The treatment of trauma in psychotherapy

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress resulting from disturbing life experiences. Practitioners are licensed and you may train in EMDR two years after qualifying as a therapist.  EMDR therapy demonstrates that the mind can heal from psychological trauma just as the body recovers from physical trauma. The technique was developed by Francine Shapiro, some say whilst out strolling on a beach in the Bay Area, to resolve the development of trauma-related disorders caused by exposure to distressing, traumatising, or negative life events, such as rape or military combat. As a Senior Research Fellow at the Mental Research Institute, she published the first research data to support the benefits of the therapy in the 1989.

EMDR therapy is only interested in feelings NOW. What is in the past is done.

The wounding metaphor.

When the body suffers a physical trauma what do you do? Think about how you got an injury treated in your life. What did you do to treat a wounding?

You would apply the following steps to treat a physical injury:

1. Clean the wound; this involves breaking open the scab and applying disenfectant
2. Make the wound safe
3. Rest
4. Healing;  The body organically learns how to heal.  The blueprint is in the genes.

The therapist will apply a similar course of treatment in EMDR therapy.

In the absence of specialist training in trauma, perhaps all you can do is work with memories.

So what is trauma?

Trauma is any threat to life or identity, mostly unexpected and overwhelms the defences.  There is extreme helplessness involving fear and horror. Trauma is the piercing of body and psyche defences and survival involves fight/flight/freeze.

Traumatic symptoms will invariably comprise of the following: Intrusion (the inability to keep memories of the event from returning), Avoidance (or numbing) (an attempt to avoid stimuli and triggers that may bring back those memories), Hyper Arousal (similar to jumpiness. It may include insomnia (trouble sleeping), a tendency to be easily startled, a constant feeling that danger or disaster is nearby, an inability to concentrate, extreme irritability, or even violent behaviour).

Post-traumatic stress disorder, or PTSD, is a new name for a very old condition. It was known as “shell shock” or “battle fatigue” in the early 20th century. Previously,  it had no name. In PTSD, a witness or victim of a tragic event is so haunted by memories of the event that personal health and personality is affected.

Neuroscience

The amygdala performs primary roles in the formation and storage of memories associated with emotional events. When assessing the role of the Amygdala think of it as the control desk in the brain.  It will flash red warning lights at perceived threats.

The most valuable recovery tool for anyone suffering from the effects of trauma is a support system of family and friends.  Most people will not need counselling after a traumatic event as they will heal through their own processes.

What is NOT recommended for the treatment of trauma

  • automatic psychological debriefing: This risks retraumatising people who might not have been directly affected by an event.
  • Ineffective psychological treatments
  • For PTSD, drug treatments NOT a first line treatment (different for depression)

What IS recommended

  • Watchful waiting
  • Checking in after a month (Professor David Richards research from 1997 on the prevention of post-traumatic stress after armed robbery showed that 80% of those who witnessed an armed robbery will heal on their own within a month)
  • If PTSD, then trauma-focused treatments (CBT & EMDR)
  • If acute in first weeks, CBT/sleep support can help.
The aim of therapy is to normalise and validate and the therapist will do this by displaying empathy whilst focusing on the trauma.

Resources

DSM V criteria for Post Traumatic Stress Disorder
The European Society for Traumatic Stress Studies (ESTSS)
The International Society for Traumatic Stress Studies (ISTSS)
The European Network for Traumatic Stress (TENTS)
United Kingdom Psychological Trauma Society (UKPTS)
The Master and his Emissary Iain McGilchrist is a psychiatrist and writer who works privately in London 

 

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