that work for trauma and don't promote dissociation. All of them, that I know about, share EMDR's focus on increased affect, body awareness, dual attention, and a more coherent narrative. In most of the others (AEDP, somatic experiencing, STDP) the "dual attention" is either the tracking of here-and-now body sensation and/or the intense connection/containment by the therapist.

EMDR with Veterans

Like a Ghost: Using EMDR to revive a traumatized vet's marriage by Nancy Errebo is a wonderful article in the recent Psychotherapy Networker. Click here to read it.

The Psychotherapy Networker is my favorite therapy magazine. It's readable, easy to look at, open to many modalities, and full of useful information. I always find at least one piece of information I can use in each issue. It's written for clinicians, though lay people would be able to follow many of the article. Since it comes every two months, I'm not overwhelmed with issues. (Unlike the weekly New Yorker! Fall behind one issue and you're a goner!) If you subscribe to only one publication, get this one.