Expressive Therapies for Affect Regulation with Trauma Survivors - PowerPoint PPT Presentation

1 / 40
About This Presentation
Title:

Expressive Therapies for Affect Regulation with Trauma Survivors

Description:

Expressive Therapies for Affect Regulation with Trauma Survivors Lisa Ferentz, LCSW-C, DAPA www.lisaferentz.com lisa107107_at_aol.com 410-486-0351 * * * * * * additional ... – PowerPoint PPT presentation

Number of Views:130
Avg rating:3.0/5.0
Slides: 41
Provided by: LisaFe4
Category:

less

Transcript and Presenter's Notes

Title: Expressive Therapies for Affect Regulation with Trauma Survivors


1
Expressive Therapies for Affect Regulation with
Trauma Survivors
  • Lisa Ferentz, LCSW-C, DAPA
  • www.lisaferentz.com
  • lisa107107_at_aol.com
  • 410-486-0351

2
When children have emotionally available and
consistent caretakers, they develop secure
attachments.Healthy attachment equals affect
regulation (the ability to mange ones emotional
states). They first inter-regulate and then
auto-regulate as they internalize positive
soothing. The lack of good attachment leads to
affect dysregulation
3
children who are not allowed to successfully
attach have chemical systems that dont develop
normally, and as a result, they are in a
perpetual state of physiological distress.
4
When clients have affect dysregulation and cant
manage their emotional states, doing trauma
retrieval work leaves them vulnerable to flooding
and de-stabilization
5
Clients need to function in an optimum window of
arousal so they can tolerate and handle anger,
sadness, and other difficult emotions and
thoughts.When clients are NOT in this window,
they will present as either hypo-aroused (freeze,
feigned death) or hyper-aroused
(fight-flight).In either of these states, they
are in their limbic systems and NOT in their
pre-frontal cortex. As a result, they are
incapable of insight, self-awareness or the
ability to process and integrate new material.
6
affect dysregulation not in the optimal window
of arousal
  • HYPERAROUSAL
  • Easily triggered
  • Psychomotor agitation
  • Hyper-vigilant
  • Separation anxiety
  • Rejection sensitivity
  • Emotional overwhelm
  • HYPOAROUSAL
  • Flat affect
  • Numb, detached
  • Passive, submissive
  • Victim identity
  • Avoidant, withdrawn
  • Disconnected from body

7
the foundation of treatment(L.Ferentz, 2006)
  • creating safety and a safe place
  • strategies to address affect dysregulation
  • pacing and anchoring for stabilization
  • containment to prevent flooding
  • connection/attachment to resources and
    significant others

8
safety
  • creating a context of physical and emotional
    safety during sessions allows trauma work to feel
    reparative rather than re-traumatizing
  • feeling safe as traumatic experiences are
    explored helps clients to differentiate between
    then and now
  • teaching clients to ask for what they need to be
    safe increases their sense of empowerment and
    control

9
safety
  • clients often need to be convinced of the value
    of incorporating a sense of safety into
    treatment, as feeling safe may not be normalized
    for them in their daily lives
  • clients often want to move ahead before safety is
    established, unconsciously re-enacting a lack of
    safety in the past

10
Using the metaphor of pre-maturely jumping into
the deep end of the pool
  • without reassurance that there is water in the
    pool
  • without checking the water temperature
  • without wearing a lifejacket
  • without checking to see if there is a lifeguard
    on duty
  • without reassurance that they know/remember how
    to swim

11
therapists and clients should work together to
assess and create both external and internal
safety before trauma work begins.
  • external safety relates to the dynamics within
    the therapy room, internal safety relates to the
    clients felt sense and subjective inner
    processes.

12
creating external safety
  • room temperature
  • inside/outside noise
  • physical proximity to therapist
  • arrangement of furniture
  • changing seating
  • use of artificial and natural lighting
  • phone ringer off/on

13
creating external safety
  • visual distractions or triggers
  • objects for anchoring
  • agreed upon time limits
  • agreed upon use of comforting physical touch
  • use of pillows/blankets and other comforting
    objects
  • verbal/non-verbal signals to communicate stop

14
creating internal safety
  • using soothing breath work
  • inward focus with safe space in front of closed
    eyes
  • visualization and collage of real/imagined safe
    place (activate the 5 senses)
  • visualization/collage of an inner protector

15
enhancing internal safety with breath work
  • -E,I,E,I,O
  • -inhale 4, hold 4, exhale 6 add words
  • -inhale (to top of head) say I Am, exhale
    (through feet) say here
  • -inhale- close fist, exhale- open fist
  • hand on forehead/hand on heart
  • hand on belly/hand on heart- add figure 8 rock

16
Debbies safe place
  • a small, white boat with comfortable blue padded
    seat and a soft pink blanket
  • covered in a shimmering silver net
  • anchored in clear, aqua water
  • gently rocks back and forth
  • the sun is shining, warm. There is a cool breeze
  • the air smells and tastes salty
  • there are sounds of water lapping the boat and
    birds overhead

17
arousal modulation
  • trauma survivors react more intensely to stimuli
  • once arousal is activated, the traumatized brain
    does not have the ability to calm itself
  • the deficit regarding self-soothing is also
    related to a lack of attachment in childhood

18
Hand in Hand Meditation re-connecting with
sensation in the body is one way to pause,
re-ground, and modulate emotion
19
EFT emotional freedom techniquesincorporating
tapping
20
EFT Emotional Freedom TechniqueGary Craig
  • based on Chinese meridian/ acupressure points on
    the body
  • identify a negative feeling/something that is
    bothering you
  • notice where you feel it on your body
  • rate the intensity from 1-10
  • name the feeling
  • the feeling is nervous electrical energy that
    is stuck on the body
  • tapping cleans out the blocked energy

21
EFT protocol
  • set up by starting with karate chop point and
    saying, Right now I feel______, and I deeply and
    completely accept myself
  • continue to focus on the feeling and pair it with
    remaining pressure points on the body
  • rate the level of intensity
  • continue to repeat the sets until the intensity
    drops down to a 1

22
anchoring(Babette Rothschild, 2000)
  • a concrete, observable resource
  • a person, animal, place, object, activity that
    gives the client a feeling of well-being and
    relief
  • something that can be recalled with all of the
    senses
  • used as a braking tool when therapy becomes too
    emotionally or physically arousing for the client
  • allows the client to address charged material by
    preventing the escalation of hyper-arousal

23
examples of anchors
  • a small, smooth stone
  • a picture of a beloved family member
  • a brightly colored seashell
  • a favorite sweater or blanket
  • a stuffed animal/ a doll
  • silky colored scarves
  • pressing fingers in the OK sign/yoga pose
  • a rosary
  • a wedding ring or other jewelry
  • a travel postcard
  • hand on stomach while breathing- VAH, YAH, RAH
  • aromatherapy- candles, lotion, teabags, perfume,
    etc

24
When we learn to drive a car, knowing how to step
on the brake is as important as knowing how to
step on the gas pedal. The same is true when we
work with trauma. Teaching clients how to step
on the brake and slow the process down, so they
dont become overwhelmed or flooded, is as
important as showing them how to move forward
towards healing.
  • the soda bottle metaphor(Babette Rothschild,
    2004)

25
As the client begins to access trauma material,
attention is paid to their level of hyper-arousal
and the activation of the sympathetic system.
Rather than allowing for an escalation of
arousal, we temporarily put on the brakes by
re-introducing the anchor, tapping, doing brain
gym, breathing, moving the body, heightening
external safety and/or returning to the internal
safe place. This brings the client back to a
safer, less aroused state. Toggling back and
forth between arousal and safety allows the
client to proceed without becoming overwhelmed.
26
pacing with scaling
  • create a subjective template from 0-10
  • 0 feeling totally neutral, not disturbed by
    emotion or memory at all
  • 10 completely overwhelmed by the emotion or
    memory
  • ask client to identify the thoughts, feelings,
    body sensations that accompany 0-10
  • agree to put on the brakes when a client
    reaches a 5 (or whatever number begins to feel
    unmanageable for them)

27
containment strategies
  • reassures clients and therapists that emotional
    and cognitive flooding will not occur
  • helps clients feel a greater sense of control
    over their trauma material
  • strengthens a sense of boundaries
  • introduces notion of working through without
    being re-traumatized
  • increases clients abilities to return to the
    outside world after session and function
    appropriately

28
containment
  • turning affect/trauma material into colors and
    shapes
  • putting the color/shape into another internal
    container
  • checking for an inner sense of safety
  • adding additional layers of containment, if
    necessary

29
Saras containment for RAGE
  • large, bright orange sun with jagged red edges
  • absorbed into a dark wooden asbestos box with a
    lid and carvings on it
  • black braided rope tied around the box
  • cover the box with a scratchy, grey woolen
    blanket with red stripes
  • cover the whole thing in shimmery, silver angel
    wings

30
Marks containment
  • emotion despair
  • shape and color black, lump of coal, the size of
    a large fist
  • container bury it in a swimming pool filled with
    white sand
  • additional container heavy, black tarp covering
    the whole sand pit
  • additional container braided ropes to hold down
    the tarp
  • now it feels adequately contained

31
containment
  • making a collage or drawing internal containers
    to store affect and trauma material
  • writing down untenable emotion or trauma memory
    and storing the paper in an actual container ( a
    purse, a box, an envelope, a tupperware
    container, a drawer with a lock on it, etc.)

32
Somatic resourcing using the body for
containing(Pat Ogden)
  • taking a breath
  • expanding the chest
  • re-aligning the spine
  • putting both feet on the floor
  • standing up
  • re-distributing weight on the floor
  • pressing crossed arms against inside of thighs
  • warrior poses
  • one hand under opposite armpit/other hand on
    opposite forearm
  • thumb hold

33
Ericksonian flashback halting technique(Milton
Erickson)
  • client assumes comfortable upright position, both
    feet planted on the floor
  • identifies, out loud, five things they see in the
    room, five things they hear, and five things they
    feel
  • repeat pattern, identifying four of each, then
    three, two, and one
  • this helps shift awareness from senses associated
    with flashback to present-focused senses

34
additional work with flashbacks(Lisa Ferentz,
LCSW-C, DAPA)
  • As I experience this thought/feeling/ body
    sensation/image I realize I feel ______ years
    old.
  • This tells me that I am having a cognitive,
    emotional, somatic or visual flashback
  • I am being given information back about how I
    used to think/feel in the past.
  • In the present, I can use this information to
    grow and heal.
  • In the present I am strong, safe, powerful

35
attachment and external support
  • continue to work on non-verbal attunement with
    client to strengthen attachment/ trust
  • assess for connection to external resources for
    support spiritual, 12 step meetings or other
    support groups, extended safe family members,
    colleagues and friends, 24 hour hotlines,
    appropriate Internet support, remembered resources

36
Working with clients who have been traumatized is
a balancing act. Always honor and empathically
process their pain while continuing to suggest
that there is a light at the end of the
tunnel.Timing is essential- it may take
certain clients longer before they recognize
there are potential gifts and opportunities for
growth in their painful experiences.
37
Self-Report Questionnaires for Post-traumatic
Growth The Posttraumatic Growth Inventory
(PTGI)Tedeschi, R.G. and Calhoun, L.G. (1996)
Journal of Traumatic Stress, 9, 455-471The
Posttraumatic Growth Inventory for
Children-Revised (PTGI-C-R) Kilmer, R. P.,
Gil-Rivas, V., Tedeschi, R.G.,Calhoun, L.G. et al
(2009) Journal of Traumatic Stress, 22,
248-253The Psychological Well-Being-Posttraumatic
Changes Questionnaire (PWB-PTCQ)Joseph, S.
Maltby, J. Wood, A.M. et al (2011) Psychological
Trauma Theory, Research, Practice, and Policy,
15, 1-9The Stress-Related Growth Scale
(SRGS)Park, C.L., Cohen, L.H., Murch, R.L.
(1996) Journal of Personality, 64, 71-105The
Personal Growth Initiative Scale-II (PGIS-II)
Robitschek, C. Ashton, M.W., Spering, C.C. et al
(2012) Journal of Counseling Psychology, 59,
274-287 The Thriving Scale (TS) Abraido-Lanza,
A.F., Guier, C., Colon, M.R. ( 1998) Journal of
Social Issues, 54, 405-428 The Silver Lining
Questionnaire (SLQ-38) Sodergren, S.C., Hyland,
M.E. ( 2000) Psychology and Health, 15, 85-97
38
  • Using a remembered resource
  • Visualize someone from your past or present,
    alive or deceased, who truly believed in you and
    loved you. Imagine you are sitting together in a
    safe, comfortable place. What advice would they
    give you about self-care? What would they tell
    you about your capacity to survive your pain and
    heal? How would they re-frame your negative
    experiences?

39
Encouraging clients to creatively document their
growth through self-made videos
40
Encourage clients to use inspirational messages
as screen savers on their cellphones and laptops.
This offers ongoing reminders of hope and
resiliency. It helps clients to be their own best
cheerleaders!
Write a Comment
User Comments (0)
About PowerShow.com