PRACTICE STANDARDS FOR TRAUMA WORK

Many places, all of which no doubt see things through the eyes of their own paradigm.  In general, the more familiar the entire therapeutic community is with the foremost researchers, scientists, authors and thought leaders in the field (specifically areas such as neuroscience, trauma care, psychoimmunology, epigenetics, etc.), the better off each 'branch' of application will be, and the more informed, successful and fluid our conversation and application standards will be, to everyone's benefit.  These include but are not limited to Van der Kolk, Scaer, Mate, Levine, Rothschild, Lipton, Ruben, et al.  This question presents the community at large with a fantastic opportunity;  if not taken as such, a free-for-all where all intervention varietals and schools of thought will fight to dominate the 'standard' will ensue.  I surely hope (and participate in developing) the former!

My first EMDR therapist [Ph.D., and trained at 'Facilitator' (highest) level] used to share his printed EMDR clinician's newsletter with me. That was long before the O'Shea/Paulsen EMDR protocols were developed, and became available, and although I'm not yet familiar with those new protocols, I certainly would appreciate an explanation of their purpose and use.

We've had some major changes in Peer Support training in our state, and other than previous [almost a decade ago] training in [trauma-informed] Intentional Peer Support training based on a "Risking Connection" model, I'm not sure of much.

The Boston and Cambridge, Massachusetts Intentional Police Peer Support is 'encouraged' by the On-Site Academy --which provides crisis/respite to First Responders and Human Service Personnel [world-wide, now], and the North Shore of Massachusetts municipal Police departments just started something similar.....

Glad you made your comment, but I was thinking more broadly than any specific treatment modality.

You see, I'm trying to set up a peer support service for survivors of trauma, abuse and childhood adversity, being both a former psychologist, now retired, and a survivor myself. 

Some "standards" do exist, although maybe not often spoken of as such, such as if you're a survivor - group facilitator you should be able in some way to talk about your own experiences of abuse without it rendering you speechless -- not being harsh, but ..

This is probably not exactly what you're looking for but this could support somewhat:

http://www.ascasupport.org/manual.php

All the best with your group, Russell. I'm sure it will be the participants who'll be left speechless, not you, when you present the ideas and why you're doing this when your include your personal experiences!

thanks, Mem, it's taking me a little while to get "back up to speed" but, now I again know why "Policy and Procedures" manuals are P&P Manuals -- good ones are reflected in the other. Which is why I started this query.

Interesting that the Australian ASCA organization (no connection with the ASCA) has changed its name to Blue Knot -- it's broadened its focus, sure, but ..

disappointingly low number of responses to this query so far, so I thought I might add something that might interest others. Don't know how many people have heard of Mary Jo Barrett, maybe via Psychotherapy Networker but I enjoyed, both as clinician and survivor,  her presentation there about the essentials of trauma work. Have a look here: http://russwilson.coffeecup.co...rauma%20therapy.html

Russell, thank you very much for this. I appreciated that the approaches I already use and teach were being validated. And it also gave me a chuckle,  as I'd asked Don a couple of years ago to a radio interview and he rudely blew me off, as he didn't like my brand of 'acronym' intervention.  Good to know he would've been happily surprised, had he come to take a look!  At the end of the proverbial day I guess we're all doing the best we can to break our own 'vicious cycles,' right? ��

I approach trauma healing from the body side so we have our own standards. A lot of my colleagues are therapists/counselors, and the founder of the technique is a PhD in social work, so that has informed the process.

I agree that the lack of response is telling. It brings to mind van der Kolk's admonitions to his own profession, the latest in the New Yorker, but his last book was sufficient. 

Can I speak to something you said, Russell? that being the point of being left speechless?

I attended a number of [trauma-informed, 'Risking Connection', 'Intentional Peer Support'] trainings. I found the work of Peer Support facilitator Shery Mead (and her current organization: "Mental Health Peers") to be quite comprehensive, and reviewed favorably by NH-Dartmouth Psychiatric Research Center, among other organizations.

I also had attended CISD training with First Responders  - in the late 1980's, but I think the recent development of "Police Intentional Peer Support", now in use in Boston, Cambridge, and North Shore municipalities of Massachusetts-in conjunction with the [now international] On-Site Academy of Gardner, Massachusetts, and initiatives such as Leckey Harrison described, to be noteworthy, as I hadn't heard of any adverse outcomes. But I hadn't heard of any 'adverse outcomes' from "Athenian Theater", either.

At a PTSD continuing education conference at the Veterans Administration, some years ago, it was noted that a British journal reported questions about the efficacy of CISD with automobile accident survivors in Britain.

I would hope that the ISTSS (International Society of Traumatic Stress Studies), might have an "Evidence Base", as well as EMDRIA-an international group of EMDR Clinicians, who now have the "O'Shea/Paulsen [EMDR] protocols". The "EENet" (Evidence Exchange Network of Ontario province in Canada) may also have data.

I regret that I had once encountered "an adverse bias" to Bessel van der Kolk's work, at our National Center for PTSD Library, even though it was while I was there perusing his book: "The Body Keeps the Score:...".  I'm not sure that all staff there concurred with the one person who said to me: "We don't like him!" [pointing to van der Kolk's name on the book cover]. 

I hope this is helpful, at this 'late date'.

Well, this reply of yours, Robert, certainly has the potential to open some "can o'worms", in lots of different areas. Just to invite some more objective consideration of Peer Support, I'd encourage people to do a search for evaluations of such services -- IF you can find any let me know. IPS is not the only model of peer support though it's the most referred to. The days of "we like it so therefore it has to be good", apart from any other "data" would have / should have, I would have hoped, ended 40 years ago. Instead, I encourage people to read, and heed, the recommendations of Lloyd-Evans http://www.biomedcentral.com/1471-244X/14/39/abstract

Locally, in New Zealand, if you can get the Kites Reports, which attempted to review the "success" of local peer support organizations, you'll see how such organisations often fail to have any evaluation measures capable of responding to calls for greater accountability. The local local Dunedin Otago MH peer support service forestalls having to hear any criticism by labelling its form the "Complaint and Feedback Memorandum" -- New Zealanders don't like to complain so ...

Yes, poor old Bessel, really does cop a hiding, as do most people who choose to stand out from the crowd, perhaps because he's made some bold comments about taboo subjects. Reading Martin Dorahy's review of the history of trauma and abuse in Lanius' book shows how clearly various forces have suppressed coverage of such issues over years past. Still, as someone who has suffered Complex Trauma, and saw his brother go through the whole "Developmental Trauma Disorder" I must say no one else has ever, in my opinion, written so compassionately and empathetically of developmental trauma issues.

Could you please tell me the name of this book by Lanius? Thank you!

"sorta" giving you the name of the book, via Martin's chapter -- if you contact Martin at Univ Canterbury, Christchurch NZ, requesting the article he'll probably send it to you -- he's great like that -- if not, let me know. Check my website and you'll get to see some videos by Lanius (a trauma-informed psychiatrist -- a bit frustrated by Canada's relative neglect of the issue, but still far in advance of backwater NZ).

Dorahy, M. J., van der Hart, O., & Middleton, W. (2010). The history of early life trauma and abuse from the 1850s to the current time: how the past influences the present. In R. A. Lanius, E. Vermetten, & C. Pain (Eds.), The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic (pp. 3–12). Cambridge, MA: Cambridge University Press.

if you're up to it, it's a fascinating subject to get into, even further back in time, and cross-culturally, the uses to which adults put children.

Robert Olcott posted:

I attended a number of [trauma-informed, 'Risking Connection', 'Intentional Peer Support'] trainings. I found the work of Peer Support facilitator Shery Mead (and her current organization: "Mental Health Peers") to be quite comprehensive, and reviewed favorably by NH-Dartmouth Psychiatric Research Center, among other organizations.

I also had attended CISD training with First Responders  - in the late 1980's, but I think the recent development of "Police Intentional Peer Support", now in use in Boston, Cambridge, and North Shore municipalities of Massachusetts-in conjunction with the [now international] On-Site Academy of Gardner, Massachusetts, and initiatives such as Leckey Harrison described, to be noteworthy, as I hadn't heard of any adverse outcomes. But I hadn't heard of any 'adverse outcomes' from "Athenian Theater", either.

At a PTSD continuing education conference at the Veterans Administration, some years ago, it was noted that a British journal reported questions about the efficacy of CISD with automobile accident survivors in Britain.

I would hope that the ISTSS (International Society of Traumatic Stress Studies), might have an "Evidence Base", as well as EMDRIA-an international group of EMDR Clinicians, who now have the "O'Shea/Paulsen [EMDR] protocols". The "EENet" (Evidence Exchange Network of Ontario province in Canada) may also have data.

I regret that I had once encountered "an adverse bias" to Bessel van der Kolk's work, at our National Center for PTSD Library, even though it was while I was there perusing his book: "The Body Keeps the Score:...".  I'm not sure that all staff there concurred with the one person who said to me: "We don't like him!" [pointing to van der Kolk's name on the book cover]. 

I hope this is helpful, at this 'late date'.

In a recent New Yorker article, van der Kolk was at it again, stating that Exposure Therapy was creating dissociation rather than healing, and the CBT was ineffective. I think he's been clear about his profession and trauma, Gaboe Maté as well, and van der Kolk's book it titled very similarly to Babette Rothschild's, and they both mention where the issue really is: the body. There is also this article (http://www.madinamerica.com/20...y-incremental-steps/), and again, there is a gross neglect to consider the fact that what's staring us in the face doesn't need rocket science. Again, where Maté agrees: we've got all the research, it all comes back to stress and trauma (he would say childhood), and the problem is in the body. Yet we want to keep talking to the problem. 

yes, and no. People familiar with the "ICCE" - International Center for Clinical Excellence -- will know it is but one example of how important the therapeutic relationship, over and above ANY particular treatment model; and past research has shown that behavioral / CBT practitioners (what is "the" CBT approach, since there are many forms of CBT) are as empathic, if not more empathic and supportive as treatment providers from any other approach. So,  I  would have to disagree with Bessel's broad-brush condemnation of any approach. If therapists do not tune into how their clients are going they can certainly re-traumatise certain, but not all,  people. A similar argument could be made concerning the use of Mindfulness -- either it's extremely risky (if you don't know your patient's vulnerabilities) or it's the bees-knees. So, hasten slowly, REALLY get to know your patients, and have  a solid relationship in place, before you doing anything else.

People who have been following the treatment literature -- from Cloitre's article in American J of Psychiatry onwards, including the consensus statement (again, the details are obtainable from my website -- search "consensus") -- will know there's to and from arguments concerning the proposal that treatment needs to be phase-based, with clients "needing" to be trained in emotion regulation skills before addressing the fear-focused exposure phase, with some of the best, "single-phase" treatment coming from Europe (unfortunately the most recent articles are in Dutch! but the authors are very generous in supplying the background articles in English). Similar caveats could be raised concerning the "poor response" to treatment of patients with "Personality Disorder" -- many of those with CPTSD - with the Dutch research showing they cause no problems in treatment and respond at least as well.

But, following your line, if people like more cookbook-style approaches, there's Ogden's recent excellent book on sensorimotor psychotherapy for trauma.

On the other hand (and I'll be ending this soon), one "body" therapy for trauma, and everything else, is Primal Therapy --- one of my current clients -- desperate to understand his issues has practically memorized two of Janov's books -- and I was never into it so it's especially challenging.

Again, and I didn't mean for this to be a lecture, I think if client and therapist can establish a good relationship, respect those fundamentals raised by Bennett, and find a language by which they can establish a shared language in which to share their understanding of the client's wishes, reformulate stored constructions, and take steps to help the client build a life consistent with the client's values, I think that goes a substantial way towards helping the client to a better life -- and no one particular model will be THE way to that end, certainly not for us all. Just my 2c worth :-D

I'm not sure I know of Bessels condemnation of anything, but I am less educated on the vast and competing canon of trauma lit out there than you.  However I think all of us could agree that developing the intention, skills and practice of creating empathic, therapeutic relationships with and for our clients, beginning with the creation of a safe space (I mean this in every way one could imagine), is true no matter which 'technique' you choose to employ.  I have a lot of respect for the variety of people and ways engaged in the same pursuit of assisting with healing for others.  As an experienced trainer of meridian-based therapeutic interventions, I am consistently mindful of the pyramid of systems that all play a part in trauma creation and release: Cognitive/Mental, Physical/Somatic and Emotional/Affective. From that paradigm I find it easy to communicate with others about their preferred modality, and share information.

I appreciate your generous shares,  Russell.  (I wrote to the professor as you suggested.)  Thank you.

I haven't been in touch with Martin for quite some time, so don't know his current availability,

but any problems, contact me -- I have the article, and depending on your interest a couple of others of possible interest.  I think the ACEsC system permits private messages, though my website also has my address.

HI all- great discussion! I wanted to alert folks that don't subscribe to PESI that they are offering a webinar training by some of the leaders in the trauma, ACEs and addiction world (Bessel A van der Kolk, MD; Vincent Felitti, MD; Lisa Ferentz, LCSW-C, DAPA; Gabor Maté, MD and other leading trauma and addiction experts will provide you with invaluable insight including:

• The therapeutic alliance, along with all its inherent challenges with boundaries and clinical enactments
• The use of contemplative practices for changing the brain
• Teaching skills for self-regulation
• Evidence-based modalities for both stabilization and processing traumatic material

I can't vouch for it but did want to share with our community in case it is of help to anyone. The link is here

ACEs Toolkit Crittenton, NEAR @Home 

Peter Chiavetta posted:

ACEs Toolkit Crittenton, NEAR @Home 

Thanks for the suggestion.

I do so like a man of few words, except that they tend to leave everyone around them feeling confused.

How did you mean your reply to be related to practice standards, except in the area of who/how the ACEsQ should be administered -- in that way it's useful; but it's mostly what happens AFTER that that I'm most interested in (after all, the word "standard" is only included in the document two or three times -- one of those for "standard time"). By "practice" I was referring to "clinical practice" type standards consequent upon the individual's acknowledging or volunteering that they have an ACEs background.