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ETHICAL ATTUNEMENT AND COMPLEX TRAUMA

Mary Jo Barrettwww.centerforcontextualchange.org

Ethical Attunement■ The range of what we think and do

■ Is limited by what we fail to notice

■ And because we fail to notice

■ That we fail to notice

■ There is little we can do

■ To Change

■ Until we notice

■ How failing to notice

■ Shapes our thoughts and deeds -

R.D.Laing

Performance, health and happiness are grounded in the skillful management of energy

Jim Loehr

Awareness, Stamina, Creativity, Resources

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Healing, Growth and Change

Healing,change and growth comes from a process of encircling a person with a sense of being valued and empowerment. This is done by identifying and engaging with them through their own natural cycles of growth. Collaboratively gathering resources from within a person, their family and their community

Abuse/Neglect and Complex Trauma

■ Traumatic experiences embedded in ineffective hierarchies and/or hostile contexts: Behavior makes sense.

Fight ----- Flight ----- Freeze– Difficulty regulating emotions and impulses

– Difficulty in ego adaptive capacity/cognitive consciousness

– Somatization

– Self loathing, negative perceptions of others, victim/perpetrator cycles (sexually and violently acting out)

– Meaning making impaired

The Effects of Abuse and Complex Trauma

■ I experience myself as powerless

– Symptoms as attempted solutions

■ I am disconnected from myself, others, and the world around me

– Interactional Cycle of Survival

■ I experience myself as devalued

■ I am out of control

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Therapist Use of Self

Ethical Attunement Role of Mindfulness Interventions that decrease helplessness, extreme

behaviors and increase mastery Collaboration An Effective Model to build therapist’s confidence and self

empowerment-Stage oriented integrative model Supervision and Consultation

Five Essential Ingredients for Healing

Relationships connecting to a deep set of values that provide a meaningful vision of present and future Collaboration/Power/Attachment

Skills: Psycho educational Experiences/Cognitive Behavioral/Neuro-Mind-Body/Communication/Mindfulness/Thought Process/Self Regulating

Resource Based Guidance/Vulnerability and Resilience

Safe Context/Boundaries/Structure

The Creation of Workable Realities/Hope

Essential Elements of Trauma Informed Treatment

■ Co-creation of secure, safe, attachment, in and outside office

■ Assess and access resources of both clinician and client

■ Structured and Transparent Collaboration

■ Understanding and Implementing the Dynamic nature of self regulation and Co-regulation- client and clinician

■ Recognizing the moments that are opportunities to co-create change

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Guidelines for Standard of Care

Therapy enhances clients’ capabilities-of faith; creativity;and control response to a situation

Skills training

Cognitive Stability

Behavioral Stability

Interpersonal Regulation and Stability

Stabilization of Core sense of self

Therapy must improve the clients’ motivation for change

■ Collaboration: understanding of process, engaging in process, and investing in outcome.

■ Enhancing Positive Emotions not focusing on Negative

■ Interventions that help quickly

■ Clear Treatment Plan

Assure generalization to natural environment

What happens in sessions can be applied out side of room

Homework assignments and practice

In session Practice of Skills and Experience

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Enhance therapist capabilities & therapists’ motivation to treat effectively

■ Therapist Use of Self Ethical Attunement-self and other

■ Interventions that decrease helplessness, extreme behaviors and increase mastery

■ Collaboration

■ An Effective Model to build therapist’s confidence and self empowerment-Stage oriented integrative model

■ Supervision and Consultation

Structured Environment

■ Clarity of Model

■ Clear Boundaries

■ Coaching strategies

■ Predictability

Family Therapists’ Journey

Evolving

Judgmental Ruminative

HopefulDiscerning

Unreasonable Optimism

Cynical Naïve Stuck in Despair

Barrett and Stone Fish, 2016

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Mirror NeuronA mirror neuron is a neuron that fires both when a person acts and

when the person observes the same action performed by another.

■ You each become the reflection and extension of the other

■ A back and forth energy emerges between you- liken to an electrical energy flow

■ Positive resonance needs certain ingredients to exist-safety being primary

Collaborative Stage Model

Creating a Context for Change

Challenging Patterns/Cycles and Expanding Realities

Consolidation

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■ What the caterpillar calls the end of the world,

the masters call a butterfly

■ Richard Bach

Ethical Attunement with Clients■ Before Session

– Grounding with the knowledge that by being equally attuned to our emotions, body experience, and autonomic arousal, rather than ignoring our experience to “be there” for the client, we are centered and present

■ During Session– By welcoming challenging responses as opportunities, I can

regulate my body’s reaction to anger, shutdown, resistance, and stuckness, and the client’s experience will be changed

■ During and After Session– If I transform my somatic responses, the client’s experience is

transformed. It’s hard to be angry, resistant or stuck when your therapist is enjoying being with you and being a psychotherapist!

Barrett and Stone Fish, 2016

Unlock their bodies

Activate effective fight/flight

Tolerate their sensations

Befriend their inner experiences

Cultivate new action patterns

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Ethical Attunement■ Therapeutic Talent and Complex Trauma:

– Our Gift■ Energy Resources: Emotional, physical, spiritual, intellectual,

sensual

– Giving and Receiving

– Natural Cycle of Contraction and Expansion in Relationship

■ Therapeutic Wisdom: – Mindfulness (Empowerment)

– Open Hearts (Value/Attachment)

– Influence (Idiosyncratic or Relational Power)

■ Individual Thoughts/Your Wisdom– How do you think change happens?– Think of a time you changed– What were the essential ingredients of your change?

■ Relational/Therapeutic Thoughts– What are your idiosyncratic gifts for influencing others?– What are the core therapeutic ingredients you bring to your relationships?– How do you take care and nurture your gifts

■ Heart– Think of a time you gave to another and your gift was received– Think of a time you gave to yourself and you allowed yourself to receive it

■ Engaged Mindstate– What is going to help you feel supported today?

You as Therapeutic Resource

The therapeutic journey requires ENERGY –for our clients and for ourselves

Five Domains of Human Energy■Emotional■Intellectual■Physical■Sensual■Spiritual

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Compassion Fatigue

…..is the exhaustion, fatigue, and subsequent symptoms that are the result of passionately, skillfully, and compassionately giving of yourself to help others.

Performance, health and happiness are grounded in the skillful management of energy

- Jim Loehr

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In order to be a successful therapist (or caregiver)

■You need to be mindful of the possible of effects of your compassion

■You need to understand the energy exchange –what you give out and what you get back

■You need to understand your vulnerability and the need for balance in the expenditure of energy and replenishing of energy

When We Are Not Ethically Attuned• The client’s dysregulated emotions, attachment styles, and behavior

can have contagion effects

■ We may experience impending threat; e.g., violence, self-destructive and addictive behavior, threats to self/other, eating disorders

■ We may experience responsibility without power to change the outcome

■ We have difficulties tolerating details of abuse and neglect and holding clients’ terrible knowledge

■ We may experience client’s pleas for help as entitlement, intrusions, boundary challenges

■ We may experience client’s passivity, numbing, disconnection as an insurmountable barrier to progress and/or the relationship

Barrett and Stone Fish, 2016

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Feeling Helpless

and Hopeless

A Sense That One Can Never Do Enough

Hyper-vigilance

Diminished Creativity

Inability to Embrace

Complexity

Minimizing

Chronic Exhaustion

/Physical AilmentsInability to

Listen/Deliberate

AvoidanceDissociative Moments

Sense of Persecutio

n

Guilt

Fear

Anger and Cynicism

Inability to Empathize/Numbing

Addictions

Grandiosity

An Inflated Sense of

Importance

DYS-REGULATIO

N EXPOSURE RESPONSE

• Submission: we become numb, robotic, lose energy or

apathetic, become more depressed or detached in our own

personal lives.

• Flight: it is harder to pay attention, to want to go to work.

We may dream of vacations or of terminating the client

• Fight: we become more irritable, tense, or defensive. Or

quicker to ‘try to save the day.’ Our hyper vigilance or posttraumatic

paranoia may affect our personal lives, interfering

with sleep or relaxation

• Attach: our separation anxiety increases in tandem with

their instability and un-safety.

When we are depleted

Possible Consequences

■ Compassion Fatigue

■ Vicarious Traumatization

■ Burnout

■ Rigid boundaries

■ Confusing boundaries

■ Inconsistent boundaries

■ Loose boundaries

Barrett and Stone Fish, 2016

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Validation

What is it?

Definition: To accept, legitimize, support, attempt to understand and assign benevolent meaning to your own and/or someone else’s emotions, thoughts and behavior.

Invalidating Environments

Characteristics of Invalidation

• Communication of private experience met with exaggerated, inappropriate, extreme response.

• Communication of private experience not validated, often punished and/or trivialized.

• Painful emotions and factors causing them are disregarded.

• The individual’s interpretations of his/her behaviors and motivations for behaviors are dismissed.

• Tells the individual he/she is wrong in both the description and analysis of the experience particularly what is causing the emotion, belief or action.

• Attributes the experience to socially unacceptable characteristics or personality traits.

• Failure to live up to expectations brings disapproval, criticism, sarcasm, or attempts to change the individuals attitude.

Invalidating Environments

Consequences of Invalidation

• Individual does not learn to label private experiences and emotions in normative manner.

• Individual does not learn to modulate emotional arousal.

• If problems are not recognized, problem-solving skills are not learned.

• Extreme problems or emotional displays become necessary to provoke a response.

• Inhibition or extreme emotional states occur.

• Individual does not learn to tolerate distress or form realistic goals and expectations.

• Individual does not learn to trust his/her own emotional response.

• Self-invalidation and shame.

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Function of Validation

• Creates safety (verbal, emotional, physical and sexual)• Establishes the environmental context for constructive,

useful, effective behavior (verbal and nonverbal; with self and others)

• Enhances connections in relationships• Teaches trust and helps it to evolve• Strengthens empathy• Generates feeling understood and supported• Generates comfort through emphasis on naturalness of

responses• Generates encouragement and effectiveness

What to Validate

• The value of each individual as a person.

• The value of the relationship to those involved.

• One’s own and other’s behaviors that are legitimate, natural and effective. This includes: emotions (feelings and needs), thoughts (beliefs, intentions, goals), and constructive actions.

• Facts when they are factual, what is actually happening.

• Worries and fears as worries and fears - not facts.

• Self-initiated actions by a person for themselves consistent with their own values, feelings, desires and goals.

GOALS OF BRAIN-DIRECTED INTERVENTIONS

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Body Regulation –Balancing the accelerator and the brakesEmotional BalanceResponse FlexibilityEmpathyInsightModulating fear and AngerIntuition

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FIVE FACETS OF MINDFULNESS PRACTICES

1. Decreased reactivity to inner experiences

2. Increased capacity to remain present even with

painful emotions and sensations

3. Increased capacity to react with awareness and

intention

4. Increased capacity to describe/label with words

5. Non-judgmental of experiences

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AWARE MIND PARADIGM

Integrated

Present in the

moment

Balancing

Internal locus of control

Trigger and Reaction

I need to create a

pause and bring the

anger down

Focus on safety and effectivene

ssSelf-observing

Assessing Needs

Enact a goal-driven action plan

WarmIncreased heart rate

NegotiableNeither self nor others

are less than human

Resilience

■ Awareness/Realism

■ Creativity

■ Humor

■ Courage/Intiative

■ Flexibility/Adaptability

■ Faith/Trust

■ Social Support

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We fall into Negative Energy with FatigueOur goal is to recognize this and Create Positive Energy

■ Positive Energy- High and Low– High Positive; Joy, Happiness, Playfulness, Movement…

– Low Positive; Meditation, Prayer, Stroll in Nature…

■ Negative Energy- High and Low– High Negative; Anger, Critical, Judgment, Irritable…

– Low Negative; Depressed, Withdrawn, Isolation …

The Collaborative Change ModelBarrett, M.J. and Stone Fish, L. (2014). Treating complex trauma: A relational blueprint for collaboration and change. NY: Routledge.

Creating a Context for Change

Sharing our vision of ethical boundaries

Creating safety inside and outside of office

Discussion of boundaries

What makes you feel safe? You- meaning both you and the client

In session, out of session, between session

Barrett and Stone Fish, 2016

Creating a Context for Change, Cont’d. ■ Digital Boundaries Explored:

– Passwords on phones and computers

– Lock computers like file cabinets

– Assume your clients can get on Facebook and Google

– Establish text and email boundaries from beginning

– In session use of phone

Barrett and Stone Fish, 2016

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Challenging Patterns and Expanding Realities■ Our boundaries get challenged. The more intimate we

become and the more fatigued we are the more vulnerable we become.

■ Inside the office

– Self disclosure, gifts, role reversal bids

■ Outside the office

– Spilling

■ Organizational

Barrett and Stone Fish, 2016

Consolidation

■ On-going Consultation

■ Consistency

Barrett and Stone Fish, 2016

How to Maintain our Energy to Ensure We Make Wise and Ethical Decisions■ Acknowledgment of how caring for others has impacted our

lives and changed us-both positively and negatively. Recognizing our expenditures and replenishers

■ Designing the program that will re-create the proactive energy which lies within all of us in each domain. Constructing a personal energy formula

■ Commitment to ongoing practice of replenishment in all 5 energy domains- through an energy efficient personal formula

Barrett and Stone Fish, 2016

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Worksheet

■ Your Symptoms you want to change:

What behaviors at home or work -do I want to change?

What beliefs about myself and others no longer serve me- in fact expend my energy?

What reactions of mine are problematic at home and work?

■ Your Energy Expenditures:

What tasks?

With Whom?

What Life Style Choices?

Wellness Plan

Write your Personal Vision:

How would you like to see yourself as a person.

What are your Top personal energy expenditures

What are your Positive energy replenishers

Create the specific plan and formula that is realistic for you-what, when, and how

Write your Professional Vision:

How would you like to see yourself as a person.

What are your Top energy expenditures

What are your Positive energy replenishers

Create the specific plan and formula that is realistic for you-what, when and how

Keys to Success

■ Boundaries

■ Explain phenomena to others-work and home

■ Mindfulness

■ Be Creative

■ Watch what you say to yourself

■ Plan something every month/every week /every day that you look forward to

■ ASK for what you want and need

■ Create an energy plan

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