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Resolving Trauma - PPT Presentation

Without Drama Bill O Hanlon MS LMFT Possibilities Santa Fe NM USA Billbillohanloncom wwwbillohanloncom Good News about PTSD We are finally recognizing it Bad News about PTSD ID: 388599

trauma future people traumatic future trauma traumatic people post ptsd resolving inclusion pattern find pull compassion www growth time

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Slide1

Resolving TraumaWithout Drama

Bill O

Hanlon, M.S., LMFT

Possibilities

Santa

Fe, NM

USA

Bill@billohanlon.com

www.billohanlon.comSlide2

Good News about PTSDWe are finally recognizing itSlide3

Bad News about PTSDW

e have mainly one idea and approach to it and some prevalent mythsSlide4

Myths and misconceptions about trauma and treatment

1

All

people who suffer trauma develop PTSD Slide5

Trauma doesn’t necessarily lead to PTSD

60.7%

of

men

;

51.2%

of

women

in the U.S. have experienced at least one traumatic event meeting DSM criteria

In Detroit,

nearly 90%

of residents have been exposed to traumatic events

But the general lifetime prevalence of PTSD is about

7.8%

and Detroit residents is

9.2%

.

Kessler, R.C.;

Sonnega

, A.;

Bromet

, E.; Hughes, M.; and Nelson, C.B. (1995).

Trauma and Posttraumatic stress disorder in the National Comorbidity Survey,

Archive of General Psychiatry, 52(12):1048-1060.

Breslau, N.; Kessler, R.;

Chilcoat

, H.; Schultz, L.; Davis, G.; and

Andreski

, P. (1998).

Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma,

Archive of General Psychiatry, 55(7):626-632.

Slide6

Myths and misconceptions about trauma and treatment

2

People

who develop PTSD only resolve it through

therapySlide7

PTSD often resolves without treatment, but treatment can help resolve it fasterThere was a steep decline in the prevalence of PTSD over the first 12 months after it developed, followed by a gradual decline for 6 years.But treatment seekers had about half the duration as non-treatment seekers.

Kessler, R.C.;

Sonnega

, A.;

Bromet

, E.; Hughes, M.; and Nelson, C.B. (1995).

Trauma and Posttraumatic stress disorder in the National Comorbidity Survey,

Archive of General Psychiatry, 52(12):1048-1060.Slide8

People are often more resilient than we therapists give them credit forExpected rates of PTSD following 9/11 didn’t materialize

Resilience is often the most commonly observed outcome trajectory following exposure to a potentially traumatic event.

There is a whole literature on Post-traumatic Growth and Resilience

G. A.

Bonanno

, C.

Rennicke

and S.

Dekel

, (2005)

Self-enhancement among high-exposure survivors of the September 11th Terrorist Attack: Resilience or Social Maladjustment?

Journal of Personality and Social Psychology

, 88:984-988.

Bonanno

, G.A.

et. al

, (2002)

Resilience to Loss and Chronic Grief: A prospective study from

preloss

to 18-months

postloss

,

Journal of Social Issues

, 83:1150-64.

Tedeschi

, R. G. and Calhoun, I.G. (2004)

Posttraumatic Growth: Conceptual foundations and empirical evidence,

Psychological Inquiry

, 15:1-18.

Linley, P.A. and Joseph, S. (2004)

Positive Change Following Trauma and Adversity: A review,

Journal of Traumatic Stress

, 17:11-21.

Carver, C.S. (1998)

Resilience and Thriving: Issues, models and linkages,

Journal of Social Issues, 54:245-266

.Slide9

Example of natural resolution of PTSD (post-Katrina)911 operator in Katrina disasterSlide10

Myths and misconceptions about trauma and treatment

All people who suffer trauma develop PTSD

People who develop PTSD only resolve it through therapy

Long-term,

abreactive

therapy that helps people relive and assimilate the trauma is the most effective approach

There are only negative effects from traumaSlide11

Resilience and recovery from trauma:A lesson from CambodiaSlide12

Four major approaches

1

Future pullSlide13

Four major approaches

2

InclusionSlide14

Four major approaches

3

Pattern ChangeSlide15

Four major approaches

4

Re-ConnectionSlide16

Resolving TraumaWithout Drama

Future-oriented

interventions for resolving traumaSlide17

Resolving TraumaWithout Drama

“All pasts are like poems; you can derive a thousand things, but you can’t live in them.” –John

FowlesSlide18

FUTURE PULL:Connecting with a Future with Possibilities and in which the Post-Trauma is Resol

vedSlide19

FUTURE PULL:The Victor Frankl StrategySlide20

Howard Lutnick, CEO Cantor FitzgeraldLost his brother, his best friend and 658 of his employees in the 9/11 attacks

We always thought

we’d

fall apart at some point.

I’d

tell people it was like surfing in front of a very large wave and as long as I kept going forward as fast as I possibly could, the wave would never get me. But if I ever stopped, and took a moment to look back . . .Whoosh, the wave would crash over me, and I

d get crushed. But if I kept moving forward, the wave would get smaller and smaller, and

that’s

what happened. (Fall 2006)Slide21

Elspeth McAdam-Future Pull

. . . A young girl I was working with had experienced abuse. She walked into my office as a very large girl with shaved hair, tattoos on her head, and I don't think she had showered in a week. I had been asked to see her because she was so angry. She clearly didn't want to come and see an expletive expletive shrink. She was very angry at being there. I just said to her, 'You've talked to everybody about your past. Let's talk about your dreams for the future.' And her whole face just lit up when she said her dream was to become a princess. In my mind I could not think of two more opposite visions–but I took her very seriously. I asked her about what the concept of princess meant for her. Slide22

Elspeth McAdam-Future PullShe started talking about being a people's princess who would do things for other people, who would be caring and generous and a beautiful ambassador. She described a princess who was slender and well dressed. Over the next few months, we started talking about what this princess would be doing. I discovered that, while this girl was 14 and hadn't been attending school for a long time, the princess was a social worker. I said, 'Okay it is now ten year's time and you have trained as a social worker. What university did you go to?' She mentioned one in the north of England. I asked, 'What did you read

[study]

there?' She said, 'I don't know, psychology and sociology and a few other things like that.' Then I said, 'Do you remember when you were 14? You'd been out of school for two or three years. Do you remember how you got back in school?'Slide23

Elspeth McAdam-Future Pull

She said, 'I had this psychiatrist who helped me.' I said, 'How did she help you?' And she started talking about how we made a phone call to the school. I said, "Who spoke? Did you or her?' She replied, 'The psychiatrist spoke but she arranged a meeting for us to go to the school.' I said, 'Do you remember how you shook hands with the head teacher when you went in? And how you looked and what you wore?' We went into these minute details about what that particular meeting was like–looking from the future back. And she was able to describe the conversations we had had, how confident she had been, how well she had spoken, and the subjects she had talked about. I didn't say any more about it.Slide24

Elspeth McAdam-Future Pull

About a month after this conversation she said to me, 'I think it's about time we went to the school, don't you? Can you ring and make an appointment?' I asked if she needed to talk about it anymore and she said no, that she knew how to behave. When we went into the school she was just brilliant. I first met that girl ten years ago. Now she is a qualified social worker. She fulfilled her dream–although she didn't go to the university she mentioned.Slide25

Future Pull“There is a

reason

the rearview mirror is smaller than the

windhield

.” –Sign on a church in WinnipegSlide26

Problems into PreferencesRephrase from what is unwanted to what is desiredRedirect from the past to the future

Mention the presence of something rather than the absence of something

Suggest small increments rather than big leapsSlide27

Expectancy TalkYet, so far

Before

After

When

How quickly?Slide28

Letter From Your FutureWrite a letter from your future self to your current self

From five years from now

Describe where you are, what you are doing, what you have gone through to get there, and so on

Tell yourself the crucial things you realized or did to get there

Give yourself some sage and compassionate advice from the futureSlide29

Letter From Your FutureUse these questions to guide their letter writing:

What have you learned and gained perspective on since back in [fill in the present date/year]

?

What things were you worried or frightened about in those days that seem trivial or far away for you today

?

What problems seemed overwhelming or insurmountable in those days that you did eventually resolve or overcome

?

What sage advice would your future self give to that present self

?

What comfort or reassurance would your future self give to your present self

?

Who were you troubled by, frightened by or concerned with that now doesn’t matter as much?Slide30

Future Pull"You have to go fetch the future. It's not coming towards you, it's running away." –Zulu proverbSlide31

A simple future method

What is your sense of a future you would prefer (vs. problem-determined or problem-continued future)?

What would you do or focus on or think in the near future if you were committed to or moving toward that future

?

Could you do any small part of that right now or in the near future?Slide32

The Miracle QuestionSay: “

Imagine that as you were asleep tonight, a miracle occurred and the problem or concern that brought you to therapy was resolved.

Make certain that the client is experientially involved in the scenario.

Ask:

When you first open your eyes, what the first thing you will notice that will let you know that this miracle has occurred?

Ask:

How would other people know the miracle had occurred? What would they notice that is different about you or what you are doing?

Keep tracking the changes through the day, the week, the month and so on.Slide33

Other Future MetaphorsCrystal ball

Time machineSlide34

Other Future MetaphorsRainbow bridgeSlide35

Future Pull

The future enters into us, in order to transform itself into us, long before it happens.

—Rainer Maria RilkeSlide36

Future Pull“

The best thing about the future is that comes only one day at a time.

–Abraham LincolnSlide37

Future PullMethods

Problems into preferences

Letter from the future

Positive expectancy

talk

Miracle question/time machine

/crystal ball/rainbow bridgeSlide38

Acknowledgment and PossibilityTransitioning between past, problem and possibilities

Carl Rogers with a twist

3 methods

Reflecting in the past tense

Reflecting from total to partial

Reflecting from truth/reality claims to validating perceptionsSlide39

Letter from Abraham Lincoln to Fanny McCulloughDear Fanny

It is with deep grief that I learn of the death of your kind and brave Father; and, especially, that it is affecting your young heart beyond what is common in such cases. In this sad world of ours, sorrow comes to all; and, to the young, it comes with bitterest agony, because it takes them unawares. The older have learned to ever expect it. I am anxious to afford some alleviation of your present distress. Perfect relief is not possible, except with time. You can not now realize that you will ever feel better. Is this not so? And yet it is a mistake. You are sure to be happy again. To know this, which is certainly true, will make you some less miserable now. I have had experience enough

to

know what I say; and you need only believe it to feel better at once.Slide40

Resolving TraumaWithout Drama

Validating/inclusive

interventions for resolving traumaSlide41

Undifferentiated/Unboundaried Self

Undifferentiated

selfSlide42

Typical development process leading to integrated self

Undifferentiated

selfSlide43

Split Happens:Intrusion, Devaluation and Shame

Undifferentiated

self

Shaming/devaluing

Sexual/physical intrusion

Attribution of experience

Leads to

3-D effectSlide44

Dissociated/Disowned/Devalued Aspects/Experiences

Unowned

/

bad

feelings, thoughts, sensations, memories, fantasies, desires, aspects of self

Aspects of experience with which the person identifiesSlide45

Inhibition or Intrusion

Devalued aspect is either inhibited, suppressed and numbed or becomes intrusive, dominant or compulsive

AKA

The Missing Roommate

”Slide46

Inclusion Level 1Permission #1

To

You can

It

s okay

You

re okay ifSlide47

Inclusion Level 1Permission #2

Not to have to

You

don’t

have to

It’s

okay if you

don’t

You’re

okay if you

don’tSlide48

Inclusion Level 2Inclusion of seeming opposites

You can

and

not

Opposite polarities

Previously incompatible experiences/traitsSlide49

Inclusion“Do I contradict myself? Very well, then I contradict myself. I am large, I contain multitudes.

–Walt WhitmanSlide50

Inclusion“In logic, no two things can occupy the same point at the same time, and in poetry that happens all the time. This is almost what poetry is for, to be able to embody contrary feelings in the same motion.

—Donald HallSlide51

Inclusion “

Anger and tenderness–my selves. And now I can believe they breathe in me as angels and not as polarities. Anger and tenderness–the

spider’s

genius. To spin and weave in one moment anywhere. Even from a broken web.

—Adrienne RichSlide52

OXYMORONSAwfully nice Exact estimate Found missing Same difference

Almost exactly Sweet sorrow

Now, then ...

Working vacation

Terribly pleased Tight slacks

Definite maybe Pretty uglySlide53

Inclusion Level 3Exceptions

That’s

the way it is, except when

it’s

not

Moments of exception

Including the opposite possibility

Recognizing complexitySlide54

The Inclusive Self

Previous

solutions

Nature

Influenced by alien voices

(society

s/others)

Identified Self

(Identity Story)

Devalued aspects

(

Disidentified

Self)

Resources

Alternative

Stories

Community

Exceptions

Polarities

(

Non-identified self)

Spirituality

Future selvesSlide55

Where to Apply Inclusion

Injunctions

Restraining - Can't, shouldn't, won't

Compelling - Have to, should, will, must

Be, think, feel, know, notice, do, talk aboutSlide56

Undoing Injunctions

Determine the injunction

Sex is bad.

It's not okay to get angry.

I have to relax or stop obsessing

.

Use any or all of the inclusive methods to undo injunctions

"It's okay to be connected and sexual."

"You don't have to relax. If the obsessions are there, you can just let them be there."Slide57

Review: Levels of Inclusion3

Levels of Inclusion

Permission

To

Not to have to

Inclusion of (seeming) opposites

ExceptionsSlide58

Resolving TraumaWithout Drama

Pattern

changing/breaking

interventions for resolving traumaSlide59

Patterns as problems John Cage:

I

can’t

understand why some people are frightened of new ideas.

I’m

frightened of the old ones.

”Slide60

Patterns as problemsEmile

Chartier

:

“There’s

nothing as dangerous as an idea when

it’s

the only one you have

!”Slide61

Patterns as problems12-step saying

Insanity is doing the same thing over and over and expecting different results.Slide62

CHANGE THE DOINGSlide63

CHANGE THE VIEWINGSlide64

CHANGE THE CONTEXT/SETTINGSlide65

Changing the Pattern

1.

DE-PATTERNING

Find and alter repetitive patterns of action and interaction that are involved with the problem

2. RE-PATTERNING

Help clients establish a new pattern in place of the old one

Find

and use solution patterns of action and interactionSlide66

External

sensory

perception

Internal

experience

External

environment

Thoughts

Beliefs

Stories

Behavior

Actions

Neurology

Patterns/ProcessesSlide67

Pattern Intervention

External

sensory

perception

Internal

experience

External

environment

New views

Behavior

Neurology

Lead out of the old repeating patterns

InterventionSlide68

Breaking the post-traumatic patternFind any regularity in the post-traumatic experienceNeurological/physiological

Perceptual

Behavioral

Interpersonal

Frame of reference

Focus of attention

Find any place to make a small or dramatic change in the pattern that is under your or their influence

Find the exception/solution pattern

Find a substitute that

wouldn

t be so harmful or upsettingSlide69

Resolving TraumaWithout Drama

Neurological interventions for resolving

trauma:

The fast track out of traumaSlide70

Neurology works rapidlyRecent trauma treatmentsEMDR

TFT/EFT

Controversial but clinically effectiveSlide71

Websites for further infoThought Field Therapy

www.tftrx.com

Emotional Freedom Technique

www.emofree.comSlide72

EMDRWebsites for more information:

www.emdr.com

www.emdria.org

Francine says: GET SOME TRAINING!Slide73

Resolving TraumaWithout Drama

Perceptual interventions for resolving traumaSlide74

Breaking the post-traumatic patternFind any regularity in the post-traumatic experienceNeurological/physiological

Perceptual

Behavioral

Interpersonal

Frame of reference

Focus of attention

Find any place to make a small or dramatic change in the pattern that is under your or their influence

Find the exception/solution pattern

Find a substitute that

wouldn

t be so harmful or upsettingSlide75

ExternalizingMove the post-traumatic pattern outside the person’s body

Raggedy Anne

Slash paintingSlide76

The Writing RitualWrite about the trauma for as little as 3 days in a rowWrite for about 15 minutes or soKeep the writing private

Be honest and write freely without editing or worrying about getting it exactly right

Consider burning it, burying it, throwing it away or some such ritual after it is completedSlide77

Resolving TraumaWithout Drama

Reconnecting

interventions for resolving traumaSlide78

Trauma can disrupt connections

Initial disconnection is normal

But

if it persists, then PTSD often ensues

Discover natural places or ways of connection

Help people reconnect or connect in places or ways they

haven’t

beforeSlide79

Connection can help reduce PTSDBeing with someone else during an earthquake is protective against PTSD

Armenian, H. et. Al. (2000).

Loss as a determinant of PTSD in a cohort of adult survivors of the 1998 earthquake in Armenia: Implications for policy,

Acta

Psychiatr

. Scand.,

102(1):58-64.

Post-traumatic stress disorder sufferers in group treatment recovered at a significantly higher rate (88.3%) than those in individual treatment (31.3%)

.

Beck, J.

et.al

. (2009).

Group Cognitive Behavior Therapy for Chronic Posttraumatic Stress Disorder: An Initial Randomized Pilot Study,

Behavior Therapy

, 40(1):82-92.Slide80

Maryann Burns, Cantor FitzgeraldMissed her train the morning of 9/11The only place I felt like myself was work. I needed to be around other people

who’d

been where

I’d

been. I

didn’t

want to have to explain myself. In groups of other people I often felt detached, you know

?

Work made me feel sane. I wanted to go to work every day

.Slide81

Pathways to ConnectionSoul/spirit/core self/intuition

Body/sensory experience

Another being

Community/groups

Nature

Art

God/universe/higher power/bigger picture, meaning and purposeSlide82

Assessing the 7 pathways

Discover the natural connections people have

Help them reconnect where they have disconnected

Help them find and create new connectionsSlide83

Connective RitualsRegularly repeated activities

Reconnect one to self, others or something beyond

Give one a sense of continuity

Restoring previous rituals

Creating new ritualsSlide84

Resolving TraumaWithout Drama

Post-Traumatic Success:

How trauma can contribute to a person’s lifeSlide85

Positive DisintegrationPsychiatrist Kazimierz

Dabrowski

first posited a theory of

Positive Disintegration

in 1964 (

Dabrowski

, K.

Positive Disintegration

. Boston: Little, Brown & Co.), suggesting that overwhelming crises are necessary and natural elements that help people move from one developmental stage to the next.Slide86

Post-Traumatic SuccessSlide87

Post-Traumatic Success“Dear Mom and Dad: Thanks for the happy childhood. You’ve ruined any chance I had of becoming a writer.”Slide88

Resilience is learnable“We do know there are factors that make some people resilient. There are genetic components to it, but there’s a huge learning component. People can train themselves to be more resilient.”

Dr. Steven Southwick, himself a veteran of the Vietnam War, deputy director of the Clinical Neurosciences Division of the National Center for PTSD

“Facing Combat Without Stress? Researchers Examine Most Resilient Soldiers,” VA (Veterans Administration) News Flash, August 26, 2007, http://www.vawatchdog.org/07/nf07/ nfAUG07/nf082607-7.htmSlide89

Post-Traumatic Growth InventoryPosttraumatic Growth Inventory,

a 21-item scale for

assessing positive outcomes reported by

people who

have experienced traumatic events, is described.

Women

tend to report more benefits than do

men

People who

have experienced traumatic events report more positive change than do persons who have not experienced extraordinary events.

Ref:

Richard

G.Tedeschi

and Lawrence G. Calhoun. (1996).

The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma,

Journal of Traumatic Stress

, July, 9(3):455-471Slide90

Post-traumatic GrowthReports of posttraumatic growth have been found in people who have experienced:Bereavement

Rheumatoid arthritis

HIV infection

Cancer

Bone marrow transplantation

Heart attacks

Coping with the medical problems of children

Transportation accidents

House fires

Sexual assault and sexual abuse

Combat

Refugee experiences

Being taken hostage

Ref:

Tedeschi

, R. G. and Calhoun, I.G. (2004)

Posttraumatic Growth: Conceptual foundations and empirical evidence,

Psychological Inquiry

, 15:1-18.Slide91

Post-traumatic Growth InventoryCategories are:New Possibilities

Relating to Others

Personal Strength

Spiritual Change

Appreciation of Life

The American Psychological Association has this inventory on their website so people can take it:

http://

cust-cf.apa.org

/

ptgi

/Slide92

Post-traumatic Growth InventorySample statements; rate on a scale of 1-5 how much the trauma or crisis led to this:I established a new path for my life.

I know better that I can handle difficulties.

I changed my priorities about what is important in life.

New opportunities are available which wouldn't have been otherwise.

I have more compassion for others.

I discovered that I'm stronger than I thought I was.

I have a greater sense of closeness with others.Slide93

Thriving Through Crisis:Creating Post-Traumatic Success

Connection

Compassion

ContributionSlide94

Thriving Through Crisis:Creating Post-Traumatic SuccessSlide95

Compassion/Contribution/ServiceMitzvah therapyThe African Violet Queen

Sol Gordon

s Abuse Victim

M.A.D.D.

When a man is wrapped up in himself, he makes a pretty small package. –John Ruskin

The Dead Sea (no outlet) vs. The Sea of Galilee (outlet)Slide96

Transforming PTSD into Post-Traumatic SuccessBlissed

or

DissedSlide97

DISSEDWounded/Cursed (Disrespected)or

Righteously Indignant

(Dissatisfied)Slide98

The KeyTransforming the “negative

energy of anger and hurts into positive energySlide99

DissedWounded/CursedSlide100

DissedVocal coachPatsy

RodenbergSlide101

DissedRock music and movie criticKen TuckerSlide102

DissedHorror writerStephen KingSlide103

WoundedLeonard Cohen:

There’s

a crack in everything.

That’s

how the light gets in.Slide104

DissedWe all leave childhood with wounds. In time we may transform our liabilities into gifts. The faults that pockmark the psyche may become the source of a man or a woman’

s beauty. The injuries we have suffered invite us to assume the most human of all vocations–to heal ourselves and others. –Sam KeenSlide105

Dissed to Creativity, Contribution or Career

Where have you been wounded?

Where or about what have you been cursed?

How can you turn this wound or disrespect or curse into a blessing or contribution?

How could this wound, curse, or disrespect fuel your creativity or career?Slide106

Resolving Trauma

Compassion

Passion=Feeling

Com=withSlide107

Compassion/Self-Compassion

People who are unable to forgive themselves or others also have an increased incidence of depression and callousness toward others.

Pargament

, K.L., et al. (1998).

Journal of Scientific Study of Religion

, 37:710-724.Slide108

CompassionFind contexts of compassion/self-compassion (the solution-oriented approach)

Ask about moments when the person softened toward themselves or someone else

Find another context (like being a friend, a child, or a client) that can access

compassion

Ask the person how they would like to be treated if they have wronged someoneSlide109

Self-Compassion

Bumper Sticker:

I honor and express all facets of my being, regardless of state and local laws.Slide110

Four major approaches to resolving trauma briefly and respectfullyConnect

the traumatized person to a future with

possibilities

Validate/value and include all aspects of the person

Change the pattern of the post-traumatic problem

Reconnect the person in places where he or she has been disconnected (from self, others or the world)Slide111

Plus: Post-Traumatic SuccessConnection

With self, others and something beyond

Compassion

For others and for self

Forgiveness

Contribution

Letting the wound or the trauma lead to being of service and changing the world in a positive waySlide112

THANK YOUREMEMBER:

You can get a free copy of these slides:

Billohanlon.com

Click FREE STUFF, then SLIDES

You may share these with others, as long as you don’t profit from this activitySlide113

This Powerpoint presentation was created by Bill O’Hanlon ©

2011.

You have my permission to use it for non-commercial purposes (like sharing it with your colleagues or studying it yourself). If you want to use it in any commercial (money-making) activities, please contact me for permission and discussion.

Permission to useSlide114

Bill O’Hanlon’s infoWebsites:

http://

www.BillOhanlon.com

http://

www.PublishingaBook.com

http://

www.PaidPublicSpeaker.com

http

://

www.GetOverTrauma.com

Email:

Bill@billohanlon.comSlide115

Bill O’Hanlon, M.S., LMFT

Possibilities

223 N. Guadalupe #278

Santa Fe, NM 87501 USA

Bill@billohanlon.com

www.billohanlon.com

Contact information