“Exposure!” a choir of professional voices sings, “its the only proven way.”
“No, no,” others insist, “You can tap yourself to emotional freedom.”
“Poppycock!” another group jumps in, “Horizontal saccadic eye movements are the ticket!”
“Beware the dominant discourse,” a few, particularly literate warn, “focusing on what was done to the person can retraumatize, help them reauthor their experiences instead.”
Meanwhile, a smaller and less vocal group shakes their heads in disbelief, saying, “There are no shortcuts. Healing comes only from identifying and ‘working through’ painful unconscious feelings.”
Turning to the research to answer the question–what heals trauma?”–offers little clarity. Advocates of most approaches can offer evidence that their preferred approach works–at least one study, and often more, many more–a fact all should find puzzling. Simply put, how could all approaches work, given they offer competing and often contradictory explanations and techniques? And yet, no consistent superiority of one particular approach over others is exactly what the latest dismantling and meta-analytic studies show (1, 2, 3, 4, 5, 6, 7).
When attempting to account for why all approaches work equally well, the most common argument made is that different models work for different people. Said another way, what may be effective in the aggregate may not work for the individual. “Choice is key,” advocates of this position assert.
More recently, and perhaps in response to the continuing failure to find any meaningful difference in outcome between treatment methods, it has become popular to talk of a set of “mechanistically transdiagnostic…therapeutic strategies…[targeting] the role of a given mechanism in the development and maintenance of a range of psychopathology.” Ironically, the call for a “universal treatment protocol,” is the “go to” position of those who once advocated for the creation of officially sanctioned lists of specific treatments for specific disorders.
So, which explanation holds water? Here again, the empirical evidence offers little clarity. What is important, however, is that these two, diametrically opposed perspectives share a common assumption: healing results from the appropriate application of the right treatment methods.
But what if that’s not true? What if therapeutic techniques–whether specific to a given model or shared by all–have no inherent power to heal? Where would that leave us as a profession? Does it mean that our methods are the therapeutic equivalent of Dumbo’s magic feather?
“A great deal changes, in terms of our ability to help and heal,” psychologist Stephen Bacon suggests, “if we embrace what the research indicates. Psychotherapy, as a science, is not like engineering. It operates in a different reality.”
Recently, I had a chance to interview Stephen about his work, and new, thought-provoking, and imminently practical book, Practicing Psychotherapy in a Constructed Reality: Ritual, Charisma, and Enhanced Client Outcomes.
As you’ll see, he’s a very interesting person–six years in an ashram, a neighbor and student of Krishnamurti, a degree in religious studies, and more. For me, the “enhanced client outcomes” referenced in the title immediately got my attention. Wait until you have 30, uninterrupted minutes available, as the interview is one of my longer, and you will want to watch every minute.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
My answer to what heals trauma is what psychotherapy as a whole has ignored for many years: i.e., crying. There is a critical difference between therapeutic and non-therapeutic crying, and any other emotional release [“Catharsis” is regarded by the field as a “bad” word]. The criterion for the unforced (healing) activation of the client’s emotional experiencing is that it spontaneously arises coincident with the person receiving sufficient support for their experiencing. Support means the client’s explicit and implicit experiencing, with the later far more important. The forced activation of emotional experiencing is not therapeutic. This usually occurs outside of session when an unexpected stimulus, usually objectively not hurtful or threatening, activates too much unresolved stuff. When a client arrives for a session in an upset state, this is usually the reason. Forced activation can also occur with a therapist that is too insistent. EMDR creates – see phases 3-5 especially of the 8 phases of its protocol – ideal conditions for the unforced activation of emotional experiencing. There are many reports in the EMDR literature of client’s crying deeply. Foa mentions that many clients in exposure therapy cry deeply. I’ve yet to find a discussion that mentions crying as the therapeutic factor.
My term, therapeutic catharsis, is a sympathetic-parasympathetic ANS sequence (I borrowed this from a neurologist who had an interest in psychotherapy.) The unforced activation of emotional experiencing is the sympathetic phase as the imprint of past hurts is activated. It has all the features of an impending panic attack, mistaken for re-traumatization. When the S phase reaches a particular intensity, determined by the nervous system, it spontaneously transitions to the P phase. All activated physiological signs immediately drop to base-line values and the person talks in an eager way about how he/she had been affected, and arrives at their own insight into the experiences, and which is more profound than any I could offer. The therapist, as Rogers once wrote, is just a “mid-wife,” someone who creates the conditions for a natural process to operate. My understanding of that process is that there exists a natural healing process for what I call a psychological injury; i.e., the typical presenting problem has, until show otherwise, an interpersonal origin and its effect cannot be significantly altered by a conscious effort.
Mr. Von Glahn, I’d love to hear/read more about your approach, have you anything published or written? If not, you should!
Jodon,
My best articles are in the Person-Centered and Experiential Psychotherapies journal. See the PsycINFO database for the three: Search: Von Glahn, Jeffrey. Only the abstracts are available online. One or two of them are on my LinkedIn page. I’d be happy email you any of them. See also my psychological case study: Jessica: The autobiography of an infant
https://amzn.to/2vmnkRE
Jeffrey
I am overwhelmed with appreciation for your work. Thank you.
Scott, I recently read an article in the Psychotherapy Networker about the use of MDMA in the treatment of trauma. It seemed convincing but I’m wondering what your thoughts are on it.
This post is timely. I recently am confronted with needing to treat someone with severe PTSD – been looking into both disorder-focused treatment and the transdiagnostic approach, and then I read this article. So much to learn and decipher…
This was highly interesting and well articulated, Scott and Stephen. Looking foreward to reading the book.
This is jargon at best. I watched this video and it was sadly disappointing. Nothing about trauma. Basically two guys saying they like each others books.
I would love to see a copy of the article. thanks.
Scott have you looked at the data from the people at Heartmath who focus on getting the heart and mind in harmony? As I read the literature and research about the sympathetic and parasympathetic systems and how they interact, it seems plausible to encourage Clients to do Cognitive Meditation/Mindfulness and Heart Meditation from a Christian Perspective of gratitude, thankfulness, and praise/worship.
Hi Eric, yes please for a copy of your article
Best Bengt
I would love to read the article optimalcounselling@gmail.com
As a clincal spiritual carer who has sat with 1000’s of people in hospitals and also a psychotherapist.
Who knows what the answer is. I just know that when I have an agenda and think I know. I have to take stock. And have a little look.
Thats why I love Scotts work.
Please send me the article to read.. optimalcounselling@gmail.com
I like the idea pointed out in this article that different ways of healing from trauma work for different groups of people. My daughter experienced a traumatic experience when she was lost for a day, and she has had a hard time trying to recover. I’m worried about her, so I’ll look into getting her counseling treatment because my daughter usually responds positively to interactions with other people.
Dear Scott,
I would love a copy of your article on trauma.