Auckland PSI^TM  Institute

 Below are three approaches that have been shown to be effective with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another page I wrote on effective 
approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons  if known) that they work. The affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse, but are  described on a separate page as they are helpful on a broader and less specific basis.

PLEASE NOTE: The techniques described below have been integrated into PSI^{TM ,} an overall approach in working with trauma and abuse survivors.  PSI^TM is described here in more detail.

1. Link to: EMDR (Eye Movement Desensitization and Reprocessing)
2.Sensorimotor Psychotherapy

3. Ego State Therapy
4 Lifespan Integration

Link to: Effective Treatment Approaches to Healing Problems Related to Poor Affect Regulation

1. EMDR http://www.emdr.com/briefdes.htm (evidence-based effective)
founder: Francine Shapiro

         ....EMDR is an information processing therapy that uses an eight phase approach.
        During EMDR¹ the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session.

Eight Phases of Treatment

        The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

        During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions....

        In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions....

            In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

        The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session.... (for more details go to http://www.emdr.com/briefdes.htm)

¹Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.

²Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.

Copyright 2004, EMDR Institute, Inc

Also see: All About EMDR  by Shirley Jean Schmidt

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2. Sensorimotor Psychotherapy: http://www.sensorimotorpsychotherapy.org/about.html (Anecdotal)    Founder: Pat Ogden

        In the 1970's, Pat Ogden became interested in the correlation between her patients' disconnection from their bodies, their physical patterns and their psychological issues. As both a psychotherapist and body therapist, she was inspired to join somatic therapy and therapy into a comprehensive method for healing this disconnection. SPI offered its first course in the early 1980's under the name Hakomi Bodywork. Influenced by leaders such as Bessel van der Kolk, Emilie Conrad, Peter Levine, Peter Melchior, Allan Schore, Ken Wilber, Onno van der Hart, Ellert Nijenhuis, Kathy Steele, Stephen Porges, and Martha Stark, Sensorimotor Psychotherapy draws from somatic therapies, neuroscience, attachment theory, and cognitive approaches, as well as from the Hakomi Method, a gentle psychotherapeutic approach pioneered by Ron Kurtz. (http://www.hakomi.com/) SPI conducts trainings throughout the world, and has gained international acclaim over the past twenty years.

        Sensorimotor Psychotherapy integrates both cognitive and somatic methods in the treatment of trauma, attachment, and developmental issues. It is taught internationally to psychotherapists and allied professionals who want to include somatic interventions in their clinical work.

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3. Ego State Therapy

Ego State Therapy

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual.  This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma. Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies.
 

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4. Lifespan Integration: (Anecdotal) )This article has been adapted and reproduced by myself, with permission, from a handout originally written by Regina A Delmastro, RN., CEDA THTP, a registered psychiatric nurse in Bellevue Washington. Lifespan Integration, as currently taught by Peggy Pace, its founder, has changed and evolved since this writing in ways I have not incorporated into PSI^TM , as I find the approach described below to be of most benefit to my clients. For more information on LI in its current incarnation, please go here:  http://www.lifespanintegration.com 

Description and Process of Lifespan Integration ( referred to as LI therapy) as it is used in PSI^TM

 Lifespan Integration is a psycho-neurological/bodymind therapy created by Peggy Pace, MA, LMHC, LMFT, based on early neural development research.   LI is body-mind based in that memory is stored in the neurological system and comes forward in response to associated experiences as explicit verbal memory or in body sensations (implicit / before- cognition memory).

 The LI part of the PSI Protocol involves first creating a Personal Lifespan Timeline of age-specific memories which is referred to, as needed, in the session.  Often, the client may do this at home before the actual session.  If the client has suffered recurrent, prolonged childhood neglect or trauma, (complex trauma ), there may be little or no explicit memory of childhood. For some just the creation of the timeline may trigger traumatic anxiety or flashbacks.  In this case, the Personal Timeline may be done with the therapist in advance of the full PSI Protocol.

 In the PSI Protocol, the client identifies a problem, physical sensation or symptom, neurological/ body reaction (eg: nausea, anxiety) or past memory that they wish to resolve.  The client then “floats back” on that body sensation, which will then locate a memory related to the current body sensation or life problem. The client then connects to their DNMS Resources (developed before the PSI Protocol is done) and brings them into the memory scene so that the emotions and needs that weren't attended to originally can be attended to by the Resources.

 Using bilateral stimulation of the brain via alternating tones or pulses (if helpful), the client then imagines the Resources surrounding the younger self in the memory scene, and "walking" that self through the Personal Timeline of memories and corresponding “self states”. Since prolonged focus on traumatic events reinforces trauma imprinting ,(neural pathways that “fire together, wire together”),  there is only brief acknowledging of any single memory or event.  The focus is to imaginally travel through the Lifespan Timeline pausing only long enough to integrate the self-states that are “frozen in time”.  The autobiographical narrative which was disrupted in childhood is recreated through the active imagining of the memories as sequential “past” events.  

 In the successful treatment, the neuro pathways and “self states” frozen in time recognize that the upsetting experience or trauma is from the past and is no longer relevant in present time.  Once accomplished, the neurological system can relax and function more properly, no longer hyper-reactive to the past experiences.

 Please Note:

 Lifespan Integration is a newly developed modality that is based on valid psycho-neurological research. The modality itself has not been researched or proven to be effective in any specific psychological condition.  There is ample anecdotal information showing profound benefit in clients who suffer from anxiety, depression, eating disturbances and/or complex childhood neglect and abuse.  In my 25 years as a psychotherapist and specialist in the treatment of post- trauma syndromes, I have been most impressed with the relief that LI has afforded my clients.  I have seen the strongest effects in the healing of eating disturbances, depression, PTSD and dissociation-based difficulties. 

Neurobiological Basis of Lifespan Integration Therapy

 In the infant and young child the “self” originally exists as a series of separated emotional states.  When development proceeds normally, these separated states or parts of self are integrated into a unified sense of self. “The integrating mind attempts to create a sense of coherence among multiple selves across time and across contexts.” (Siegel,1999).  Though this process is not completely understood, some neurobiologists believe this integration happens as a result of the co-construction of autobiographical stories between parent and child. “The co-construction of narratives drives the integration of cognition [thought]), affect [emotion], sensation, and behavior (Cozolino, 2002).

 Brain development is an active process between parent and child.  Siegel (1999) tells us that “the human mind emerges from patterns in the flow of energy and information within the brain and between brains” (of caregiver and infant).  Schore (1994) demonstrates the importance of the caretaker-infant dyad in which the adult caregiver contains and soothes  the emotional states of the infant during critical development stages until the infant has become capable of self-regulation. For optimal neural development in the infant and young child, the parent must be finely tuned to the child and receptive to his/her changing states and needs. When the parent is prevented from providing this, or if the parent is incapable of regulating his/her own emotions, neural development in the child can be impaired. 

           Traumatic experiences which occur during development can have profound and lasting effects, ie: “neural networks that fire together, wire together”.  Until recently, the prevailing view among neuroscientists was that the human brain continued to develop through childhood, but once completed, no further synaptic growth occurred. There is now ample evidence that neural networks are not static, but rather dynamic and changing, and that the cerebral cortex has the capacity to reorganize itself. This is called “neural plasticity’.

           “Now there is no question that the brain remodels itself throughout life, and that it retains the capacity to change itself as the result not only of passively experienced factors such as enriched environments, but also of changes in the ways we behave (taking up violin) and the ways we think”  (Schwartz & Begley, 2002, pp 253-254)

 Research shows that learning and memory are enhanced and neural networks are more “plastic” when subjects are optimally emotionally engaged but not overwhelmed.  LeDoux (2002) describes how optimal emotions contribute to neural plasticity.

 “[B]ecause more brain systems are typically more active during emotional than during non-emotional states, and the intensity of arousal is greater, the opportunity for coordinated learning across brain systems is greater during emotional states.”

           “Co-constructed narratives in an emotionally supportive environment can provide the necessary matrix for the psychological and neurobiological integration required to avoid dissociative reactions” (Cozolino, 2002).  Lifespan Integration creates the opportunity to co-construct the autobiographical narrative that may have been disrupted during childhood development.

 Childhood trauma and neglect disrupts normal neuro-emotional development, creating a bodymind system that is hyper-reactive neurologically and lacking integration of a healthy core sense of self.  Lifespan Integration allows for integration of the bodymind system, thus promoting healing from complex trauma and early relational misfortunes.

References:

 Cozolino, L. (2002). The Neuroscience of Psychotherapy: Building and rebuilding the human brain. NY: W. W. Norton & Company

 LeDoux, J. (2002). Synaptic Self: How our brains become who we are.  NY: Viking  Adult

 Schwartz, J. & Begley, S. (2003). The Mind and the Brain: Neuroplasticity and the power of mental force. NY:Regan Books

 Seigel, D. (1999).  The Developing Mind: How relationships and the brain interact to shape who we are. New York: The Guilford Press

Shore, A. (1994). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Mahwah, N.J.: Lawrence Erlbaum Associates

 Also link to:   Effective Treatment Approaches for Poor Affect Regulation, Imaginal Nurturing,  DNMS, Best Foot Forward,  Overcoming Powerlessness;  Sharing Power in the Family; Fat, Thin and Power;  Trauma Survivors Treatment; Self Empowerment for Women,  Improving Body Image,  The Diet/Binge/Purge Cycles,  Techniques for Treating Eating Problems;