We proudly announce the publication of Principles and Techniques of Trauma- Centered Psychotherapy this spring by Drs. David Johnson and Hadar Lubin, Co-Directors of the Center. The book was published by the American Psychiatric Publishing company, which is associated with the American Psychiatric Association.
“This book emerged out of the training courses we taught to our staff and interns over many years,” commented Dr. Johnson, “and we owe a great deal to them for helping us clarify and organize the material.” The book presents an integrated and in-depth method for conducting trauma inquiry, regardless of the theoretical orientation of the practitioner.
“Asking for details of traumatic experiences can take courage on the part of the therapist as well as the client,” emphasized Dr. Lubin, “because of everyone’s natural avoidance of the horror and helplessness of trauma.”
The book contains many detailed clinical examples to help therapists understand the nuances of the technique, more than is usual in texts on trauma treatment.
Dr. Johnson concludes, “This book is the result of our years of working with traumatized people, and learning from them what is helpful and what is not. We hope that we have been able in just a little way to transform their pain and suffering into knowledge that will help other therapists be more effective with their clients.”
Many individuals with PTSD also struggle with substance abuse. One study found that, in women with PTSD, as many as 59 percent have sought treatment for substance use disorders. Because these substance abuse treatments often only deal with the behavioral aspect of addiction, and do not address the traumatic root, people with PTSD and addiction often find that these treatments don’t “stick.”
Why is it necessary to address a person’s trauma history when treating their addiction? Imagine that every person is like a bucket, whose goal it is to be filled up with resources and energy that give them a sense of fulfillment in the world. Trauma creates a hole in that bucket, which creates a void many traumatized individuals attempt to fill with things like drugs, alcohol, food, sex, or money.
The hole that the trauma put in the bucket can only be repaired by what was lost; love, trust, peace, security and so on. Food does not repair the loneliness of abandonment; only caring relationships do. Sex does not replace the sense of safety lost in violence; only peaceful experiences do. Drugs and alcohol may temporarily alleviate the feelings of emptiness, but over time, if the holes are not repaired, they get bigger and the void gets deeper.
Trauma-centered treatment can help a person identify exactly what it was that was lost in the trauma, so that the individual can be empowered to repair the hole and start filling the void with healthy relationships and positive experiences.
Co-Director Featured on "Mind Matters"
Hadar Lubin, MD, Co-Director of the PTSC was featured in a recent episode of "Mind Matters" on WESU 88.1 FM, addressing the consequences of trauma and the PTSC's approaches to healing from it. The show's host, Dr. Helen Evrard, inquired about the main principles of trauma-centered psychotherapy.
Dr. Lubin stated that the approach of the PTSC is to provide opportunities for individuals to openly discuss the way trauma has impacted their lives.
Dr. Lubin said that when someone comes to the Center, the clinicians assume that the effect of the trauma is the most important aspect of their condition. People are either flooded by memories of the trauma or, alternatively, spend a lot of energy to avoid remembering them. Either way, it takes a great deal of effort to manage. So when clients come to the Center, the clinician immediately communicates their understanding that the trauma is on their mind.
“The first question we ask is, ‘What happened?'"
Dr. Lubin explained that the trauma clinician’s role is to gain an understanding of what happened to a client and how they are pained by it, so as not to prolong the client's suffering by colluding with the avoidance that fuels their symptoms. "Our perspective is that any delay that we take in addressing the trauma communicates to the client that we are either not ready to listen to it, or we do not understand how disruptive it is in their life."
Dr. Lubin continued, "Trauma is very upsetting. By discussing it directly, we assume clients may get initially upset or distressed, however the expression of these emotions is an important part of addressing the problem. We are not frightened by a display of emotion, and communicate to our clients that they need not be frightened by their emotions either. Rather than engaging in avoidance, numbing, or maladaptive behaviors such as substance abuse, actively expressing the emotion while remembering what happened helps to lower their anxiety."
Jesse Toth is a Licensed Professional Counselor and Registered Drama Therapist. She is a supervisor at the Post Traumatic Stress Center and has been a clinician at the Center for 3 plus years.
Why trauma work?
I believe everyone has their own unique story, including traumas that have happened to them. In some of my former work I found it frustrating that trauma was avoided. Addressing it, in my perspective, is the only way to make it better.
What brought you to the Center?
I finished up my initial training at the San Francisco VA medical hospital working with US military veterans who suffered from PTSD amongst other diagnoses. The team at the PTSC presented at a conference and I was intrigued and inspired. I thought it might be fun to try Connecticut and continue the trauma work. The rest is history.
How do you self-care?
I write. I take photographs. I spend a lot of time with my dog. I am working on being more active. I also make my office a calm and meditative space for myself and my clients.
What’s your favorite quotation?
“Don’t ask yourself what the world needs; ask yourself what makes you come alive and then go do that. Because what the world needs is people who have come alive.” Howard Thurman
What’s one thing people don’t know about you?
I can tap dance.
What do you hope for?
I hope one day people can talk about their own specific traumas without experiencing stigma.
A Bird's Eye View of Trauma
A new sculpture has recently been placed in the second floor lobby!
Writing and Sculpture by A. E. Aaronsohn
The birdhouse came in a box. Nothing fancy. Like my life in the aftermath of what happened and everything that didn’t happen, I had several pieces varying in shape, size and texture with which to build. I didn’t even like all of the pieces. Some seemed too small, or looked too big, or were too rough to the touch. The function and purpose of certain pieces were unknown at the outset of the process and seemed useless. They were just there. All of the pieces were mine.
The single most important choice a trauma survivor makes is the choice to heal. Redefining what healing is – or what it means to be healed - is the second.
Sometimes patients and clinicians focus so much on what trauma has done that we overlook the opportunity to understand what it hasn’t. Trauma did not take away the capacity to choose to rebuild my life with the pieces I had. Many pieces had been lost. Many pieces had been gained – including loss. That was a big, new, piece. All of the pieces were mine, even the one’s I didn’t want or thought I couldn’t handle.The process of building the birdhouse was much like piecing together my life. Here is some of what I learned.
You only get so many pieces to work with. Not all pieces must be used, but they are all there and can be.
The importance of each piece may vary at different stages. Some pieces need to be in place before others.
Instructions can be useless, adding the pressure to build it “right”. Might as well build it your way.
Your life is your own self portrait. If you sculpt your entire life, then that is exactly what you have done.
Some things stick well together; the opposite is also true.
It is important to take breaks and turn away from that which is in front of you in order to gain perspective, so that you may return with greater perspective.
A relationship with God isn’t needed to build a birdhouse, but a relationship with yourself is.
It’s ok if your birdhouse doesn’t look like anyone else’s.
You can stop what you’re doing at any time, but if you stop, your birdhouse won’t change, it’ll remain the same.
Patience is required; there are many periods of waiting.
One will often be met with opposition, sometimes from within. Opposition often fuels enriched growth.
Ideas, like feelings, must oftentimes be re-examined, worked and re-worked from different angles.
Rebuilding after trauma requires looking at the pieces of truth of your own life. Within those truths exist opportunities for new ideas, realizations and understandings to take flight, nestle in or both. Choice is an essential tool in sculpting the once-incomprehensible: a journey of healing and self-discovery anew. Choice is a tool. All of the pieces are yours.
An important component in the day-to-day operations of the Post Traumatic Stress Center is an extensive training program for all its clinicians. A new program was instituted two years ago which is working to extend the reach of the training to international and out-of-state clinicians. The Center has welcomed over 10 residents in the past 2 years from the Netherlands, Belgium, and Israel, as well as across the USA.
Every three months, the Center welcomes residents to our training program. Applicants’ experience can range from early career clinicians or those who have already been engaged within a lengthy career. Accepted residents have the benefit of attending weekly seminars in trauma treatment and drama therapy, as well as training to function as a full participant in the ALIVE school program.
After an orientation period, residents shadow full-time clinicians for onsite training. They partake in the ALIVE school’s Miss Kendra program as well as stress reduction sessions. Within a month, residents begin to take on certain duties on their own with increasing demand as their residency progresses. Weekly supervision and processing of their experience has been indicated by residents as vital to their success throughout the residency program.
Residents have returned to their home countries and have begun to pilot projects based on their training within the PTSC. These residents have been indispensable to the ALIVE school programming and have added much to the regular programming within the PTSC.
Where are they now?
Spreading the Word About
Educating future clinicians is one of the many functions of the Post Traumatic Stress Center. Every year new interns and budding therapists arrive and then depart taking with them the knowledge they’ve obtained about the trauma model. This article tracks where some of the diverse places that the trauma model trainees have ended up.
Dr. Rebecca Giagnacova, who began with the PTSC as a psychology intern in 2005 and continued until 2010, has gone on to work at a university counseling center where she is routinely referred clients with trauma histories. Originally she worked primarily with sexual assault victims but more recently she has become an ally for the LGBTQA community on campus.
When asked to reflect on how her experiences at the PTSC have informed her current work, she explained that she acquired “a social justice approach to therapy” from her training. She feels she can “stand in solidarity with people who have experienced suffering” and create “a safe place so that suffering does not have to happen alone” … that it “can be transformed into something meaningful.”
Dr. Giagnacova discussed how being willing to talk about the trauma with a client establishes a more immediate rapport and builds a healing bond. In addition to working with clients in individual, group, couples, and family therapy, she trains other staff in trauma-centered psychotherapy and collaborates with other departments on campus who need her trauma-focused expertise.
Jason Frydman MA, RDT, began working at the PTSC in 2011 and returned to graduate school in 2013 to pursue a doctoral degree in School Psychology. He works as a clinician in a community mental health center in an urban setting where exposure to trauma is high. Using trauma-centered psychotherapy with individuals, families and groups is key to helping his clients “lower their symptoms, organize their thoughts and feelings, and engage in posttraumatic growth.” He credits his training at the PTSC with helping him to appreciate the impact trauma can have on the whole person, through psychological, emotional, and cognitive domains. His work expands beyond the clinic as well, as he is engaged in academic research looking into the impact of trauma on school functioning.