Psychotherapy
TRAUMATYS provides …
Psychotherapy, specialized and effective
Since 1991, TRAUMATYS has evaluated and treated ‘thousands’ presenting with PTSD, along with co-morbidity and functional limitations.
According to a study by the research team of Dr Brunet at McGill University, examining 100 files randomly selected at TRAUMATYS (2004), psychotherapy lasts an average of 9 months, ranging from a few months to a few years. At termination, using a research structured interview, PTSD remission rate was 96%, with 48% of full remission.
In addition, a prospective neurological study of individuals treated at TRAUMATYS (Dickie et al., 2011), using magnetic resonance imaging (fMRI), showed that …
• PTSD changes were associated with activity changes in key neurological centers :
• amygdala (conditioned memory, anxiety, fear, anger)
• hippocampus (non-emotional memory, integration of complex informations, etc.)
• right anterior cingulate cortex (modulation of affects and behaviors)
• after 6 to 9 months of psychotherapy (some patients had not terminated yet), using diagnoses obtained from a structured interview (CAPS), PTSD remission rate was 65%.
At TRAUMATYS, psychotherapy may entail a therapeutic focus on the reexperiencing of the traumatic event, like in EMDR ou prolonged exposure (PE), but only if certain conditions are pre-established (see an neurobiological explanation here).
A dynamic integrative model
Goals
In order to reach these goals, the objectives of the psychotherapeutic process are to assist the individual to recognize and accept one’s traumatized self and, in parallel, to regain control over one’s outer and inner worlds. Subsequently, psychotherapy aims at integrating the traumatic information, both cognitively and emotionally, through an experiential revision of the traumatic event and through accommodating one’s psychological structure to the newly assessed traumatic information. Finally, psychotherapy aims at practicing the newly adopted skills and attitudes, and at fostering a new sense of self. This model is based on Horowitz’s model and is described elsewhere in details in Dynamic Therapy for Posttraumatic Stress Disorder (Gaston, 1995). Bowlby’s and Masterson’s models have been added and adjusted to treat the personality disorders associated with PTSD.The goals of psychotherapy are to eradicate PTSD and co-morbidity symptoms, to resume normal psychosocial functioning, and to prevent relapse. When an individual needs to cease working temporarily because the symptoms are interfering with the psychosocial functioning, or when there is a crisis situation, psychotherapy is provided twice a week. Otherwise, psychotherapy is provided once a week.
Phases
The first phase aims at establishing the conditions to develop an alliance, at completing the psychological history, and at reviewing the details of the traumatic event, along with its circumstances, as long as it does not induce overwhelming anxiety or destabilization. In order for the individual to be able to fully explore one’s traumatic experience, it is necessary to first work on the consequences of the chronicity of the psychological condition, if any, to reinforce appropriate adaptive strategies, to ensure that anxiety is not overwhelming, to encourage the seeking of valuable social support, to help resolve situational problems which contribute in maintaining the psychological condition, if possible, and to address the individual’s avoidance mechanisms and their functions in order to bring them to a non-defensive level.
The second phase consists of reviewing the traumatic event at a tolerable dosage. It entails identifying the defense mechanisms interfering with its revision, and addressing the conflicts or structural deficits reactivated by the traumatic event. This review takes place in the usual waking state or under introspective hypnosis if the former does not yield the idiosyncratic meanings of the traumatic event. Afterwards, trauma-related emotions, desires and meanings are fully acknowledged, internal representations of self and others are identified and revised, and defensive and interpersonal patterns are delineated and modified. Having completed this process, the information associated with the traumatic event should be integrated within the individual’s psychological structure.
If this second phase cannot be dealt with or completed given structural deficits encountered within the individual, the models of Bowlby and Masterson are applied. Over months, the strong and benevolent figure of the psychotherapist is internalized which allows abandonment anxiety and depression to be worked through. Reinforcing the psychological structure of the person is also undertaken through some pharmacological, cognitive and behavioral tools to help the person contain the overwhelming emotions associated with PTSD and its comorbidity. Such an approach can succeed at remitting PTSD without direct therapeutic work on the traumatic experience, at bringing the person back into full functionality, and at preventing a PTSD relapse. This structural work takes longer.
The third phase aims at ensuring that the psychotherapeutic gains are sustained over time and preventing relapse,. It strives at encouraging the individual to practice the newly acquired cognitive, behavioral and interpersonal patterns. A novel attitude toward adversity is also addressed, unless it has emerged spontaneously, so that the individual can consider life’s obstacles as challenges rather than threats, and realistically assess the possibility of life’s dangers. Termination of psychotherapy is discussed. Gains are recognized, while the individual’s active participation in them is emphasized.
Techniques
• Providing empathy regarding the individual’s suffering and experience.
• Validating reality and the individual’s appropriate reactions to it
• Reassuring the individual, and normalizing symptoms while educating about PTSD
• Resolving stressors (continuous danger, administrative difficulties, judicial process, etc.)
• Suggesting ways of resolving these problems and developing new abilities to solve them
• Exploring, specifically and actively, the experience of the traumatic event
• Interpreting the unconscious issues associated with the traumatic experience
• Linking traumatic and pre-traumatic experiences (cognitions, emotions, meanings, etc.)
• Differentiating reality from fantasies
• Teaching relaxation techniques and techniques for regaining control
Within this specialized approach, it is essential to help the individual regain control at all times, restore and preserve the individual’s self-esteem as much as possible, and encourage an experiential review of the traumatic event. It is also important to proceed gradually, in tolerable doses, starting with peripheral reactions and heading toward the heart of the psychological wound.