9-11 Rendition by Viktor Orloff. He immigrated to the US from Poland in 2005.
CONGRATULATIONS NEW CERTIFIED PROFESSIONALS
Members of August 2012 Training Class, Sarasota, FL
Delores D. Blackwell
Timothy Shea Enniss
Mary Ann Gastiger
Arlene N. Hunt
Kathleen D. Kenna
Hong Tran Klein
Paul C. Lam
Ernesto Lopez, Jr.
Patricia Ann Masucci
Lou Ann Mayhew
Lily C. Munavu
Debora L. Nesbitt
Janet S. Oliver
Claude E. Ouellette
Mary St. Aubin
June Michele Taylor
Sandra I. Templin
Dana Hunt Unruh
Carla Viesti, Jr.
Trauma Practice: Tools for Stablization and Recovery
Anna Baranowski, Ph.D.
J. Eric Gentry, Ph.D.
Franklin D. Schultz, Ph.D.
Trauma Competency and EMDR: 3 DVD Set
Linda Curran, BCPC, LPC, CACD, CCDP-D
Mike Dubi, President
J. Eric Gentry, Vice President
With the Holiday Season upon us I was hoping to make this a simple message of hope and joy with best wishes for the New Year. Writing now, four days after the terrible tragedy that occurred in Newtown, Connecticut, there is no simple message. As a Traumatologist and Trauma Counselor, I am frequently involved with tragedies - but this one was especially difficult for me to bear - I have such a hard time when children are the victims. I have discussed and read all I can about this type of violence and am still at a loss as to why these things happen. And so it appears, are the experts.
I hope we can use this tragedy to motivate us to begin studying violence more thoroughly, to conduct brain scans, tests and interviews, and learn why these acts happen and, maybe, how to prevent them in the future.
One way to honor victims and support their families is to continue doing great work as trauma professionals to help them carry on with their lives.
Mike Dubi, President
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Two New Certification Training Opportunities
Mike Dubi, President
IATP is pleased to announce the addition of two new training programs leading to two new certifications available to our members in the spring of 2013.
These workshops fulfill all education requirements for the Certified Clinical Trauma Professional (CCTP) credential. After completion of the workshop you will be eligible to apply for certification through IATP.
Date: Friday/Saturday, January 18-19, 2013
(snow date 1/25-26)
Time: 9am - 5pm
1000 Morris Ave.
Union, NJ 07083
For more details, contact:
The Counselor Education Department
Cost: $160; $135 for students.
There is an additional $75 fee for certification with appropriate documentation
Date: Friday/Saturday March 15 - 16, 2013
Time: 8am - 5pm
Child Protection Center
720 South Orange Ave
Sarasota, FL 34236
For more details contact Mike Dubi
IATP, 5104 N. Lockwood Ridge Road, Suite 303E, Sarasota, FL 34234
Tel: 941 724 1026
Cost: $160; $112 for child protection workers.
There is an additional $75. fee for certification with appropriate documentation.
TRAUMA COMPETENCY SKILLS:
Review of Linda Curran DVDs
by Debra Leggett, Ph.D.
Through this continuing education series, a practitioner can gain a good understanding of the trauma response, the use of EMDR techniques for stabilization of clients who have experienced trauma, and the use of EMDR techniques to reprocess the trauma after stabilization has occurred. Linda Curran provides a fascinating examination of the biological responses to trauma in her step-by-step guide on how to work with trauma clients. Special highlights of the Trauma Competency: Stabilization video are guest interview clips from trauma specialists Van der Kolk, Levine, and Porges. Curran also includes in-session demonstrations in all three videos.
In the initial stabilization video, Curran points out that "trauma is a natural human reaction" to a stressful event. The basic fight, flight, or freeze response occurs initially, but trauma does not occur until a person becomes overwhelmed and cannot react. We have all felt the relief when we managed to avoid being involved in an accident, but we do not become traumatized because we have processed the reaction. Alternatively, if we are involved in an incident that is so traumatic that we cannot deal with it (due to size, age, or many other reasons) our bodies will continue to exhibit the same response symptoms over time. As therapists, we consider this unprocessed trauma. In this model, the response to the precipitating event is normalized through psychoeducation. All behavior is adaptive. Clients learn to recognize and then to manage their symptoms. Curran asserts how important it is to stabilize the client before beginning to process trauma. Stabilization begins with creating an environment of trust and safety. As with other modalities, the therapeutic relationship is a cornerstone of treatment. Without trust, the client will not progress.
After establishing safety, the client needs to enter a state that is relatively free from crisis; according to Curran, this is any significant emotional, behavioral, or relational trauma. In response to trauma, a client may dissociate. Techniques are demonstrated that help a client get out of the dissociative state, into the present, and into their body. Biological cues are recognized to help clients develop insight into their own feelings. The therapist may direct the client to notice the floor under their feet, or the arms of the chair under their hands. Observation skills are crucial, so that the therapist can track with the client and bring them back to the present if they drift away. These techniques are helpful as well as the review of complex and simple PTSD. Accurate clinical assessment and diagnosis is crucial in determining the treatment plan, which includes projected length of treatment and speed with which a feeling of safety can be evoked in session. Questions in the book, Trauma Competency: A Clinician's Guide may serve as an assessment guide.
Curran explains the similarity between complex PTSD and Borderline personality disorder (BPD). This leads to the conclusion that many clients may be misdiagnosed with BPD, however, she asserts after this explanation that the difference does not matter, as the treatment is the same. She explains that it is important to share a diagnosis with clients from a psychoeducational perspective to reduce misperceptions (e.g., I'm crazy!). Treatment begins with sharing the diagnosis, helping clients recognize their symptoms, teaching that their symptoms may be managed and reduced, and they can develop their strengths and resiliency. Curran presents both Cognitive Behavior Therapy and Dialectical Behavior Therapy as models for symptom management.
Based upon previous work on attachment (John Bowlby) and development of relationship in a traumatic environment (Judith Herman), Curran explains that the therapist must model, explain, and engage the client in relationship. Mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness are used in this approach. In teaching symptom management, the therapist must collaborate with the client to develop a crisis plan, which includes how accessible the therapist will be. The plan should address such questions as (a) Who am I calling first, (b) What will I do next, (c) When can I talk to you. The crisis plan is reviewed in session. When working through symptom recognition, the client identifies strengths and recognizes the costs of behaviors that have served them to the present. Thus, the client begins to build a toolbox of coping behaviors.
Sample sessions demonstrate acceptance of the client's actions, stabilization, recognition of the costs of the behaviors, techniques for emotional regulation, and finally use of tapping or electronic stimulus to help ground the client in the present as the client processes trauma. The emotional freedom technique utilizes tapping and may be explored at www.emofree.com . A mantra accompanies the tapping such as, "Even though I feel scared, it's not happening now." In the demonstration, the client is led through a series of tapping acupressure points and repeating the mantra.
For those interested in learning more regarding polyvagal theory, a discussion is presented based on Stephen Porges work. This fascinating approach posits a triune autonomic nervous system (as opposed to a dual system - Sympathetic and Parasympathetic). When an individual goes into a primitive parasympathetic response to a threat, the body begins to conserve energy. Oxygen level goes down, metabolism and heart rate slows, breathing becomes shallow, (considered the freeze response) and bonding ability is lost. During this reaction, the fight or flight response becomes thwarted and must be completed in treatment. During the dissociative dorsal vagal response, the face will appear vacant and inexpressive. The client needs more oxygen. When he can begin breathing more deeply, he is getting out of the dorsal response into the sympathetic response, which needs to happen in a slow, smooth transition. As this occurs, a lot of energy will be released (which may be fear, anger, etc.) which may result in trembling or shaking as the client discharges the energy. The prefrontal cortex must be engaged to deal with the threat. The front part of the response is called the ventral vagal response or the social engagement nervous system. This system controls the lifting of eyelids, facial muscles, larynx, pharynx, muscles of the mouth, and the middle ear. When the client begins processing in this system, more energy is exhibited in the face. Grounding is demonstrated to "bring the client back" to the present.
The next phase of treatment is resource development. Telling of the story is postponed until the client can be present. Bilateral stimulation may be used involving criss-crossing the arms and tapping the upper arms or thighs or snapping alternate fingers. These stabilization techniques assist the client to stay in the body and regulate affect. The stabilization process can take anywhere from two months to a year. Resources must be internalized in order for the client to feel more effective. The client is encouraged to identify a time that was an exception to the feeling of fear. This time may include images of protector figures, nurturing figures, and a safe place. The goal is to tie the image, thought, emotion, and feeling together. "Neurons that fire together wire together," asserts Porges. In development of resources, imagery is used to develop and install a container. In the demonstration, the client imagined a well in which she could put things. She was given permission to take them out any time she wished, and was instructed to visualize a heavy lid she could pull over the top. The client was utilizing bi-lateral simulation during the visualization to reinforce the imagery. She was instructed to breathe into the feeling of dropping something into the well, and walking away. This was reinforced with the stimulation for six cycles to reinforce the relaxation. The client was instructed to practice the visualization outside of session, but not to tap due to the possibility of free association of other memories that would be reinforced in the process. The same sort of process was used to introduce a protector image. Once these resources are installed, the treatment proceeds to Eye Movement Desensitization and Reprocessing (EMDR) of the trauma.
In the use of EMDR for reprocessing, the therapist explains that EMDR is a misnomer, that rather, the other side of the brain is being accessed through bilateral stimulation to help process the trauma memory. The client is assured that there is no "doing it right". Additionally, any information that begins processing in session continues to process between sessions. The client is instructed to keep a journal and bring it to the next session. This process does not remove the memory, but the emotional charge connected to it is gone. The individual will have a coherent narrative after treatment, but not the feelings associated with the bad memories. Initially, the client utilizes guided visualization to enter their safe place. They then signal the therapist when they have reached that place. This place is a refuge when the client wants to bring their feelings down. Then bilateral stimulation is used like the Theratapper, an electrical stimulator that the client can hold. As in other behavioral approaches, this imagery includes all of the senses to reinforce the visualization. The stimulation is used again and the client is instructed to breathe into that feeling. Then the stimulation ceases. This sporadic use of stimulation continues to keep the client grounded in the present while experiencing the imagery and subsequently reinforcing the more positive state to override the negative one.
Next, the client is asked to recall the worst of the traumatic incident. She is asked to connect the thought, feelings, body sensations more and more. The more she feels it, the more the neural net is activated. The therapist keeps reminding the client that the situation is not happening now; she is safe. The client talks throughout the process as the therapist asks her, "What are you noticing?" In this technique, the therapist encourages the client to keep pushing forward. When the client has brought up the worst of the incident, the therapist asks her to scale the response. On a Subjective Units of Distress (SUDS) scale of 0 - 10, with 0 being no response, and 10 being the worst possible response, the client reports a number. She is prompted to think of the image that goes with the worst of it and then to think of the thought that occurs when that image comes up. The therapist asks, "When you think of the incident, what would you like to think of yourself?" The prompt is made that this thought too can change over time, that the most important part is the thought of the worst of it. The client is then prompted to focus on what feelings come up, and asked to identify the strongest of those. The therapist asks the client where in the body she notices the feelings and what it feels like. When she has identified it all, the therapist reviews all the parts and activates the stimulation when the client agrees she has it all. The client is then asked to talk through whatever happens. The therapist continues to ask the client what is going on and helps the client process until it ends organically. This sequence is repeated: bring up the worst of it (describe), feelings (describe), thoughts (describe), feelings in body (describe), when you have it all give me a signal, begin bilateral stimulation, let the scene run, just notice it, stay in the tension.
Finally, Curran explains flashbacks. She proposes that memories degrade over time, but traumatic memories do not degrade until they are processed. The EMDR procedure helps get the memory into a narrative or semantic memory. She explains to the client that all of that sensory information is of no use currently. She provides several techniques that the client can use when flashbacks occur to help them get out of the parasympathetic response. The hand can be placed on front of head (the frontal lobe is activated in the sympathetic system) to bring blood back to frontal lobe to get executive function back. Ice water on the face brings the individual back real quick. Another technique for people that dissociate is counting things in the room or asking them what they hear. Encourage them to stay present, eyes open. You can have them hold ice saying, "even though my body feels scared, it's not happening".
Curran demonstrates how to handle a flashback in session, grounding the client in here and now. She asks questions like, "What's happening? What are you noticing?" She instructs, "Ok, you can stay like that, but I want you to look around. Do you hear my voice? Who am I? Look around, do you know where you are? Say even though I feel scared, it is not happening now. Say what you see...breathe...what else do you see? Pay attention to that feeling, put your hand on your forehead, and breathe...Name three things that you see, two things that you hear. Do you feel the chair under you? What does floor feel like under your foot?"
After completion of each of the videos in this series, the DVD offers a continuing education post test/evaluation form. The participant can print out the forms, answer the questions, and mail in to PESI for a nominal fee and receive the CEUs. These videos are very informative and offer an excellent introduction to the trauma competency approach.
Debra Leggett, Ph.D. is Associate Professor and Associate Department Chair of Psychology and Behavioral Sciences at Argosy University/Sarasota.
Dancing Mindfulness: A Community Practice for Coping and Healing with Movement
by Jamie Marich, Ph.D., LPCC-S, LICDC
What do you picture when you hear the word mindfulness?
For many, an image of a fit yogini sitting cross-legged on a rock, hands resting comfortably on each knee with thumbs touching middle fingers, making a perfect circle, comes up. For others, the picture may be that of a saintly Buddhist monk with his prayer beads in tow. For others still, the image may be that of a large community of meditators chanting in unison. But would you ever go to a dance floor full of people of all shapes, sizes, and physical abilities discovering their body's own sense of dance with the simplest of rhythmic movements, or even getting down and grooving to the latest pop numbers?
In truth, there are a variety of ways to experience mindful awareness and to cultivate its practice. Jon Kabat-Zinn, often associated with promulgating the ancient concept of mindfulness into Western psychology simply defines it as "paying attention in a particular way: on purpose, in the presence of the moment, and non-judgmentally." Considering this definition, any activity can be engaged in mindfully-eating, stretching, breathing, walking, praying, and speaking are all areas that workshop presenters, authors, and retreat leaders touch on with regularity. So why not dancing? Dancing is a naturally wonderful coping skill for the relief of stress, an exercise that indigenous and Eastern cultures have accessed for millennia, in lieu of talking, for total healing following a traumatic experience. Yet, in modern Western cultures, we tend to be inhibited when it comes to dancing, fearing that if we don't dance well, then we really shouldn't be dancing, victims of the looks are everything mentality. But what if we could work with people to move in a non-judgmental way and stay present, witnessing themselves, and not judging themselves? Imagine the healing potential we can help people in our communities and our clinical settings tap into!
Tapping into each individual's potential for movement, creating beauty, and achieving mindful awareness is what the Dancing Mindfulness practice is all about. I grew up taking dance lessons of all kinds. My parents met in Slavic folk dancing troupes and I began lessons in folk dancing at the tender age of 4. Later in my childhood I took up figure skating and took my requisite ballet and jazz classes to help me with lyrical expression. However, even through thousands of hours of lessons and training, I never once called myself a dancer. At best, I was a skater who danced, but that label of dancer was somehow reserved only for people who were good enough to do this professionally. As I aged and became disconnected with my body, I abandoned taking any formal dance classes, yet I was always the first one to get up at weddings and move when the band started! As a successful professional in my late twenties, after several years in recovery from addiction and issues connected to my own traumatic stress issues, I sought out to explore my unfulfilled desire to move. I enrolled in a local ballroom dancing program but ultimately found it too expensive and too limiting since I did not have a regular partner who wanted to participate with me. Thus, going to ballroom social dances recreated some of the trauma of my junior high days!
Then I discovered yoga; although it transformed my recovery, I still found that there was something missing. While I was on a retreat at the Kripalu Center for Yoga & Health in Massachusetts not too long ago, I took one of the noon conscious dance classes and was hooked! These were numerous brands of expressive dance led by a different facilitator each day, facilitators that were knowledgeable in yogic language and fostered empowerment in the participants. It was during one of these classes, as I moved with ease across the floor in a way I hadn't since I was a child, that I was able to own the phrase, "I am a dancer!" This declaration opened up a whole new world for me and ushered in a period of reconnecting with my own body to continue my healing process.
I studied with some leaders in the conscious dance movements and took a variety of classes in different modalities before developing Dancing Mindfulness. No matter the flavor of conscious dance class that I took or studied, it connected me back to the experience of being a young child in my parent's basement, just cuing up music and dancing around, not caring about what people thought, and experiencing release. Although I benefitted from doing this type of "free dance" within a community of people, it struck me that for trauma survivors, some serious considerations in the realm of safety and flexibility must be considered in order to most effectively take such conscious dance approaches into the community. In our yoga schools and fitness venues around the world, so many trauma survivors take classes in silence about what they really experienced, not to mention in clinical settings where many dance/fitness instructors go with good intentions, but often fail to consider just how triggering movement can be if not properly addressed.
Thus, I decided to bring my knowledge as a clinician who primarily specialized in traumatic stress, adhering to the principles of safety and flexibility (e.g., adjusting your modality to meet the client or the group, not the other way around) within a three-phase model (e.g., stabilization, processing/ "going deeper," reintegrating) to my experiences with conscious dance. Considering that I experience dance as an ultimate form through which to experience mindful awareness, I decided to call the practice Dancing Mindfulness. At present, I facilitate these hour to hour-and-a-half long classes within community settings, like yoga studios, and I have also had the pleasure of sharing them on retreats and with my professional colleagues at national conferences.
There are seven primary elements that make up a Dancing Mindfulness experience: breath, sound, body, story, mind, spirit, and integratedexperience. In a typical class we start on the floor without music, connecting with our breaths and heartbeats, recognizing these qualities as our own natural instruments. Then music enters the space and we begin to breathe it in as we stretch. Working our way into a standing position, the facilitator gently prompts participants to begin experimenting with standing motion and exploring the dance space. Any type of music can be used in a Dancing Mindfulness class and in my classes, I generally pick a variety of rhythms, tempos and qualities based on a theme for the class (e.g., love). In Dancing Mindfulness classes I use everything from African drumming to classical standards to Madonna and Lady Gaga. The key is that the music promotes personal exploration of one's own heart, soul, and ultimately, the personal stories that their bodies want them to tell on any given day. Each class seems to take on a life of its own, depending on the venue and the students. Some classes seem to naturally cause participants to connect more with other dancers, but this process is to never be forced for the sake of safety. Other classes seem to be focused on personal depth of exploration. Regardless of the shape the class takes, we always end make on the ground with safety and relaxation, connecting back with the breath, the heartbeat, and often some light chanting. As the facilitator, I always make myself available for one-on-one processing with people after the group in case something triggering came up.
Dancing Mindfulness is an evolving practice that I hope will bring the benefits of mindfulness, with its awareness-promoting capacity and non-judgmental tenderness, to even more people in the community. I look forward to continue monitoring its potential in reaching survivors of trauma. For more on Dancing Mindfulness, including a short video and information on training opportunities, please go to www.DancingMindfulness.com.
Dr. Jamie Marich is a licensed clinical counselor and chemical dependency counselor in the State of Ohio, and the creator of the "Dancing Mindfulness" practice. She travels the country offering continuing education workshops and retreats on issues related to trauma and addiction. She is the author of Trauma and the Twelve Steps: A Complete Guide to Enhancing Recovery and EMDR Made Simple: 4 Approaches for Using EMDR with Every Client. Her dissertation on the use of EMDR in addiction continuing care was published in the prestigious APA journal, Psychology of Addictive Behaviors.
For more: www.TraumaTwelve.com, www.DancingMindfulness.com, www.jamiemarich.com, www.drjamiemarich.com