Correct therapy type?

[Blueberry]

I watched a live video from Diane Poole Heller and Dr. Frank Anderson, which was chiefly for practitioners but OK for survivors to watch too.

They were explaining how it's not a one size fits all thing. So not just that a method such as EMDR or IFS or relational/attachment healing may not be the appropriate treatment method for a particular person, but also a particular method might not be the correct method for a particular person right now. That may sound logical but I for one am always forgetting it, constantly hoping EMDR might resolve all my trauma reactions, survival strategies etc. Not just that, from reading around on the forum and lots of my own experience e.g. with various psychiatrists over the years, it seems a lot of doctors, therapists etc are stuck in this mindset too.

Diane P.H. and Frank A. plugged the line about the necessity for therapists to know about a bunch of methods in addition to the one or two they're specialised in. Don't have to be qualified in all of them, so long as they're trauma specialists in at least one method, meaning that if they integrate parts of other methods in their work they'll be automatically doing it in a trauma-informed way. Yay! 
When I think back, all my really good therapists have worked like that! So some of you on here will have 'heard' me say that here there's never just talk therapy or just CBT/DBT, they're just part and parcel of trauma therapy, and although various of my really good trauma therapists have done Parts work with me, it's never been called IFS. "So what is it?" I've been asked. Aha, I say now :lightbulb: those therapists who used it with me to great effect like U, W, D were well-versed enough in the methods they otherwise employed to learn a bit in addition about IFS, adapt it successfully to fit in with their other methods, including adding to it but also possibly simplifying it and/or seeing how much of IFS-like stuff was appropriate for which clients, as well as which clients went to their adapted method like a duck to water (me!). Also seeing how clients adapted the methods for themselves in a helpful way. I'd say this is part of the integrative model of trauma therapy that D.P.H. and F.A. are explaining in their presentation.

Then there were therapists who were either not very good or not very good yet (everybody needs experience to turn learnt theory into good practice) who stuck too much to whatever Parts work or Inner Child work they'd learnt and overwhelmed Adult me of the time with e.g. all their questions on one Inner Child, leaving me sitting there thinking but not daring to say: "I have about another 15 Inner Children, you want me to do this with all of them??" I never did btw, not with all of them. Plus I'd already been doing that work on my own, which T didn't even inquire about.

One thing that is clear to me - I've been exposed to a lot of relational healing methods before trauma-informed therapy was really a thing and afterwards too. So I'd say the majority of what I did was very helpful, very healing, even before trauma-informed was a thing, though some of it maybe a touch or even a lot re-traumatising, which accounts in part for my long healing journey. Otoh things were what they were 20-25 years ago in therapy. I'm glad, grateful even, that I was in the healing places and environments I was in, most anyway. I learnt and practised and integrated and healed so much!
Sorry this got so long. Maybe I'll remove some of the more personal stuff tomorrow and put it on one of my Journals.

Oh yes, another thing this pair was plugging was client agency and how practioners can allow their clients agency without overwhelming them and retraumatising them. Maybe more on that tomorrow too...

[Kizzie]

Judith Herman wrote a foreword to a book I have about just this issue BB; that is, researchers and clinicians need to move away from single models to more of a mixed methods approach. I couldn't agree more actually as our trauma is complex after all. For me, the most important element though is as you say relational because what we were exposed to was interpersonal trauma that lasts over our lifetimes.

I do think elements of different types of therapy will be found to be important to recovery, even CBT.  When it comes down to it, we need whole person treatment so we also need those in medicine to look at our health against a background of complex trauma. My hope it that as they learn just how much trauma impacts us physically, they will educate patients about this and offer ways of tracking, protecting and nurturing our physical health.

[sanmagic7]

i agree w/ all that's been said here.  i firmly believe the best therapists are able to work 'outside the box', change course as needed, pull on a little of this, a little of that as warranted, and be creative above all.  besides all that, yes, i do believe that there needs to be a trusting, guiding relationship w/ the therapist - which goes to the 'agency' idea.  we do know what's best for us in the long run, even if we can't always explain it at the time.  that's where a T needs to be asking the right questions, give options, look at us as individuals, and make decisions based on their own best knowledge, all the while checking it out w/ their client.

in my experience, the best therapists had an outstanding relationship w/ their clients.  from there, the best work could be accomplished with the two of them acting as a team of sorts, except that the therapist has more resources, more knowledge, more skills that can be brought to the table.  as clients, we are going for help and that's what we deserve first and foremost.  as i'd been taught, there are no 'bad' clients, only therapists w/o the skills to help them.

[NarcKiddo]

I agree with all you say. What particularly stuck out for me, though, was the comment that a particular therapy may not be right at a particular time. Because that of course suggests that it could well be right at another time. Or it may be right, then stop being right for a while, and then start being right again.

I have noticed this phenomenon very much in connection with my fitness activities. I have tried so, so many things over the years. What I have come to learn is that for me, personally, the best approach is to try something and try to give it a decent chance. I may then conclude it is not for me and assume I will never do it again. Only to find some years later that now that thing is precisely what I need to do. I have had to make friends with many pieces of gym equipment that I despised on first glance and would have consigned to the rubbish tip that instant were it up to me!

[TheBigBlue]

... researchers and clinicians need to move [...] to more of a mixed methods approach. I couldn't agree more actually as our trauma is complex after all.

I full-heartedly agree with Kizzie and everyone else in this thread (and many pioneers and scholars who wrote about this in their books before) 😊.

The APA GUIDELINE 2 (www.apa.org/practice/guidelines/adults-complex-trauma-histories.pdf⁠):
Psychologists seek INTEGRATIVE solutions to the complex psychological and psychosocial problems often experienced by persons with complex trauma histories.
[...] It is possible thus that "one size does not fit all" [...]. Accordingly, it may be that a personalized, client-centered approach that is flexible, eclectic, and tailored to individual clients' presenting issues and concerns, goals and preferences, and identity intersections and group contexts, could benefit professional practice with individuals with complex trauma histories." (p. 12)
Such modalities could include e.g. Trauma-Focused CBT, EMDR, IFS, somatic and body-oriented therapies, and many more.

Before I go into my recent experience that I want to share, a bit of context first: I was diagnosed with CPTSD a year ago - following a year where a big T-event started to collapse my "high-functioning survival adaptations". The first 10 months following diagnosis, I call my "historian and analysis phase"; despite being dysregulated, anxious, depressed, sometimes dissociated, in panic attacks or even calling 988, I was still highly analytical, and for the most part CBT was a great help guiding me (also kudos to my CBT therapist for evolving with me 💛, e.g. adapting her style once I explained to her that my 5-year-old child sitting under the tablecloth does not understand CBT - instead she needs to be found and feel safe 🧸). In that phase I wrote many pages of reflections and analyses for every CBT session (2x per week), so I have hundreds of journal and reflection pages.

But around New Year's Eve, I wrote my last reflection; after that my illusion of structure and external safety collapsed ("de-enmeshment" began). Since then, I am no longer analyzing my feelings - instead I am in the middle of them; it is messy, flip-flopping (e.g. within days whiplashing from not being able to remember any positive childhood memories to full-blown fawning to stabilize insecure connection), deeply sad and intensely painful (and at times dangerous 😔). It feels like I am being run by my feelings instead of making conscious decisions.

Again, more guided by serendipity than smart decision-making, over the past 2 months I was on a path to find "somatic healing". I got a haircut and noticed that the 30 seconds head massage during washing felt really good; seeking replication I booked a head-neck spa treatment ... unbeknownst to me it was a Korean spa => so way too activating and intense (at times painful 😅).

My next stop was craniosacral therapy (CST); I had 3 sessions and it was much more soothing, and there was some somatic release of tension (and tears), but I wasn't sure if there was truly something happening - it felt a bit "esoteric" 🤔.

Inspired by some of my OOTS friends 💛, I looked for equine-assisted therapy (EAT) (with a licensed therapist, but still self-pay). Last Wednesday I had my 3rd weekly EAT session, and the next day my CBT therapist was astonished: she said I am the most regulated I have been in 12 months, closer to my ventral vagal state, meaning my nervous system was calmer 🐴💛. I think EAT is helping me to manage my bodily sensations, feelings, and nervous system dysregulation.

Now, I have always had a huge affinity to animals and felt safe with them, so the combination CBT plus EAT seems to be - at the moment - the perfect fit for me 😊. ... But the key take-home message here is "personalized approaches", meaning finding what works best for you at a given time (phase).

My two cents 🙂💛

[Kizzie]

in my experience, the best therapists had an outstanding relationship w/ their clients.  from there, the best work could be accomplished with the two of them acting as a team of sorts, except that the therapist has more resources, more knowledge, more skills that can be brought to the table.

I like what you've said San and also your quote Big Blue about one size does not fit all. The more tools healthcare providers have, the better treatment is likely to be according to the sentiments expressed by clinicians, researchers and us. 

Not to be Debbie Downer but right now complex trauma and CPTSD are not taught in many university programs for mental health and medical providers (which is the reason for doing the healthcare project). It's one reason it's difficult to find a T who knows about what we struggle with and about a mixed approach to treatment, not at the moment at least. Like Big Blue we need to be lucky enough to find a T who wants to learn more and grow with us if they only have one approach. 

That said, I do believe the more we push from the bottom up for more effective treatment, services and support the faster it will become a reality. For example, I am attending an international medical conference in a week or so as a Patient Partner and I fully intend to meet attendees/presenters and pass along the flyer for the project. If it's something you would feel comfortable doing you could print off and pass the flyer along to your T and/ or physician if they're not knowledgeable about complex relational trauma and CPTSD. I do believe we can make a difference in terms of our care and that of other survivors.

[TheBigBlue]

 

[sanmagic7]

yes, kizzie, i would be interested.  could you send it to me?  funnily enough, i just fired my current T for just this reason - not enough knowledge nor enough creative thinking when it came to tackling my issues.  but my doc's husband is a psychiatrist, so she's already made known her understanding of at least how stress affects the body, so that's a start.

bottom up!  love and hugs to us all.

[Kizzie]

Yay, here's to you San for being part of the from the "bottom up" movement! 

You can just click on the word "flyer" and it will take you to the document. There's a QR code on it that will take whomever to the project and the downloadable guides.