Some Descriptions of Different Approaches

[Kizzie]

If you have an approach to add please let me know and I will add it here to the summary.


Relational Therapy

By facilitating a safe and positive relationship in the security of the therapeutic environment, the client is armed with a stronger sense of self and confidence. The primary goal of this technique is to empower the client with the skills necessary to recognize and create productive and healthy relationships. The therapist strives to address any and all past and present relationship traumas or impressions that have served to create discord in the present life circumstances of the client.

Cognitive Behavioural Therapy (CBT)

CBT is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.  The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change. When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic. CBT helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. 

Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a cognitive-behavioural treatmentand is helpful for people who struggle with difficulties in managing their emotions. DBT normally involves a weekly individual therapy session and a weekly group therapy session that involves learning skills in managing attention (mindfulness skills), managing and coping with emotions (emotion regulation skills), dealing effectively with interpersonal relations, and tolerating emotional distress.

Eye Movement Desensitization and  Reprocessing (EMDR)

EMDR is an evidence-based psychotherapy for Posttraumatic Stress Disorder (PTSD). In addition, successful outcomes are well-documented in the literature for EMDR treatment of other psychiatric disorders, mental health problems, and somatic symptoms. The model on which EMDR is based, Adaptive Information Processing (AIP), posits that much of psychopathology is due to the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. This impairs the client's ability to integrate these experiences in an adaptive manner. The eight-phase, three-pronged process of EMDR facilitates the resumption of normal information processing and integration. This treatment approach, which targets past experience, current triggers, and future potential challenges, results in the alleviation of presenting symptoms, a decrease or elimination of distress from the disturbing memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers.

Note: Given that CPTSD differs from PTSD in that it involves repeated trauma and flashbacks which tend to be emotional rather than visual, EMDR must be tailored accordingly.  If you do plan to undertake EMDR, ensure that you ask the T if s/he has training in EMDR for CPTSD. See the post below for some links to information about CPTSD and EMDR. 

[Rain]

WOW, Kizzie!!! 



Thank you sooooo much!

[Annegirl]

   :
Thank you. It's very interesting.

[Sasha2727]

Just saw this after posting on DBT! You go!! Great thread! Thank you!

[Kizzie]

No problem and any time anyone has anything to add go ahead and post. We want to build as many resources as possible given that CPTSD is well.... complex.

[Sasha2727]

Anyone have any experience with ACT - Acceptance and Commitment therapy? It seems pretty awesome!

[Kizzie]

Have you got some links Sasha?  I know nothing about it - sounds interesting though.

[sweetsixty]

Just interested to know if anyone else has used Imagery rescripting with their T?

It's a very powerful Therapy if you have visual flashbacks as well as emotional ones.  Not something you can do alone very easily as it can be quite provocative and it needs to be guided to prevent re traumatising.

I am currently in the middle of this and just wanted to know how others had got on.

[globetrotter]

We have done something like that in addressing old memories by introducing a trusted person from my childhood in a 'rescue' sort of scenario, interacting with soothing words toward me. Is that what you mean?

[sweetsixty]

Hi globetrotter,

yes you can use a trusted friend or compassionate other in the image and it often helps. How did you get on with it?

Here is a paper on it my T gave me when we started using it:

http://www.researchgate.net/profile/Emily_Holmes/publication/5812956_Imagery_rescripting_in_cognitive_behaviour_therapy_images_treatment_techniques_and_outcomes/links/0fcfd50ab4cc24742c000000

She is very good but I was just interested in others experiences of it.

[globetrotter]

We've only done it two or three times and she guided the imagery to a different potential outcome than what actually happened.
We practice what I call' All Over The Map' Therapy.  Some of this, some of that...
I thought it a form of Inner Child work combined with some of the Somatic Experiencing work. I didn't realize it has a different name. Reading now I see where the intent is to introduce some desensitization to the event.
Honestly, Sweet, sometimes I am so dissociated in therapy, I'm not sure what sinks in and what does not. We're working on that, too.

[sweetsixty]

Globetrotter it sounds as though you and I are on the same page here. Yes the imagery should guide to a different outcome that's why I helps. It also helps us see as an adult and bystander how small and innocent we were to help disperse the shame and guilt.

My T and I just go with whatever comes up and use various methods to but the imagery has helped many of my visual flashbacks.  I also have problems in seeing progress and dissociating. But I'm sure we will get there. Thanks for your feedback x

[schrödinger's cat]

Kizzie, is this okay? I'm assuming we still need a text about mindfulness? There's a short version and a long version. The long version includes a Caveat taken from a few blog entries I found on the internet, so I'm BEGGING you all - would a kindly soul please look that over and check if it sounds okay?    Or many kindly souls, that would be better still. Thanks in advance for your patience!

SHORT VERSION:

Mindfulness is the practice of focussing one's attention on one's present experience. It means observing your sensations, feelings, and thoughts as they occur, without instantly judging them and/or distracting yourself from having to feel them. A common metaphor for this is watching traffic go by. According to the US Agency for Healthcare Research and Quality, mindfulness meditation programmes are proven to "reduce multiple negative dimensions of psychological stress" such as anxiety, depression, and perceived stress/general distress. Jon Kabat-Zinn PhD has developed a secular (i.e. non-Buddhist) programme he calls Mindfulness-Based Stress Reduction. For people who are willing to explore mindfulness meditation in a more Buddhist context, Jack Kornfield's books are a good place to start.

LONGER VERSION: as above, with additions. I abbreviated the parts already given above.

Mindfulness is the practice of focussing --- SNIP --- traffic go by.
An example: One form of mindfulness meditation encourages you to keep your attention on your breathing. You sit with your back straight, usually cross-legged on a cushion, and focus on the sensations of your breath as it moves in and out of your body. When your attention starts to wander, you're not supposed to judge yourself or feel guilty: you're supposed to simply notice it happening, and to direct your attention back to your breathing. The goal of mindfulness meditation isn't necessarily to achieve a state of uninterrupted mindfulness. Rather, it's to practice redirecting your attention back to the present.
According to the US Agency for Healthcare Research --- SNIP --- good place to start.
Caveat: Some teachers of mindfulness meditation will tell you that you're to deal with "negative feelings" by observing them without actively engaging in them. You're to observe them from outside, as it were, the same way you'd watch traffic go by. This detaches you from your negative experiences. That has the following advantages:
-- It can help you access and strengthen an observant, detached, grown-up part of you. This part might then function as a helper figure during flashbacks.
-- It can help you be more accepting of "negative emotions" or "negative experiences". For example, if you're experiencing some mildly depressed feelings, going about them in this observant and accepting way can help you see them as simply another part of what life is like for humans. This may makes it easier for you to move through those feelings and out on the other side. (Note: this isn't meant to fight flashbacks.)
For those of us with CPTSD, however, it's important to never let mindfulness become yet another obligation to "not feel bad" and "simply focus on the here and now instead". That isn't how CPTSD works. Flashbacks will intrude. Mindfulness isn't an alternative to flashbacks or difficult feelings. It's simply one of several tools that might help us cope with them.
Also, mindfulness should never be understood to mean that we should stay passively present to a traumatic experience instead of using our coping skills. Even something as un-mindful as dissociation has its time and its place, depending on where you're at in your recovery and what you're dealing with.
Moreover, we should probably not follow the more extreme forms of mindfulness, where only one's observer-self is said to be real, while one's thoughts and feelings are simply unhelpful distractions. For one thing, it's a reductionist view of humans nature. We're all those things - we can't cherry-pick the bits we like and simply pretend the rest isn't real. Also, an important part of CPTSD recovery is learning to spot when it's safe to listen to our negative feelings, and to validate them. True, often enough, they don't give us accurate information about the present. We might feel endangered while being perfectly safe. But those feelings still give us accurate information about the time when we were traumatized. They are messages from our past self, in a way. Simply just ignoring them or "letting them pass by" without engaging in them in any way might only make us feel ignored and abandoned. It's often better to act towards this wounded part of our selves (our Inner Child, as it were) in a validating, compassionate way. For people with CPTSD, therefore, it's important to learn how to be mindful - and to learn when not to be mindful. In this as in so many other things, it's best to take things slowly and to listen to your instincts instead of blithely pushing yourself way out of your comfort zone.

[Kizzie]

We did still need a text about mindfulness Cat, tks so much for writing this up!  It looks good to me although I must admit this is not something I know much about just yet. I certainly want to though as it seems quite useful to recovery.  How about we leave it here for a bit and let folks have a chance to comment?

I'll mention it here and maybe under "Glossary" again,  but I will not be doing much with Glossary except get a starting version uploaded along the top of the page in the next week or so. It will include the short versions of what we have already written, terms which need a write-up period, and quite a few terms which relate to CPTSD and personality disorders and which link to a writeup at Out of the FOG.  At some point the latter writeups may be rewritten so they better reflect CPTSD. Eventually all write-ups will link to longer version than shown on the main page (see OOTF's Glossary http://www.outofthefog.net/Glossary.html)

[schrödinger's cat]

We did still need a text about mindfulness Cat, tks so much for writing this up!  It looks good to me although I must admit this is not something I know much about just yet. I certainly want to though as it seems quite useful to recovery.  How about we leave it here for a bit and let folks have a chance to comment?

Yes please. I'm no expert, I do some mindfulness meditation and I've read some texts, but there's bound to be someone around who knows more. Also, I'm still not sure if the caveat is helpful or not - mindfulness is useful, and I wouldn't want the OOTS text on it sound so doom-and-gloom that it discourages people from giving it a try. On the other hand, some of the things I read in some texts on mindfulness came periliously close to saying that our feelings and physical sensations don't matter and are best ignored. So... keep or delete, delete or keep, I'm simply not sure.