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.