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
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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
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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
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http://
www.BillOhanlon.com
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www.PublishingaBook.com
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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