I attended the 21st Annual Counseling Skills Conference in Dallas this past week (Sept. 24th – 26th) and I wanted to share a few of the helpful things I picked up and learned from the speakers. My hope is to integrate these points into my life personally and professionally, and my hope is that you may find some of the information that I was exposed to helpful for your own life and relationships as well.
September 24th, Day One:
Plenary Session #1: New Developments in the Treatment of Complex Trauma by John Briere, PhD, Associate Professor of Psychiatry and Psychology at the Keck School of Medicine, University of Southern California and Center Director of the USC Adolescent Trauma Training Center of the National Child Traumatic Stress Network.
John’s spoke about his recent research in the area of Complex Trauma wherein he encouraged us to rethink our views on Post-traumatic Stress Disorder. We normally think trauma occurs when people commit and inflict traumatic behaviors upon others (trauma by commission), however John wanted us to think about the type of trauma that impacts others when people don’t provide caring, protective and nurturing behaviors to others, especially to children (trauma by omission).
John mentioned that children need the love and protection of parents and caregivers. Historically and in some places in the world today, if children do not receive this level of care means they may starve to death, freeze to death or be eaten by animals. So nature hardwires into the neurobiology of children the ability to send “proximity signals” to parents so they will bond with and take care of their children.
Unfortunately, if healthy, connected, validating and nurturing bonds are not practiced with the child or if they are absent, then the child may be traumatized due to the omission of behaviors that would normally help the child to thrive. This form of trauma, based on the omission of behavior, impacts a child’s identity and more importantly could impede upon their ability to regulate their affect (emotions, mood, and behavior) and form healthy attachments with people within their life. John said that when this occurs, people may dissociate (“what you do when your pain exceeds your capacity to regulate your pain”) and engage in the “Avoidance Triad,” which is to engage in substance abuse, dissociation or pain-blocking behaviors to reduce unwanted tension.
John mentioned that humans starve for love and connection. His research points out that the demonstration of therapeutic experiences such as displaying validation, warmth, unconditional positive regard for a person and demonstrating empathy (see the work of Carl Rogers) with someone who has experienced complex trauma creates healing and corrective experiences that helps the brain to heal. When the brain heals, John states that the person could develop the capacity to introspect and “do emotional detective work,”which means they could notice when they are triggered and choose healthy life enhancing behaviors versus defaulting to maladaptive behaviors to regulate their internal mood and feelings. Breathing, practicing mindfulness, being compassionate with yourself and talking about things that hurt and you feel bad about but don’t overwhelm you (“inviting your pain to tea”) is valuable and leads the person on the road to Post-traumatic Growth.
Plenary Session #2: Complexity of treating the Young Adult by Claudia Black, PhD, Clinical architect of the Claudia Black Young Adult Center at The Meadows. She works with their team assessing and enhancing the quality of the program. She is a Senior Fellow and a clinical consultant at The Meadows Treatment Center in Arizona since 1998. Her seminal work with children impacted by substance abuse in the late 1970s created the foundation for the adult child movement.
Claudia started her talk by asking the question: “Where do you run to when it is traumatic in your family of origin system?” She then carried John Briere’s work further by stating if people are chronically dysregulated long enough, they tend to get “stuck” in a dysregulated state, regardless if the original pain is still present or not. Claudia stated the longer we are stuck in this place, the more discomfort we feel living within our own skin and when this occurs, we tend to engage in self-medicating behaviors in order to move away from the pain and toward some form of pleasure.
Claudia also spoke about 3 different types of stress that impact a person: (1) Postive stress, which is associated with moderate, short-lived physiological responses, (2) Tolerable stress, which is associated with physiological responses that can disrupt brain architecture, but is relieved by supportive relationships, and (3) Toxic stress, which is associated with strong and prolonged activation of the body’s stress management system in the absence of buffering protection.
Claudia mentioned 7 Core Elements to Treatment, that support a person’s ability to respond positively to the stressors in his/her life:
- Engage in Grounding: This helps a person to orient their self to the present versus being stuck in the past.
- Emotional Regulation: This facilitates internal peace, and the feeling of being “OK” within your own skin.
- Trauma Therapies: Psychodrama, Somatic Experiencing, Journaling, Neurofeedback, EMDR (Eye Movement Desensitization and Reprocessing).
- Community: Developing healthy rituals with non-shaming people validates and provides internal safety and promotes external security.
- Gender specific programming: Sometimes genders heal more effectively separately.
- Life Skills: Provides self-efficacy, responsibility, self-esteem and confidence in one’s own abilities.
- Family Treatment: The family that develops healthy rituals is less likely to shame, abuse or abandon, but on the contrary, connect, validate, empathize and communicate with each other.
Plenary Session #3: Integrative Treatment for Individuals with Substance Abuse and Co-occuring Disorders by Donald Meichenbaum, PhD, Distinguished Professor Emeritus, University of Waterloo, Ontario, Canada. Dr. Meichenbaum is presently research director of the Melissa Institute for Violence Prevention, Miami, Florida. He is one of the founders of cognitive behavior therapy. In a survey of clinicians, Dr. Meichenbaum was voted “one of the 10 most influential psychotherapists of the 20th century.”
Donald spoke about how to understand the person who made their way into your office to visit with you, and provided a lot of practical handouts that I will be poring over for weeks to come.
One of the most helpful things he said in his brief one hour session was to focus on the strengths of the person, even though the person may have been exposed to experiences of severe traumatization. Donald encouraged us to “get the rest of the story,” by asking “In spite of the trauma, what have you been able to accomplish and how did you accomplish this?”
By focusing on the strengths of the person, we validate their ability to be resilient and highlight the resources they have within them (or need to rediscover) in their effort to help their self. Additional questions could illuminate the possible barriers the person may encounter on his/her way to achieving the goals they have for their self. This collaborative approach is another way of demonstrating unconditional positive regard with the person, which promotes healing and goal fulfillment.
Breakout Session #1: Working with the Pain Paradox: Mindfulness, Compassion and Resilience in Trauma Therapy by John Briere, PhD. In this session after lunch, John opened the session with a series of questions as he expounded on points from his morning session: “How did certain cultures develop due to responses to trauma (specifically, Christian, Buddhist, Germanic or the Romance Countries)? How do these cultures interpret suffering? How do you live through suffering? What contributes to suffering and when you hurt, how do you respond to your pain?”
John talked about how Western approaches to pain tend to label the person with “badness,” that is we say they have a disorder and may demonstrate or support the avoidance of their pain by facilitating pills to fix, suppress or numb the pain. John mentioned that suffering occurs when pain seeks avoidance and that pain + resistance = suffering. Others are likely to contribute to the suffering experience of another with the philosophical and/or unintentional and less than empathetic viewpoint that “your suffering has exceeded my capacity to care for it.” Sometimes this viewpoint is a hint to the unresolved trauma in that person, because “they want you to shut up about your pain so they won’t feel bad about theirs.” When this occurs, pain is pushed “underground” but comes up at unexpected times.
John also mentioned that we may confuse pain and suffering, in that Pain is the direct effect of adverse things, traumas, losses and unprocessed memories of these experiences. Suffering on the other hand, occurs when our pain is psychologically misinterpreted, is avoided, rejected, suppressed, numbed and denied. When our distress exceeds our own capacity to tolerate our pain then avoidance is required. Avoidance typically is achieved through mood and misery stabilizers (addictive substances, processes and behavior) to medicate our pain.
The Pain Paradox occurs when we embrace our pain versus trying to escape it, which seems like it should hurt more by addressing it, but in reality, it helps us to reduce our hurt versus increasing our hurt. The existing literature on substance abuse and dissociation reveals a downside to engaging in behavior that numbs, suppresses, rejects or avoids looking at and embracing our pain. This attempt to decrease our awareness about our own pain paradoxically increases our suffering versus diminishing it.
Paradoxically, it is the non-judgmental acceptance and embrace of our pain and distress that decreases our suffering and helps us to gain greater awareness to process, “decatastrophize” and experience the benefits connected to Posttraumatic growth. “Awareness makes therapy a growth process” and John reported that therapy (or people demonstrating therapeutic qualities) is key to helping people grow beyond the pain connected to their trauma. It is not only the relationships that helps but it is the quality of that relationship plus personal acceptance of learning to live with what has impacted you that helps people begin to heal from their trauma. A final point was made in that accepting and working through the pain associated with the trauma versus suppressing or resisting the pain and suffering connected to the trauma may lead a person to realize there is a gift in the trauma, as John stated “this adversity has given your personality texture.”
Breakout Session #2: Honoring the Survivor Within by Leanne Lemire, MSW, LCSW. Leanne is the Clinical Director of the Claudia Black Young Adult Center. Her specialty focus is with trauma resolution, addictive disorder, and complex psychiatric disorders among young adults. Her training includes: Pia Mellody’s Post Induction Training, Sensorimotor Psychotherapy, Somatic Experiencing, Low and High Ropes Challenge Course, Gestalt Therapy, and Equine Assisted Psychotherapy. Her passion lies in helping to foster an environment that allows for young adults to feel empowered as they navigate through their recovery process and embrace the hope embodied in a new day.
Leanne’s session was practical and experiential, in that she works to ensure that the people she visits with have a “toolbox” of “Grounding techniques” to assist him/her as they work not only through their traumatic experiences, but also work to return to their “Optimal Zone.” The Optimal Zone is the comfortable and tolerable place between being hyperaroused (anxiety, panic, hypervigilent, etc.) and being hypoaroused (depressed, flat affect, disconnected, etc). Some of the benefits of using these tools to become grounded and to stay in your optimal zone are:
a) Being grounded helps to regulate your nervous system: When you are dysregulated, you may react (vs. choose) and you may react defensively because you feel flooded and threatened. Regulation promotes clear-headed choices.
b) Being grounded helps you to get to a place where you could process information effectively. This is important because we need to be able to communicate our thoughts, feelings, “requests” for the other person to consider and the responsibilities we will implement in our attempt to resolve interpersonal and interpersonal conflict(s). The sooner we are able to get grounded, the sooner we’ll be able to achieve this goal.
c) Being grounded gets the “silent observer” (your Functional Adult/and Wise part of you) back on board, as this is the part of you that intervenes when your Wounded Child or Adapted Adolescent Ego states are fearful, want to react, rebel or “take over and want to things.” These parts of you actually want to help you to try to resolve your problems, but unfortunately, they do so from an Adolescent frame of mind.
d) Being grounded provides a sense of safety, serenity and internal peace. This is a great personal starting point to becoming introspective about that which is going on in your head or in your heart.
e) Being grounded provides a sense of control and containment (versus feeling out of control and feeling all over the place).
Some of the tools to assist a person to become grounded are:
- Breathing: From the lower midsection of our body; it costs us nothing and proves to be most beneficial!
- Orientation: Using all of your senses to describe what is around you when you feel disoriented. Leanne mentioned she would have people take in data around them and describe it as if she were a blind person.
- Anchoring: Imagine you were a tree with roots that dig deep in the soil and you are solid and immovable. Feel your feet touching the floor or the chair beneath you to create a sense of connection and sturdiness within you.
- Pendulation: Rocking back and forth in an effort to “get moving” and possibly to release the pent up energy within you that needs to be released. Walking helps as well!
- Grounding Objects: Hold a coin, a stone, your actual “tool box” that contains all of these items or tools.
- Music: There is nothing like listening to your favorite or inspiration music to create a shift in your thinking and in your mood. Singing out loud is better as it engages your brain to produce the necessary shift.
- Mail: Sometimes receiving a positive and inspiring letter or picture from a sponsor, a friend, a child or family member at the right time creates movement from distress to calm.
- Letter to Self: Letters to Self are empowering and therapeutic letter(s) that your wise self writes to your troubled or distressed self, in an attempt to “hit a psychological reset” in your brain and body. They serve as “wise guidance” from yourself to yourself regarding what steps you could take to ground, problem solve, validate and affirm yourself, in addition to re-directing you to take good care of yourself.
- Scent: Certain scents, candles and aromas trigger and facilitate soothing memories or experiences for you. Feel free to collect items that are pleasant to your nose and are positive and grounding with your mood!
- Grounding Kit: Your Grounding Kit is actually a box that contains items #1 – 9 that you could access any time you feel you need to ground yourself.
Breakout Session #3: The Best Kept Secret in Psychology, Recovery and Personal Growth: Understanding Emotional Regression by John Lee, MA. John is the best-selling author of The Flying Boy: Healing the Wounded Man, has written 22 books, including the The Half- Lived Life and the upcoming Breaking the Mother-Son Dynamic: Resetting the Patterns of a Man’s Life and Loves. Known for his innovative work in the fields of emotional intelligence, anger management and emotional regression, his contributions in the fields of recovery, relationships, men’s issues, spirituality, parenting and creativity have put him in the national spotlight for over 25 years. John served as a professor at the University of Texas and Alabama.
I have never heard a funnier and engaging presenter as John Lee. John spoke about how Emotional Regression (one of the ego defenses identified by Sigmund Freud, MD) seems to hijack our brain and creates chaos versus calm when we become emotionally flooded. Some of the insightful and salient wisdom that John imparted was:
- Regression usually leads to Regret: It is an unintentional return to our history (and to issues from the past that may be resolved or not, but are coming up maladaptively in the moment).
- Regression is usually accompanied by the phrase “I lost it:” Regressed people react and project shame; Adults tend to respond thoughtfully and considerately.
- Regression is “leaving” the Pre-frontal cortex (the executive, intellectual part) in your brain: It is triggered by the Amygdala, that small part of the brain where our fear comes from. John describes the function of the Amygdala as: “The little brain that remembers just enough to keep us safe,” but sometimes fear gets us in trouble.
- Regressed people rage, do the silent treatment and unfortunately, don’t know what to say or how to say it.
- Regressed people love company, and operate by the resentful premise of “I’m taking someone else down with me.”
- Time gets weird with Regression: It either expands or contracts (i.e., If your teen is not home by curfew, minutes seem like hours; if you are in a new dating relationship, hours pass by like minutes).
- Regression typically happens during Holidays with your Family of Origin (instead of the 55 year old adult you are, you’re cast back into the child-like role of “Little Billy”) or Holidays like “Black Friday” (i.e., fighting for the item on sale at Walmart, etc.).
John mentioned 5 things that will bring people out of Regressed Ego States (with each point building upon the previous point):
a) Attention: Validate your viewpoint of the other by Listening and giving your undivided attention for 5 – 10 minutes (interestingly, or less, as this will help).
b) Empathy: Empathy will help the other person to come back into their Pre Frontal Cortex way of seeing, thinking and acting because the high emotional reactivity is being calmed if not extinguished altogether.
c) Time: Give yourself or the other a “Time Out” to sort things out. John mentioned a poet who penned “Sometimes the truth depends on a walk around the lake.” John also said “When you are in an Adult Ego State, there is almost nothing that is too much for you to handle; when you are in a Regressed (Child-like) Ego State, everything seems like it is too much.”
d) Contact: Make eye-to-eye, hand on shoulder, voice-to-voice connection with the other person. Safe, timely and empathetic touch promotes healing and reconciliation.
e) Release: Try to move from a “clenched fist” stance and way of viewing situations toward more of an “open hand” way of being receptive and open to giving or receiving help.
Well, this is what I learned at the conference on Day One. As time permits, please visit and read “So what did you learn at your conference?” Day 2 of 3 and Day 3 of 3.
Thanks for visiting and please visit the other blogs written by Dr Ken McGill: Daily Bread for Life and “3 – 2 – 5 – 4 – 24″ for additional information that could be helpful. I welcome your comments below or via email and your favorites, your retweets and your “+1’s” if you have a brief moment and find the information helpful. Again, it is my desire to provide the very best info for your consideration.