Therapeutic Change From the Perspective of Integrative Trauma Treatment

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Acknowledgments

I wish to acknowledge with appreciation the colleagues who have read drafts and offered suggestions during the course of several revisions of this paper: Kim Bernstein, PhD, Wilma Bucci, PhD, Jacqueline A. Carleton, PhD, Kenneth A. Frank, PhD, Diane Poole Heller, PhD, and Nancy Napier, LMFT, and to the NIP Trauma Program for providing a community in which the understanding and treatment of trauma continue to evolve.

Notes

¹For an introduction to the treatment of extreme dissociation, see Howell (2011) and for use of EMDR in treating dissociative disorders with EMDR, see Forgash & Copeley (2008).

²There are many affect regulation techniques, including breathing exercises, the use of imagery to contain unbearable affects or experiences, construction of a safe/comfortable place in the mind, learning to identify affects, and grounding exercises that enhance the experience of being present. (See Omaha 2004; O'Shea & Paulsen, 2009; Rothschild, 2003, for examples.) Suggesting adjunctive practices such as yoga or meditation may also be appropriate.

³Substantial discussions of somatic forms of therapy have been published both by analysts working with somatic experience (Anderson, 2007; Aron & Anderson, 1998; La Barre, 2001) and by nonanalysts who work with body awareness and mindful awareness of interpersonal regulation (e.g., Ogden et al., 2006). See also Paulsen and Lanius (2009).

⁴Somatic Experiencing, developed by Peter Levine (1997), and Sensorimotor Psychotherapy, developed by Pat Ogden (Ogden et al., 2006), are clinical approaches that have evolved from mindfulness practice and an appreciation of basic patterns of affect regulation and adaptive defensive response. Pat Ogden, particularly, emphasizes interpersonal regulatory effects in her use of Sensorimotor psychotherapy. Diane Poole Heller (personal communication, September 30, 2009), notes that Somatic Experiencing uses resourcing and slowing down processing just to the point that allows the client to stay aware (not dissociated) and able to discharge arousal, achieve a balance between sympathetic and parasympathetic activity, and integrate experience.

⁵Actually, EMDR processing can be quite effective even during training, when practicing patient/therapist dyads are newly formed. A well-established relationship is therefore not usually necessary for EMDR processing, but it is the likely context in which psychoanalysts would introduce EMDR work to insure emotional safety and to further the goals of an analytic treatment.

⁶This process is regarded as a form of “pendulation” in Somatic Experiencing therapy.

⁷This description does not do justice to the SE rationale for slowdown and its approach to trauma resolution. Some examples of the use of slowing in trauma treatment appear in discussion of the similar approach of Sensorimotor Psychotherapy (in Ogden et al., 2006).

⁸Diana Fosha offers frequent invitations to patients to explore and embody their reactions to the therapist's bearing witness and to the therapist's own emotional reactions to the patient, in the service of resolving attachment trauma in Accelerated Experiential Dynamic Psychotherapy (AEDP). See Fosha (2003).