Relationship Trauma Repair: A User-Friendly, Experiential Model of Healing PTSD

The greatest shift over the past two decades in the mental health world is the recognition that the body, as well as the mind and heart, need to be part of the therapeutic process. Relationship Trauma Repair (RTR) is a multi-sensory, experiential model that is easy to incorporate into any treatment setting. Because psychodrama and sociometry are experiential methods, they allow therapists and clients to work with whatever issues and concerns the group puts forward, and these methods can be adapted to any treatment population, gender or age group.

The nature of traumatic memory is that the feeling and sensory data related to a traumatic event or series of events are thrown out of consciousness because fear has triggered the shutting down of the prefrontal cortex, or the thinking part of the brain. An experiential approach to treating PTSD allows the body to tell its story through role play and experiential exercises through action before we ask clients to tell us their “trauma story”. Due to the way the brain processes experience, feelings related to having been traumatized are oftentimes frozen – they have remained, in a sense, unfelt. When the client is suddenly being called upon to reflect on what they may have defended against feeling or even knowing, they can feel intimidated, angry or simply stupid. In their anxiety to get it right, they may 1) make something up that sounds plausible; 2) create a sort of story based on what they have heard or read; or 3) adopt the therapist’s version (co-dependency in the making!).

Psychodrama allows the mind and body to tell their story, which makes it an ideal modality for doing trauma resolution. It is also relational, that is, through role play the object relationships or those people who have been introjected, through repeated exposure and limbic bonding, into the self system can be dealt with not only in absencia, but directly through a role-playing experiencing. Role play allows for the body to move in a fashion that is natural to the human being, rather than to ask them to so do that one thing that victims of trauma find so difficult – mainly sit still, disengage from the body and talk exclusively from the head about their trauma. Therefore the intense and often split-off emotions and body sensations that are stored in the limbic system become naturally stimulated through role play, after which words can be added to that direct experience rather than the opposite.

Sociometry focuses on the dynamics within the group; it helps group members to connect with each other and explore the relationships between and among them. Because I work mainly in the addictions field, and because therapists all around the country were constantly asking me to train them in experiential approaches that did not require the level of training that psychodrama requires, I created exercises that interface theory with sociometric group exercises (spectrograms, locograms and the like). This met a very necessary goal of treatment centers to both teach and provide a healing experience in an integrated fashion.

There are few things more difficult for a survivor of trauma than to be asked to “talk about” their painful experience. The very nature of trauma is that feelings become inaccessible that are related to frightening or terrifying events. In that moment of intense fear or terror, the thinking brain (the prefrontal cortex) shuts off so that the limbic brain, the fight/flight brain can operate without the interference of random thoughts to help us flee for safety or stand and fight. When we can do neither, which is so often the case in families where escape is not really so possible (particularly for children and, all too often, women), we freeze or shut down. RTR deals with that frozen material that gets shut down through trauma; it deals with the disturbing body sensations that often accompany fear states, such as stomach aches, headaches, muscle tension, backaches and sizzling/queasy feelings. It deals with the kind of despair and helplessness that we collapse into when we feel that our best efforts get us nowhere. It deals with our inability to connect feelings to words and words to feelings. It offers hope, healing and a way out of the kind of chronic pain, anger and hopelessness that, if not dealt with as aggressively as one might deal with any spreading cancer, become intergenerational.

Some Points for Healing Relationship Trauma

  1. Essentially trauma work includes making unconscious, split-off limbic emotional and sense memory impressions conscious, so that fragmented sense impressions and emotional memories and responses can be given context, meaning and reintegrated into a working model of the “self”.
  2. Trauma work consists of feeling frozen or split-off emotions so that they can be drawn forward, translated into language and elevated to a conscious level where they can be reflected upon and thought about.
  3. We need to connect the limbic (feeling) mind with the thinking mind so that the thinking mind can create meaning of our experience.
  4. We need to allow the body to have a voice, to inquire about what’s going on in the body and to find out what interrupted action patterns emerge.
  5. We need to allow the client to come forward slowly, rather than expect them to be able to immediately self-reflect, which they cannot, since their painful memories are stored as sense impressions, feeling or perceptual flashes and often detached from genuine emotion.
  6. We need to create space for clients to re-inhabit their bodies at the time of the trauma, to be with them in the here and now and help them to tolerate their state of hyper-arousal and feelings of fragmentation. Then they will slowly knit the fragments of memory back together again. Show us don’t tell us: the story emerges in both body and mind, in action and words. The body leads. We reflect afterward, not the opposite.
  7. The idea is not to ask question after question but to “hold” the affective environment with the client as the story unfolds so that they can heal themselves.
  8. We need to help the client to reconnect their sense of self before the trauma occurred, before numbness and memory loss made them lose access to it (if applicable).
  9. Physical mechanisms, or sensory impressions, are what produce our experience of the world, and we need new sets of physical impressions to change or alter those impressions. Therefore we need a model of treatment that allows new relational forms of connection.
  10. We need to understand how trauma impacted normal emotional development.
  11. We need to help the client to find emotional middle ground and self-regulation.

RTR is modular; that is to say it has several moveable parts that interact, hopefully to make the therapist’s job easier and to allow the material to be delivered clearly and smoothly. It is hands-on an user-friendly. It is designed so that it can fit into whatever length of stay you use at your particular facility. It can also be done as separate units, e.g. three to five days on any one subject area.

Therapist’s Guide: You are now reading the therapist’s guide, which will take you through the model step-by-step and tell you exactly what to do with your group.

Client Workbook: The client workbook interfaces with the exercises in the therapist’s guide, the DVDs and the guided imageries. Each group experience has journaling exercises to go with it that are coordinated by title. Clients can write in their workbook, either in the group or on their own. Or, if this is used by individual clinicians, the work book can be homework.

DVDs: These are a combination of lecture and demonstration; the model will tell where to pop them into a TV so that they can be watched by clients then shared in the group.

CDs, Guided Imageries: The guided imageries are designed to support both group exercises and workbook journaling. They can be listened to either in the large group and processed together or individually. I will indicate where these imageries fit in to the various exercises throughout the book. The RTR model is available for purchase at unrivaledbooks.com

Dr. Dayton will be giving a training in New York City on November 18, 2011, sponsored by Freedom Institute 212.838.0044, as well as a three-day training at Onsite, in Nashville, Tn., Jan 26-29, 2012, 800.341.7432.

 

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