Sunday, June 7, 2009

20th Annual Trauma Conference: Final Notes

I love learning. If being a student was a profession it would have been the perfect one for me. Since I can't be a serial degree candidate, these sort of crash course weekends are really invigorating.

The trauma conference ended yesterday, but not until I learned about emergence, complex systems science, attachment theory, theater vs. therapy and somatic transference. And then I had a very, very illuminating chat with a neuroscientist, but I'll save that for tomorrow. Here's how the day went:

Complex Systems & Traumatic Stress- Glenn Saxe's theory in this lecture applied the complex systems of science model to PTSD. What does that mean? This: Complex Systems Science studies, identifies and unravels how diverse systems (i.e. flocks of birds, schools of fish, molecules) go from scattered individuals to organized systems. The answer is 'emergence' -- things organize from the bottom up, instead of from the top down. For example, there is no top bird in a flock or lead fish in a school. Each individual falls into a part of a pattern based on his relationship in space and timing to the other individuals around him.

What this means in terms of trauma: In this theoretic model patterns of traumatic response organize into complex systems that can be measured, put into a graph, and charted so that the most highly triggering actions can be pinpointed and treatment efficiently focused.

[In the collective opinion of myself and others sitting nearby: this is science gone a little ga-ga over itself. The primary example of this whole idea boiled down to how a traumatized child's world could be charted this way and so it be pinpointed that a major problem was the way his father treated him. But this father issue was apparent at the beginning presentation of the case -- we all immediately knew the father needed to be removed from the boy's presence. And so, while science takes its time observing, gathering data, inputing it, charting and graphing, the poor boy remains in harm's way when the rest of us would have just immediately suggested the father's visitation be restricted and monitored. Sometimes, common sense is better than science.]

Safety & Exploration for Trauma Resolution and Attachment Organization- Dan Hughes is a gifted therapist and a wonderful presenter. In this very clear, very organized and interactive lecture he disucussed attachment theory - "lasting psychological connectedness between human beings" - and applied it to the therapeutic relationship. He spoke of how important it is for therapists to make eye contact with clients, how they need to be present in their facial expressions, posture and tone of voice and most importantly, how vital it is for the therapist to experience the survivor's narrative so that his engagement deepens the survivors experience of his own retelling.

Using his own clinical experience as a model, Hughes showed us very compelling video about how he works in a session to read body cues and foster attachement between himself, his client, and the client's caregivers. In our survivor world this all comes down to this: in order for us to get the full measure of therapy we 1) must have a therapist willing to engage with us on a personal level (not one who has been trained to remain removed), 2) we need to be willing to allow a therapist to join us in the experience of our stories.

Developmental Trauma Disorder: Diagnosing the Impact of Trauma on the Developing Mind, Brain and Self- Bessel is bitter. Mr. van der Kolk has a bone to pick with the DSM V committee. The story goes like this: the clinical community daily sees the traumatic impact of child abuse and neglect. Studies have proven that early child abuse leads to such negative traits and habits as aggression, obesity, smoking, depression, etc. By the time these children are teens they end up with Type 2 Diabetes and other health issues, not to mention extreme psychological issues that involve such negative behaviors as aggression, cutting, suicide and drug addiction.

Bessel and many colleagues got together to propose to the DSM V committee the addition of a diagnosis that captures this segment of the PTSD population: Developmental Trauma Disorder. The DSM committe demanded data; Bessel et. al. complied with data compiled on over 10,000 kids from around the country.

Last week, the DSM rejected the petition saying there was not enough data. Bessel, in his own words, is "f*&%ing angry!" and speechless as well. Without this diagnosis and its deliberate criteria Bessel says kids will continue to be misdiagnosed with Bi-polar Disorder, doped up, and never treated for their real issues. A very sad state of affairs. The audience as a whole agreed to begin a grassroots movement to use this diagnosis on their own until the committee and insurance companies have no choice but to investigate acceptance.

Using Shakespeare's Words to Embody the Whole Self- Tina Packer looks like Dame Judi Dench and has almost as commanding a presence. She's magnetic and energetic and was the highlight of yesterday's conference -- at the end of her presentation she received a standing ovation.

Here's where the day started to get really interesting. We dropped the scientific proofs and got back to the humanity. It seems I'm not alone in feeling this aspect of the conference was important and missing. The entire auditorium was riveted as Tina showed us how her Shakespearean theater troupe works with traumatized teens to do a theater therapy that is extremely effective in helping kids find the words they need, reground themselves in their power, and evolve a physical, emotional, linguistic and mental strength.

First, Tina led all of us through a breathing exercise designed to teach how important it is to inhabit the body all the way from the top of the head through the bottom of the solar plexus - how this grounds us in feeling and emotion. Then, using Bessel and his assistant as volunteers, Tina worked them through an actor's warm up exercise where the two sit facing knee to knee, look into each other's eyes and repeat words from the text of MacBeth at Tina's bidding without losing eye contact. The focus for each actor individually was on the single or group of words Tina supplied. The words had to be said on the outgoing breath and the actors were told to be aware of what emotions and feelings arose during the exercise. It was interesting to see how the actors' voices, body language, breath, and tone changed according to their emotional resonance with the words. A short discussion of how they felt during the exercise followed.

The implications here for therapy are enormous, including how to gradually and directly/indirectly get a survivor back into a somatic experience at the same time as allowing associations, emotions and feelings to arise around a specific topic.

Dancing in the Dark: Somatic Transference in Trauma Treatment- Ellen Searle is a small woman with Big Ideas about how important the somatic experience is in healing trauma. 'Somatic transference' is all about emotions passing from the mind into the body, and how important feeling in the body is in the healing process. What I found really interesting about this presentation (which included a lot of our own somatic experience laced throughout) is how somatic work can ramp up feelings of safety and security and so progress healing by creating a space in which the words more easily flow. I thought of my own experience in healing: a large part of my dissociation came from my fear of my body, and my fear of being held hostage in my body. I didn't learn to address and heal this until my therapist taught me transcendental meditation, which allowed me a slow re-entry into my physical self. Dance, too, catapulted this process for me.

In Searle's presentation we danced and explored the use of our entire body through movement. We learned about the kinesphere (peripersonal space, or: the area around your body) and kinesthetic empathy (embodying the feelings and movements of another - the somatic version of Hughes' attachment theory). Quoting Jung, Searle taught us that "The symbols of the self arise in the depths of the body." Powerful, thought-provoking stuff. For a population for which the body has become a source or repository of terror, healing on this level is incredibly important to pave the way for healing in the mind.

In Friday's post I was frustrated by the divorce of science and humanity in this conference program. I wasn't wrong about that. The audience response to yesterday's program - especially the final two segments - proved I wasn't alone in wanting to bridge the gap between the scientific observations and their application in the real world of survivor healing. If only each day had been more balanced this way - science in the morning, humanity in the afternoon! I'm going to have to speak to Bessel about that....

(Image: Witelson)


Jaliya said...

Yay Bessel ... and yay you for being at that conference, taking in so much info and wizardry ... and then scribing it for the rest of us!

Thanks, Michele :-)

Michele Rosenthal said...

@Jaliya - Thank you for appreciating it! This weekend has left me with the big desire for a conference of our own -- from the survivor, not the clinical, perspective. Another future goal for my fledglin company, Heal My PTSD, LLC!

Jaliya said...

YES! How brilliant would that be!

BTW ... I finally got my ears cleared out Friday and am getting caught up ... Life was so muffled and unbalanced when I was almost deaf ... !

I'm going to read more of your links and all from the conference ... What an event, eh ...

Michele Rosenthal said...

@Jalya - Better yet: I'm thinking we survivors need OUR OWN CONFERENCE! Something for Heal My PTSD, LLC, to sponsor in the future. :)

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