Come into my Parlour said the spider to the fly: Complex trauma and betrayal

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Come into my Parlour said the spider to the fly: Complex trauma and betrayal Naomi Halpern, CQSW, Grad Cert Human Rights Lead Victorian Senate Candidate, Nick Xenophon Team Email:

1 Come into my Parlour said the spider to the fly: Complex trauma and betrayal Naomi Halpern, CQSW, Grad Cert Human Rights Lead Victorian Senate Candidate, Nick Xenophon Team STARTTS Clinical Master Class Evening Refugee trauma and dissociation: reintegrating lost parts of the being Sydney, NSW, 30 May 2016,

2 Outline Psychobiological impacts of trauma Attachment Transference & countertransference Dance of the triangle Steps to stay off the triangle

3 What is complex trauma? - Survival Threat - Exceeds the individual s adaptive capacities & resources - Alters the individual s development of self- regulation Courtois & Ford

4 Child-Onset Complex Developmental Trauma Associated with chronic, pervasive, cumulative trauma or adverse events in childhood, often on a foundation of attachment/relational trauma insecure attachment, especially disorganized Severely impacts the developing child s: neurophysiology psychophysiology bio-psycho-social maturation & development, including attachment capacity/style 2014 C. Courtois & J. Ford

5 Adolescent / adult onset complex trauma Entrapment in abusive relationships(dv/ipv) Prolonged captivity with isolation or torture Ethnic cleansing annihilation / degradation Prolonged war /violence/ destruction Human trafficking / slavery / prostitution 2014 C. Courtois & J. Ford

6 Dissociative Disorders Associated with disorganized attachment and/or abuse in childhood Can develop in the aftermath of trauma that occurs any time in the lifespan 5 forms in the DSM-5 Many complex trauma survivors selfregulate w/dissociation not necessarily a dissociative disorder differential diagnosis needed 2014 Courtois & Ford

Basic structure of the brain Cerebral cortex / frontal lobes: Thinking, analytical, concepts, reflection (conscious) Limbic: non-verbal relational, emotional memory,

7 Basic structure of the brain Cerebral cortex / frontal lobes: Thinking, analytical, concepts, reflection (conscious) Limbic: non-verbal relational, emotional memory, gut feelings, trauma memory (unconscious) Brain Stem: instinctive response, breathing, heart rate, eating, fight, flight, freeze, submit (automatic -reptilian brain)

8 PTSD Psychosis PSYCHOBIOLOGICAL EFFECTS OF Dissociative CHRONIC TRAUMATIZATION Disorder AND SEVERE ATTACHMENT DISRUPTIONS Anxiety Depression Personality Disorder K. Steele

9 Chronically Traumatized Individuals Are too rigid and closed instead of flexible: fixed in particular and narrow ways of being, defense and avoidance; overly closed to learning from the present; respond with conditioned reactions Are too unstable and open: overly open to the influence of internal experiences and perceptual distortions, sometimes to other people; overly open to the influence of the past Are reflexive instead of reflective: difficulty being reflective or staying in a reflective mode; are impulsive and reactive (K.Steele, 2009) 2014 Courtois & Ford

10 Attachment Organization (Ainsworth, 1978; Liotti, 1992; Main, 1986, Siegel, 1999) Child style secure insecure-avoidant insecure-dismissing/ resistant/ambivalent insecure-disorganized/ disoriented /dissociate Adult style autonomous dismissive /detached ( teflon ) preoccupied/anxious ( velcro ) fearful / anxious unresolved / dissociative 2014 Courtois & Ford

11 Come into my parlour said the spider to the fly unequal power relationship with an authority figure conducted in private (secrecy) trust me facilitate stepping closer to that which the client s defences are designed to avoid

12 Post-traumatic transference Unmet attachment needs, expectation of further betrayal, & re-enactments will arise in the context of therapy & relationship with the therapist. Culture, language, gender, ethnicity factors

13 Behaviour, symptoms and boundaries arriving late going over time non-attendance non-engagement excessive calls / flashbacks / panic attacks self-harm suicidality depression overt or passive aggression

14 Posttraumatic countertransference Therapist s attachment needs, countertransference, vicarious trauma &/or trauma history will rear its head in relationship with the client. Culture, language, gender, ethnicity factors

15 Countertransference responses Type I: Enmeshment, rescuing, boundary violation behaviour (crossings considered occasionally therapeutic) Type II: Counter-phobic, avoidant, numbed response and behaviour Pearlman & Caringi in Courtois & Ford, 2009

16 Stepping on the triangle Rescuer Going over time, excessive out of hours contact Victim Perpetrator Accept unreasonable behaviour Angry, judgmental, emotional withdrawal

17 A therapeutic misadventure in the transferential relationship can lead to the re-victimization of the client and VT of the therapist Our need to constantly monitor our CT responses results in compassion fatigue or empathic strain. Farber, 1995

18 Stepping off the triangle Please place the oxygen mask over your face FIRST before assisting other passengers.

19 Psychoeducation & stabilization normalise symptoms & behaviours ego strengthening identification & management of triggers reframe cognitive distortions healthy affect management & containment regrounding internal & external safety

20 Window of tolerance Hyperarousal Zone Can t think clearly, become quick to anger or tears, easily overwhelmed, can t recall or retain what therapist says WINDOW OF TOLERANCE Hypoarousal Zone Non-responsive, doesn t give full answers (yes/no), doesn t recall or retain what therapist says, very difficult to engage

21 Stepping off the triangle: Don t be frightened to try new things Anyone who has never made mistakes has never tried anything new! Albert Einstein

22 Thank you for your commitment to assist and make a difference to those who are suffering

23 Recommended reading Briere, J. & Scott, C (2006) Principles of Trauma Therapy: A Guide to Symptoms, Evaluations and Treatment, Sage Boon, S., Steele, K., Van der Hart, O. (2011) Coping With Trauma-Related Dissociation, Norton Courtois, C.A. & Ford, J.D., (2013), Treatment of Complex Trauma : A Sequenced, Relationship-Based Approach, Guilford Fisher, J. Self-harm and Suicidality (Unpublished paper) Fisher, J. The of Self-Hatred: Learning to Love Our Loathed Selves Psychotherapy Networker, July/August 2012 Ferentz, L. (2015) Treating Self-Destructive Behaviours in Trauma Survivors: A Clinician s Guide (2 nd Edition), Routledge Ogden, P. & Fisher, J. (2015) Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, Norton Ogden, P. & Minton, K., Pain, C. (2006) Trauma and the Body: A sensorimotor Approach to Psychotherapy, Norton Ross, C.A. and Halpern, N. (2009) Trauma Model Therapy: A Treatment Approach For Trauma, Dissociation And Complex Comorbidity, Manitou Communications Inc. van der Hart, O., Nijenhuis, E., Steele, K. (2006) The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, Norton. van der Kolk, B. (2014) The Body Keeps The Score: Mind, Brain and Body in the Transformation of Trauma, Allen Lane

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Trauma Informed Practices Jane Williams & Elizabeth Dorado Social Worker & Academic Counselor Gordon Bernell Charter Rising Up! Taking Charters to New Heights 2017 Annual Conference What is Trauma? Traumatic