PTSD Treatments
There are many modalities that can relieve you from the suffering caused by Post Traumatic Stress Disorder, PTSD and complicated PTSD. Some techniques are better known than others and EMDR is perhaps the most well known modality for recovery.
At Surf Ridge Counseling you can get help recovering from PTSD, with EMDR, CPT, TFCBT or IFS.
EMDR
Eye Movement Desensitization and Reprocessing is a lot of words that are shortened to EMDR. Francine Shapiro began using EMDR in 1987. She is a therapist and still alive today. The story I recall is that she was walking along outside, thinking of something troubling and her eyes were going back and forth as she thought. After walking, she felt better. She came up with a method to help people recover from trauma, using thoughts and eye movements. This technique worked so well, she shared the technique with other clinicians and they began doing clinical trials and soon had clinical evidence that the technique worked very well. So well in fact, that the military now uses it.
What are the end results?
After experiencing EMDR, a person is able to recall the traumatic event without having the visceral reaction that used to go along with it. Which means if you were triggered a lot by subtle reminders, that won’t happen as much, or any more, which is an amazing thing, especially if you have been suffering for years. If you see a movie, with the similar event, you won’t be all torn up inside the way you used to be.
Not only that, but with PTSD, you body is continually creating adrenaline and cortisol which can be enormously exhausting. It could be possible to have more energy to move through the day. You might be able to turn your attention onto moving ahead in your life.
What happens during an EMDR session?
During the first session with a new therapist, the client has a lot of options. Some people want the counselor to know why they ended up seeking counseling and provide a full trauma history. Some people have a lot of past trauma and really want the therapist to know what they have been experiencing for their whole lives, how difficult and traumatizing their childhood was and the event or events that occurred that contribute to their diagnosis of PTSD. Some people like to get to know the therapist a little bit before they open up and tell their personal and troubling stories. Clients really have the right to choose how they want their therapy to move forward. Eventually, if you are a candidate for EMDR, you will move into the phase of therapy, where you do the actually work.
The work itself includes remembering what happened during the traumatic event. A client does not have to tell the therapist what the event was, or the details of the event. However the client does have to remember it. Sometimes with a past military event, the client may not be at liberty to recount the details. They might just say it was a land battle or a skirmish at sea. It is important that the client bring the event to mind, with enough thought that they “feel” the distress. Then the therapist asks the client to rate the current distress they are experiencing because of the memory on a 1 to 10 scale with 10 being the worst, no 11s allowed, an 11 is a 10, but believe me, we get it, a 10 is a lot of stress. Some people might tear up when distraught to a level 10 some do not.
Then the counselor assists the client with bilateral stimulation. That can consist of watching there therapist’s hand go back and forth, or by holding some paddles that vibrate, first right then left, or by tapping one’s own shoulders with arms crossed over chest, first right shoulder then left. This tapping or whatever technique is used continues for a while, until the counselor says, okay, take a breath.
The clinician then may say something like, “what comes up?” Allowing the client to talk about thoughts that came up during the set of bilateral stimulation. Sometimes no thoughts come up. The counselor might then [or after several other sets] ask the client to rate their level of current stress at remembering the event. Some people require several sets of bilateral stimulation to begin to have the stress level drop. But eventually the stress level of the vent, does drop. It may go up a few times during the whole process, and then drop to a very low level of stress.
Another element of EMDR is finding the negative thought that we associate with the event about ourselves. It could be something like, it was my fault, or I was so stupid, or if I hadn’t done such and such, the whole thing would never have happened.
The therapist also asks what thought would you rather have associated with this event? And the client explores what thought they would rather have associated with the event. It could be something like, there is nothing I could have done to stop this thing from happening.
The counselor then assists the client in lowering the percent amount that the client believes the negative thought and rising the percent that the client believes the more positive thought.
There are other things that weave in and out of an EMDR session, such as thoughts about other aspects of the event that come to mind. Memories of small details might come to mind that you have not thought of before. But in the end, you will be able to think of the even without the visceral stress that was once associated with the memory.
CPT
How did I find this technique?
Not many people talk about CPT, Cognitive Processing Therapy. In fact when I first was researching what techniques the military uses for PTSD, and saw CPT, I misread it and thought they used CBT, Cognitive Behavioral Therapy. It wasn’t until I hear a This American Life episode about CPT, did I understand it wasn’t CBT at all. Please go to the site and listen to the podcast. https://www.thisamericanlife.org/682/ten-sessions
My daughter heard it and told me to have a listen. I was so moved by the story, I drove 7 hours to a center near Baltimore Maryland, and spent a long weekend learning how to use it.
Since studying the technique, I have not had many clients request it, or want to work with it. The few clients I have used it with, did not go through all the sessions.
What I like about CPT
Cognitive Processing Therapy is a didactic [instructive] approach. It is time limited, and can be completed in 12 sessions. It helps the client learn how to use the technique on their own, and resolve possible future events, or other past traumas on their own. It helps clients learn how to change or challenge their beliefs about the trauma in such a way, that the symptoms of PTSD are reduced.
What happens during CPT?
The clinician educates the client about what PTSD is and how it affects emotions. The therapist helps the client identify “automatic thoughts” which prolong the distress of PTSD.
There is a lot of homework involved with CPT. Each week the client has assignments such as writing a detailed account of the event. When the client reads the account out loud, during the following session, the counselor uses Socratic questioning to assist the client identify self-blaming thoughts. Each week the client is given handouts to work with that help him or her notice unhelpful thoughts and begin to develop a sense of esteem, safety, intimacy, power, trust and control.
This therapy is one that can work for clients who may disassociate so much, they are not good candidates for EMDR.
TFCBT
Who is it good for?
Trauma Focused Cognitive Behavioral Therapy [TFCBT] is a technique developed for children ages 3 -18. It helps children and adolescents recover from a trauma, or multiple traumas.
What is TFCBT?
It is a system that is used with the client, their guardian, or trusted adult. It is structured so that both the client and the caregiver come to a session together, then the client comes alone for the next session, and after the care giver comes alone to a session. This structure continues throughout the therapy.
Initially there is an intake, assessment and measurements taken for the symptoms of PTSD.
The client is taught what PTSD is in the initial individual session, then encouraged to help the guardian understand what they have learned in the joint session. When the guardian comes alone, the therapist helps him or her learn ways to support the client in a way to aid in their recovery. These sessions include information such as helping the guardian learn what parenting styles work the best to support overall behavior and recovery.
The child or adolescent learns coping skills to assist in emotional regulation. The parent learns how to reinforce these skills. Once a strong foundation of skills is established, and trust in the counselor, the client begins to write a trauma narrative. The client is not told about this step in therapy initially, as to help the client gain trust in the therapist first. The parent/ caregiver, does know about the narrative from the beginning.
When the personal narrative part of the protocol starts, the client begins to tell the therapist the story and the therapist writes it down. The client knows the guardian will be hearing their story on their guardian’s individual session. When they both meet together, space is provided to talk about how things are going at home. No discussion is made about the narrative. The parent is instructed not to talk to the child about the narrative as it is being created.
Near the end of treatment, the client reads the narrative out loud to the guardian. The client and guardian go home and destroy the narrative together. The narrative is not something kept for prosperity. Destroying it is part of the healing process.
The closing sessions include discussions about future safety and remeasuring symptoms of PTSD and review of the measurements. Lastly evaluation of future therapy needs and referral for a therapist is given as needed.
Internal Family Systems, IFS
Brief summary of Internal family Systems use for PTSD
Internal Family Systems, [IFS] created by Richard Schwartz, back in the 1970s is a protocol that examines the parts of ourselves that cause us difficulty. Our “parts,” are aspects of ourselves that feel certain emotions and have thoughts about everything. We all have parts. For example, part of me may want to eat better and exercise more and another part of myself might want to indulge in watching television and eat potato chips.
With IFS we use somatics to better understand our parts. Somatics is the use of exploring the mind-body connection to help learn how to pay attention to body sensations as a way to gain better mental understanding of what is going on with your emotions.
IFS assists cultivating mental states which support a safe internal environment that assist processing past traumatic experiences.
The road to recovery for PTSD
I am Amoret Sprunt Phillips and my counseling business name is Surf Ridge Counseling. I believe that recovery from PTSD is achievable. My primary goal is also to learn what your goal for therapy is and follow your lead. I am here to help you on your journey and move forward in your life, in such a way, that you do not need me for therapy any longer. I’ll be here for you as long as you need and for return visits in the future, should you be encountering struggles again and help you continue to build the skills you need to have a nice life with the natural supports in your community. Thank you for reading this blog post, please let me know how I may best support you.
