The Treatment of Trauma: Recreating Developmental Stages

1. The Treatment of Trauma: Recreating Developmental Stages Ron J. Llewelyn Psy.D. Amanda GallowayACMHC-i Dr. Llewelyn’s Affiliations: Living Waters Counseling LLC., University of Phoenix, Valley Mental Health, & The Center for Christian Therapy

2. Objectives

3. Psychological Trauma: The sudden uncontrollable disruption of our affiliative bonds. Lindemann1944

4. Domestic Violence in 3 Minutes • Types of Offenders • Socially limited • Borderline/Jealous • Antisocial/Narcissistic Offender Survivor Perception of self starts to change Lowered or lost confidence Questioning own decisions Questions if anyone loves them Blames self for others leaving Starts to feel defiled Starts to feel helpless Starts to feel hopeless Feels shame, guilt and blame Identifies with abuser language Believes that options are few Increase sense of insecurity Increase in emotional states Turning Against the Self Idealization of the Offender May rationalize their behavior to others May rational their behavior to self May blame self for their behavior Due to isolation, feels they are the only one there for them My become dependent upon them May perceive them with unrealistic power. Perception of Close others & the World Due to isolation, may feel abandoned Others will not understand May see others as a threat People have failed to rescue them • Offender • Perception of self (un-projected or reversed) • Self is threatened • Often insecure • Lost • Out of control • Fears being blamed • Fears abandonment • Underlying shame • Feels limited options • Jealous • Perception of Survivor • Is a threat to their own sense of stability • Has too much power • Can be difficult • May abandon them • The “safest” place to project to • Perception of others and the world • Fears being found out • Fears not being able to look competent • Needs to use persona • Well-meaning others may expose their incompetence’s

5. Understanding the Diagnosis

6. Diagnostic Comparison Type 1 - PTSD Type 2 – Complex PTSD

14. Cognitions & Loss of Meaning Janoff-Bulman Epstein

15. What Is Posttraumatic Growth?

16. A Disorder?

17. Areas of Posttraumatic Growth Outcomes Grubaugh & Resick, 2007

18. A Brief Overview of the 3 Staged Treatment Model for Type II PTSD

19. Three Stages

20. Stage One: The Corrective Therapeutic Experience: Working with Attachment, Intrapsychic Conflict, and Transference Neurosis

21. Stage one: Stabilization Primarily a personal experience Primarily a social experience

22. Three Stages in a Social Context Intra-psychic & Therapeutic Interaction Micro Therapeutic Dynamics Macro Level Dynamics

23. Stage One:Key Terms

24. Stage One: Psychoeducation

25. The Neurobiology of the Fight or Flight Response This occurs before information reaches the Cortex Stressful Event Cortex Thalamus Amygdala Locus Coeruleus Hypothalamus Sympathetic NS Thyroid Pituitary Adrenal Medulla Thyroxin Adrenaline Adrenal Cortex Cortisol Noradrenalin Adapted from Preston, O’Neal, & Talaga 2010

26. Neuro-anatomical Factors Broca’s Area Right Hemisphere

27. Genetic Expression

28. Stage One: Physical Well Being

29. Stage One:Self Soothing

30. Stage One: Self Soothing

31. Beyond the Pre-Frontal Cortex:Sensory Motor Trauma Therapy Nerve Stimulation

32. Stage One:Safety, Trust & Boundaries Trust vs. Mistrust/Oral Autonomy vs. Shame & Doubt

33. Treatment Through the Corrective Therapeutic ExperienceAn In Depth Look at Safety, Trust & Boundaries

34. Stage One:Psychosocial Redevelopment(Herman, 1992)

35. Early Stages of Life and Their Spatial Needs. (Erikson 1968)

36. Developmental Models Hope Oral Trust vs. Mistrust Willpower Autonomy vs. Shame & Doubt Anal Purpose Genital Initiative vs. Guilt Competence Industry vs. Inferiority Latency Fidelity Identity vs. Role Confusion Phallic Love Intimacy vs. Isolation Generativity vs. Stagnation Care Integrity vs. Despair Wisdom

37. Adapted from Childhood & Society Erikson 1950. Old Age . VIII VII VI V IV III II I Integrity vs. Despair Adulthood . Generativity vs. Stagnation Young Adulthood Intimacy vs. Isolation Adolescence . Identity vs. Confusion School Age . Industry vs. Inferiority Play Age . Initiative vs. Guilt Early Childhood Autonomy vs. Shame & Doubt Infancy Basic Trust vs Mistrust 1 2 3 4 5 6 7 8

38. Erikson

39. Eriksonian &Freudian Basics

40. War Crisis 1 Crisis 3 Crisis 2

41. A Strange Situation Ainsworth, M. D. S., Bell, S. M., (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67.

42. Homeostatic Mechanism of Attachment Janssen, C. G. C., Schuengel, C., & Stolk, J. (2002). Understanding challenging behaviour in people with severe and profound intellectual disability: A stress-attachment model. Journal of Intellectual Disability Research, 46, 445-453.

43. Attachment(Bartholomew, 1990; Muller & Rosenkranz, 2009)

44. Stage One:Safety

45. Stage One:Safety

46. Stage One:Boundaries

47. Enhancing Posttraumatic Growth through the Corrective Therapeutic Experience

48. Repetition Compulsion

49. The Transference Neurosis Violation of Silence

50. Essential Treatment Factor