My Approach to
Trauma-Focused Treatment

David V. Baldwin, PhD

All trauma-related disorders are inherently psychobiological.  Unfortunately, this view is at odds with the prevailing cognitive-behavioral view which sees PTSD as (only) a mental disorder.  Because it fails to understand the true nature of trauma, this prevailing view has difficulty accepting the varied symptoms observed in some people with PTSD, or understanding why comorbid physical disorders would be associated wth traumatizing experiences.  For a more detailed explanation of these views, please see my review article either at the Neuroscience & Biobehavioral Reviews website or here.  In any case, if you have had difficulty finding resolution for your trauma-related symptoms in prior attempts using either "talk therapy" or medications alone, this may be why.

Within the context of psychotherapy, the value of remembering and re-experiencing any available disturbing experience lies in the emotional healing and accompanying physiological discharge that allows such events to feel resolved and "in the past". This has nothing to do with legal understandings of "truth". My interest in emotional trauma stems from clinical, humanitarian, and scientific perspectives, and does not include legal or political debates surrrounding traumatic memories.

In addition to the standard practices common in all good psychotherapy, I primarily use three distinct approaches when working with traumatic-stress disorders in individual psychotherapy: Eye Movement Desensitization and Reprocessing (EMDR), Somatic Awareness, and Biofeedback. The specific ways that these approaches are combined varies with the needs of each individual patient; this requires experience, communication, and clinical judgement.

Eye Movement Desensitization and Reprocessing, a specific method of cognitive-behavioral therapy discovered and developed by Francine Shapiro, PhD, can be used for accessing or building internal resources; it may be particularly useful when it is possible to focus directly on the traumatic incident(s), as in recent or single-incident traumas. I was trained in EMDR by Francine Shapiro in June and August 1991, and have been an EMDR facilitator at (or sponsor of) EMDR Instititue trainings in the Pacific Northwest and elsewhere since 1992. Although this is sometimes the best approach, not all patients tolerate EMDR. When clinically indicated and well-tolerated, EMDR can often bring rapid and very effective relief from intrusive and other traumatic symptoms.
Somatic Awareness:
Somatic awareness approaches -- specifically Peter Levine's Somatic Experiencing (SE), Pat Ogden's Hakomi Somatics' Sensorimotor Psychotherapy, Bill Bowen's Psycho-physical Therapy, and aspects of other related somatic approaches (e.g., Bodynamics, etc.) -- epitomize gentle yet effective ways to approach traumatic material within psychotherapy. Somatic awareness aproaches can be most useful for helping patients build internal resources or avoid overwhelm, and may be combined with Biofeedback or EMDR. I've studied somatic awareness approaches for several years, through individual consultations with Bill Bowen as well as taking various trainings and teaching workshops. Learning somatic awareness methods requires extended time, since the necessary skills in observing and "tracking" sympathetic / parasympathetic balance develop only through practice.
Biofeedback -- both peripheral and central (Neurotherapy, or EEG Biofeedback) forms -- represents another distinct way to work effectively with traumatized patients. Peripheral biofeedback (e.g., providing information about breathing, blood pressure, or heart rate variability) helps patients become more aware of their bodies; this greater insight permits them to monitor and reduce physiological arousal or reactivity, moderating their levels of activation. For some patients, this may open the door to discuss traumatic material in psychotherapy. Neurotherapy (EEG or central biofeedback) may be particularly appropriate where the patient is dissociative, or lacks somatic awareness -- resists (or fears) attending to their own body or somatic sensations. Additionally, the software I use for neurofeedback training (NeurOptimal; formerly NeuroCare Pro) permits monitoring electrical activity in the brain during psychotherapy sessions, can help deepen eyes-open and eyes-closed states (through fractionation), and allows joint time-frequency analysis of brain electrical activity (e.g., comparing pre- and post-session samples, or measuring change across sessions). After experiencing these applications, clients' perceptions regarding emotionally-charged traumatic events may change -- furthering our therapeutic discussions.

With clinical judgement and communication with clients, these distinct approaches can be effectively combined. Together -- by strengthening internal resources, building somatic awareness, increasing insight, reducing dissociation, and deepening presence -- these methods facilitate patients' resolution of traumatic issues that may have seemed overwhelming at the outset of therapy.

Obviously, the range of possible traumatic events varies broadly and individuals' responses to these experiences also differ widely; thus, the specific clinical approaches I take are tailored to the internal resources and treatment needs of each individual client as this changes over the course of our work.

Generally, my stance concerning traumatic memories within treatment is to:

  1. Stay a couple of steps behind the client in this work, generally keeping my intuitions or interpretations to myself;
  2. Ascertain that client's current internal resources (e.g., ego strength, affect tolerance) are adequate, or strengthened (see above), before beginning to process early chronic traumatic experiences, so that this difficult work is seldom overwhelming.
  3. Focus on what troubles the client in their life now, then noticing and following associated sensations, feelings, thoughts or images -- rather than "going after" memories of possible past trauma directively;
  4. Remain open to alternate possibilities and explanations; and
  5. Remember the goal is to help my clients function in the present, not necessarily to uncover as much memory as possible -- though trauma-focused therapy often does involve retrieving and resolving old and painful memories.

Consequently, I do not take cases where someone wants me to help them remember something that "might" have happened. Further, I am not interested in participating in courtroom expert testimony for either the defense or the prosecution; I may be willing to appear as an expert psychologist for the court, but the purpose of this would be testimony on emotional trauma, not about any patients or former clients of mine.

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