Ethical Attunement and Complex

TraumaMary Jo Barrett

www.centerforcontextualchange.org

Disclosures

■The speaker and members of the planning committee do not have a conflict of interest in this topic.

■There is no commercial support for this program.

Ethical Attunement

■ The range of what we think and do

■ Is limited by what we fail to notice

■ And because we fail to notice

■ That we fail to notice

■ There is little we can do

■ To Change

■ Until we notice

■ How failing to notice

■ Shapes our thoughts and deeds -R.D.Laing

Performance, health and happiness are grounded in the skillful management of energy

Jim Loehr

Awareness, Stamina, Creativity, Resources

Healing, Growth and Change

Healing,change and growth Healing,change and growth comes from a process of comes from a process of encircling a person with a sense encircling a person with a sense of being valued and of being valued and empowerment. This is done by empowerment. This is done by identifying and engaging with identifying and engaging with them through their own natural them through their own natural cycles of growth. Collaboratively cycles of growth. Collaboratively gathering resources from within gathering resources from within a person, their family and their a person, their family and their community.community.

What is Therapeutic Change

Differentiation of Trauma Mind Self-View from a Reality-Based Experience of Self-Aware Mind

Develop Value-Collaborative Based Therapeutic Goals

Build New Patterns of Action-Mind and Body

Four Levels of Stress Reactivity

STRESS TRAUMATIC STRESS PTSD COMPLEX DEVELOPMENTAL TRAUMA

Any demand on the body system.

Consequence of exposure to trauma. Interruption to flow

FeelingsFearHelplessnessUrgencyAnxietyAnger Sadness

Urges Fight or Flight or Freeze

Exposure to events that are experienced as life threatening, intolerable or could cause injury or death.

Experience of trauma becomes more intrusive. Avoidance of cues in the six senses (sight, sound, smell, taste, touch, mind) Hyper-arousal to triggers

Result of Multiple Traumatic Events and reaction to EventTraumatic events begin in childhood- ComplexityMultiple victimization Interacting contextual effectsAnxietyDepressionEmotional deregulationIntrusive thoughts and feelingsIdentity disturbanceEfforts to avoid /numbRelational DisturbanceHyper-arousal to both internal and external events

CComplex Trauma

■ Interpersonal in nature

■ Disruption in attachment in significant relationships

■ Repeated/chronic

■ Over time

■ Involving all forms of traumatization

■ Revictimization through reactions, as well as, actions

1. “When acutely threatened, we mobilize vast energies to protect and defend ourselves. We duck, dodge, twist, stiffen and retract. Our muscles contract to fight or flee. However, if our actions are ineffective, we freeze or collapse.” -Levine

2. In normal development, state changes are co-regulated with changes in state becoming smoothed out over the course of development. -Putnam

3. States become traits: “if the neurobiology of a specific response, Hyper-arousal or Dissociation, is activated long enough, there will be molecular, structural and functional changes in those systems.” -Perry

Childhood Trauma and Attachment

■Children who experience trauma-abuse and neglect may be more dramatically affected by chronic hyperarousal than adults. Trauma in childhood occurs before the brain has developed sophisticated modulation techniques.

■Good enough caregivers provide external modulation for internal states.

■Responsive, stable, and predictable caregivers and contexts hold traumatized children and alleviate symptoms and prevent trauma mindstates from re-occurring.

Abuse/Neglect and Complex Trauma

■ Traumatic experiences embedded in ineffective hierarchies and/or hostile contexts: Behavior makes sense.

Fight ----- Flight ----- Freeze– Difficulty regulating emotions and impulses– Difficulty in ego adaptive capacity/cognitive

consciousness– Somatization– Self loathing, negative perceptions of others,

victim/perpetrator cycles (sexually and violently acting out)

– Meaning making impaired

The Effects of Abuse and Complex Trauma■ I experience myself as powerless

– Symptoms as attempted solutions

■ I am disconnected from myself, others, and the world around me

– Interactional Cycle of Survival

■ I experience myself as devalued

■ I am out of control

Therapist Use of Self

Ethical AttunementRole of MindfulnessInterventions that decrease helplessness,

extreme behaviors and increase masteryCollaborationAn Effective Model to build therapist’s confidence

and self empowerment-Stage oriented integrative model

Supervision and Consultation

 

■ Attachment and Connection: To build and rebuild relationships where they felt mutual curiosity, compassion, empathy, connecting to a deep set of values that provide a meaningful vision.

■ Safety and Empowerment: Safe context/boundaries/structure within and between themselves and their relationships

■ Value: Collaboration/Strength based guidance/Vulnerability and Resilience

■ Skills: Psycho educational experiences/cognitive behavioral/neuro-mind-body/communication/mindfulness/self-regulation within and between

■ Hope: Creation of workable realities

Five Essential Five Essential Ingredients for HealingIngredients for Healing

Guidelines for Standard of Care

Therapy enhances clients’ capabilities-of faith; creativity; and control response to a situation

Skills training

Cognitive Stability

Behavioral Stability

Interpersonal Regulation and Stability

Stabilization of Core sense of self and Self Regulation

Therapy must improve the clients’ motivation for change

 

■ Collaboration: understanding of process, engaging in process, and investing in outcome.

■ Enhancing Positive Emotions not focusing on Negative

■ Interventions that help quickly

■ Understandable and Clear Treatment Plan

Assure generalization to natural environment

What happens in sessions can be applied out side of room

  Homework assignments and practice

In session Practice of Skills and Experience

Enhance therapist capabilities & therapists’ motivation to treat effectively 

■ Therapist Use of Self Ethical Attunement-self and other

■ Interventions that decrease helplessness, extreme behaviors and increase mastery

■ Collaboration

■ An Effective Model to build therapist’s confidence and self empowerment-Stage oriented integrative model

■ Supervision and Consultation 

Structured Environment ■ Clarity of Model

■ Clear Boundaries

■ Coaching strategies

■ Predictability

■ Brain informed CCM----We want to build pathways between all parts of the brain, to intersect and strengthen our Engaged Mindstate.

And to Build Pathways between Our Engaged Mindstate and the Engaged Mindstates of Others.

Lower Brain■ This is where our Survival Instinctual Behaviors and Functions exist.

It is at the Base of the Brain. This HindBrain regulates; Fight, Flight, Freeze, our autonomic functions; digestion, heart rate, hunger, breathing. This part of our brain manages our impulses. The Hind/Lower brain is reactive and protective.

MidBrain

■ The Limbic regulates emotion and motivation, as well as learning and memory. This part of our brain provides us with greater flexibility of behavior and integrates messages from both inside and outside the body. This is where we process: nurturing, fear, social bonding, joy stress; the range of emotions. This is our library, where and how our body remembers

Upper Brain

■ This section regulates our executive functioning; planning,self awareness, analysis that involves thought and feeling. The Forebrain is where we experience logic, empathy, compassion, creativity, self regulation, self awareness, attention, and problem solving. The Forebrain uses both left and right hemispheres. And the Upper Brain attempts to integrate information from Mid and Lower brain, helps us plan.

Mirror NeuronA mirror neuron is a neuron that fires both when a

person acts and when the person observes the same action performed by another.

■ You each become the reflection and extension of the other

■ A back and forth energy emerges between you- liken to an electrical energy flow

■ Positive resonance needs certain ingredients to exist-safety being primary

Collaborative Stage ModelCreating a Context for Change

Challenging Patterns/Cycles and Expanding Realities

Consolidation

■ What the caterpillar calls the end of the world,

the masters call a butterfly

■ Richard Bach

Ethical Attunement■ Therapeutic Talent and Complex Trauma:

– Our Gift■ Energy Resources: Emotional, physical,

spiritual, intellectual, sensual– Giving and Receiving– Natural Cycle of Contraction and Expansion in

Relationship

■ Therapeutic Wisdom: – Mindfulness (Empowerment)– Open Hearts (Value/Attachment) – Influence (Idiosyncratic or Relational Power)

■ Individual Thoughts/Your Wisdom– How do you think change happens?– Think of a time you changed– What were the essential ingredients of your

change?

■ Relational/Therapeutic Thoughts– What are your idiosyncratic gifts for influencing

others?– What are the core therapeutic ingredients you

bring to your relationships?

■ Heart– Think of a time you gave to another and your gift

was received

■ Engaged Mindstate– What is going to help you feel supported today?

You as Therapeutic Resource

The therapeutic journey requires ENERGY – for our clients and for ourselves

Five Domains of Human Energy■Emotional■Intellectual■Physical■Sensual■Spiritual

Compassion Fatigue

…..is the exhaustion, fatigue, and subsequent symptoms that are the result of passionately, skillfully, and compassionately giving of yourself to help others.

Performance, health and happiness are grounded in the skillful management of energy

- Jim Loehr

In order to be a successful therapist (or caregiver)

■You need to be mindful of the possible of effects of your compassion

■You need to understand the energy exchange – what you give out and what you get back

■You need to understand your vulnerability and the need for balance in the expenditure of energy and replenishing of energy

• Submission: we become numb, robotic, lose energy orapathetic, become more depressed or detached in our ownpersonal lives. • Flight: it is harder to pay attention, to want to go to work.We may dream of vacations or of terminating the client• Fight: we become more irritable, tense, or defensive. Orquicker to ‘try to save the day.’ Our hyper vigilance or posttraumatic reaction or paranoia may affect our personal lives, interfering with sleep or relaxation• Attachment: our separation anxiety increases in tandem with their instability and un-safety.

When we are depleted

Validation

What is it?

Definition: To accept, legitimize, support, attempt to understand and assign benevolent meaning to your own and/or someone else’s emotions, thoughts and behavior.

Invalidating Environments

Characteristics of Invalidation

• Communication of private experience met with exaggerated, inappropriate, extreme response.

• Communication of private experience not validated, often punished and/or trivialized.

• Painful emotions and factors causing them are disregarded.

• The individual’s interpretations of his/her behaviors and motivations for behaviors are dismissed.

• Tells the individual he/she is wrong in both the description and analysis of the experience particularly what is causing the emotion, belief or action.

• Attributes the experience to socially unacceptable characteristics or personality traits.

• Failure to live up to expectations brings disapproval, criticism, sarcasm, or attempts to change the individuals attitude.

Invalidating EnvironmentsConsequences of Invalidation

• Individual does not learn to label private experiences and emotions in normative manner.

• Individual does not learn to modulate emotional arousal.

• If problems are not recognized, problem-solving skills are not learned.

• Extreme problems or emotional displays become necessary to provoke a response.

• Inhibition or extreme emotional states occur.• Individual does not learn to tolerate distress or

form realistic goals and expectations.• Individual does not learn to trust his/her own

emotional response.• Self-invalidation and shame.

Function of Validation

• Creates safety (verbal, emotional, physical and sexual)

• Establishes the environmental context for constructive, useful, effective behavior (verbal and nonverbal; with self and others)

• Enhances connections in relationships• Teaches trust and helps it to evolve• Strengthens empathy• Generates feeling understood and supported• Generates comfort through emphasis on

naturalness of responses• Generates encouragement and effectiveness

What to Validate

• The value of each individual as a person.• The value of the relationship to those involved.• One’s own and other’s behaviors that are

legitimate, natural and effective. This includes: emotions (feelings and needs), thoughts (beliefs, intentions, goals), and constructive actions.

• Facts when they are factual, what is actually happening.

• Worries and fears as worries and fears - not facts.• Self-initiated actions by a person for themselves

consistent with their own values, feelings, desires and goals.

GOALS OF BRAIN-DIRECTED INTERVENTIONS

Body Regulation – Balancing the accelerator and the brakesEmotional BalanceResponse FlexibilityEmpathyInsightModulating fear and AngerIntuition

FIVE FACETS OF MINDFULNESS PRACTICES

1. Decreased reactivity to inner experiences

2. Increased capacity to remain present even with

painful emotions and sensations

3. Increased capacity to react with awareness and

intention

4. Increased capacity to describe/label with words

5. Non-judgmental of experiences

AWARE MIND PARADIGM

Resources

■ Awareness/Realism

■ Creativity

■ Humor

■ Courage/Intiative

■ Flexibility/Adaptability

■ Faith/Trust

■ Social Support

We fall into Negative Energy with FatigueOur goal is to recognize this and Create Positive Energy

■Positive Energy- High and Low– High Positive; Joy, Happiness, Playfulness, Movement…– Low Positive; Meditation, Prayer, Stroll in Nature…

■Negative Energy- High and Low– High Negative; Anger, Critical, Judgment, Irritable…– Low Negative; Depressed, Withdrawn, Isolation …

Worksheet

■Your Symptoms you want to change:

What behaviors at home or work - do I want to change?

What beliefs about myself and others no longer serve me- in fact deplete energy?

What reactions of mine are problematic at home and work?

■Your Energy Expenditures:

What tasks?

With Whom?

What Life Style Choices?

Wellness Plan

Write your Personal Vision:

How would you like to see yourself as a person.

What are your Top personal energy expenditures

What are your Positive energy replenishers

Create the specific plan and formula that is realistic for you-what, when, and how

Write your Professional Vision:

How would you like to see yourself as a person.

What are your Top energy expenditures

What are your Positive energy replenishers

Create the specific plan and formula that is realistic for you-what, when and how

Keys to Success

■ Boundaries

■ Explain phenomena to others-work and home

■ Mindfulness

■ Be Creative

■ Watch what you say to yourself

■ Plan something every month/every week /every day that you look forward to

■ ASK for what you want and need

■ Create an energy plan

“Only Bacteria Survive and Thrive in a poorly cared for body and soul”

■I believe that we learn by practice. Whether it means to learn to dance by practicing dancing or to learn to live by practicing living, the principles are the same. In each, it is the performance of a dedicated precise set of acts; physical, intellectual, emotional, spiritual, from which comes shape of achievement, a sense of one’s well being, a satisfaction of spirit. Practice means to perform over and over again in the face of all obstacles, some act of vision, of faith, of desire. Practice is a means of inviting what is desired.

■ Adapted From Martha Graham by Mary Jo Barrett