Full Course Description

Janina Fisher’s Certified Clinical Trauma Professional Training Level 1 (CCTP): Working with the Neurobiological Legacy of Trauma

This program, the first year of a two-year certificate program, focuses on the applications of the neuroscience and attachment research to the treatment of psychological trauma. The program content integrates traditional psychotherapy methods with newer theoretical models based on both clinical and neuroscience research. Next, it expands on the research to describe and discuss the implications for treatment.

The implications for treatment are not simply the instructor or program developer’s individual ideas but are concepts widely supported in the trauma treatment field or by research. A number of widely-accepted treatment approaches are referenced and their interventions discussed in the light of the neuroscience research. The interventions cited in the seminar include: psychodynamic psychotherapy and psychoanalysis, EMDR, Sensorimotor Psychotherapy, Somatic Experiencing, Internal Family Systems, cognitive-behavioral therapy, couples and family therapy, clinical hypnosis, and.

The final third of the seminar focuses on complications found in trauma treatment, including dissociation, traumatic attachment, and unresolved shame, fear and anger. Ethical and professional standards are emphasized as they are relevant to each topic area.

Program Information

Objectives

Session I - Trauma and the Body

Demonstrate knowledge of three neurobiologically-based trauma responses and articulate how this information may inform choice of treatment interventions.
Appraise how the somatosensory and autonomic effects of trauma exacerbate symptoms of PTSD in clients.
Assess the role and treatment implications of procedural learning and memory in client presentations.
Incorporate sensorimotor interventions into treatments to decrease symptoms of PTSD in clients.

Session II - Working with the Complications of Dysregulation: Addictions, Eating Disorders, & Self-Destructive Behaviour

Assess the relationship between autonomic dysregulation and addictive or self-destructive behaviour in relation to assessment and treatment planning.
Articulate the necessity for an integrated treatment of trauma and addictive or suicidal behaviour to improve treatment outcomes.
Assess appropriate cognitive-behavioural techniques for treating autonomic dysregulation in clients.
Specify three somatic techniques for regulating autonomic arousal traumatic reactions in clients.

Session III - Working with Traumatic Memory: Principles and Techniques

Determine ‘implicit memory’ and break down its role in post-traumatic stress disorders as it relates to treatment outcomes.
Determine potential complications of addressing narrative memories of traumatic events in treatment sessions.
Specify three interventions that address these complications and put to practical use in session.
Analyze the efficacy of these interventions and distinguish the signs that traumatic memory has been sufficiently processed.

Session IV - Disorganized Attachment and the Traumatic Transference

Outline the root causes of ‘disorganized attachment’ status in children and its clinical implications.
Specify difficulties associated with disorganized attachment for symptom management.
Articulate the role of disorganized attachment on therapeutic transference/countertransference.
Utilize clinical strategies that reduce the complications of traumatic attachment in clients.

Session V - The Role of Dissociation in Trauma-Related Disorders

Differentiate ‘dissociative states’ versus ‘structural dissociation’ as symptoms of trauma and express their treatment implications.
Evaluate the role of structural dissociation in the treatment of complex trauma and personality disorders.
Diagnose common trauma-related internal conflicts and determine their impact on clients as it relates to case conceptualization.
Utilize mindfulness-based interventions to address resolution of internal conflicts in clients.

Session VI - Working with Shame, Fear and Anger

Articulate the role of shame as an adaptation to trauma and its treatment implications.
Specify the roles of fear and anger as animal defence survival responses to traumatic experiences in clients.
Demonstrate use of both somatic and cognitive interventions to decrease shame, fear and anger in clients.
Determine the role of re-framing in the successful treatment of post-traumatic emotional responses in clients.

Outline

Session I: Trauma and the Body

How the body and brain respond to threat
Implicit remembering as the hallmark of trauma-related disorders
Triggers and triggering
The long-term somatosensory and psychological effects of traumatic experiences
Understanding trauma-related procedural learning
Working with the traumatized nervous system
Restoration of precortical functioning
Increasing client ability to regulate the nervous system and tolerate triggering

Session II: Working with Complications of Dysregulation

The consequences of autonomic dysregulation
Addictive behaviour
Eating Disorders
Suicidal and self-harming behaviour
Post-traumatic complications of abstinence and sobriety
An integrated treatment for trauma and unsafe/addictive behaviour
Top-down approaches to regulating dysregulation
Bottom-up somatic approaches to regulating dysregulation
Differentiating unsafe versus ‘safer’ versus safe behaviour

Session III: Working with Traumatic Memory: Principles and Techniques

What brain science has taught us about traumatic memory
Recognizing and understanding implicit memory in client presentations
Do we treat traumatic events? Or do we treat their consequences?
Remembering vs. reprocessing vs. repairing
‘Telling the story’
Resolving the implicit memories
How do we know when memories have been adequately resolved?
Creating a healing story

Session IV: Disorganized Attachment and the Traumatic Transference

Attachment and trauma
The effect of having attachment figures who are neglectful or abusive
“Frightening and frightened” parenting
Disorganized attachment and its consequences
Understanding the effect of disorganized attachment on the therapeutic relationship
Traumatic transference challenges
The therapist as a trigger and a neurobiological regulator
Using the social engagement system to overcome the challenges

Session V: The Role of Dissociation in Trauma-Related Disorders

Dissociation: normal versus pathological dissociation
Dissociative states versus structural dissociation
Understanding the structural dissociation model as a trauma model
Using mindfulness techniques to identify emotional and behavioural responses as ‘parts’
Recognizing internal conflicts as survival-related conflicts driven by structurally dissociated parts
Mindfulness-based interventions to strengthen client resources and prefrontal functioning
Developing empathic relationships to one’s parts
Resolving inner conflicts and healing the past

Session VI: Working with Shame, Fear and Anger

The role of emotion in trauma treatment
Shame as a survival strategy
Using somatic and mindfulness-based interventions to address the effects of shame
Fear as an animal defence response
Changing client relationships to fear
Anger as an animal defence response
Re-framing anger as a ‘bodyguard’ or protection
Using somatic and mindfulness-based interventions to address fear and anger

Copyright : 01/11/2018

Janina Fisher’s Certified Clinical Trauma Professional Training Level 2 (CCTP-II): Treatment of Complex Trauma and Dissociative Disorders

This second-year seminar program concentrates on complex cases and dilemmas: resistance and stuckness, treatment-resistant depression, therapy-destructive behavior, regression, characterological issues, identity and sense of self, and vicarious traumatization. Using research-supported theory, we attempt to understand the etiology of complex symptoms and presentations from a trauma perspective and to apply the treatment approaches most likely to be effective in each individual case. The program content integrates traditional psychotherapy methods with newer theoretical models widely supported in the trauma treatment field.

A number of widely-accepted treatment approaches are referenced and their interventions discussed in the light of the neuroscience research. The interventions cited in the seminar include: psychodynamic psychotherapy and psychoanalysis, interpersonal neurobiology, EMDR, Sensorimotor Psychotherapy, mindfulness-based cognitive therapy, clinical hypnosis, couples and family therapy, and Internal Family Systems. Ethical and professional standards are emphasized as they are relevant to each topic area as well as cross-cultural sensitivity.

Program Information

Objectives

Session I - Introduction to the Treatment of Dissociation

Determine three signs or symptoms of ‘complex trauma’ as it relates to case conceptualization.
Differentiate dissociative compartmentalization vs. alterations in consciousness.
Apply the Structural Dissociation model as related to clinical treatment.
Determine signs of altered consciousness in traumatized clients.
Discriminate symptoms caused by activity of trauma-related parts.
Discriminate signs of voices found in dissociative disorder versus schizophrenic clients.
Specify therapist interventions that increase patient ability to identify and determine dissociated parts to improve client level of functioning.
Articulate role of mindfulness-based techniques in the treatment of dissociation.

Session II - Increasing Awareness of Dysregulated Parts and Dissociative States

Determine signs of dissociative parts in the therapy hour.
Determine manifestations of parts observed in physical presentation and facial expression in session.
Differentiate characteristics of fight, flight, freeze, attach and submit parts.
Utilize the term ‘blending’ as it applies to structurally dissociated parts for symptom management.
Implement parts language as an intervention in the therapy of dissociative and dysregulated clients.
Determine and analyze dissociative “switching” to improve client engagement.
Utilize clinical strategies to increase internal communication in clients.
Determine the therapist’s role in ‘coaching’ internal dialogue skills to improve treatment outcomes.

Session III - Working with Traumatic Memory in DID: Implicit Memory and Animal Defense Survival Responses

Determine the distinction between trauma-related explicit memory and implicit memory for purpose of client psychoeducation.
Differentiate implicit memories versus situational emotional responses.
Determine the complications of treating event memories with dissociative disorder clients to improve clinical outcomes.
Utilize clinical strategies to determine the role of animal defence survival responses in dissociative disorders and their relationship to traumatic memory.
Determine characteristic trauma-related internal conflicts found in trauma-related disorders as related to clinical treatment.
Utilize clinical strategies to develop client’s ability to determine internal conflicts as struggles between parts to improve clinical outcomes.
Determine indications and best practices for processing traumatic memories to inform the clinician’s choice of treatment interventions.
Apply the meaning of the term “integration” in the treatment of dissociation as it relates to case conceptualization.

Session IV - Traumatic Attachment and the Treatment of Dissociative Disorders

Apply the concept of “controlling strategies” as a complication of disorganized attachment to improve client level of functioning.
Determine the implications of the controlling strategies in dissociative disorders as related to clinical treatment.
Differentiate the interaction between traumatic attachment and self-destructive behaviour to improve treatment outcomes.
Articulate the effects of traumatic/disorganized attachment on the transference.
Demonstrate uses of right brain-to right brain communication to address attachment-related issues.
Utilize interventions for enhancing internal collaboration.
Apply the use of the social engagement system (Porges) to improve client engagement.
Facilitate increased access to states of self-compassion to improve client level of functioning.

Session V - Working with Regression, Aggression and Passivity

Articulate the role of regression and aggression as survival responses to threat.
Analyze personality disorder diagnoses in the light of research on disorganized attachment in clients.
Specify verbal and somatic interventions for working with client dependency as related to clinical treatment.
Demonstrate use of somatic and cognitive interventions to ameliorate devaluing and verbally aggressive behaviour.
Articulate the role of depression as an adaptation to trauma.
Specify cognitive and somatic interventions for addressing chronic depressive states in clients.
Determine how to address depression and passivity as a part to improve client level of functioning.
Apply the use of positive re-framing in work with parts of the personality as it relates to treatment outcomes.

Session VI - Integration and Healing

Articulate the traditional view of integration used in dissociative disorders treatment.
Evaluate the complications of a focus on ‘integration’.
Demonstrate interventions for increasing internal communication and cooperation among parts.
Demonstrate internal collaboration as an alternative to traditional models of integration in a clinical setting.
Determine how “healing” has been defined historically as it relates to clinical practice.
Articulate ‘bottom-up’ approaches to healing that have developed over the past ten years.
Determine the ‘negativity bias’ and its effects on psychological health and resilience in clients.
Outline the role of self-acceptance and compassion in the healing process to improve clinical outcomes.

Outline

Session I - Introduction to the Treatment of Dissociation

What distinguishes ‘complex trauma’ symptoms from the symptoms of simple PTSD?
The Structural Dissociation model as a trauma model
Assessment and diagnosis of dissociative symptoms
Assessment questions and measures
Mindfulness-based techniques in the treatment of dissociation
Teaching mindfulness skills to fragmented individuals
Differentiating structurally dissociated parts of the personality
Using the language of parts

Session II - Increasing Awareness of Dysregulated Parts and Dissociative States

Treatment challenges in working with complex trauma and dissociation
Identifying signs and symptoms of dissociative parts
Differentiating the presence of fight, flight, freeze, attach and submit parts
Increasing dual awareness
Dissociative switching and “blending”
Helping clients increase their ability to “unblend” from trauma-related parts
Helping clients decrease dissociative “switching”
Distinguishing psychotic versus dissociative symptoms

Session III - Working with Traumatic Memory in DID: Implicit Memory and Animal Defence Survival Responses

Memory systems: explicit and implicit, voluntary versus involuntary
The role of procedural memory in complex trauma
Helping clients differentiate implicit and procedural memories from situational responses
Dissociative compartmentalization as a complication in memory processing
Loss of a sense of time and place due to fragmentation
Re-thinking the role of witnessing client’s traumatic experiences
Discuss indications and best practices for processing traumatic memories in this population

Session IV - Working with Regression, Aggression and Passivity

Traumatic attachment and animal defences
The “controlling strategies” in individuals with disorganized attachment
Regression and aggression as controlling strategies driven by trauma-related parts
Working with regressive states and child parts
Aggression in therapy: devaluing and self-destructive behaviour
Working with verbally abusive and devaluing parts
Depressive states as an adaptation to trauma
Interventions for addressing chronic depressive states

Session V - Traumatic Transference in the Treatment of Dissociative Disorders

Stimulation of the attachment system in therapeutic relationships
Effects of traumatic/disorganized attachment on the transference
Why some clients become more dysregulated rather than less
Co-regulation and right brain-to right brain communication
How therapists can use contingent co-regulation in treatment
Internal attachment versus self-alienation
Using the social engagement system
Rupture and repair: visualization techniques for repairing childhood attachment failure

Session VI - Integration and Healing

‘Integration’ as the goal of dissociative disorders treatment
What does it mean to be “integrated”?
The evolution of treatment models for dissociative disorders
Identify interventions for increasing internal communication and cooperation among parts
Markers of progress in fragmented individuals
How should clients and therapists define “healing”?
Self-acceptance and compassion in the healing process
Best practices in trauma treatment

One Size Doesn’t Fit All

Despite advances in trauma research and claims of “gold standard” treatments, one method doesn’t work for everybody. Trauma treatment requires addressing many different systems that can be affected in different ways in different people. Understanding how to adapt and apply interventions for individuals experiencing traumatic stress is as important as the interventions themselves. In this workshop, you’ll learn:

What we currently know about the impacts of developmental trauma on brain development
How to access what is the best clinical intervention for particular problems
Learn how we can change people’s internal map of predictions and expectations by introducing new experiences with precision, attunement, and interactions
Why the potential role of some unconventional approaches such as yoga, martial arts, and theatre are interesting subjects of current research

Program Information

Objectives

Investigate how traumatic stress impacts humans differently at different stages of development.
Describe the research on the impact of traumatic experience on future perception.
Construct a model for selecting individualised trauma interventions based on the client needs.

Outline

Identify the basics of the brain circuitry involved in self-experience, salience, and executive functioning, and how these are impacted by trauma
How trauma impacts the processing of subsequent experiences
Learn how physical mastery, memory processing, affect regulation, sensory integration and other techniques can help people from moving from being trapped in their traumatic past into living in the present
The potential role of both traditional and innovative techniques in the future of the field of traumatic stress
Summarize treatment strategies and alternatives to drugs and talk therapy

Undoing Shame

More than any other obstacle, shame can block the joy and peace traumatized clients seek in therapy. Feelings of worthlessness prevent them from metabolizing positive experiences. Rather than seeing their accomplishments and strengths as accurate reflections of who they are, shame sabotages their progress. Paradoxically, as clients get better in treatment, standing up for themselves more and reaching their goals, these shifts can evoke other forms of shame, like self-doubt and self-judgement. In this workshop, you’ll explore. You’ll explore how to:

Understand and accept the role of shame in surviving traumatic events
Undo negative beliefs rooted in traumatic events that fuel feelings of inferiority and unworthiness
Connect with and move through feelings of shame to make space for more pride and self-love

Program Information

Objectives

Summarize the role of shame and self-loathing as symptoms of trauma.
Identify the neurobiological effects of shame.
Discriminate the physiological and cognitive contributors to chronic shame.
Describe the survival advantages of shame.

Outline

The Role of Shame in Traumatized Individuals

How shame supports the dorsal vagal or submission response
Procedural learning of survival responses
How shame can be adaptive in a dangerous environment

The Neurobiological Effects of Shame

Flushing, gaze aversion, collapse, loss of speech
How somatic symptoms of shame become belief systems

Survival “Advantages” of Shame

Inhibiting behaviour that might elicit abuse
How shame supports loyalty to family over self
Shame as a non-threatening response to perpetrators

Interventions for Addressing Shame

Developing a mindful relationship to the shame as implicit memory
Cognitive re-structuring of shame as a survival response
Treating the shame as a child part humiliated by an inner critic

Limitations of the research and potential risks

Evaluating risk in use of mindfulness-based or cognitive restructuring techniques
Identifying clients appropriate or inappropriate for these approaches