Techniques
No individual is the same, I offer a variety of techniques to meet each person where they are.
EMDR stands for Eye Movement Desensitization and Reprocessing. It is a form of therapy that helps people heal from trauma or other distressing life experiences. It’s widely assumed that significant emotional pain takes a long time to heal. Numerous studies have shown that EMDR can be highly effective and expeditious, and one can experience the benefits of psychotherapy that once took years. Some studies show that 84% - 90% of survivors of single trauma events no longer have PTSD after only three 90-minute sessions. In another study, 77% of combat veterans were free of PTSD symptoms in 12 sessions.
EMDR was originally established to treat veterans and sexual assault survivors. Now EMDR is used to treat a wide variety of challenges and conditions:
- PTSD and other stress-related traumas
- Sexual assault
- Violence and physical abuse
- Veterans & first responders
- Dissociative disorders
- Grief and loss
- Shock trauma
- Anxiety, panic attacks, and phobias
- Depression
- Substance abuse and addiction
- Eating disorders
- Performance anxiety and performance enhancement
- Pain issues
Our brains have a natural way to recover from traumatic memories and events. EMDR therapy is designed to resolve unprocessed traumatic memories in the brain, thereby allowing the brain to resume its natural healing process.
When distress from traumatic or disturbing experiences remain stuck, the disturbing images, thoughts, and emotions may create a feeling of being overwhelmed, of being back in that moment, or of being frozen in time. EMDR therapy helps the brain process these experiences and allows normal healing to resume by utilizing bilateral stimulation (alternating eye movements, sounds, or tapping/vibrations) to restart communication between the amygdala, the hippocampus, and the prefrontal cortex. The experience is still remembered, but the fight, flight, or freeze response from the original event is resolved. For example, a rape survivor will shift from feelings of shame and self-disgust to firmly believing, “I survived and it wasn’t my fault.”
Unlike talk therapy, the insights and growth gained in EMDR are not a result of clinical interpretation, but from the client’s newly formed, adaptive memory networks.
Somatic Experiencing (SE™) is a psychobiological method for resolving symptoms of trauma and chronic stress. It is the life’s work of Dr. Peter A. Levine, based on a multidisciplinary intersection of physiology, psychology, ethology, biology, neuroscience, indigenous healing practices, and medical biophysics, and has been clinically plied for over four decades. The SE approach releases traumatic shock, which is key to transforming PTSD and the wounds of emotional and early developmental attachment trauma.
In his studies, Dr. Levine found that prey animals in the wild are rarely traumatized despite routine threats to their lives. Yet human beings are readily traumatized. Since humans and mammals possess nearly identical brain- and body-based survival mechanisms, Dr. Levine worked to identify what was interfering with the human threat-recovery process, and to develop tools for restoring people’s innate capacity to rebound following overwhelming experiences.
All mammals automatically regulate their survival responses from the primitive, non-verbal brain, enabled by the autonomic nervous system (ANS). Under threat, massive amounts of energy are mobilized to ready for self-defense via the fight, flight and freeze responses. Once mammals are safe, they spontaneously “discharge” this excessive energy through involuntary movements which may include shaking, trembling, and deep breaths. This discharge process resets the ANS and restores equilibrium.
Human beings are designed to rebound from high-intensity survival states; however, we also have the problematic neo-cortex which gives us the ability to override the natural discharge of excess survival energy. Through rationalizations, judgments, shame, enculturation, and fear of our bodily sensations, we can disrupt our innate capacity to self-regulate, thereby reprocessing disabling terror and helplessness. When the nervous system does not reset after an overwhelming experience, sleep, cardiac, digestion, respiration, and immune system function can be seriously disturbed. Unresolved physiological distress can also lead to an array of other physical, cognitive, emotional, and behavioral symptoms.
SE teaches that trauma is not caused by the event itself, but rather the failure of the body, mind, and nervous system to process adverse events. SE facilitates the completion of self-protective motor responses and the release of thwarted survival energy bound in the body, thus addressing the root cause of trauma symptoms. This is approached by gently guiding clients to develop increasing tolerance for difficult bodily sensations and suppressed emotions.
SE does not require the traumatized person to re-tell or re-live the traumatic event. Instead, it offers the opportunity to engage, complete and resolve — in a slow and supported way — the body’s instinctual fight, flight, freeze, and collapse responses. Individuals locked in anxiety or rage can then relax into a growing sense of calm and safety. This resets the nervous system, restores inner balance, enhances resilience to stress, and increases people’s energy, strength and capacity to actively engage in life.
Relational Bodywork and Somatic Education™ (BASE™) is body-oriented approach that can be used by psychotherapists to help clients overcome the effects of trauma using relational touch, movement and somatically-oriented interventions. BASE™ was created by Dave Berger, MFT, PT, MA, SEP, a senior international faculty with the Somatic Experiencing Trauma Institute. He is also a part of Dr. Peter Levine’s initial legacy faculty and his BASE™ Training for trauma practitioners is an integration of his decades of work in behavioral and physical health. The body’s holding of psychological trauma, and its importance as the vehicle for healing is now broadly recognized in academic and clinical settings and in research.
“BASE™ is founded on two primary pillars: First, the relational dynamics between the practitioner and the client. Like the physiological conversation an infant and parent have, the practitioner’s refined attuned touch supports a client in feeling met and ‘heard’. This is accomplished via the second primary pillar—refined, attuned finessed touch of organs and structures of the body to support them in coming back into flow, ease and motility when a trauma response has maintained dysregulation.”
“Psychological and emotional processes manifest physically through the physiology, structures and usage of the body. Sensory feedback of the bones, muscles, fascia and organs/viscera (interoception) provides information about our emotional state of being. That is, does the body signal alarm and arousal or safety and calm (neuroception)? If interoceptive systems signal discomfort, pain or distress, a person may enter into and stay in a heightened state of arousal or activation through a self-perpetuating positive feedback loop. This can result in intrapersonal challenges, relationship, work and educational problems, chronic pain, headaches, gastrointestinal problems, sleep issues, feeling detached, anxiety, PTSD and other difficulties.”
“The emotional, physical, and physiological distress described above may stem from a variety of challenges, including: pre and perinatal difficulties, attachment insecurity or disorganization, physical injury, sexual assault, emotionally toxic relational or societal factors, natural disasters, car accidents, surgery/anesthesia, suffocation, and other threatening circumstances.”
“Somatic psychotherapy and relational bodywork are essential for interrupting and changing this positive feedback loop and healing trauma. This occurs by releasing this freeze/shutdown allowing expansion, capacity and ease. A new set of interoceptive information develops to inform the brain, thereby allowing for greater resilience and choice—the opposite of a trauma response.”
Taken from Relational Bodywork and Somatic Education (BASE™) — Dave Berger
The theory of structural dissociation offers a framework for understanding how trauma can lead to a psychological split, creating distinct parts within an individual that respond differently to traumatic experiences.
The left hemisphere of the brain, associated with daily functioning and routine activities, enables people to continue on with their lives even after a traumatic event. Conversely, the right hemisphere holds non-verbal memories of the trauma and is always on the alert for potential threats. Viewing the left hemisphere as the “going on with normal life” part, and the right hemisphere as the “traumatized” part, can aid clients in relating to their trauma.
Chronic trauma, often resulting from prolonged exposure to threats, leads to further psychological splitting. The “going on with normal life” part coexists with the “traumatized” part, which further divides into subparts driven by distinct responses such as fight, flight, fear, total submission, and cries for help. These subparts can disrupt daily life, leading to complex PTSD or dissociative disorders.
Understanding such parts as defensive approaches provides insight into their functions and impacts. The “going on with normal life” part focuses on survival, often avoiding discussions of trauma for fear of being overwhelmed. The “cry for help” part displays intense distress, aiming to elicit sympathy and assistance. The “submit” part, usually the least problematic, shows feelings of hopelessness and a need to appease, while the “fear” part serves as a warning system. The “flight” part engages in escape behaviors, and the “fight” part aims to establish control, sometimes through aggressive behaviors.
This theory also works off the assumption that no one is born with an integrated personality. Instead, infants operate based off a loose collection of different ego states that handle their different needs: feeding, attachment to the caregiver, and the world around them. Over time these ego states naturally integrate into one coherent and cohesive personality, usually by the ages of 6 to 9. However childhood trauma disrupts this process. Different ego states are left unable to merge with each other due to conflicting needs, traumatic memories, or learned responses to trauma. A coherent sense of self cannot form when the primary caregivers of the child are inconsistent, loving one moment and abusive the next, preventing healthy attachment from occurring and instead facilitating disorganized attachment.
Structural Dissociation with ANPs and EPs
The theory of structural dissociation of the personality proposes that patients with complex trauma-related disorders are characterized by a division of their personality into different prototypical parts, each with its own psychobiological underpinnings. As one or more apparently normal parts (ANPs), patients have a propensity toward engaging in evolutionary prepared action systems for adaptation to daily living to guide their actions. Two or more emotional parts (EPs) are fixated in traumatic experience. As EPs, patients predominantly engage in action systems related to physical defense and attachment cry. ANP and EP are insufficiently integrated but interact and share a number of dispositions of the personality (e.g., speaking). All parts are stuck in maladaptive action tendencies that maintain dissociation, including a range of phobias.
Phase-oriented treatment helps patients gradually develop adaptive mental and behavioral actions, thus overcoming their phobias and structural dissociation.
- Phase 1, symptom reduction and stabilization, is geared toward overcoming phobias of mental contents, dissociative parts, and attachment and attachment loss with the therapist.
- Phase 2, treatment of traumatic memories, is directed toward overcoming the phobia of traumatic memories, and phobias related to insecure attachment to the perpetrator(s), particularly in EPs.
- Phase 3, integration and rehabilitation, treatment is focused on overcoming phobias of normal life, healthy risk-taking and change, and intimacy.
Ego-State Therapy (EST) is a treatment method for working with clients on the dissociative spectrum, including Dissociative Identity Disorder (DID). It is based on the premise that personality is composed of separate parts, rather than being a homogeneous whole. These parts, which everyone has, are called ego states. (Note: Ego states, parts, and alters are used interchangeably.)
We are all made up of a number of different ego states; each with its own feelings of power or weakness, emotions, defenses, skills, and other personal traits. Ego states can also be seen as parts of the mind that carry out the functions of solving life’s problems, overcoming obstacles, absorbing pain, and managing the demands of day-to-day living. We will switch into an ego state when a need for that state occurs. Our parts can be resources that we can call upon, according to our needs in the moment.
We are not born with different parts or ego states. They develop as we live. Our ego states are formed when we do something over and over again. This learning creates a physical neural pathway in the brain that has its own level of emotion, abilities, and experiences. For example, you feel and behave differently when talking with a friend who you feel completely safe with, versus another adult who is threatening or authoritarian over you.
If, as a child, I am feeling a need for attention and I tell a joke or do something funny, and if I get a positive response then and over months and years for being funny, I may develop a joking, comedian, ego state. If, on the other hand, when I tell those first jokes, and I get a “Be quiet, get out of here” response, I will probably not develop a joking ego state. We each have our own special parts according to the experiences we have lived. The ways our family and friends react to us help us develop the particular parts we have.
With significant dissociation and DID, we know that ego states were formed out of trauma, and different ego states can hold different parts of one’s past experiences and memories. A person may develop an “angry alter,” who took much of the painful abuse they experienced as a young child. An alter is unconsciously assigned to take this pain, in order for their overall personality to not be burdened or impaired with it. As often is the case with ego states in pain, the pain can’t remain repressed and has to be expressed somehow, most often in some kind of “acting out behavior” such as aggression, addiction, or hypersexuality.
With dissociation, this angry alter state can separate the highly painful and traumatizing experiences from the conscious self. Therefore, this angry alter will only emerge from its dissociated place when triggered by provocations. For example, it is understandable how a woman’s ego state could form and develop under the extreme duress of a sexually abusing and violent step-father, and then could be activated by a boyfriend whose behaviors resembled those of the abusive step-father.
Effective treatment of ego states involves not challenging the parts’ unique identity but increasing the communication of parts with each other, which encourages an adaptive sense of cohesion and harmony. The dissociated ego state becomes an alter which cooperates with the other alters in the personality system, maintaining that cohesion between the individual’s inner and outer worlds. It is not uncommon for many of the original ego states, when their need for separateness no longer exists, disappear spontaneously; their energy and capacity fusing into remaining ones. The remaining differentiated ego states are now simply functional ego states – and the individual manifests only one personality to the outside world.
Acceptance and Commitment Therapy (ACT), pronounced as the word “act,” is one of the more recent mindfulness-based behavior therapies shown to be effective with a diverse range of clinical conditions. In contrast to the assumption of ‘healthy normality’ of Western psychology, ACT assumes that the psychological processes of a normal human mind are often destructive and create psychological suffering. Symptom reduction is not a goal of ACT, based on the view that ongoing attempts to get rid of ‘symptoms’ can create clinical disorders in the first place. When one gives up the struggle, they will experience symptom reduction as a by-product
The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it. ‘ACT’ is a good abbreviation, because this therapy is about taking effective action guided by our deepest values and in which we are fully present and engaged. It is only through mindful action that we can create a meaningful life. Of course, as we attempt to create such a life, we will encounter all sorts of barriers, in the form of unpleasant and unwanted ‘private experiences’ (thoughts, images, feelings, sensations, urges, and memories). Against a background of the suffering generated by experiential avoidance and emotional control, ACT teaches six core principles of developing psychological flexibility; defusion, acceptance, contact with the present moment, the observing self, values, and committed action.
Taken from Russell Harris’ article, Embracing Your Demons: An Overview of Acceptance and Commitment Therapy.
Mentalization-Based Therapy/Mentalizing is seeing yourself from the outside and others from the inside. Mentalizing is a form of mindfulness; being mindful of what others are thinking and feeling, as well as being mindful of your own thoughts and feelings. Mentalizing is similar to empathy but it goes beyond empathizing because it also includes an awareness of your own state of mind—empathizing with yourself. Like using language, you mentalize naturally and most of the time you don’t need to think about it. You don’t need to don’t need to become a professional psychologist to mentalize. Yet mentalizing is a skill that can be developed to varying degrees. Failing to mentalize can contribute to serious problems in relationships.
Mentalizing others takes effort: you cannot merely assume that others think and feel the way you do, although they might; you must shift perspectives and try to take their point of view. You cannot take for granted your ability to mentalize with respect to yourself: even though you live in your own mind, you don’t necessarily always know how your mind is working. All of us are capable of self-deception. Developing the ability to mentalize and using it consistently is critical.
And there is a Catch-22: mentalizing is most difficult when you most need to do it. Your level of emotional arousal is a major factor in being able to mentalize at any given moment, and you’re likely to have the most difficulty mentalizing in emotionally close attachment relationships when conflicts arise, and feelings run high. Mentalizing develops best in trusting and safe relationships—what we call secure attachment relationships.
Taken from Jon Allen’s article, What is Mentalizing and Why Do It?
Brainspotting utilizes eye positions to locate, access, and discharge stuck material held in the brain and body. It works like this: The eyes are the extension of the brain. When you are looking at someone’s eyes- you are essentially looking at their brain and the part of their brain that meets the world. The eyes are connected to the subcortex/midbrain (the site of trauma/emotions/survival responses/memories) via the optic nerve. The brain devotes a lot of energy to the eyes and visual scanning and input from the environment. So the brain uses the eyes to scan the world outside itself, but what Brainspotting discovered was that the brain also uses the eyes to connect and find information inside itself and the body!
Have you ever been lost in thought and noticed you were staring into space, often gazing at a particular spot? This phenomenon is the brain holding an eye position to orient/locate/process information (regarding whatever you were thinking or feeling about) inside itself. It is this orienting reflex that Brainspotting harnesses. The spot you were gazing at is the access point for a Brainspot- which are the neural networks holding the information you are thinking/experiencing in that given moment. This allows the brain to then activate its self-scanning capacity and bring about homeostasis to dysregulated emotional states.
The brain is constantly scanning itself and the body 24/7. It is always seeking homeostasis or is in homeostasis. When we locate a Brainspot, we activate this self-scanning so that it can release the dysregulation (which is an experience of non-homeostasis). Another few examples of homeostasis are the brain’s regulation of respiration, heart rate, peristalsis, blood pressure, and keeping each and every cell in our body in a balanced state.
A brainspot is an eye position that correlates to a subcortical area of relevance, which can be found in the brain, and is elicited by bringing up a topic and its correlating somatic activation (how one senses what they’re thinking/feeling/experiencing in their body).
Once a brainspot has been located using a variety of techniques by a trained Brainspotting practitioner, the client is guided to keep their gaze on the brainspot/eye position, so that the brain can begin a self-scanning process. Focusing on this eye position allows the brain’s self-scanning capacity to engage in accessing the neural networks that are holding the somatic material/information that the client is wanting to work on. Once found and held, the brain can basically say “oh hey, here’s the location of this issue we have been dealing with for so long! Here’s all that stuck survival energy that we’ve dissociated from or had to avoid!” It then can engage it’s homeostatic capacity to discharge the held survival energy.
Clients will sometimes experience strong waves of emotions or somatic sensations, memories, and thoughts (sympathetic arousal related to the event/trauma) followed by parasympathetic activation which is the process of homeostasis (feelings of calm, groundedness, or relaxation). These waves of processing continue as the therapist holds space for the client in a deeply relational way and gives the client space to allow their body to unfold and unload the trauma as it needs to.
Clients find that the processing goes deeper and that their brains travel to different memories, sensations, and points in time that may be related to the issue (even if it seems unrelated), while simultaneously experiencing waves of discharging and releasing of the material, and returning to homeostasis- a sense of well-being in the world.
Ketamine-Assisted Psychotherapy (KAP) is a holistic modality in which ketamine is used as a complement to psychotherapy to help eligible patients experience more frequent breakthroughs and sustained improvement in symptoms. I take on the psychotherapy portion of the experience, while Journey Clinical’s medical team supports you on all medical aspects. This includes determining eligibility, developing a custom treatment plan, prescribing the medicine and monitoring outcomes. Click here to learn more about Ketamine-Assisted Psychotherapy (KAP).
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Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion. Third, emotion regulation covers strategies to manage and change intense emotions that are problematic. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.
Emotionally Focused Therapy (EFT)
Emotionally Focused Therapy (EFT) concentrates on attachment and bonding with couples and families who are having trouble managing their distressed relationship. EFT looks at patterns in the relationship in order to create a more secure bond and develop more trust. Clients learn to express emotions in a way that fosters connection with their partner or family member. EFT focuses on the present time to make changes in the here and now. There are three stages of EFT. The first is to de-escalate the couple’s or family member’s negative cycle of interactions and help them see and understand their cycle. The next stage is to restructure interactions by helping clients to turn toward each other and discuss their needs. Consolidation is the third stage of EFT, where clients see how they got into negative patterns and learn to change those patterns.
Existential Psychotherapy
Existential Psychotherapy is based on some of the main ideas behind existentialism as a philosophy, including: we are responsible for our own choices; we are all unique individuals due to the choices we make and are constantly remaking ourselves through these choices; we make our own meaning in life; anxiety is a natural feature of human life and we must come to terms with this anxiety to live authentically. Existential therapy aims to help clients in accepting and overcoming the existential fears inherent in being human, which include: freedom and responsibility, death, isolation, and meaninglessness. Existential therapy guides clients in learning to take responsibility for their choices and making choices that align with their values and help them to live more authentically.
Internal Family Systems Therapy
IFS is another treatment method for parts work. In IFS, there are three primary categories of our parts: Exiles, Managers, and Firefighters.
Exiles are the younger parts of self that hold emotions, vulnerabilities, needs, and memories that went ignored, unresolved, and went to “exile” or put away because there was no space to process the needs or the traumas experienced. Managers are the ones that keep the person going on a day-to-day basis. They help put the exiles aside so that the functioning part of self can go on with life. Managers can be healthy or unhealthy. Firefighters are extreme versions of managers; they act more impulsively and engage from a place of desperation to make any pain or hurt go away. They might present with addictive behaviors, completely shutting down (dissociating and disconnecting from self) or self-destruction. All of this is to keep “exiles” away, fearful of what will emerge if they arise.
The goal of IFS therapy, and any parts work, is to be where the individual can resolve conflicts between parts so that the person can live life from their core self. The therapeutic work involves locating those parts harboring pain, trauma, or anger and facilitating healthy discussion and expression, where parts can learn to work together. Parts can come to a healthier agreement about their roles and learn to come out when their behavior is appropriate and helpful to the self.
Polyvagal Theory
The Polyvagal Theory (PVT), developed by Dr. Stephen Porges, breaks down the autonomic nervous system into three subdivisions. The first is the “dorsal vagal,” a part of the parasympathetic nervous system that enables us to shut down, or freeze/fawn when a situation of danger overwhelms us. The second is our sympathetic nervous system or fight/flight system. Lastly is our mammalian parasympathetic social communication and social engagement system – the “ventral vagus.” PVT is hierarchical, meaning that all three of these subdivisions follow a natural order depending on the neuroception of safety or danger in the situation. Neuroception describes the way our autonomic nervous system scans for cues of safety and danger through the senses without involving the thinking parts of our brain.
Psychodynamic Therapy
Psychodynamic therapy is an in-depth form of talk therapy that focuses on the client’s relationship with their external world. Psychodynamic therapists attempt to help clients find patterns in their emotions, thoughts, and beliefs in order to gain insight into their current self and current relationships. These patterns are often found to begin in the client’s childhood as early life experiences are extremely influential in one’s psychological development.
Radically Open Dialectical Behavior Therapy (RO DBT)
Radically Open Dialectical Behavior Therapy (RO DBT) links the communication of emotional expression to the formation of close social bonds and does so with skills targeting social-signaling and changing neurophysiological arousal. At the center of many mental health problems are struggles with excessive self-control. There are 5 themes of over-control in RO DBT treatment: inhibited and disingenuous emotional expression; hyper-detailed focused and overly cautious behavior; rigid and rule-governed behavior; aloof and distant style of relating; and high social comparison and envy/bitterness. Psychological health in RO DBT involves three core features: Receptivity and Openness to new experiences, Flexible-control to adapt to change. Intimacy and social-connectedness to form long-lasting bonds.
Shame Resilience Theory (SRT)
Shame Resilience Theory (SRT) is a grounded theory of Shame Resilience by Brene’ Brown, Ph.D., LMSW that attempts to explore resilience in the face of shame. Shame is a universal emotion that can have serious negative consequences if left hidden and unacknowledged. Shame can also lead to social withdrawal and isolation, which only further exacerbates feelings of shame. Based on goals of reaching feelings of empathy, connection, power, and vulnerability, SRT is essentially made up of four steps, which are not necessarily linear: Recognizing shame and shame triggers by examining the internal factors that attribute to shame; Practicing Critical Awareness by recognizing the external factors that attribute to feelings of shame; Reaching Out by connecting with others to offer and receive empathy; Speaking Out by practicing vulnerability and sharing one’s feelings of shame.