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Do you have Trauma A or Trauma B?

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There are two types of trauma: Trauma A and Trauma B. Do you know the difference? Which one has impacted you? One is much more recognized by society but both are important to healing from trauma, managing anger and aggression and improving our family relationships.

(via https://www.youtube.com/watch?v=ZXWUrRXSSoU)

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TheraPlay Helps Children Overcome Trauma and Increase Attachment

Ron Huxley, Licensed Marriage and Family Therapist is trained in TheraPlay for Families and Child Therapy Groups. To arrange a private session with Ron, go here: https://ron-huxley-lmft.clientsecure.me/client_portal .

“Theraplay is a structured play therapy for children and their parents. Its goal is to enhance attachment, self-esteem, trust in others, and joyful engagement. The sessions are designed to be fun, physical, personal, and interactive and replicate the natural, healthy interaction between parents and young children. Children have been referred for a wide variety of problems including withdrawn or depressed behavior, overactive-aggressive behavior, temper tantrums, phobias, and difficulty socializing and making friends. Children also are referred for various behavior and interpersonal problems resulting from learning disabilities, developmental delays, and pervasive developmental disorders. Because of its focus on attachment and relationship development, Theraplay has been used for many years with foster and adoptive families.

Program Goals:

The goals of Theraplay are:

Increase child’s sense of felt safety/security
Increase child’s capacity to regulate affect
Increase child’s sense of positive body image
Ensure that caregiver is able to set clear expectations and limits
Ensure that caregiver’s leadership is balanced with warmth and support
Increase caregiver’s capacity to view the child empathically
Increase caregiver’s capacity for reflective function
Increase parent and child’s experience of shared joy
Increase parent’s ability to help child with stressful events”

TheraPlay is considered to be an Evidenced-Based Approach for Family Therapy: http://www.cebc4cw.org/program/theraplay/detailed

Four Steps for Working With Trauma: An Interview with Bessel van der Kolk

Step 1: Start with Self-Regulation

Dr. van der Kolk: I would say the foundation of all effective treatments involves some way for people to learn that they can change their arousal system.

Before any talking, it’s important to notice that if you get upset, taking 60 breaths, focusing on the out breaths, can calm your brain right down. Attempting some acupressure points or going for a walk can be very calming.

Dr. Buczynski: So this is learning to modulate arousal?

Dr. van der Kolk: Yes, and there’s alarmingly little in our mainstream culture to teach that. For example, this was something that kindergarten teachers used to teach, but once you enter the first grade, this whole notion that you can actually make yourself feel calm seems to disappear.

Now, there’s this kind of post-alcoholic culture where if you feel bad, you pop something into your mouth to make the feeling go away.

“The issue of self-regulation needs to become front and center in the treatment of trauma.”
It’s interesting that right now there are about six to ten million people in America who practice yoga, which is sort of a bizarre thing to do – to stand on one foot and bend yourself up into a pretzel. Why do people do that? They’ve discovered that there’s something they can do to regulate their internal systems.

So the issue of self-regulation needs to become front and center in the treatment of traumatized people. That’s step number one.

Step 2: Help Your Patients Take Steps Toward Self-Empowerment

The core idea here is that I am not a victim of what happens. I can do things to change my own thoughts, which is very contrary to the medical system where, if you can’t stand something, you can take a pill and make it go away.

The core of trauma treatment is something is happening to you that you interpret as being frightening, and you can change the sensation by moving, breathing, tapping, and touching (or not touching). You can use any of these processes.

It’s more than tolerating feelings and sensations. Actually, it is more about knowing that you, to some degree, are in charge of your own physiological system.

There needs to be a considerable emphasis on “cultivating in myself,” not only as a therapist, but also as a patient – this knowing that you can actually calm yourself down by talking or through one of these other processes.

So, step number two is the cultivation of being able to take effective action. Many traumatized people have been very helpless; they’ve been unable to move. They feel paralyzed, sit in front of the television, and they don’t do anything.

“Programs with physical impact would be very, very effective treatments.”
Programs with physical impact, like model mugging (a form of self-defense training), martial arts or kickboxing, or an activity that requires a range of physical effort where you actually learn to defend yourself, stand up for yourself, and feel power in your body, would be very, very effective treatments. Basically, they reinstate a sense that your organism is not a helpless (tool) of fate.

Step 3: Help Your Patients Learn to Express Their Inner Experience

The third thing I would talk about is learning to know what you know and feel what you feel. And that’s where psychotherapy comes in: finding the language for internal experience.

The function of language is to tie us together; the function of language is communication. Without being able to communicate, you’re locked up inside of yourself.

“Without being able to communicate, you’re locked up inside of yourself.”
So, learning to communicate and finding words for your internal states would be very helpful in terms of normalizing ourselves – accepting and making (the communication of internal states) a part of ourselves and part of the community. That’s the third part.

Step 4: Integrate the Senses Through Rhythm

We’re physical animals, and to some level, we’re always dancing with each other. Our communication is as much through head nodding and smiles and frowns and moving as anything else. Kids, in particular, and adults, who as kids were victims of physical abuse and neglect, lose those interpersonal rhythms.

“Rhythmical interaction to establish internal sensory integration is an important piece.”
So, some sort of rhythmical interaction to establish internal sensory integration is an important piece that we are working on. With kids, we work with sensory integration techniques like having them jump on trampolines and covering them with heavy blankets to have them feel how their bodies relate to the environment because that’s an area that gets very disturbed by trauma, neglect, and abuse, especially in kids.

For adults, I think we’ve resolved rhythmical issues with experiences like tango dancing, Qi Gong, drumming – any of these put one organism in rhythm with other organisms and is a way of overcoming this frozen sense of separation that traumatized people have with others.

Dr. Buczynski: These are four keystones that can make healing from trauma faster and more effective. In order to give patients the best chance for recovery, consider these steps as you plan your interventions and treatments.

– See more at: http://www.nicabm.com/bessel-van-der-kolk/confirmed/?del=7.8.15BesselLMtoall#sthash.tU3FljBE.dpuf

The Fourth “F” of Trauma
By Ron Huxley, LMFT

When I work with traumatized people, I always keep in mind that they have one of three reactions: Fight, Flight and Freeze. These are primal brain mechanisms that manage threats to the self. Each type of reaction has its intervention but at the core of these interventions is the fourth “F”: Fusion.

Trauma disrupts relationships and self/other organization. At extreme levels it can cause dissociative disorders (what we used to call Multiple Personality Disorders) splitting off internal parts of the self in an effort to survive and function. At milder levels it can cause us to build defenses or social masks that allow us to get through our days despite feelings of pain or loss. Either we are not acting out of our true self. We also have difficulties with others manifesting by poor intimacy, commitment fears, unmanageable anger, feelings of anxiety and depression.

What we want to achieve is fusion. A fusion of self and personality and a fusion of relationships (self with other). This is easy said than done but it is possible. It is not hopeless as we once thought. The real challenge is trying to help others who are in a state of fight, flight or freeze without ourselves going into a similar state. Staying “fused” in our emotions, in the face trauma, is hard!

Positive and negative changes after trauma | Psychology Today

Trauma can shatter peoples’ world assumptions. In the process of rebuilding an assumptive world people often report ways in which they change positively. It is becoming increasingly important to integrate this idea into trauma work.
To help do this my colleagues and I have developed a new self-report psychometric tool – the Psychological Well-Being Post-Traumatic Changes Questionnaire (PWB-PTCQ) with which to assess positive changes following trauma.

To illustrate, a sample six items are shown below.

Read each statement below and rate how you have changed as a result of the trauma.

5 = much more so now

4 = A bit more so now

3 = I feel the same about this as before

2 – A bit less so now

1 = Much less so now

1. I like myself____

2. I have confidence in my opinions____

3. I have a sense of purpose in life____

4. I have strong and close relationships in my life____

5. I feel I am in control of my life____

6. I am open to new experiences that challenge me____

Responses to these statements provide an opportunity for people to reflect on how they have changed. 

Did you score over 3 on any of the items? 

Can you think of think of one or two examples in your life that illustrate these changes?

Are there things you can do in the coming weeks that will help you build on and strengthen these changes?

Clinicians will also find the new tool useful as it allows them to bridge their traditional concerns of psychological suffering with the new psychology of posttraumatic growth. The full scale is 18 items so it is not too time consuming and can be used alongside traditional measures of PTSD.

This is not the first such measure of positive changes to have been developed. But there is a difference.

Those of us who study positive changes following adversity are sometimes criticised for offering an unrealistically optimistic view of the world. I don’t think this is true as the literature makes it clear that change can also be in a negative direction. But the critics may be right that this needed to be more fairly recognised in our measurement tools. 

At any single point in time people will have changed in either negative or positive ways.

But existing measures do not offer the opportunity for people to say how they have changed in a negative direction as well as in a positive direction.

Thus, an important and novel aspect of this new instrument is that it recognises that people may also experience themselves as having changed in negative ways.

Did you score under 3 on any of the items?

If you scored under 3 on one or more of the items, is this causing you considerable problems at home or at work?  Is it leading to significant difficulties with family, friends or colleagues?  Have you tried dealing with the problems already, maybe through reading self-help or talking to others? If so, it may be appropriate to seek professional advice.

So as well as giving indications of how people may grow following trauma the PWB-PTCQ can also help people understand the ways in which they need to look after themselves better or flag up areas in which they might need professional help.

The full questionnaire is described in my new book, What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth http://www.whatdoesntkillus.com.

But the book does not go into full technical detail on its psychometric development. For those who do want to learn more the research paper describing the development of the new tool is now available online in the journal Psychological Trauma http://psycnet.apa.org/psycinfo/2011-17454-001/

In the paper we describe the logic behind the questionnaire, its advantages and the research showing its reliability and validity.

I hope this work will interest people. I am always eager to meet new research collaborators – there is so much more yet to be done in this field – so if this new tool does spark some interest in you to use in your own research or clinic please do get in touch.

Ron Huxley’s Reaction: It is good to see a “strength-based” approach to trauma. Trauma has many negative impacts in someones life but it is not destiny. Many people do become stronger and more resilient following a traumatic event. How would score yourself on the measures listed above?

Video: Chi Lessons from Horses : Spirituality & Health Magazine

Video: Chi Lessons from Horses

Allan Hamilton was all by himself one morning years ago when he leaped off a fence at summer camp and onto the back of a horse named Thunder. No saddle, no bridal, and no clue how to get down. And so the future brain surgeon simply hung on as the horse wandered. He missed lunch and dinner and rode late into the night, until a camp counselor finally showed up with a flashlight and got him down. The long ride left him so sore he couldn’t walk, but it transformed him from being the shy and fearful new-kid-at-camp to being the camp hero. It was also a giant leap into a lifelong love affair with horses and a fascination with how humans and horses connect.

In the current issue of Spirituality & Health, Dr Hamilton writes about lessons in spiritual leadership that can be learned from horses. He also promised video examples of some of these lessons. He’s been working on the videos for the last couple of weeks at his ranch in Tucson, where he and his wife Jane teach equine-assisted therapy. Check out the video below to see this fascinating work in action, and click here to see even more. Hamilton’s wonderful new book, Zen Mind, Zen Horse, is also available at Amazon.com or your favorite book store.

Last February I had the opportunity to experience these lessons firsthand with Dr. Hamilton. The videos don’t capture the thrill of learning to control a beautiful horse with a simple shift of intention. At the same time, it is amazing to see footage of what I experienced directly in the horse ring. My skeptical left brain still doesn’t know what to make of this silent, right brain communication, but having experienced it in person and watched it on video, I find it difficult to deny.

There are great lessons in these short clips. Enjoy!

Stephen Kiesling is editor-in-chief of Spirituality & Health magazine, winner of the Folio Gold Award for best magazine in religion and spirituality. Kiesling is the author of four books, including the bestselling The Shell Game: Reflections on Rowing and the Pursuit of Excellence. His writing has appeared in publications such as The New Yorker, Sports Illustrated, and Outside. Kiesling has been featured on NBC’s The Today Show, NPR’s All Things Considered, and in the New York Times.