1. CERTIFIED CLINICAL TRAUMA PROFESSIONAL: Trauma, PTSD, Grief & Loss J. Eric Gentry, PhD, LMHC Board-Certified Expert in Traumatic Stress

2. Day II

3. Certifications: CCTP: Certified Trauma Professional/Certified Clinical Trauma Professional CCFP: Certified Compassion Fatigue Professional CETP: Certified Expert Trauma Professional Certified SANATIVE Professional CSOTP: Certified Sex Offender Treatment Professional CYTP: Certified Youth Trauma Professional CFTP: Certified Family Trauma Professional QTIP: Qualified Trauma-Informed Professional Certified Master Trauma Professional Certified Anger Management Specialist Certified Gambling Addiction Professional FREE MEMBERSHIP!!!!!

4. Resources www.traumapro.net/resources Password: iatp2go CAPSULE 8: Survey of Effective Treatments

5. Graphic Time Line Use Part 1 of TRS 5 min – all the difficult/painful/traumatic experiences 5 min – all the positive experiences 30 min – verbal narrative International Association of Trauma Professionals 5

6. Graphic Time LifeLine Birth Present

7. +10 -10 Sexual Abuse Private practice Divorce – close of practice PhD Graduation NYC SF Active Addiction MVA Recovery Multiple positive personal & professional accomplishments Physical Abuse & DV MVA

8. Present +10 -10 Sexual Abuse Divorce – close of practice Graduation NYC SF Active Addiction MVA Physical Abuse & DV MVA

9. Cognitive Restructuring What would any reasonable rational human being come to believe about themselves(intellectually, emotionally, spiritually, psychologically, physically, socially, and academically) from having these things occur in their life? What would any reasonable rational human being come to believe about important relationships(intellectually, emotionally, spiritually, psychologically, physically and socially) from having these things occur in their life? What would any reasonable rational human being come to believe about the world at large from having these things occur in their life?

10. Early Sessions ACE – Trauma History TRS – Trauma History & Tx Planning PCL – Diagnosis Tools for Hope (Perceived Threat/ANS/Self- regulation) Psychoeducation Graphic Time Line of life including ALL significant traumatic experiences Verbal Narrative using GTL as map

11. Exercise Think of a difficult experience you encountered in your life (Then SUDs > 7) that has resolved (Now SUDs < 2). Answer the following three questions: 1.What were some of the effects in my life (behavioral/emotional/physical/spiritual) that occurred in the six months following this event and how did you adapt. 2.What helped me to resolve these effects. 3.Name one (or more) good thing(s) that came from this event. International Association of Trauma Professionals 11

12. Effects & Adaptation EffectsAdaptation AnxiousIncreased Alcohol Consumption ChaoticOrganization International Association of Trauma Professionals 12

13. Healing Healing Tools International Association of Trauma Professionals 13

14. What Good Came From Our Adaption Healing Tools International Association of Trauma Professionals 14

15. Tri-Phasic Model Tri-Phasic Model Herman, 1992 Safety (Stabilization) Remembrance & Mourning – Trauma Resolution – Desensitization & reprocessing – Metabolization of trauma Reconnection – Present & future

16. Tri-Phasic Model vs. Empowerment & Resilience Structure 16 TRI-PHASICEmpowerment & Resilience 1. Safety & Stabilization1. Preparation & Relationship 2. Psychoeducation & Skills-building 2. Remembrance & Mourning3.Desensitization & Integration 3. Reconnection4.Posttraumatic Growth & Resilience

17. What is Necessary? Six Empirical Markers 1.Resolve (real) Danger 2.Distinguish between real vs. perceived threat 3.Develop battery of regulation/relaxation, grounding, and containment skill 4.Demonstrate ability to self-regulate & self-rescue while accessing trauma memory 5.Contract (verbal) to address traumatic material – transfer of initiative to CT 6.Non-anxious presence + good prognosis ALL In Stage II Only for Stage III

18. Additional Skills Relaxation – PMR (sleep problems) – Anchoring – Tapping (TFT) Grounding – 3-2-1 Sensory Containment – Envelope method International Association of Trauma Professionals 18

19. Progressive Relaxation Start at toes – Tighten for 5 sec – Release for 5 sec – Repeat – Notice difference Each muscle group all the way to head Back down to toes International Association of Trauma Professionals 19

20. Anchoring - NLP Draw pix of place from hx or imagination that is safe & comfortable (5 min) “May I approach you?” Experiment – flashbacks of “good” stuff Anchor (squeeze) stone while telling story Carry stone for week – Squeeze when anxious – Squeeze when comfortable Report next week International Association of Trauma Professionals 20

21. Thought Field Therapy (TFT) Thought Field Therapy (TFT) Callahan What is Thought Field Therapy ® (TFT)? Thought Field Therapy (TFT) is a little-known, but highly effective, drug-free and non-invasive way to reduce or eliminate even chronic pain without the risk of medications. TFT was discovered and developed by California clinical psychologist, Dr. Roger Callahan. It works with nature’s healing system combining the acupressure meridian system and modern psychology. While there is increasing evidence as to its effectiveness for TFT (even more with EFT), especially with pain, we are using TFT here as a SELF-HELP METHOD for ANXIETY REDUCTION – not a treatment for traumatic stress!

22. SUDs 10 9 8 7 6 5 4 3 2 1 0 Distressing Thought

23. Thought Field Therapy (TFT) Thought Field Therapy (TFT) Callahan (1985; 2000) 1. Trauma Memory 2. SUDS 3. Algorithm (trauma) – Eye brow (8 -12 taps) – Under eye (8 - 12 taps) – Underarm (8 - 12 taps) – Collarbone (8 - 12 taps) 4. 9 Gamut – while continuously tapping 9-Gamut spot... – Eyes open – Eyes closed – eyes open down right – eyes open down left – eyes clockwise – eyes counterclockwise – hum a tune – count to five (aloud) – hum a tune 5. Repeat # 3

24. Thought Field Therapy (TFT) Thought Field Therapy (TFT) Callahan Callahan Techniques ®,Ltd. 78-816 Via Carmel La Quinta, CA 92253 (760) 564-1008 FOR ORDERS CALL 1(800)359-CURE Dept. WB OR FAX Your Order to (760) 360-5258 E-Mail joanne@tftrx.comjoanne@tftrx.com 6. SUDS If decreased 2+ units then repeat until SUDS = 0 If decrease < 2, then: 7. Psychological Reversal – tap on heel of hand –“ I accept myself event though I still _______ ” (3x)

25. Grounding Lose your mind and come to your senses Can be done to rescue from abreaction or taught in skills building session(s) Takes about 90 seconds 3 – 2 – 1 senses – See? – Hear? – Sensation? What is different? International Association of Trauma Professionals 25

26. End-of-Session/Containment End of Session Draw for 2 MINUTES an expression of what is happening inside of you Containing Trauma Draw for 1 MINUTE an abstract symbol of the memory International Association of Trauma Professionals 26 Have client place drawing in envelope Staple envelope closed Brief statement Therapy happens here/life out there I will keep this safe here (the pain and fear associated with it) Ask client at beginning of next session if they wish to work on the envelope material

27. STAGE III Desensitization & Integration International Association of Trauma Professionals 27

28. Stage III: Integration and Desensitization Explain that in the beginning it is your job to keep the brakes on, so that things don’t go too fast Creating narratives that can expand as needed and in the process lessen the reactivity to the event/events. Normalize difficulties, unwanted emotions, thoughts, behaviors and beliefs Focus on discovering and highlighting strengths and capacity Mourning or working through grief International Association of Trauma Professionals 28

29. Trauma Treatment BONA FIDE & EBT (TF)CBT – Prolonged Exposure – Direct Therapeutic Exposure Cognitive Processing Therapy EMDR NLP – V/KD Hypnosis Psychodymanic Rx (SSRI/SNRI) Utilized with Some Evidence SE/TRE Yoga ART/Brainspotting/BLS Traumatic Incident Reduction (TIR) TFT/EFT TRI Method Bio//Neuro-feedback Art/non-verbal Group Therapy

30. The IATP 5-Narrative Model (Gentry, 2004; 2011; 2014)

31. IATP NET Non-abreactive narrative trauma memory processing for desensitization and integration Trauma-Focused CBT Excellent tool for helping survivors have a positive mastery experience with confronting trauma memory Simple and easy to use Highly structured

32. Steps 15 – 30 min set up in previous sesison – Instructions for Graphic Time Line Written Narrative – Two 5min halves Pictorial Narrative Verbal Narrative Recursive Narrative Closure

33. Graphic Time Line Narrative 1 Introduced in previous session End Points (beginning & end) Beginning – When did you first perceive threat? End – When did you first realize that you were going to survive? Middle part completed as homework

34. Graphic Time Line Beginning End Impact Nissan Unbuckle seat belts Waiting w/ surgeon EMT=OK Upside down Flip & skid

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36. Written Narrative Narrative 2 5 min writing of the FIRST HALF of the GTL with RELAXED BODY INTERMISSION: Relaxation Skill (i.e., Diaphragmatic Breathing) 5 min writing SECOND HALF of GTL with RELAXED BODY 90 second prompts (“Keep your body relaxed;” “With a relaxed body, take two more minutes.”

37. Pictorial Narrative Narrative 3 Use template to have survivor draw six pictures that tell the story just written Draw endpoints first (Beginning & End) then full in four middle drawings 10 minutes max RELAXED BODY

38. Pictorial Narrative

39. Verbal Narrative Narrative 4 As soon as survivor completes drawing ask: May I approach you? Ask survivor to use the pictures to tell you their story with a REALAXED BODY No interruptions unless dysregulation Thank survivor when completed 15 min max

40. Recursive Narrative Narrative 5 Ask survivor: May I see your pictures ? (survivor hands pix to therapist) Tell back survivor’s story as accurately as possible using same language and inflections. Use third-person (Survivor's name and gender- specific pronoun) DO NOT embellish Therapist MUST keep relaxed body

41. CLOSURE 5 – 10 min at end of session to discuss survivor’s reactions Suggestions – Aerobic activity following session – Access & utilize support – 36 hours of re-experiencing/dissipating within 72 hours – Call if any difficulties Count backwards from 100 by 7s

42. GRIEF & MOURNING Counseling or Therapy? Grieving allows us to heal, to remember with love rather than pain It is a sorting process One by one you let go of things that are gone And you mourn for them One by one you take hold of the things that have become part of Who you are and build again --Rachel Naomi Remen In Worden, 2009

43. Grief Counseling vs Grief Therapy < 1 YEAR Assume Health and Support 1.Listen 2.Build & maintain relationships 3.Educate (validate & normalize) 4.Case Management (connect with services; help with basic needs) 5.Teach self-regulation > 1 YEAR Helper more active All support functions Facilitate narrative (eulogy) paired with relaxed body Help create new relationship with deceased. 43

44. Tasks of Mourning (Worden, 2009) 1.Accept the Reality of the Loss 2.Process the Pain of Grief 3.Adjust to a World without the Deceased (Object) a.External Adjustments b.Internal Adjustments c.Spiritual Adjustments 4.Find an Enduring Connection with the Deceased in the Midst of embarking on a New Life

45. GRIEF

46. Grief Normal Mourning Los s Energy >>>> Crescendo (usually tearfulness) Desensitize Recovery (remembrance with love instead of pain) Energy >>>>

47. Grief Normal Mourning Remembrance of the LOSS Energy >>>> Crescendo (usually tearfulness) Desensitize Recovery (remembrance with love instead of pain)

48. Grief Normal Mourning Energy >>>> Crescendo (less tearfulness) Desensitize Recovery (remembrance with love instead of pain) Remembrance of the LOSS

49. Complicated Bereavement & Mourning Los s Energy >>>> Crescendo (usually tearfulness) Desensitize Recovery (remembrance with love instead of pain) Fear and muscle constriction No Desensitization No Resolution Avoidance Bewilderment/Hopelessnes s Depression Suffering

50. PROBLEM to SOLUTION RELAXATION Remembrance of Loss + Relaxed Body = Desensitization and lessening of pain NARRATIVE Telling Story of Loss (Eulogy)+ Relaxed Body = Relegating Loss to the Past + Remembering with Love (instead of Pain)

51. Resolution Los s Energy >>>> Crescendo (usually tearfulness) Desensitize Recovery (remembrance with love instead of pain) Fear and muscle constriction Soften Muscles in Body Lower arousal Confronting pain Desensitizing fear Resolving grief

52. Three Steps to Resolving Grief 1.Supportive Relationship (must have people who we can turn to in our pain and who can listen without anxiety) 2.Relaxed Body (regulation by softening muscles) 3.Telling our Story (Narrative IS integration and relegates loss to the past allowing us to remember with love)

53. STAGE IV Posttraumatic Growth & Resilience International Association of Trauma Professionals 53

54. POSTTRAUMATIC GROWTH WHAT IS POSTTRAUMATIC GROWTH ? It is positive change experienced as a result of the struggle with a major life crisis or a traumatic event Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-471. Calhoun, L. G., & Tedeschi, R. G. (2013) Posttraumatic growth in clinical practice. New York: Brunner Routledge.

55. New Opportunities New Relationships Greater Strength Greater Appreciation Spiritual Maturation Calhoun, L. G., & Tedeschi, R. G. (2013)

56. POSTTRAUMATIC GROWTH MADE SIMPLE Perceived Threats (i.e. “stress”) Perceived Threats (i.e. “stress”) Confronted with Relaxed Body RESULTS IN… Comfortable Body > Minimal Distress Increased Motor & Cognitive Capacity/Performance Intentional vs. Reactive Behavior Facilitates & Accelerates Posttraumatic Growth

57. Healing Trauma Through Principle- Based Living

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59. RELAXTION PERCEIVED THREAT + DESENSITIZATION =

60. Joseph Wolpe (1955-56) CS (Anxiety) + Relaxation = Extinguished CR Engine of ALL effective psychotherapeutic treatments for anxiety/trauma Most trauma survivors confront perceived threats with ANS arousal (i.e., “brute force”). Treatment proper is teaching them to confront these perceived threats with ANS regulation (left-hand side of Yerkes-Dodson) BOUDEWYNS promulgated this idea in 1990. He was, however, inconsistent with the use of relaxation with exposure.

61. Direct Therapeutic Exposure Direct Therapeutic Exposure (DTE) is a behavior therapy technique pioneered by Patrick A. Boudewyns, where stressors are vividly and safely confronted to help combat veterans, and patients suffering from posttraumatic stress disorder (PTSD), panic disorder, or phobias. Exposure therapy has supporting evidence with both simple and complex traumas. BOUDEWYNS, P.A., & HYER, L. (1990). Physiological re­ sponse to combat memories and preliminary treatment out­ come in Vietnam veteran PTSD patients treated with direct therapeutic exposure. Behavior Therapy, 21, 63-87

62. Three stages 1. EDUCTION – Tools for Hope (Perceived Threat/ANS/Self- regulation/Intentionality) – Skills Development for Self-regulation 2.INTENTIONALITY (vs. REACTIVITY) – Covenant/Mission Statement – Code of Honor – Vision 3.COACHING – Confronting Perceived Threats (triggers) with Regulated ANS – Helping client to identify breaches & triggers – Continue confronting triggers with relaxed body

63. Trauma: Thwarting Intention – Breaching Integrity Covenant Trigger Reactivity Past painful and/or traumatic learning experiences See Hear Feel Taste Smell Vision ImpatientImpatient SnarkySnarky ResentfulResentful Loving & Supportive Listening Supporting Feeling Love Eric, you should…

64. Healing Trauma With Intentional Living Covenant Trigger Past painful and/or traumatic learning experiences See Hear Feel Taste Smell Intentionalit y Self- Regulation Vision Reactivity ImpatientImpatient SnarkySnarky ResentfulResentful Loving & Supportive Listening Supporting Feeling Love Eric, you should…

66. The Empowerment & Resilience Structure: An Active Ingredients Approach I.Preparation & Relationship II.Psychoeducation & Self- regulation III.Integration & Desensitization IV.Post Traumatic Growth & Resilience Rhoton & Gentry, 2014

67. 67 Exposure Narrative Exposure Narrative Interoception & Self-regulation Interoception & Self-regulation Therapeutic Relationship & Positive Expectancy Therapeutic Relationship & Positive Expectancy Cognitive Restructuring/ Psycho-education Cognitive Restructuring/ Psycho-education The Empowerment & Resilience Structure: An Active Ingredients Approach Stage I Stage III Stage II Stage IV Stage IV With Stages I & II completed, many survivors will experience a reduction in Criterion B symptoms to a level of comfort and will not need to revisit their trauma memories. Stage IV is self-help.

68. Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. - Viktor Frankl

69. J. Eric Gentry, PhD, LMHC PO Box 15729 Sarasota, FL 34277 (941) 720-0143 eg@compassionunlimited.com www.compassionunlimited.com www.traumapro.net www.kleenmusic.com