Registration now open for January 11, 2021 session

TraumaOnline

The newsletter of the

International Trauma Training Institute (ITTI)

www.traumaonline.net

Mike Dubi, Ed.D., LMHC, Editor

Jeanne Thomas, MBA, Associate Editor

Winter 2020, Vol. 3, No. 4

From everyone at ITTI, we wish you a safe and happy holiday season.

As COVID hit last spring, we reduced our course fees by 10% from $220 to $198. We will continue that policy throughout 2021.

ANNOUNCEMENTS

With the new session starting on January 11, 2021, we are pleased to include two new courses: Internal Family Systems & Trauma by Alyssa Weiss Ph.D., and Motivational Interviewing by Jim Reynolds, Ed.D. Both courses consist of 6 weekly modules.

Webinar #3 - Basic Techniques in Trauma Treatment with Mike Dubi, Ed.D., LMHC, is scheduled for January 13, 2021 at 1pm Eastern Standard Time. The fee is $25. Register here.

Erasing Anxiety: Understanding & Treatment is now approved for post-course certification by Evergreen Certifications.

We continue to seek contributions to our newsletter and to our professional journal, The Practitioner Scholar. If you have ideas or suggestions please contact me at mdubi@comcast.net.

We all look forward to a healthier and safer 2021.

Mike Dubi, ITTI President

TRAUMA ROAD MAP

WEBINAR SERIES

(via Zoom)

This series of 1-hour long webinars will cover topics such as 1) Trauma and Brain Basics, 2) What Works in Trauma Treatment, and 3) Basic Techniques in Trauma Treatment.

These webinars will provide a road map to help inexperienced professionals begin training in trauma treatment. They will also provide experienced professionals with a review of trauma fundamentals.

These webinars will allow 15 minutes of Q&A. One (1) CE Hour will be awarded upon verified completion.

Click here to register

January 13, 2021

1-2pm EST

Basics Techniques in Trauma Treatment

Presented by

Mike Dubi, Ed.D., LMHC

Basics Techniques will cover:

-Fast and Easy Case Conceptualization - PIDIB

-Techniques to Teach as Homework:

Tapping/Touching Technique
Meditation Technique & Relaxation Response

-Techniques to Be Used in the Office:

Bilateral Stimulation
Laughing Technique
From Hypnotherapy

-Post Traumatic Growth

Cost: $25

Click to register

beginning on

January 11, 2021

To see course descriptions and to register, click this link:

http://traumaonline.net/online-training/

ARTICLE

THE FAWN RESPONSE:

THE LINK BETWEEN TRAUMA

AND PEOPLE-PLEASING

Dr. Jakub Owca and Dr. Andy Brown

Psychiatrist and author, Bessel van der Kolk has spent his career advocating for the inclusion of developmental trauma, also known as complex post-traumatic stress disorder (C-PTSD), into the Diagnostic and Statistical Manual of Mental Disorders (DSM). Despite his efforts, clinicians still do not have an effective or robust classification system for clients who have been exposed to protracted trauma. Moreover, the current definition of trauma is limited in that exposure to some form of bodily harm is required to meet criteria for post-traumatic stress disorder (PTSD). This definition of trauma does not envelope individuals who grew up in an atmosphere where they suffered chronic shaming, real or perceived abandonment, systemic oppression and other stressful events that might not include bodily injury or become life threatening. Additionally, research has supported the fact that these interpersonal traumas affect the brain in similar ways to physical trauma. “Trauma affects the entire human organism—body, mind, and brain. In PTSD the body continues to defend against a threat that belongs to the past,” writes Bessel Van Der Kolk in his notable work The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. While clinicians and diagnosticians debate the intricacies of C-PTSD it is a seemingly obvious fact that it is a clinical phenomenon marked by significant and lingering distress.

Current literature links the experience of complex trauma to specific reactions. Among those, most clinicians are familiar with fight, flight and freeze responses. Pete Walker proposes a fourth response which he coined the fawn response. It exhibits itself as a tendency to focus on others with servility while abandoning the self. Behaviors include a person always saying “yes,” caring for others to the detriment of the self, being unable to express genuine thoughts or feelings and struggling to feel seen by others. According to Walker, the fawning individual will act in these codependent ways to ward off the threat of re-traumatization.

For several years I have worked with a woman named Lynn (not her real name) who was plagued by fawn tendencies. In individual therapy, she would relate to me with deference. She would watch the clock like a hawk to ensure she would not overstay her allotted 45 minutes. Additionally, she would apologize profusely on the rare occasion she would be a few minutes late to her session. In group therapy, she was always the last to speak, citing that other members had more important matters to discuss. Her anxiety was palpable, and she coped with it by ensuring that she made herself as small as possible and gave ample space and extreme doses of empathy to those around her. Other group members and I were aware of this tendency, but her anxiety was so high I decided to proceed carefully by not putting the spotlight on Lynn suspecting that she could not yet cope with pointed attention in the group.

The client in question is not the only one that I have treated with this particular presentation. Just like her, similar clients reported a history of traumatic experiences that often occurred in the home. Shame and stifling of anger were the common threads that I observed in all those cases. To better understand this fawning reaction, I looked to the body of psychodynamic literature, which eventually culminated in my doctoral dissertation.

Psychodynamic authors have argued that anger is an emotion that is necessary for productive living. Stifling the release of anger results in what has been coined by Heyman Spotnitz as the narcissistic defense. In some instances, an individual who is unable to protest injustices perpetuated against them will instead turn the anger inward. As a result, this individual will suffer from low self-esteem, self-attacks and in many cases fawning tendencies. Therefore, in psychodynamic therapy, deliberate and accidental frustrations are given special consideration.

When I saw Lynn in individual therapy, she would make mention of the fact that one particular member of the therapy group had a tendency to make me laugh. Although it was true, I asked Lynn what feeling was associated with her accurate observation. As Lynn grew more uncomfortable, I remarked that maybe she felt some anger toward me because another member made me feel special by sharing some humor. As predicted, Lynn engaged in the narcissistic defense of self-shaming, stating, “I guess I’m just not that funny.”

Donald Winnicott indicated that for therapy to be effective, the analysand must subject the analyst to “maximum destructiveness” while the analyst displays an ability to withstand such intense emotions without retaliation. However, when working with clients exhibiting fawn tendencies, it is important for therapists to recognize that individuals whose anger was thwarted will have a difficult time expressing this emotion. Jacob Kirkman identified three reasons for avoiding anger. First, a client may fear retaliation. Second, a client may fear destroying an individual with their rage. Third, the client may be afraid of destroying any sense of goodness they feel toward the target of their aggression. The latter was the case for Lynn.

In one group therapy session, I was pressing a particular member quite hard around his tendency to over-function at work. I turned to another member and in a similar fashion went after their defenses with an analytical scalpel. My therapeutic zeal was out of control, as I was determined to demonstrate my value as a group therapist. Reflecting back on this situation, I realize that this was not my best therapeutic moment, but I am also of the belief that there is no such thing as a clinical mistake as long as there is awareness over the effects of such a mistake. I did not have to reflect too hard as Lynn read me the riot act for the very first time. Anger flew out of her with ruthless abandon. She pointed out that I was being insensitive to some members while “doing the work for others” whereas she was lucky to get a commercial break. In a rapid moment of introspection, I agreed with Lynn, thanked her for pointing out the dynamic and inquired into how she felt toward me for having done so. She continued to express her anger by saying that group therapy is a fool’s errand. I redirected her and stated that maybe she felt that I was an inadequate leader who did not protect the group sufficiently and most importantly, I failed to cultivate a safe space for her to be her genuine self. She stormed out of the room. My heart was racing, and I tried convincing myself that my intervention was the right one. I did not know how she would process the interaction. Thankfully, we had a solid three-year relationship, and she returned the following week for our regularly scheduled individual therapy.

Walker stated that in the case of the fawn reaction, any expression of anger will automatically attach itself to shame. Shame serves as a protective emotion from various threats. To help an individual with a fawn reaction, Walker emphasizes calming the inner critic. This can be accomplished in several ways. A clinician can take a cognitive approach that would involve reconfiguring the shame response using logic. Simultaneously, the therapist can continue to draw anger toward themselves that would promote a sense of entitled anger.

As expected, Lynn was filled with shame when we met again. Her normal fawning tendencies were surprisingly accompanied by productive reflection as we discussed the incident in detail. She said her delivery was uncalled for and she should have had the presence of mind to assess the situation more fairly and acted in a more composed fashion. I challenged Lynn’s thinking by emphasizing that I did, indeed, disappoint her and that her observations were accurate. She laughed and indicated that she would never want to subject me to that again. We concluded with a fruitful discussion that we, in all likelihood would have many more “wild fights.”

Not all therapists agree that the fawn reaction is tied to complex trauma and that repressed anger is the maintaining factor of this presentation. In fact, there is a correlation that a therapist is less likely to make these connections the less they identify with the psychodynamic school of thought. Nevertheless, psychodynamic literature provides us with theory-based support that the fawn response is, indeed, tied to complex trauma and repressed anger.

Lynn’s explosive exit example provides a glimpse into one therapist’s experience of the utility of unearthing repressed anger in the case of the fawn response. As usual, more research is needed on the fawn response, particularly research which will lead to therapeutic interventions necessary to abate this manner of relating with the social world. Until this research is produced, psychodynamic theory offers a very powerful tool in the form of excavating anger. Perhaps when this research is eventually produced, developmental trauma will finally also receive the diagnostic recognition it deserves by being included in the DSM and those who suffer from the realities of that kind of trauma will be better served by proper formal diagnosis and efficacious treatment options.

ABOUT THE AUTHORS

Jakub Owca is a therapist in private practice. He completed his doctorate in Counselor Education and Supervision at The Chicago School of Professional Psychology and a master’s in Counseling Psychology at Northwestern University. Jakub’s clinical work focuses on treating trauma and anxiety-related disorders. He also takes a special interest in working with gay men.

Andy Brown, Ed. D, LCMHC has completed his doctorate in Counseling Psychology and is currently a fulltime professor in Mental Health Counseling at The Chicago School of Professional Psychology. Dr. Brown is a Certified Master Traumatologist and serves as the Vice President of Education for the International Trauma Training Institute.

ABOUT OUR TWO NEW COURSES

Internal Family Systems & Trauma by Alyssa Weiss Ph.D.,

and

Motivational Interviewing by Jim Reynolds, Ed.D.

Motivational Interviewing

Jim Reynolds, Ed.D., LMHC, MAC

Jim Reynolds, Director of Addictions Training for ITTI, has developed a new course for our Addictions program which is approved by NAADAC (#193785 Exp. 5/1/22).

This course offers a detailed description and orientation to this effective evidence-based counseling perspective focusing on how to assist individuals to bring about change.

The theoretical foundations of Motivational Interviewing were built upon the person-centered theory of Carl Rogers.

At the core of Motivational Interviewing is the requirement of being a good listener. Many counselor educators would insist that being a good listener is perhaps the most important skill to possess. Empathic listening and communication skills can go a long way in reducing conflict, divisiveness, and strife.

Motivational Interviewing is an effective evidence-based counseling perspective which focuses upon how to assist individuals to bring about change.

It is also evocative and encourages us to recognize and utilize the experience of “ambivalence” regarding change. It is usually the case that part of us may want to change, but part of us does not.

Ambivalence is almost always present when people are considering change. As ambivalence currently appears to be skyrocketing in almost all areas of our lives, how can we learn to utilize this ambivalence to help draw out motivation to change? This course will specifically address how counselors can utilize this ambivalence to help bring about behavioral change.

This course presents the core skills and basic processes of Motivational Interviewing

Participants can learn how to recognize and assess client readiness to change. The course also provides information regarding how to direct discussions in a way that invites the client to make arguments for change.

To round out, the eight stages of learning Motivational Interviewing are explored in this course.

For an expanded view of Motivational Interviewing by Jim Reynolds, visit our blog at traumaonline.net/blog

Internal Family Systems & Trauma

Alyssa Weiss Ph.D.

Alyssa Weiss is a licensed Marriage and Family Therapist specializing in families who have children with special needs. Her main focus is on children diagnosed with Autism and associated disorders.

The Internal Family System Model, an integrative method to individual psychotherapy, was created in the 1980s by Richard Schwartz. This model incorporates system thinking with the view that the mind is composed of relatively separate subpersonalities. It provides an alternative understanding of psychic functioning and healing that allows for innovative techniques in relieving clients symptoms and suffering.

Dr. Schwartz developed Internal Family Systems in response to clients’ descriptions of experiencing various parts – many extreme – within themselves. He noticed that when these parts felt safe and had their concerns addressed, they behaved less disruptively and would be less disruptive and would acquiesce to the wise leadership of the entity Dr. Schwartz came to call the “Self.”

In developing IFS, he recognized that, as in systemic family theory, parts take on characteristic roles that help define the inner world of the clients. The coordinating Self, which embodies qualities of confidence, openness, and compassion, acts as a center around which the various parts revolve. IFS discovers the source of healing within the client, the therapist is freed to focus on guiding the client’s access to his or her true Self and supporting the client in employing its wisdom.

This approach makes IFS a non-pathologizing, hopeful framework within which to practice psychotherapy. The purpose of this course is to teach you how to implement the Internal Family Systems Model when working with families who have experienced trauma. As you move through this course you will be exposed to how trauma affects the brain, introduction to IFS model, how to apply the model, strengths and weaknesses of the model and its importance and application to Evidence-based practice.