NP0015 21st-Century Trauma Treatment

This blog focuses on discussion regarding the course NP0015 21st-Century Trauma Treatment: The State of the Art.

NP0015, Trauma, Session 1, Mary Jo Barrett

Welcome to “21st-Century Trauma Treatment: The State of the Art.” This new series will explore the clinical implications of the latest advances from attachment, development, and neurobiological research and how to effectively apply them with clients. What’s the best way to structure treatment with trauma clients? How can therapists help clients reshape their trauma narrative? How can clinicians effectively tailor therapy to meet clients’ needs in the context of trauma? Discover the answers to these questions and much more.

In this first session with Mary Jo Barrett, the founder and director of the Center for Contextual Change, she’ll explain what she’s identified as the five essential ingredients to effective trauma work, through the lens of a structured, collaborative method of working with clients.

Throughout the series, a Comment Board after each session will be available. The Comment Boards are a way for participants to share thoughts and reflections about what was most interesting and to ask questions of the presenters and of each other. We invite and encourage you to use these Comment Boards as a forum for thought and to continue the conversation sparked by each session. After listening to this first session, please just take a few minutes to share what you think. What was most striking about this session? What questions do you have?

Thank you so much for your participation, and welcome to this relevant and important series. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.
02.08.2012   Posted In: NP0015 21st-Century Trauma Treatment   By Psychotherapy Networker
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  • 0 avatar Jim Kubalewski 02.08.2012 14:07
    Thank you very much. It was extremely helpful to know that combining an energetic relationship with structure and respect for the client's need for control and safety is necessary for this treatment. Well done.
  • 0.1 avatar Amy Fleming 02.08.2012 14:07
    very good and well organized which is what she teaches
  • Comment was deleted

    • 0 avatar rita murphy 02.08.2012 14:43
      i found his summaries and highlighting of key points to be helpful. i also like how he kept the session on track to amke sure everything important was covered.
  • 0 avatar Anne Moss Riley 02.08.2012 14:12
    I am not sure about how or if I want to contain the client's desire to share the narrative of the trauma(s). Either the client does not recognize the issue as past trauma until asked, or during the first few sessions the client reveals the narrative in a rush. The revelation often seems as if it is a test to see if I can withstand the enormity of their experience and keep them safe in that process without judgment.

    How do you handle this need to reveal the trauma?


    (Really? A thumbs down for a legitimate question? Just, wow.)
    • 0.1 avatar Nan Richter 02.09.2012 10:24
      Oops -- I think I accidentally gave you a thumbs down Elizabeth. I think your question is great and I have it as well. (I didn't know what the arrows were for .. sorry. So, I probably gave a lot of other thumb directions while I was scrolling through the board!)
    • 0 avatar Andrew Gray 02.10.2012 07:44
      I share your experience of clients who launch into telling their stories but I think it is important not to get "diverted by the story" before establishing the ground rules, setting the context and establishing a therapeutic contract. In this regard - and also agreeing with the process and benefits elaborated by Mary Jo - I think it is reasonable to "slow down" clients who are in a rush to tell their story. This can be done in a way that is respectful of their painful/difficult/distressing issues, but can be contextualised using various rationales. For example a progressive approach to therapy which defers details until preliminaries are completed "based on experience", wanting to ensure that the client is not thinking they have to tell their story if they are not ready and so on. Clients may be testing to see how a therapist reacts to their experience, but I think a "catch and hold" approach parallels the process of providing context, safety and options for the client - especially important in the early stages of therapy.
      • Not available avatar Skosh Jacobsen 02.14.2012 05:49
        You said that WAY better than I did. Thanks for your sharing.
    • Not available avatar Skosh Jacobsen 02.14.2012 05:33
      Elizabeth, I thought your comment and q were good.
      I have been taught to urge people to share briefly about their trauma (or not at all if it is uncomfortable for them) because when people share too much too quick, something kicks in and they don't come back again. Maybe they think "I got it out, I should be fixed now" or maybe they think "I got it off my chest and I feel better, so why go back" or maybe they share so much that they "lose face" and are afraid to go back, or because they think that they have to share their pain at the counseling office and who wants to go back week after week and face that mess that has been haunting them for so long. So, I encourage clients to get to know me on the first session, get a sense of how I work with people and at the end I ask them how they are feeling in the session right now. Most reply that they feel safe, comfortable, like they came to the right place to get help for their concerns.

      On rare occasion I've had a person who was insistent that they wanted to tell it all immediately, and I find that these people either don't come back, or they are very stuck retelling their story every time they come with very little movement.

      For those who blurt out their story, I will listen and just get a sense of their pain or the unjustice that they are stuck on. And assure them that their feelings are valid, that there are things that we can do that can help, and that it will take time, it won't be fixed overnight. I don't know if this answers your question. I hope it helps.

      P.S. I am not sure I fully understand or agree with the speaker on not letting them tell ANY of their story the first session...you would do paperwork and insurance/fees and what else? Talk about your hobbies?

      You would have to get some of their story to determine what treatment options to offer, right?

      So I ask people to put the problem into a brief statement or like in a headline. If I have qs about that, we discuss those. And we look at the initial paperwork: the family hx, school, employment, partner hx, children, and previous treatment(s). So parent/sib or school or job or partner or children concerns may come up and we can get a sense of how "the problem" has affected the areas of a person's life and what they've tried so far or we just get a sense of the area(s) of concern. There's so much more that can be handled in that first session, but that is enough to keep from spilling the whole can of worms. Again, I hope that helps.
  • Not available avatar Nan 02.08.2012 14:18
    Thank you. Very information. What is your opinion of Traumatic Incident Reduction?
  • 0 avatar Jacquie Latzer 02.08.2012 14:18
    The stress on structure and organization was helpful especially in the context of creating safety.
    Thank you.
  • 0 avatar Deborah Briggs 02.08.2012 14:21
    Very helpful. I am interested in hearing Mary Jo's views on treating trauma related to large-scale disasters and terrorist attacks. CISD was used often to treat 9/11 survivors soon after the event and the method was later deemed by some researchers to be retraumatizing due to the retelling of stories in a group setting.
  • Not available avatar Maria 02.08.2012 16:31
    Thank you for this great session! Looking forward to the rest of this series.
  • 0 avatar VeLora Lilly 02.09.2012 03:13
    Thank you Mary JO. Escellent presentaion. I appreciate the thoughtful contextual way you approach clients in trauma. Too often people are separated , isolated and not able to work to reintegrate their family after a crises.
    VeLora from San Francisco
  • Not available avatar M Twynam 02.10.2012 13:54
    Thank-you so much for this wonderful distillation of the essentials of working with traumatized clients. It will be extremely useful to me as a therapist who is relatively new to trauma work.
  • Not available avatar Leslie 02.10.2012 15:35
    I, too, appreciate Rich's ability to keep the session organized and highlighted essential markers of the interview. I have to agree with Mary Jo, it is so important that our clients know that what they have to tell us about their experience with previous therapy, and what they know and want to learn is worth slowing down to listen to so that they know we really get them.
  • Not available avatar Nancy Brown 02.11.2012 16:36
    I appreciated the presentation by Mary Jo Barrett. One thing I think is crucial is to clarify what healing from trauma is and what it isn't. I can understand doing this within a context of hope and change, but I think the hopes also need to be very realistic.
  • 0 avatar sarah mason 02.11.2012 17:09
    Thank youso much for this series and specifically today's webinar session. I am a newcomer to trauma Therapy and so found this to be very helpful and clarifying. I am wondering if there are some resources that Mary Jo might suggest in the form of books, articles, cd's for me as therapist and also for clients.
  • Not available avatar Christine 02.11.2012 20:32
    I really enjoyed the webinar and appreciated the emphasis on therapists to create a structure for clients. What recommendations do you offer for establishing the framework of treatment without seeming paternalistic or controlling during sessions? Also, how do you handle a client's limited willingness or ability to commit to a longer term of therapy? If a client comes in with 10 sessions authorized by their insurance, how can you know if this will be enough time to get through all of the stages and if a client will benefit?
  • Not available avatar Tracy Krause 02.12.2012 09:36
    Many of my clients have experienced childhood abuse. The specifics about how to structure therapy to help clients feel safe, empowered, and part of a collaborative team was wonderful. I used to ask them to sit in a specific chair to maintain confidentiality since there is a window in my office. I think I'll give them a choice and, if necessary, change the orientation of the blinds. Even the little things can make a difference. I also really liked the idea of developing a community with therapists who have different specialities so that the client can get someone who offers the best fit. Thanks for a wonderful presentation on a very important topic.
  • Not available avatar Renee Segal 02.12.2012 14:48
    This webcast couldn't come at a better time. Yesterday I had a client and her boyfriend come in for a 1st session. He told her he was done and she immediately started hyperventaling and had a panic attack. I successfully calmed her down but after watching your webcast, I realize that I can help her understand her symptoms and cycle by naming them.
    I agree with the other comments that Mary Jo is calming and powerful presence. I do EMDR and I love the breathing component. I teach yoga as well but I have been reluctant to bring it to my clients, after watching this I intend to use it with them.
    I really like the idea of an energy exchange between the client and therapist and also to get them to find other resources.
    This was one of the better webcasts. I look forward to the symposium next month to meeting you in person.
    Rich, thank you again for providing us such rich material.
    I am grateful.
    Renee Segal, Mtka, MN
  • Not available avatar Ravi Chandra 02.12.2012 20:00
    I liked this session very much. Good information and orientation to the goals and pillars of trauma treatment. There's a part of me that feels that while preparing the patient for therapy by instructing them on the methods that will be used is helpful and pertinent - but there's also a bit of the unknown here that has to be acknowledged. They have to trust that this is a creative partnership that will respond in the moment to their needs and what is arising. I think Mary Jo Barnett said pretty much this, but I do have a reaction to technique overall. It is important to have a toolbox, but sometimes techniques can be "magic tricks" as Jung said, getting between you and the patient. It's more about really being present, aware and open, I think.
  • Not available avatar Aneta Shaw 02.13.2012 07:55
    What an enormous privilege to sit at my desk in Somerset West, South Africa and follow your webcast on contextual treatment of trauma. Your enthusiasm and clarity of presentation impressed me and I made many notes as I also work with trauma. I have recently trained with D Berceli who came to SA to teach TRE, Trauma release exercises a method which discharges trapped tension and trauma through tremoring whilst rebalancing the ANS. It focuses on the physiology of the body and reintegrates trauma at brainstem level. Therapy goes much quicker as a result. I wonder if you are aware of this modality? traumaprevention.com Thank you for your teaching. Aneta (Clinical Psychologist)
  • Not available avatar Carol McDermott 02.13.2012 12:37
    Mary Jo- I love all the stages, the use of metaphors, the respect you give to your clients, the collaboration you establish with them, how you have set up your treatment center, I find your comments on touch most helpful and i could go on about the way you use the language of respectful attention to your client's needs.
    You briefly mentioned hypnosis. i work for a psychiatrist as an individual therapist in a conventional setting. i am trained in hypnotherapy and use trauma events for the client to express emotions, to hold and comfort their wounded child, to understand the etiology of a powerful life decision made in protection of self by an undeveloped brain, and to embed in the experience the competent, protective part of themselves that does make good, healthy decisions.
    At the end of the webinar, your comments on energy and health of the therapist are validating to my own beliefs. I will use so much of what you have given me..love the crystal ball.
    Many thanks
  • Not available avatar Joy Lang 02.13.2012 12:57
    Thank you so much Mary Jo for a coherent and well organized presentation. I found the 5 elements to be very helpful as I look at my own practice, and I liked what you said about all sessions having a piece of all 5 elements present. Thanks again for your open and energetic presentation.
  • 0 avatar Carol Peyser 02.13.2012 22:03
    Thanks very much for a great talk.

    You said that you divide each session into three stages but there wasn't time to lay those out.
    Can you clarify this?

    Thanks again

  • Not available avatar Kari Taylor-Evans 02.13.2012 23:59
    Thank you for your leadership in this treatment. I appreciate the language of the various stages, elements of effective trauma treatment, and integration and honor for the multitude of modalities in treating trauma. I work at the VA providing trauma treatment for veterans. I would love to know more about your groups. For example, length of time, open or closed group, process and/or skills group. I love facilitating groups, but I'm struggling with the time limited nature at the VA. It is a tough situation with so many people needing treatment. Love to hear your thoughts and recommendations. Thanks again for your work!!!
  • Not available avatar Skosh Jacobsen 02.14.2012 06:00
    Thank you for providing this great resource in the format. It was very helpful to hear Mary Jo Barrett's organization of treatment for trauma. I took training for EMDR three years ago and have been amazed at the applications and great resolutions that I see clients arrive at. There is always more to learn and I look forward to the rest of the series.
  • 0 avatar Marybeth Greifendorf 02.14.2012 13:44
    Thank you for this very informative session. It's very interesting that the therapeutic relationship is, or should be, the opposite of clients' trauma. It is a collaboration which values and empowers them and gives them hope for a meaningful future, all of which the traumatic experience was not, especially in cases of childhood sexual or physical abuse. The aspect of strength orientation is very important, as trauma survivors often seem to diminish their strengths or feel that they're not good at anything. It is also fascinating that therapists who never touched their clients had less successful outcomes than those who did!
  • 0 avatar Jennifer Barrett 02.21.2012 23:31
    Thank you, Mary Jo, for a clear, concise and helpful outline of trauma treatment. I wonder if you have recommendations for how to manage treatment when the reality is that the client will have a limited number of sessions - how best to proceed?
  • 0 avatar Erika Brooks 03.12.2012 15:05
    Reviewing this lecture- really helpful in working with trauma clients.
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