Back in January, I attended a phenomenal workshop led by John Briere (a brilliant, renowned professor and researcher in the field of PTSD/trauma therapy work). I highly recommend him to clinicians in the counseling field who are interested in learning very relevant and postmodern information on the difficult arena of trauma work, one of the hardest and most complex clinical issues to treat besides addiction (in my opinion). His presentation was by far the best workshop I've attended in my quest for practical and yet interesting, helpful continuing education seminars.
I was first introduced to trauma work when I first started working at my current job (back in July 2008), as many of my clients are survivors of physical, emotional, sexual, and psychological abuse. To make matters more complicated, most of my clients suffered through multiple traumas. Imagine what it would be like to endure one specific, isolated traumatic event. Compound that by years of chronic abuse at the words or actions of various people in your life (usually beginning from the toddler or early school age years and continuing throughout adulthood), and you acquire what has become known as Complex PTSD. It is more challenging to treat and heal because it is so ingrained in the formation of one's personality/identity. In fact, Briere believes that there is no such thing as Borderline Personality Disorder, only unresolved trauma (ie, personality disorders are strongly correlated to childhood abuse and neglect).
According to Briere, trauma has two parts: 1. any kind of painful experience that 2. overwhelms your capacity to handle it. This can be either non-interpersonal (such as experiencing a natural disaster, like an earthquake) or interpersonal (which tends to affect people more strongly because someone is intentionally trying to hurt us). One of the most fascinating things Briere mentions is implicit memories vs. explicit memories.
Implicit memories are those that are formed on a sensory, pre-verbal level (ie, birth to age 2-3) in the brain. When someone has an implicit memory, they are more likely to be triggered by something visual like a photograph or a flashback/nightmare...yet not have the words to describe how or what trauma is being triggered within them in that moment (because they could not put the experience into words if they were younger than age 2-3 when it happened). This is why it can be difficult for a therapist working with a pre-verbal trauma client to talk about/describe the trauma(s). How can they put into words something that occurred before there WERE words? See the Catch-22 of treatment and recovery? Explicit memories are formed on the verbal level (age 3 to adulthood), so naturally it is "easier" to treat trauma from an explicit memory standpoint.
In addition, Briere talks about the avoidance triad: substance abuse, dissociation, and tension-reduction. As it turns out, there is a meaningfulness to avoidance behaviors with the trauma survivor. I don't know about other clinicians, but it has been my experience that avoidance behaviors seem like mere forms of escapism from pain.....which they are to a degree, but it's more complex than that. Briere goes a step further to suggest that engaging in such behaviors is the only way the trauma survivor knows how to "soothe" or "take care" of oneself, however misguided and unhealthy it may seem to others. This is what he calls "tension reducation behaviors" or "TRBs." They are intentional, external activities the trauma survivor engages in (ie, gambling, excessive exercise, self-mutilation, binging/purging, compulsive sexual activities, and drinking/doing drugs) for the purpose of reducing painful, internal states. While the trauma survivor may feel that these behaviors "help"quell the emotional pain, it only serves to perpetuate a cycle of shame and often, degradation.
While pain may be inevitable, Briere makes a distinction that suffering is optional. What does this mean? Pain may be a given, but what you do with it is optional. The pain paradox theorizes that cultivating a focused awareness can lead to relief/resolution, whereas avoidance contributes to constant suffering and emotional intrusion. This is where mindfulness as a clinical intervention with the trauma survivor comes into play. When someone has been through horrific, painful experiences, the last thing you want to do is pour salt into the proverbial wound and make them hurt even more by delving into it....but this is exactly what MUST be done...just with a gentle, mindful and timely (ie, not too fast/too soon) approach via the 'therapeutic window.'
Briere mentions the therapeutic relationship to be one of the key elements (the therapist as a caring, nurturing, and safe agent for facilitating change/healing within the trauma survivor client) and being able to teach mindfulness skills to the client.
The workshop delves into various clinical interventions/tools the clinician can utilize with the trauma client, which I won't explain in detail here. You'll have to attend the workshop yourself if you want that information.... :)
For more information, visit http://www.johnbriere.com/.
I was first introduced to trauma work when I first started working at my current job (back in July 2008), as many of my clients are survivors of physical, emotional, sexual, and psychological abuse. To make matters more complicated, most of my clients suffered through multiple traumas. Imagine what it would be like to endure one specific, isolated traumatic event. Compound that by years of chronic abuse at the words or actions of various people in your life (usually beginning from the toddler or early school age years and continuing throughout adulthood), and you acquire what has become known as Complex PTSD. It is more challenging to treat and heal because it is so ingrained in the formation of one's personality/identity. In fact, Briere believes that there is no such thing as Borderline Personality Disorder, only unresolved trauma (ie, personality disorders are strongly correlated to childhood abuse and neglect).
According to Briere, trauma has two parts: 1. any kind of painful experience that 2. overwhelms your capacity to handle it. This can be either non-interpersonal (such as experiencing a natural disaster, like an earthquake) or interpersonal (which tends to affect people more strongly because someone is intentionally trying to hurt us). One of the most fascinating things Briere mentions is implicit memories vs. explicit memories.
Implicit memories are those that are formed on a sensory, pre-verbal level (ie, birth to age 2-3) in the brain. When someone has an implicit memory, they are more likely to be triggered by something visual like a photograph or a flashback/nightmare...yet not have the words to describe how or what trauma is being triggered within them in that moment (because they could not put the experience into words if they were younger than age 2-3 when it happened). This is why it can be difficult for a therapist working with a pre-verbal trauma client to talk about/describe the trauma(s). How can they put into words something that occurred before there WERE words? See the Catch-22 of treatment and recovery? Explicit memories are formed on the verbal level (age 3 to adulthood), so naturally it is "easier" to treat trauma from an explicit memory standpoint.
In addition, Briere talks about the avoidance triad: substance abuse, dissociation, and tension-reduction. As it turns out, there is a meaningfulness to avoidance behaviors with the trauma survivor. I don't know about other clinicians, but it has been my experience that avoidance behaviors seem like mere forms of escapism from pain.....which they are to a degree, but it's more complex than that. Briere goes a step further to suggest that engaging in such behaviors is the only way the trauma survivor knows how to "soothe" or "take care" of oneself, however misguided and unhealthy it may seem to others. This is what he calls "tension reducation behaviors" or "TRBs." They are intentional, external activities the trauma survivor engages in (ie, gambling, excessive exercise, self-mutilation, binging/purging, compulsive sexual activities, and drinking/doing drugs) for the purpose of reducing painful, internal states. While the trauma survivor may feel that these behaviors "help"quell the emotional pain, it only serves to perpetuate a cycle of shame and often, degradation.
While pain may be inevitable, Briere makes a distinction that suffering is optional. What does this mean? Pain may be a given, but what you do with it is optional. The pain paradox theorizes that cultivating a focused awareness can lead to relief/resolution, whereas avoidance contributes to constant suffering and emotional intrusion. This is where mindfulness as a clinical intervention with the trauma survivor comes into play. When someone has been through horrific, painful experiences, the last thing you want to do is pour salt into the proverbial wound and make them hurt even more by delving into it....but this is exactly what MUST be done...just with a gentle, mindful and timely (ie, not too fast/too soon) approach via the 'therapeutic window.'
Briere mentions the therapeutic relationship to be one of the key elements (the therapist as a caring, nurturing, and safe agent for facilitating change/healing within the trauma survivor client) and being able to teach mindfulness skills to the client.
The workshop delves into various clinical interventions/tools the clinician can utilize with the trauma client, which I won't explain in detail here. You'll have to attend the workshop yourself if you want that information.... :)
For more information, visit http://www.johnbriere.com/.
2 comments:
Very interesting indeed. I agree with a lot of his beliefs. The bigger question is - why can some people deal with their trauma and others can't? I'm sure a variety of reasons. That's where it gets interesting to me - what are the reasons that a person cannot "rise above" trauma from childhood.
I think alot of it has to do with how open a person is to opening that "door" and making the choice to change, to transcend beyond pain from the past, no matter what. Most people are threatened by and resist change, even though most positive transformations tend to occur through working through the "muck" first. Does that make sense? That's my personal take on it anyway....
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