Trauma Treatment and the Synthesis of Intervention
Through my current practice, I work primarily with clients experiencing disrupted attachment stemming from complicated trauma. I typically start by trying to help clients clarify their goals and use mindfulness practices to increase competencies around body awareness and how to regulate arousal effectively. As we move on to process or reprocess traumatic material, I focus on helping clients to learn how to incorporate new behaviors and new responses to old material, with the aim of continually increasing both emotional and interpersonal relationship competency.
In my view, the therapist is the connective tissue between all of the factors that enable healing, whether that be the trauma and the appropriate coping or communication skills, or the felt experience of certain strong emotions and the ability to stay present in the moment, until the client can hold steady on his or her own two feet. The therapist needs to know which tools to use when, and how to walk beside the client in connecting those dots. There is no specific science to it. Rather, it is about knowing when a client has done what she or he can with a certain intervention and being able, without ending a protocol, to move smoothly into a complementary skill building or resourcing activity without any suggestion that the client hasn’t completed the protocol or done it right.
To take this approach successfully, the therapist must be able to assess a client’s resources and resilience before starting, and then be willing to reassess along the way and to deviate without allowing the client to see this deviation as a failure or disruption, an experience that often can mimic attachment disruption. Ideally, both therapist and client instead see the progression as opening up into the spaciousness of the process.
This is how I work today, and it is informed by experience and training in several areas of treatment. About 15 years ago, when I first began working with youth and family in an intensive treatment setting, I sought out training in dialectical behavioral therapy (DBT), which I felt would give me a strong framework on which to build. I appreciated then — and still do now — that DBT aids in the backfilling of skills training, a critical element for clients dealing with disrupted attachment and related issues such as emotions regulation, creation of false narratives, mood management, and effective interpersonal communications.
Though mindfulness was outlined in my DBT training, I felt that I needed to explore this component in greater depth. It was clear to me that I needed more understanding and knowledge with respect to mindfulness skills and how to work with the body to increase self-regulation and self-awareness, with the goal of helping clients increase mastery of their emotions.
At the time, a lot of mindfulness practice was “above the neck.” While there was some focus on breathing, most protocols emphasized guided imagery, visualization, and addressing cognitive distortion. What was missing was the other 80 percent of the body, which went largely unattended even though it too was affected by the client’s traumatic experience. In my view, this 80 percent of the body provides some of the best information about the client’s emotional functioning. If a therapist can learn the language of the body and the felt experience, then it is possible to start with the place the client actually is, working from there to deconstruct the narrative.
I turned to Yoga Calm to learn how to use centering and grounding practices, as well as body-centered interventions, to help clients regulate emotions. Along the way, I also trained in eye movement desensitization and reprocessing (EMDR). These studies were valuable in their own right, but they also confirmed my sense that I didn’t yet have all the tools I wanted to provide clients with the type of treatment that might work best for them. So, in 2012 I also completed Level 1 Sensorimotor training, followed by Level 2 in 2015, which enables me to take advantage of brain-based research on how the body and emotions work together.
I find that DBT, Yoga Calm, EMDR, and Sensorimotor training all are valuable treatment protocols on their own. However, to address the needs of each unique client, I knit together different elements of these protocols. For me, EMDR and Sensorimotor provide a valuable framework, and my DBT and yoga calm skill sets are useful in teaching or reinforcing client competencies when a person gets stuck in a false narrative or habituated body-response pattern.
This approach is about resourcing clients, and having enough different types of skills to be able to do complicated and multilayered trauma work — cognitive, emotionally, through the body, and through psycho education. The synthesis of theory and skill sets can combine powerfully to help the client create a new experience for an old belief.
The therapist can go in through the protocol and guide, then go outside it to push on skill building, and then move back into the depths of the trauma narrative. When the therapist continues to point out where resources are, demonstrate that motion is occurring, and validate successes that haven’t before been seen as such, the process not only fuels momentum but also helps the client to trust that the therapist has the tools necessary to help resolve issues. In this model, treatment protocols and clients don’t fail; instead, it’s a matter of using tools and resources in the right combination.
Dancing among protocols in this way does require the confidence and knowledge to go “off script.” I believe that consultation groups and trainings need to get to point that everyone has the confidence to pull dance, music, yoga, and other tools into their trauma work as a way to resource, teach, and guide a client past sticking points or through components of the work that aren’t responding to the dominant protocol or formula. Using various treatment protocols in combination to build resources, work more specifically to ground the body, and go back and teach communications skills requires the therapist to trust in his or her experience and to have the wisdom to apply different theories at the right time. This is no small task, and it is difficult in a professional landscape that has not encouraged deviation from accepted theories.
Concerns about watering down theories, truncating processes, or simply making up new theory are all valid, but they make it difficult for therapists to share a dialog about how they might “dance” into another treatment modality or bring in elements of one protocol or another into their work. I see this as a real problem for the field. When a particular protocol isn’t resulting in movement, the therapist may feel that she or he is failing. Rather than get creative, many therapists will take a narrower focus, thinking in terms of scarcity rather than abundance. They don’t trust the process, or that all the other types of training they have done can serve to complement the protocol. Instead, they feel it is their job to get the client into the confines of a particular protocol — or risk making things worse. Clients respond to this self-doubt on the part of the therapist and often experience a parallel sense of incompetency. Therapist creativity, on the other hand, can enable an unfolding process in which there is no one right answer or right approach.
When I was first starting out as a therapist, the thing that really hooked me was psychodynamic psychotherapy and the cyclical maladaptive pattern (CMP), which suggests that people continue to repeat patters of dysfunction. I later saw this idea in DBT and Sensorimotor, and I understood that all these interventions work on the same pattern, hitting on the same concept but at different layers and from different entry points. I look forward to a time when therapists feel freer to dialog about how these pieces could co-mingle or complement one another to help maximize the effectiveness of treatment in helping people overcome trauma. Such dialog also could give therapists a safe space in which to understand where the motivation to expand into different modalities is coming from — client need or therapist anxiety, for example — and to increase the chances that treatment will be successful.
The community of therapists working with complicated trauma is rich with professionals who have a great breadth and depth of knowledge, and this is important because there are times that therapists will need all the tools they can get — and then some. With a place in which to talk honestly about how no one theory, even their own, is always the answer, therapists can better prepare themselves to help their clients overcome trauma and begin to thrive. For this reason, I am excited about the launch of the MN Trauma Project website and optimistic about its potential for providing just such a safe space for dialog.