My therapeutic approach to Trauma and Post Traumatic Stress Disorder (PTSD) is different from other “Talk Therapy” approaches with which you may be familiar. In other therapy approaches the emphasis is usually on verbal expression of feelings and exploration of the meanings of events etc. This is very much a “Top-Down” approach (ie) from the Head/Language centre down to the Body. That approach has been shown to be ineffective with Trauma & PTSD in recent years. The evidence base for a “Bottom-Up” approach in PTSD is now well established (ie) from the Body up to the Head/Language centre. I also use a “titred” approach (ie) small doses at a time with recovery periods built in to the Therapy process.
The first interview is an assessment interview to ascertain the patient’s history (including family, career, relationship history etc) as well as the history of the traumatic event(s). From this a case formulation is made by me and shared with the patient at the end of the assessment session. This leads to a treatment plan and suggested number of therapy sessions. If we are both agreed on this approach, then treatment begins in the second session. This first session lasts 50 minutes as do most of the therapy/treatment sessions. When using EMDR, the session may last longer than this (up to 90 minutes) but the patient is informed in advance.
Stage 1: Stabilization
The goal of treatment at this stage is to create a sense of safety for you in the here-and-now. This is achieved by giving you the tools to attain:
- Bodily Safety – abstinence from self-injury, sobriety, good self-care and attention to bodily health
- Safe Environment – secure living conditions, non-abusive relationships, adequate supports, having a job etc. Also Emotional Safety in the therapy room is important
- Emotional Stability – ability to calm your body & self-soothe yourself, regulate emotions, keep healthy boundaries with others and identify & manage Triggers for Trauma reactions in everyday life
This is done through psycho-education (ie) learning about how Trauma affects the Body, knowing the common symptoms of Trauma, learning about cause-effect relationships between traumatic reminders and Triggers of Traumatic reactions, understanding autonomic dysregulation and distorted thinking. In this phase of treatment, the Therapist is more like a teacher or guide showing you how to develop an Emotional Survival kit & the Emotional Thermostat of your Body. This may take up to 8 sessions or longer depending on the nature of the Trauma you have suffered. For example, a single event Trauma such as a car accident will be much shorter at this stage than multiple childhood traumas such as abuse and neglect. The Therapist’s job at this stage is to teach you how.
Stage 2: Processing Traumatic Memories
The goal at this stage of treatment is the “digesting” the traumatic memories, feelings and thoughts and building a clearer sense of one’s own self in the present. This processing is much like putting the pieces of a jigsaw puzzle together with the Therapist’s help. The approach used is body-oriented (ie) identifying body sensations/feelings related to the Trauma and how they are triggered in the present. EMDR (Eye Movement Desensitization & Reprocessing) and other mind-body exercises and techniques may be used at this stage. “Remembering is not recovery” (Fisher, 2000) hence it is only necessary to find ways of coming to terms with the Trauma rather than seeking to uncover all of the details.
Stage 3: Integration and Recovery
This stage is about developing a personal narrative which has new meaning for you out of the traumatic experience, having survived and healed from the trauma(s). This phase of the treatment and recovery approach builds a healthy present and a healed self through various relapse prevention methods, promoting mastery, identifying triggers, developing Mindfulness and Compassionate mind so that the Trauma becomes further away and part of an integrated understanding of the self, but no longer a daily focus. The traumatic memories have been moved from “emotional memory” into “historical memory”.
— Dr Tim Dunne, DPsych © November 2011