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Experiential Treatment for PTSD
Dr. Kate Hudgins' new book "Experiential Treatment for PTSD" (2002) is now available from Springer Publishing Company.
Abstract: This book presents The Therapeutic Spiral Model (TSM), a systematic modification of psychodrama, for helping professionals working with people who are suffering from severe trauma and post traumatic stress disorder. A step-by-step guide for using experiential methods safely, the author first presents the theoretical foundations of TSM, research and theories on trauma, and experiential psychotherapy as a basis for understanding its development. Throughout, clinical action structures and advanced intervention modules for using experiential methods are presented. Each chapter contains action vignettes and case examples to demonstrate the process and progress of the spiral technique.
PSYCHODRAMA, SURPLUS REALITY, AND THE ART OF HEALING
This book shows how the psychodrama director joins and enlarges the fantasy world of the protagonist, thereby opening up new possibilities for trying out in action. Active imagination is often called for and is a quality which enriches the director's armamentarium.Read book reviews published in
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 Psychodrama with Trauma Survivors: Acting Out Your Pain
Co-edited by Dr. Kate Hudgins and Peter Felix Kellermann (2001). Available from Barnes and Noble and Amazon.com.
Abstract: In a world where natural, social and political disasters are a daily reality, the therapist is increasingly called upon to find rapid and effective methods of treating the survivors of trauma, including sexual abuse, torture, war-related trauma, addiction, depression and bereavement. The contributors to this book provide persuasive evidence of how psychodrama can safely be used to create paths of change for even the most severe traumatization and they also discuss the possible transmission of trauma patterns across generations
Research into PTSD has shown that many trauma symptoms are unconscious, non-verbal, right-brained experiences which cannot be accessed through talk therapy. Psychodrama creates a place to act out unprocessed trauma within the containment of therapy in order to stop the obsessive repetition of the past. This book documents the impact of trauma and explores the development of treatment, providing integrated models of experiential treatment for clinicians to use. It is an invaluable resource for those interested in psychdrama and those working with trauma survivors.
Articles Spotlight
The Dance of Transference & Countertransference
TSM Definitions of Terms
Chinese Guidance Association
September 2005
Transference: Transference is a normal developmental phenomenon that facilitates an infant’s ability to construct and internalize symbolic representations of the parents/caregivers to develop a stable self-organization. With consistent care, the infant is able to internalize stable images/representations of self and other that include both good and bad as part of self and other perception.
Transference as an adult is the tendency to overgeneralize in a present relationship elements of people from the past that are not internally stabilized in an attempt to complete the normal developmental process of stable self-organization. It is a subjective experience in the individual that is rooted in fantasy and wished for relationships.
Therapeutic transference is the patient’s ability to generalize elements of unworked through elements of the past into the therapeutic relationship in order to stabilize self and object relationships. The therapist’s clinical goal is to support the patient to discover the conscious connections between his/her present symptoms and feelings and the earlier template of dysfunctional relationships.
Freud (1912): “Finally, every internal conflict has to be fought out in the sphere of interpersonal transference in the therapeutic relationship.”
Countertransference: Countertransference is the therapist’s personal responses to a patient’s transferential behavior. It is the inability to hold the emotional projective identifications from the patient and use them to help the patient with his/her unworked through trauma patterns. Is the unconscious transference onto a patient of one’s own unworked through transference issues and unstable object relations. It is a disturbing and distorting element in treatment. Countertransference 1 needs to be taken to your own therapy and/or supervision and not shared with the patient as it is about your own needs and not useful to the patient.
Countertransference 2 is a response that anyone would have to a patient’s projective identifications and transferences. The therapist can 1) identify his or her response, 2) how it activates his or her own history and 3) can contain any acting out of countertransference toward the patient. In this case, the therapist can metacommunicate to the patient his or her impact on others in the interpersonal relationship so they can mutually work out together new ways of behaviors and what the past antecedents are being acted out in the present.
In CT2, the therapist can accurately label the projective identifications that are being thrown at him or her, contain them and accurately label them back to the patient so s/he can learn how to moderate emotional relationships better.
Tele: A psychological construct first written about by JL Moreno in 1953 (Who Shall Survive?). He describes it as a natural two-way preference and reciprocity between people. It is derived from the Greek word for distance—tele—and is described as the simplest unit of feeling transmitted from one individual toward another. It is accurate and mutual and based on realistic critiera between two individuals.
There are two types of tele.
Psyche-telic relationships are informal relationships based on mutual and accurate personal needs.
Socio-telic relationships are based on mutual common interests in formal role relationships.
Tele can be:
1) positive
2) negative
3) ambivalent
It is tele when both people accurately read the mutual relationship based on realistic elements of the psyche or socio telic aspects of their relationships.
Moreno says that we would naturally develop telic relationships except that our dysfunctional families teach us to ignore our natural preferences and instead transmit transgenerational patterns of unworked through transference and projective identifications onto their children. In this way, he says, we need to be able to discriminate between empathy, transference, countertransference, and tele to learn healthy interpersonal functioning and repair internal object relations.
The Doodah Dance: In TSM, we have coined the term “doodah” to be a user-friendly way to refer to people’s trauma patterns and psychopathology as they exist in the here and now. It allows team members and others to lightly and accurately label a trauma response as a “doodah” so that person can look at themselves objectively without shame and blame. It also allows the team or group member to not get hooked into the doodah dance by not taking the behavior personally.
The doodah dance is a term that TSM uses to describes when two people are both caught in trauma patterns and are projecting transference and projective identifications onto each other in a dysfunctional way. They are locked into negative patterns with each other and neither can see the other accurately or with empathy.
When this happens, we ask each person to return to their own intrapsychic role atom to look at what transferences and projections are distorting the relationship, work through them, and only then return to the interpersonal relationship to sort things out. We do NOT do encounters in TSM as it is too dangerous for people to engage in interpersonal encounters when then they are caught in their own trauma patterns from underdeveloped personality structures.
Newly Added Articles 2005
Newly Added Articles 2004
This program is valuable for those who care about the PTSD sufferer in their life. It explains what PTSD is, why it is important to learn about this medical disorder, what you can do to help, ways to treat it, how to deal with the caregiver burden and how PTSD affects the family and other relationships.
Survivors of trauma often have difficulty believing that they will ever recover. This film provides a realistic message of hope and teaches family members and community how they can assist in the recovery process.
The program features Dr. Frank Ochberg and Dr. Angelea Panos. Both are close advisors to Gift From Within.
Endorsement
Review By: Jacqueline Garrick, ACSW, CSW, BCETS
This program is excellent, and unfortunately there is not enough of this kind of info out there. In 18 minutes, Living with PTSD gives caregivers a new perspective and a framework for how to interact and support friends or loved ones diagnosed with Post-traumatic Stress Disorder (PTSD). The DVD features renowned psychiatrist, Frank Ochberg and psychologist Angie Panos who discuss the issues PTSD sufferers face and how caregivers can best respond.
Newly Added Articles 2003
Research and Articles on Nuerology
Information on Adolescent Brains
Other Articles
PRESS INFO >>
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Article in Counselor Magazine
Click this link to see an article about the Therapeutic Spiral Model printed in Counselor Magazine.
Body Double and Containing Double Articles
Medical Research on healing power of the arts Sat, 10 Jul 2004
From: Iris Bräuninger tanztherapie@swissonline.ch Switzerland
An: "lisa" lisa-dmt@pchs.net CC: adta@adta.org Dance therapy association
Dear AMANDA GIFFORD and dance movement therapy (dmt) colleagues, here are some reference links on research on the power and effects of dance/movement therapy on the health of the individual, which you might want to quote in the Arts Reach 2004.
Bojner Horwitz, E., Theorell, T. & Anderberg, U.M. (2003). Dance/movement therapy and changes in stress-related hormones: a study of fibromylagia patients with video-interpretation. The Arts in
Psychotherapy, 30 (5), 255-264
.
Brooks, D. & Stark, A. (1989). The effects of dance/movement therapy on affect: A pilot study. American Journal of Dance Therapy, 11 (2), 101-112.
Cruz, R. F. & Sabers, D. L (1998). Dance/movement therapy is more effective than previously reported. The Arts in Psychotherapy, 25 (2), 101-104.
Dosamantes-Alperson, E. & Merrill, N. (1980). Growth effects of experimential movement psychotherapy. Psychotherapy Theory, Research, and Practice, 17 (1), 63-68.
Erwin-Grabner, T., Goodill, S.W., Schelly Hill, E. & von Neida, K. (1999). Effectiveness on Reducing Test Anxiety, American Journal of Dance Therapy, 21 (1), 19-34.
Ritter, M. & Low, K.G. (1996). Effects of dance/movement therapy: A Meta-Analysis. The Arts in Psychotherapy, 23, 249-260.
Additionally, there are presentation abstracts on the efficacy of d/mt, printed in the Colloquium's Brochure of the First International Research Coloquium in Dance/Movement Therapy, Germany/Hannover, 13.-15.02.2004 (accecable through info@btd-tanztherapie.de)
Bojner Horwitz, E. (2004) Dance/movement therapy and changes in stress-related hormones: a study of fibromyalgia patients with video-interpretation. Paper presented at the 1. International Research
Colloquium in Dance/Movement Therapy, BTD, 13.-14. Februar 2004, preceeding the 10th annual BTD membership assembly in D-Hannover.
Bräuninger, I. (2004). Dance/movement therapy as stress management and improvement in quality of life: Results of a randomized control study. Paper presented at the 1. International Research Colloquium in
Dance/Movement Therapy, BTD, 13.-14. Februar 2004, preceeding the 10th annual BTD membership assembly in D-Hannover.
Mannheim, E. (2004). Dance/movement therapy as a clinical intervention method in oncological rehabilitation. Evaluation of treatment effects - Results of Phase I. Paper presented at the 1. International Research
Colloquium in Dance/Movement Therapy, BTD, 13.-14. Februar 2004, preceeding the 10th annual BTD membership assembly in D-Hannover.
Rodríguez Cigaran, S. (2004). The effects of Dance movement therapy work on patients with fibromyalgia. Paper presented at the 1. International Research Colloquium in Dance/Movement Therapy, 13.-14.02.2004,
preceeding the 10th annual BTD membership assembly in D-Hannover.
Best regards, Iris Braeuninger, M.A., DTR, BTD trainer
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Sabine.Koch@URZ.UNI-HEIDELBERG.DE writes:
Sherry Goodills Book will be a great resource to quote. I do not know, wheather it is out yet. Please address her via the listserv or directly at Sherry.Goodill@drexel.edu. Additionally, I am attaching the programm of the International Dance/Movement Therapy Research Colloquium in Hannover, Germany, 13./14.02.04. The work of Braeuninger, of Mannheim, of Rodriguez, and of Boyner Horwitz will be great resources for medical research (you can quote them as presentations and/or posters). There is
a brochure with the abstracts of the colloquium you can order at: btdev@yahoo.de for 8 Euro.
Best, Sabine Koch, Germany
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HOORAY: The ARTS recognized. Send to every educator and administrative official you can. Thanks to Francine on the Canadian AT List Serve Blog
site: http://ait-research.blog-city.com/read/642758.htm
FYI: This is a free download not to be missed. Roberta
Eloquent Evidence: Arts at the Core of Learning The arts are serious and rigorous academic subjects. They are an essential aspect of human knowing. The following paper explains the evidence behind art practices and how they can support learning at a number of levels. The complete text can be accessed here: http://www.nasaa-arts.org/nasaanews/ee.pdf
The arts convey knowledge and meaning not learned through the study of other subjects. They represent a form of thinking and a way of knowing that is based in human imagination and judgment. The arts delight students, but they are also intellectual disciplines of substance. Like language or mathematics, the arts involve the use of complex symbols to communicate.
To attain competence in the arts, it is necessary to gain literacy with these symbol systems. Some, like music and painting, use nonverbal symbols; others, like poetry and song, use language in particular ways. Arts teachers daily ask their students to engage in learning activities which require use of higher-order thinking skills like analysis, synthesis and evaluation. Arts education, then, is first of all an activity of the mind.
Complete article here: http://www.nasaa-arts.org/nasaanews/ee.pdf
„Science will...produce the data..., but never the full meaning. For perceiving real significance, we shall need...most of all the brains of poets, [and] also those of artists, musicians, philosophers, historians,
writers in general.‰ Lewis Thomas, Scientist
Entire paper, available for download, at: http://www.nasaa-arts.org/nasaanews/ee.pdf
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Sally Bailey, MFA, MSW, RDT/BCT Assistant Professor Kansas State University
129 Nichols Hall Manhattan, KS 66056-2301 writes:
(first a quote) "Play is the greatest form of research" --- Albert Einstein
then
There is a journal put out by the Dana Foundation called "Cerebrum" They typically have at least one article on the arts or the arts therapies and the brain each year. Most recently, in the Spring 2003 issue (Vol. 5,
Number 2), there was an article entitled "The Dancing Brain" by Ivar Hagendoorn who was a dancer who became a neurologist in order to understand how and why we dance and are moved by dancing. In Winter 2002, Volume 4, Issue 1, there was an article "How Music Can Reach the Silenced Brain." by
Concetta M. Tamaino which talked about music therapy with stroke patients. Also in the same issue was an article "In Terror's Grip: Healing the Ravages of Trauma" by Bessel van der Kolk in which he talked about his
theatre troupe for traumatized teens in Boston. He's found talk therapy doesn't work with PTSD, but the arts and embodied therapies do. Volume 2, Number 4, Fall 2000 had "In Search of the Musical Mind" by Daniel J. Levitin
I would think that the American Music Therapy Association could refer people to articles/studies on music and healing. I have a sense that there's been a lot of work done in this area, just as the past several
emails have indicated there has been a lot of work done in this area with dance/movement therapy. AMTA's website is www.musictherapy.org http://www.musictherapy.org They have an index of their journal in which research has been published on line. You might want to check with Judy Simpson, who works in their office, as well.
Helga Noice and Tony Noice have done a lot of research on memory studying how actors memorize lines and movement. They've recently done several studies looking at how involvement in theatre can help older adults improve their memory. "Improving Memory in Older Adults by Instructing Them in Professional Actors' Learning Strategies" in Applied Cognitive Psychology, Aug. 1999, Vol 13 (4), 315-328.
In a similiar vein there's a chapter entitled "Beyond Verbal Memory -- Enhancing Memory by Acting" by Monika Knopf in the book "Mood and Cognitive Disorders: Facts and Research in Gerontology" ed. by Bruno J. Vellas published in 1995 by Springer.
The other thing I've recently run across is an article in Theatre Topics, Volume 12, Number 2, Sept. 2002, a journal put out by ATHE (American Theatre in Higher Education) entitled "Reconsidering Stanislavsky: Feeling, Feminism, and the Actor" by Rhonda Blair in which the author draws parallels between what has been discovered about the brain in the last 10 years, particularly work by Antonio Damasio, and Stanislavsky's method which intuitively utilizes brain structure to help actors get in touch with the characters they are trying to portray.
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Alliance: The quality of relationship as perceived by the client. (Duncan & Miller, 2000)
Attachment Theory: Developed by John Bowlby, which sees mother/child attachment as critical for both emotional and physical reasons as mothers provide support and protection. Anxiety aroused by separation signals danger and a biological as well as psychological response. (Bowlby, J., Attachment & Loss, Vol. 1-3, 1969, 1973, 1980, in Holmes, The Inner World Outside, 1992, p. 140)
Body Dialogue: An action structure in which the client role reverses with the body in order to develop an empathic relationship with the body. (Ciotola, 2003, www.fitness-movement.com)
Body Double (BD): The body double intervention module. This is a prescriptive role from the TSIRA that is used to decrease dissociation and help people experience their bodies in a healthy state. (Hudgins, Experiential Treatment for PTSD, 2002, p. 204)
Containing Double (CD): The containing double intervention module. This is a prescriptive role from the TSIRA that is used to increase cognitive processing and narrative labeling in the face of trauma material. (Hudgins, Experiential Treatment for PTSD. 2002, p. 205)
Developmental Theory: The study of human development at every stage, from conception to death, examining physical, intellectual, and emotional change, identifying factors which support healthy development and those which impair it. (Berger, The Developing Person Through Life Span, 1994, p. 4)
Double (Classical): The Protagonist is joined by an auxiliary, either a trained co-therapist or a group member, whose role is to function as a support in presenting the protagonist’s position or feelings. Doubles should first work toward establishing an empathic bond with the protagonist. In general, they stand to the side of and at a slight angle to the protagonist so that they can replicate the nonverbal communications and present a kind of "united front". The double is one of the most important and basic techniques in psychodrama. (Leveton in Blatner, Foundations of Psychodrama. 1988, p.164)
Empathic Attunement: An intuitive mode of perceiving another’s experience, both affectively and cognitively. (Arlow, J. in Corsini & Wedding, Current Psychotherapies, 2000, p. 44)
Entrainment: The tendency for two oscillating bodies to lock into phase so that they vibrate in harmony. Synchronization of body rhythms with musical rhythms. (Neimark, Sound Healing Natural Health p. 73)
Limbic Resonance: A symphony of mutual exchange and internal adaptation whereby two mammals become attuned to each other’s inner states. When we look into the ocular portals to a limbic brain our vision goes deep: the sensations multiply, just as two mirrors placed in opposition create a shimmering ricochet of reflections whose depths recede into infinity. When we meet the gaze of another, two nervous systems achieve a palpable and intimate apposition. (Lewis, Amini, & Lannon, A General Theory of Love, 2000, p. 63)
Manager of Healthy Functioning: A transformative role that develops from the interaction of the keeper of defenses, the change agent role, and the other prescriptive roles. This role goes beyond defenses and finds healthy, adaptive coping skills such as honest communication, trusting intimacy, et cetera. (Hudgins, Experiential Treatment for PTSD, 2002, pp. 205-206)
Mirror(ing): The protagonist stands back and watches while the role he portrayed is replayed by an auxiliary. A family interaction may also be mirrored or a parent can watch a scene from his own childhood as a way of gaining insight regarding his own parenting behavior. This is a human version of videotape playback. It can be a powerful . . . technique and must be used with discretion. (Torrance in Blatner, Foundations of Psychodrama. 1988, p. 169)
Neurobiology: The branch of biology that deals with the anatomy and physiology of the nervous system. (Webster’s Dictionary)
Object Relations Theory: A psychology of the mind developed by certain of Freud’s successors: in Britain by Melanie Klein, W.R.D. Fairbairn, D.W. Winnicott, Harry Guntrip, and John Bowlby (among others), and in the United States by psychoanalysts such as Otto Kernberg.
Their theories are concerned with the consequences of an individual’s relationships with the external world on their internal psychic world. The psyche and the personality are seen as being, in part, a result of the relationships made with people in the external world, which are remembered or internalized as ‘object relationships’ in the mind. In this respect, childhood is considered to be the most formative period of a person’s life, although internal object relationships can be changed in adult life by, say, psychotherapy or other powerful life experiences.
The term ‘object’ is taken in this theory to refer both to people, or parts of people, in the external world and to the internal psychic ‘objects’ or representations in the mind that result from these relationships. (Holmes, The Inner World Outside, 1992, p. 8)
Role Reversal: The major participants in an interaction change roles. When a protagonist in a psychodrama role reverses, it is a way of transcending the habitual limitations of egocentricity. Role reversal is indicated when it is appropriate for the protagonist to empathize with the other person’s viewpoint. Also, role reversal is used during the setting up of a scene and the warming up of an auxiliary. The protagonist reverses roles and demonstrates how the other person in the scene behaves, thus giving nonverbal cues to the auxiliary so that the scene is played relatively close to the protagonist’s experience. (This is also called changing parts or switching roles.) (Blatner, Foundations of Psychodrama. 1988, pp. 174-175)
Self-Soothing Voice: Based upon neurobiology and object relations theory, this musical prescriptive role uses the elements of sound, rhythm, tone, melody, and lyrics to calm the limbic system, facilitate developmental repair, and lay the groundwork for meaning making. (Amsden, K., A Musical Road to Recovery: Healing the Effects of Trauma With Music and Experiential Methods of Practice, 2004)
Spiritual Double: A double designed to identify and hold onto Spiritual experience and insight as it occurs, and as it is relevant in a difficult moment, enabling the protagonist to call upon and employ spiritual strength. (Culbertson, R., 2003 personal conversation)
Spiritual Evolution: Theory developed by Teilhard de Chardin proposing that humans have a soul which evolves through time and "that mind and matter are not two antagonists substances, but two aspects of the same cosmic stuff." (Kopp, J. in Chardin, A New Synthesis of Evolution, 1964, p. 20)
Spontaneity Theory: J. L. Moreno’s definition as "a new response to an old situation, or an adequate response to a new situation". The central ingredient in the process of psychodrama and of healthy living. (Blatner, Foundations in Psychodrama, 1988, p. 20)
Adam Blatner, M.D.
(please reply to adam@blatner.com
website: www.blatner.com/adam/
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