SIMON HARPER MSc CBP (Distinction) PG Dip BA (Hons) BABCP Accredited

COGNITIVE BEHAVIOURAL PSYCHOTHERAPY & EMDR

COMPLEX TRAUMA & POST TRAUMATIC STRESS DISORDER ( PTSD )

"Enlightenment is not imagining figures of light but making the darkness conscious" Carl Jung

Survivors of complex trauma are sometimes unable to make the distinction between the past and the present. They are unable to accept the painful reality of their life and can remain stuck in terror, hopelessness, dread and despair. The saying 'frozen in time' sums up how the body remains physiologically frozen in an unfinished state of extreme biological readiness to react to a traumatic event even though the event happened a long time ago. The result is that a person's belief system may become distorted, they may have physical symptoms, anxieties, intolerable emotions, flashbacks and nightmares. Triggers can then result in the person feeling like the event is happening in the present.

For my MSc dissertation I examined the theory of structural dissociation of the personality. This theory explains how the self is fragmented so that various emotional parts become fixed in a state that resembles the trauma. For example a part may be in a permanent state of hypervigilance (fight/flight/freeze ) resulting in the inability to live in the present. These parts of self have been described as ego-states, dissociative self-states, or dissociative parts. The ultimate dissociative state is Dissociative Identity Disorder ( DID ) whereby a person has two or more distinct identities (alters ) and these identities repeatedly assume control of the individual.

Complex trauma requires more than a traditional 'talking therapy' because traumatic memories become stuck in the brain's nonverbal, nonconscious, subcortical regions where there is no access to the reasoning parts of the brain. "We're much less controlled by our conscious, cognitive appraisal than our psychological theories give us credit for being," suggests Van der Kolk (1994 ). Herbert ( 2006 ) suggests communication between the three systems is essential i.e. cognitive: neocortex , emotional: limbic and bodily: reptilian brain. Trauma becomes 'locked' in the body, and it's in the body that it must be accessed and healed.

Recently Stokes ( 2009 ) has described certain memories as emotion memories in that when activated the person experiences the feelings that they were experiencing at the time the memory was recorded. These emotion memories can be referred to as 'scripts' because the emotion memory tends to script our behaviours and experiences. Specifically they are called 'amygdala scripts' because it is this part of the brain that plays such a crucial role in the storage and retrieval of emotion memories.

It is suggested by Epstein ( 1993 ) that people use two different systems to process information. The rational system is verbal, analytic, and relatively emotion free, whereas the experiential system is an automatic system that operates at a preconscious level and is emotional. 'Amygdala scripts' would then be classed as experiential.

In everyday terms it can be experienced as the head telling us one thing and the heart telling us another. That is why a person may say, 'rationally I know I am not a failure but it still feels like I am'. Therefore for long lasting change to occur, the experiential system needs to be activated and consequently techniques are used that access this system, otherwise the feelings can remain the same. Consequently we will work on accessing a 'felt sense' of the problem.

Therefore some of the interventions used are EMDR, Holographic Reprocessing and Imagery Rescripting and Reprocessing Therapy. 'Holographic Reprocessing is an integrative psychotherapeutic approach to treat trauma. It provides a method for identifying reoccurring themes or reenactments of trauma where an emotional issue is replayed in interpersonal relationships. Once articulated, the treatment focuses on reprocessing the pattern' ( Katz 2005 ). Imagery Rescripting and Reprocessing Therapy is an imagery based CBT treatment that is used to transform traumatic imagery into more adaptive imagery. Additionally for complex trauma, Hart et al ( 2006 ) suggests using a phase-oriented treatment of trauma. There are three phases and I have adopted many of these treatment principles.

References

Hart, O V D, Nijenhuis, E R S, Steele, K. ( 2006 ). The Haunted Self. Structural Dissociation and the Treatment of Chronic Traumatization. New York, W.W. Norton & Company.

Herbert, C. ( 2006 ). Healing from complex trauma; an integrative 3 systems approach. In Corrigall, J; Payne, H; Wilkinson, H. About a Body, Working with the Embodied Mind in Psychotherapy. London,Routeledge.

Katz, L S. ( 2005 ). Holographic Reprocessing. A Cognitive-Experiential Psychotherapy for the Treatment of Trauma. New York, Routledge.

Stokes, T B. ( 2009 ). What Freud didn't know. A Three-Step Practice for Emotional Well-Being through Neuroscience and Psychology. New Jersey, Rutgers University Press.

Van der Kolk, B A. ( 1994 ). The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress. In Harvard Review of Psychiatry, Vol 1, No 5, pp 253-265.

 

Testimonial
"As a first experience of EMDR I was amazed by the instant and powerful results. My feelings before and after EMDR could not have been more different. Simon was able to take me from a highly stressful and anxious state to one of calm and clarity. The experience itself was surprising in its simplicity, deeply cleansing and very insightful and with Simon's expert guidance through the whole process, EMDR gave me a confidence and an 'at peace with myself' feeling during a time when I was under immense personal pressure." - Amy