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What heals trauma?

October 3, 2018 By scottdm 33 Comments

nothing-is-written-in-stone-527756_1920“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).this or that

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.

hold waterSo, 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?

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

Filed Under: Feedback Informed Treatment - FIT

Comments

  1. Eric Gentry says

    October 4, 2018 at 2:18 pm

    Hi Scott –

    We wrote an article on this topic in the July 2017 issue of Journal of Counseling & Development. The article is entitled: “Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder.” The article stands on the shoulders of recent meta-analyses (yours included) and dismantling studies to create a phased treatment structure for treating post traumatic stress that delivers all the active ingredients that work across treatments. We are busy teaching clinician to become competent in the treatment of trauma without having to subscribe to any particular model of treatment. BTW – our treatment structure has FIT as one of its centerpieces. If anyone would like a copy of this article, please feel free to email me.

    Reply
    • Eleanor CORSO says

      October 5, 2018 at 7:46 pm

      Surely, though, that the responding to trauma treatment is not one fits all. And I am saying this with most greatest respect. Eg. What would help me to overcome trauma…would be a true apology from the offender that was really meant…ect.

      Reply
    • Anne Smith says

      October 7, 2018 at 5:28 pm

      I would love to read a copy of the article on trauma that included FIT. I am a trauma therapist at a community clinic . Thank you:)!

      Reply
      • Robert Rhoton says

        October 7, 2018 at 11:38 pm

        If you would actually like a copy of the Article that Eric Referenced above you can get it through aztinfo@aztrauma.org or you can reach out the administrator at Arizona Trauma Institute, Mollie Gardner (mollie.gardner@aztrauma.org) and have a copy sent to you. We would be delighted to share it with you.

        Reply
    • William Grech says

      October 7, 2018 at 7:11 pm

      Hello Eric

      I am interested in receiving your article. Thank you
      William

      Reply
    • David Gangsei says

      October 7, 2018 at 7:23 pm

      Eric – I would like a copy of the article you mention. I’m a clinical psychologist. I attended one on your workshops on compassion fatigue in 2008 – very helpful. I am developing a project right now, at the request of a group of attorneys experiencing VT and work stress as they engage with traumatized asylum seekers. I’d like to consult with you. I will look up your contact info on line.

      Reply
    • Richard macnish says

      October 7, 2018 at 8:47 pm

      I would love to read your article on trauma and FIT

      Reply
    • David says

      October 8, 2018 at 8:53 am

      Hi Eric yes please for a copy of your article

      Reply
    • Adrian Lim PA says

      October 8, 2018 at 12:40 pm

      Hi Eric, I would love a copy of your article . Could you email me: adrian@familypsychologist.sg
      Much appreciation

      Reply
    • Jennifer Tilbury says

      October 8, 2018 at 2:52 pm

      Hi Eric
      I would appreciate reading your article
      thanks
      Jennifer

      Reply
    • John Dotson says

      October 8, 2018 at 3:18 pm

      I am one of the fortunate recipients of Dr. Eric Gentry’s training in the use of the active ingredients of effective trauma resolution therapy. The training has exponentially increased my effectiveness as a trauma professional because of its’ focus on the relational power of forging an alliance of positive expectancy, regard, and compassionate non-anxious presence with clients. Although I use EMDR extensively and am deeply grateful to all who continue to refine this protocol, I know the active ingredients are the primary key to the outcomes my clients experience.
      I strongly recommend attentiveness to Dr. Miller’s emphasis on monitoring the clients’ experience to increase the likelihood that what they need from the therapeutic experience is being heard and attuned to.

      Reply
    • Norma Smith says

      October 8, 2018 at 3:45 pm

      Philosophically, I welcome ANY technique that contributes to the well-being of my clients. I would love to read your article on trauma and FIT. Thanks so much.

      Reply
    • Stephanie Launer says

      October 9, 2018 at 3:57 am

      Hello Eric Gentry –

      I would like access to the article you mentioned..

      July 2017 issue of Journal of Counseling & Development. The article is entitled: “Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder.”

      Please share if you can: StephanieLauner@gmail.com

      Steph

      Reply
    • peter apollo says

      October 10, 2018 at 7:45 am

      I would like a copy. Thank you

      Reply
    • Willie Coman says

      October 12, 2018 at 7:41 pm

      Hi, I would like a copy of your article. Many thanks

      Reply
  2. Jeffrey Von Glahn says

    October 7, 2018 at 4:36 pm

    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.

    Reply
    • Jodon English says

      October 8, 2018 at 4:05 am

      Mr. Von Glahn, I’d love to hear/read more about your approach, have you anything published or written? If not, you should!

      Reply
      • Jeffrey Von Glahn says

        October 9, 2018 at 2:08 am

        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

        Reply
        • Monica says

          October 10, 2018 at 12:30 pm

          I am overwhelmed with appreciation for your work. Thank you.

          Reply
  3. James Venneear says

    October 7, 2018 at 4:45 pm

    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.

    Reply
  4. Philippe Isler says

    October 7, 2018 at 7:04 pm

    I relate to what Stephen Bacon says, and I look forward to reading his book. I don’t know where he goes with the idea that constructionism leaves us no place to stand in doing therapy with clients, but my immediate thoughts are these:
    – first, as he says, we are never entirely constructionist; in fact, we are very much operating within a consensual reality at many levels, and we share great deal of fundamental assumptions of reality with our clients;
    – second, ideally, we feel out where those assumptions are shared and where they differ, and we explore the gap between the two;
    – finally, if we don’t engage in constructionism as an intellectual exercise, then we engage in it by “sitting back in our chairs” (just reading your introduction to Daryl Chow’s book!); non-doing, presence.

    My focus over the past number of years, on which i have presented at conferences and am now writing a book, is on what I call Heart-Centred Therapeutic Presence. I think it is a rich source of healing potential/ potentializing healing that is congruent with what Bacon is saying.

    Reply
  5. Jason says

    October 7, 2018 at 7:56 pm

    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…

    Reply
  6. Bjørnar F. Bye says

    October 8, 2018 at 9:58 am

    This was highly interesting and well articulated, Scott and Stephen. Looking foreward to reading the book.

    Reply
  7. David G. Markham says

    October 8, 2018 at 9:59 pm

    Thanks for an interesting interview and a wonderful article.

    I am an old guy, 72, who will celebrate my 50th anniversary in field on 10/31 having started my career as a Psychiatric Social Work Trainee II at Kings Park State Hospital on Long Island in New York on 10/31/68.

    Over the years I have never bought the scientism of psychotherapy and always thought it more an art than a science. The idea of “evidence based practice” has always left me feeling like an outsider being gaslighted by the dominant discourse of psychotherapy as a research based practice.

    I loved Jerome Frank’s book Persuasion and Healing which likened psychotherapists to witch doctors and cultural healers. I have always thought of what I do as a psychotherapist as a ministry more than as a professional mercenary enterprise.

    In later years I have become enamored with Narrative Therapy because of its values of ethical practice rather than a medical procedure. One of the biggest stresses for psychotherapists is their need to be multi linguistic. They must talk several languages: one for the medical folks who demand a diagnosis and treatment plan and medical procedures for billing, one for colleagues and others as we attempt to describe our work, and one for clients with whom we engage in a helping relationship.

    In order to engage clients in a helping relationship, the theratpist must be charismatic, de-centered, and willing for ethical give and take.

    The Narrative model tells therapists to be alert to the power dynamics between the therapist and client and between both and the external discourses that influence their identities and the work they do together.

    Psychotherapy is very much a constructed reality which is co-created by therapist and client(s) for the benefit of the client(s) primarily but in the process many a therapist has benefited as has the outside community.

    Reply
  8. Mark McGinney says

    October 10, 2018 at 8:32 am

    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.

    Reply
  9. Scott says

    October 12, 2018 at 2:10 pm

    I would love to see a copy of the article. thanks.

    Reply
  10. Gary Sweeten says

    October 23, 2018 at 9:42 pm

    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.

    Reply
  11. Bengt Lindberg says

    October 25, 2018 at 6:21 am

    Hi Eric, yes please for a copy of your article

    Best Bengt

    Reply
  12. Peter Breukers says

    December 20, 2018 at 5:40 am

    After seeing the video of Stephen Bacon I hurried to his website and downloaded four articles, bought the book ‘Practicing Psychotherapy In Constructed Reality’. The book has really helped me to get a thorough and coherent view of the contextual model, Though I have studied a lot of research of the common factors model, and have applied FIT for years in my practice, it never totally clicked. This book did the job and really brought my understanding to another level. Thank you, Stephen and Scott

    Reply
  13. Nancy says

    March 25, 2019 at 10:37 am

    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

    Reply
  14. Larry Weaver says

    June 26, 2019 at 4:20 pm

    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.

    Reply
  15. Ashley Johnson says

    July 16, 2019 at 5:33 pm

    I liked that you said that one thing to consider when going through suffering or experiencing pain is to see a counselor. I would imagine that a counselor would have different techniques that would help relieve the suffering and lift your burden. I would be sure to visit a counselor if I was struggling with a major life event to receive help.

    Reply
  16. Anja Vogels says

    October 9, 2019 at 2:34 am

    Dear Scott,

    I would love a copy of your article on trauma.

    Reply

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