Trauma Therapy
Trauma Therapy
Bottom-up treatment: Those approaches that focus on engaging the senses, emotions, and subconscious structures of the
body and brain initially in order to reduce the pain associated with distressing material.
Cabin/safe place/ dissociative table: Ego state therapy techniques utilized to observe the inner community or internal family
system. The dissociative table technique was developed by Fraser in 1991. The safe place or home base is identified in ego
state work to isolate individual ego states for a therapeutic intervention. The cabin is similarly developed in The Healing
Journey Rapid Pain Release method.
Disorders of extreme stress not otherwise specified (DESNOS): Identify symptoms of PTSD that may exist on a continuum
and may be subthreshold to the actual symptoms of PTSD (Herman,1992).
Ego State: An aspect or “part” of a person’s personality that forms to respond to a specific need(s), and possesses a unique
identity, memories, and traits. These develop across the lifespan (Lizarraga, 2016). Lizarraga, 2016)
Definitions
Ego state therapy: Interventions imposed on the internal family system or inner community of ego states, usually guided
under deep relaxation.
Higher self/hidden observer: Ego states identified as the deeper self which functions as central core (Hilgard & Hilgard,
1975).
Inner child: An individual ego state or cluster of ego states that appear during childhood.
Imprinting: the bio-physiological associations of trauma to the reactionary stance of the victim, contributing to a
“fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we
think about, but also our very capacity to think” (Van der Kolk, 2014, p. 21).
Post-traumatic stress disorder (PTSD): A condition with symptoms listed and specified in the Diagnostic and Statistical
Manual DSM-5 with include exposure to or witnessing a traumatic event. It includes four clusters of symptoms of intrusion,
avoidance, negative alteration in cognitions and mood and alteration in arousal and reactivity (APA, 2013).
Definitions
Process guided imagery: Process guided imagery is a method of deep relaxation utilized to influence an internal sense of awareness to
sensation and thoughts. It is suggested that process guided imagery does not induce a full hypnotic trance.
The healing journey: Rapid pain release method (RPR): This is the method under study created by Larry D. Beall, PhD. A scripted
process guided imagery technique. The imagery includes access to individual ego states with suggestion to release pain or move pain.
Top down process: Information is processed utilizing a conceptually-driven modality which is influenced by expectations, existing
beliefs and cognitions (Cherry, 2015). The process utilizes the neurological networks primarily associated with the prefrontal cortex and
cortex.
Top-down treatment: Those approaches that focus on interacting with conscious functions and cognitive structures of the brain in
order to reduce sensitization to distressing material (e.g. mind over matter).
Trauma: The phenomena that occurs when a person’s internal resources are overwhelmed by external stimuli.
Trauma disorder: The phenomena that occurs when a person’s internal resources are overwhelmed by external stimuli which
dysregulates adaptive limbic functioning and results in enduring distress and impairment.
Vaded Ego State: Parts of personality that are highly reactive due to the effects of trauma on neural development
Differentiation in Trauma
Specific Diagnostic Criteria → Labels
Trauma
VS.
General Dynamics
Event(s) + External Stimuli > Internal Resources
Activating
event
Cognitive dampening
Trauma Treatment ●
●
CBT and the Unspeakable Terror
Traditional methods and risk for traumatic reaction
● Deepening connection to trauma vs. releasing pain
● Top-down → risk for faulty neurological
reorganization (Porges, 2001)
● Severe lack of representation of new techniques (e.g.
Ego State techniques)
○ Research and Counselor Education
Challenges in
Problem: Execution, not principles
Trauma Treatment:
● Requires sufficient safety and orientation to
present
CBT +
-
Facilitate access to additional coping skills
Cognitive reassessment poorly mediates
visceral reactions (Lizarraga, 2016)
- CBT alone: Decaying efficacy over time (Shedler,
2010)
- CBT alone: leaves the injured self still injured
(Emmerson, 2003, p.195)
Ego State Theory
Thoughts/Behaviors
Memory
Memory
Memory
Memory
Identity
Identity
Identity
Identity
Traits
Traits
Traits
Traits
Ego State A Ego State B Ego State C Ego State D
Experiences
Neurobiology
Transactional Analysis
Person A Person B
Adult Adult
Firefighters
Exiles
Self
Multiplicity:
● Individuals create ego state “families”
comprising personality
Follow-up
Reduce Pain
Training
Skills
Behaviors and
Cognitions
Establish Safety
The Healing
● Created by Dr. Larry Beall, Ph.D.
● Process guided imagery, Not hypnosis
Release (RPR) ●
●
Metaphorical representation of pain
Release pain + improve part interaction = ego
strengthening
● Facilitates bottom-up processing
● Creates space for coping skill acquisition and
cognitive restructuring
The Healing
Journey: Rapid Pain
Release (RPR)
Practice-based
● Trauma
● Anxiety
● Depression
● Grief
● Chronic Pain
● Addiction
RPR:
The Stairs & The Meadow
1) Stacking
2) Getting help (as needed)
3) Burning it down
RPR:
The Place of Rocks
1) Four Rules
2) Balance, not Vengeance
RPR:
The Cabin
Resourcing technique
Findings ●
●
Emotional reaction to the process of RPR
Physical response
● Symbolic representation of pain and energetic
release
Limitations and
● Practice-based, phenomenological strengths
and weaknesses
Future Study
depression, daily functioning.
○ More test cases
● Contraindications: psychosis/schizophrenia
spectrum
● Other considerations
○ Suitability for manualization
○ Suitability for certain diagnoses (Complex PTSD,
high Dissociative Experience Scale scores)
○ Effects on overall progress in Tx plan
Conclusion
● Trauma treatment is challenging, demands
specialized approach
● Psychodynamic and psychoanalytic approach
work well
● Ego State work precipitates pain release, sets
Tx foundation
● Traumatology needs a push to explore new
methods
● Long history of practice-based effectiveness
merits deeper study
Contact Us
Dr. Michelle
[email protected]
References
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