Modalities and Techniques in Therapy
The first step is building an alliance conveying genuine interest, accepting, caring, empathetic understanding and understanding the patient in full context. I listen to the full disclosure being presented and do not make assumptions. A free associative process is employed. Early childhood is considered important. Patient’s can bring in traumatic events from early in life and once remembered and worked through symptoms can disappear.
Dreams and dream interpretation:
The dream gives access to dynamic, genetic, emotional and economic material of basic importance. The dream can be in close proximity to memories from childhood, making use essentially of pictorial representations. Day residue and infantile material are intertwined in the dream work. The single interpretation or single recovery of a memory is not in itself curative, but needed to utilize the slower process of working through because emotional circumstances are multifaceted.
Trauma and EMDR Work:
Intense emotions that have a disintegrating effect on the mind are caused by traumatic experiences. The world suddenly becomes threatening, unpredictable and assaultive as trauma impacts on an individual’s life. The traumatic event is alien to what is expected in ordinary life, and it terrifies the victim’s sense of self, leaving the mind with little recourse, but to banish it out of consciousness or distort it. Trauma leads to abrupt disruption in daily experience. Natural disasters, war, death, rape, sexual abuse, anger, emotional abuse, betrayal, abandonment and other frightening experiences can cause discontinuities in physical and psychological experiences (Spiegel, 1986).
Traumatic events differ in degree of severity and take many different forms. They can occur unexpectedly or be repetitive and anticipated. Some individuals will be much more traumatized and others will emerge psychologically unscathed (Schlenger et al., 1992).
Subjective severity is determined by the meaning that the victim attaches to it. One can integrate the event into ones personal sense of self and the world, or one can experience it as a threat to the self. When the victim is young, there is less capacity for integration of information and the greater the psychological damage (Classen, Koopman, Spiegel, 1992). There is a point for each of us at which anxiety and fear cross the fine line into trauma. More negative effects result from early, prolonged and severe trauma. Trauma that is unresolved and unintegrated may result in a condition known as Post Traumatic Stress Disorder (Siegel, 1999).
The American Psychiatric Association (2000) suggests that trauma is not limited to surviving life-threatening experiences. They suggest among the sources of trauma experienced by a young child may be separation from parents, being in a family system with a high level of marital tension, depression and alcoholism. Sources of trauma for an adolescent may include incessant teasing from pears and caring for the needs of an alcoholic parent. Adults may experience trauma with the loss of a loved one, chronic loneliness or a sense of failure or shame.
It has been noted that psychological effects regarding trauma are expressed as changes in the biological stress response. Pierre Janet’s assumption was that intense emotional reactions are said to make events traumatic by interfering with the integration of one’s experience into existing memory schemes. Janet thought that intense emotions can cause memories related to certain events to be dissociated from consciousness and to be stored instead as visceral sensations (anxiety and panic) or visual images (such as flashbacks and nightmares). Janet stated that traumatized victims react with emergency responses to reminders of the original trauma and threat and are unable to put the trauma behind them. They can become fixated on the past behaving as though they are being traumatized over and over again and being unable to locate the origins of those feelings.
Talking through a traumatic episode within the context of a supportive therapeutic relationship creates neurobiological conditions for the reestablishment of neural coherence (Mitchell & Everly, 1993). Cognition, affect, behavior and sensation can stay dissociated when early traumas are never processed. A supportive environment allows for the necessary matrix for the psychological and neurobiological integration necessary in order to avoid reactions of dissociation.
Traumatized victims may withdraw from others by limiting contact and narrowing their range of feelings and thoughts. Avoidance can be a defense to defend against what is considered dangers. Avoidance can also take the form of denial and repression and with extreme instances, amnesia and dissociation. Williams (1994) documented 38% of adult women that suffered some form of sexual abuse as a child had no memory of it. A common aid in avoiding the negative affect of trauma can be compulsive activities as well as alcohol and drugs. Trauma in not cured by the passage of time and the intensity of flashbacks is not diminished by time.
Psychoanalytic Psychotherapy and EMDR; working with Adults and Millennials