Trauma is prevalent in society and occurs in complex as well as `single incident’ forms. Complex trauma can be hard to identify, poses a range of treatment challenges, and is generating a research base with which it can be hard to keep up. Correspondingly, applying the core principles of effective therapy for complex trauma to clinical practice is an ongoing task. This foundational course in working with complex trauma addresses both these dimensions.
Part A (Core Principles and Underpinning Insights) presents essential information on the nature of complex trauma, dissociation, memory, the development of self (a process which early life trauma can disrupt) and re-enactment (i.e. `the compulsion to repeat’ trauma if it remains unresolved).
Part B (Treatment Implications and Micro skills) translates the insights of Part A to direct clinical work. Participants will experience a mix of learning styles and extensive resources and references will be made available.
PART A: CORE PRINCIPLES AND UNDERPINNING INSIGHTS
Session 1: Complex trauma, its forms and impacts (2 hours, Aug 16th, 2021)
Complex trauma presents in diverse ways with a range of impacts it can be challenging to identify. The prevalence of complex trauma, which can underlie contrasting presentations, also means that all health professionals need to attune to it. This is because `[i]n contrast to the traumatized person who has experienced a sense of safety and well-being prior to onset of the (single-incident) trauma, the survivor of complex trauma does not start with this advantage’ (Shapiro, 2010). This session addresses the nature, forms, and impacts of complex trauma and the implications for working therapeutically with people who experience it.
Session 2: Dissociation and why we need to know about it (2 hours, Aug 23rd, 2021)
Dissociation, which in simple terms means not being psychologically present in `the here and now’ and which can take many forms, poses major challenges for clinicians because it is often unrecognized (`Many people in the mental health profession do not know what dissociation looks like or how to assess for it’; Danylchuk & Connors, 2017). This is despite research findings that dissociative disorders are prevalent in the general population, disproportionately so within clinical populations, and that `severe dissociative symptoms’ are a feature of complex trauma (Schwarz, Corrigan et al, 2017: Van der Hart, Nijenhuis & Steele, 2006). This session addresses the nature and varieties of dissociation with particular reference to its role and implications in the treatment of complex trauma.
Session 3: Memory is not unitary: conscious, nonconscious, and traumatic memory (2 hours, Aug 30th, 2021)
Understanding of and ability to work with traumatic memory is critical to the resolution of complex trauma. Yet despite landmark texts which address the non-verbal features of traumatic memory and the role of the body (i.e. that `the body remembers’) the nature of traumatic memory – and indeed the nature of memory per se – is widely mischaracterized and misunderstood. This session presents current research findings on the complex network of subsystems we call `memory’, the need to distinguish contrasting kinds and varieties of memory, and the significance of this research for effective therapy with clients who experience the impacts of complex trauma.
Session 4: The nature and process of self: developmental trajectories and adult impacts and implications (2 hours, Sept 6th, 2021)
While reference to the `whole person’ is common in diverse therapeutic modalities, clients who experience the impacts of complex trauma often do not experience themselves in this way. This means that effective therapy for complex trauma needs to adapt accordingly. In fact the notion of a unified self has been critiqued for some time (`It is the nature of the human mind to be subdivided…multiplicity is inherent in the nature of the mind’, Schwartz, 1995; `[t]hough the self is a unit, it is not unitary’; LeDoux, 2002). From this perspective, it is `how well we can keep it together, how harmoniously we can bridge, coordinate and even integrate the different parts of ourselves that determines how functional we are’ (Putnam, 2016). This session addresses the development and process of self, how healthy developmental trajectories are disrupted by early life trauma, and the differences between `normal multiplicity’ and dissociated self-states which are trauma-generated.
Session 5: Complex trauma and re-enactment (`the compulsion to repeat’) (2 hours, Sept 13th, 2021)
It is well known that trauma is re-enacted but the re-enactment of trauma poses many clinical challenges. This is partly because unresolved trauma is often dissociated and non-verbal. While the basic trauma response of `fight/flight/freeze’ is now familiar, less attention has been paid to the third of these and to dissociative responses in which what cannot be expressed in words is interpersonalised and enacted including in the therapy room. Many clinicians recognize that trauma is enacted in the lives of their clients but are less attuned to how it plays out within the therapy relationship itself. This session addresses the interface between complex trauma and dissociation, which is interpersonalised in the form of enactments which occur within - as well as outside - the therapy room and which can derail the therapy unless identified and addressed.
PART B: TREATMENT IMPLICATIONS AND MICROSKILLS
Session 6: Introduction to phased treatment for complex trauma (`the therapeutic rollercoaster’ Chu, 2011) (2 hours, Oct 11th, 2021)
Phase based treatment has long been endorsed by clinicians of complex, as distinct from standard (`single-incident’) PTSD. Consisting of three stages, which are not strictly linear, the rationale is that initial focus on affect regulation, improved functioning and self-care assists stabilization and thereby the ability to process traumatic experience and memories. This session introduces the phased therapy approach to treatment of complex trauma. It addresses the issues to which it gives rise, including criticisms of it, delineates the three phases, and how they apply in clinical context.
Session 7 Phase 1, Stabilizing and resourcing (2 hours, Oct 18th, 2021)
The extensive impacts of complex trauma underline the importance of stabilization, affect regulation, and the capacity to self-soothe and tolerate emotion prior to the processing of traumatic experience (`It is almost impossible to overstate the importance of traumatized patients maintaining an appropriate level of functioning in their lives’; [processing] must be deferred pending the development of basic skills concerning relating and coping’; Chu, 2011). Acquiring the necessary skills requires resourcing, which takes many forms and which encapsulates in a single word the primary task of Phase 1. This session focuses on the multifaceted task of client resourcing in contexts of complex trauma, and the many issues and challenges it involves.
Session 8 Working with diverse self-states (`parts’) (2 hours, Oct 25th, 2021)
Reference to `parts’ of the personality is common in the psychotherapeutic literature and the term is widely used by clients and therapists alike. What we call `self’ is not unitary and mental life is subject to state fluctuation and change. To this extent `we all have parts’ (van der Kolk, 2015) and `[w]e are all multiple to some degree’ (Putnam, 2016). The language of `parts’, `ego states’, and `self-states’ is also helpful and non-stigmatising with respect to the problematic divisions of personality generated by trauma, disrupted attachment, and experiences of overwhelm, in which self-states are unintegrated and flexibility, continuity, and coherence are impeded. This session presents an introduction to `working with parts’ with particular reference to the crucial distinctions between standard ego-states which characterise health, and dissociated self-states which pertain to the impacts of complex trauma (and which `can range from very simple to extremely complex divisions of the personality’; van der Hart et al, 2006) Note that while reference to structural dissociation generated by severe early life trauma is included, this seminar does not equip participants to work with Dissociative Identity Disorder (DID).
Session 9 Phase 2, Processing (2 hours, Nov 1st, 2021)
The second stage of phased therapy for complex trauma – for which the client has a foundation via the resourcing of Phase 1 – is the processing of traumatic memory and experience. But what does `processing’ of traumatic memories mean and entail? This session addresses these questions. As traumatic memory is implicit and non-verbal, `nameless feelings…can be verbalized in words’ in Phase 2 (Chu, 2011) and it becomes possible `to bring nonverbal memory into a domain that is regulated by a different part of the brain’ (Ogden et al, 2006; re Siegel, 1999, 1995). It is crucial to understand that this is not about focusing on the content and detail of the memories per se. Rather it attunes to the impacts of traumatic memories on current functioning (`and that’s the focus of the therapy’, Danylchuk & Connors, 2017). Here the distinction between explicit and implicit memory is again underlined: `[a]t an explicit memory level, the client may have long known that the traumatic events are over. The work of phase 2 facilitates the felt experience that the danger is past’; Ogden et al, 2006).
Session 10: Phase 3, `Life after trauma’; post-processing (2 hours, Nov 8th, 2021)
When clients are resourced (Phase 1) to the extent of being able to process traumatic memories (Phase 2) an additional third phase may seem unnecessary. Phase 3 often receives less attention in commentary on the phased treatment approach to complex trauma relative to the previous two. But clients whose lives have been disrupted by the impacts of complex trauma face contrasting issues in the `post-processing’ period. Adjusting to `life after trauma’ presents a new set of challenges, including emancipation from trauma-related beliefs and behaviors which may have existed for decades. It is also not uncommon for clients to encounter new areas of unresolved trauma in the Phase 3 period, in light of increased ability to engage with experiences of distress which could not be approached before. This session addresses the final phase of therapy for complex trauma in which increased integrative capacity includes enhanced ability to mentalise (i.e. attune to the internal experience of others as well as self, which is required for responding to social cues and enhanced interpersonal relationships; Fonagy et al, 2002). Phase 3 involves `consolidation of gains, achieving a more solid and stable sense of self, and increasing skills in creating healthy interactions with the external world’ (Chu, 2011).
CPD Hours: This event counts as 20 hours of category A CPD for PACFA’s membership renewal requirements.
PACFA MEMBER DISCOUNT * PACFA members can avail a discount of 20% off the registration fees for all live events and digital seminars on our website by applying the code ‘PDP20PACFA’ at the checkout.
For full details regarding the event and registration please go to the website.