International Society for the Study of Trauma and Dissociation.
International Association of Trauma Professionals
We have found that there is no single approach to trauma that will be effective for every patient. The effects of trauma can manifest in a wide variety of ways that depend heavily on the uniqueness of each patient and their history. Our trauma therapists are allowed to specialize and are trained in multiple modalities for symptom management, direct trauma processing and repairing developmental gaps or attachment injuries. Our therapists regularly complete trainings in new and promising treatment modalities as they become available. We believe that in order to effectively treat trauma survivors we need to be able to tailor the treatment plan to the needs of the patient.
Our focus is on stabilizing patients, providing relief from dysregulation and identifying and changing the negative core belief schemas that are governing the lives of our patients. We do this by providing education, assistance with central nervous system regulation, tools for symptom management as well as processing the source of shame based core belief schemas/identities and then incorporating more adaptive beliefs. In this way we assist patients in improving self-esteem, self-worth, and improving quality of life by enabling patients to view current experiences through a clearer, more present focused perspective rather than one that is tainted by negative past experiences.
Types of Trauma and Tracks
Our approach includes a two track, three phase trauma therapy. Patients are assessed using standardized, evidenced based assessment tools and trauma patients are placed in either track A or track B. The major difference between these two tracks is the patient’s level of natural internal resilience and amount of existing internal and external resources. Track A addresses mostly “shock” trauma while track B attends to the needs of patients with complex PTSD and attachment/developmental trauma. The three phases are loose guidelines which allow considerable flexibility to modify treatment to the individual patient. The phases will be slightly different depending on which track patients are assigned to. Track B patients tend to require more time in therapy than those in track A due to the complexity of their needs. For both tracks, the phases include: 1) stabilization and resourcing, 2) reprocessing and integration and 3) rebuilding and maintenance.
Because of the complex nature of trauma, and the uniqueness of every patient, this treatment guide allows for flexibility and defers to the clinical judgment of the trauma therapist. The trauma assessment instruments used in the beginning of treatment in addition to the clinical interview assessment by the therapist will determine which track would be the best fit for each patient. The major difference between these two tracks is the patient’s level of natural internal resilience and amount of existing internal and external resources.
Note: type delineations are sourced from The Body Remembers (Rothschild, 2000)
PTSD Track A: Patients have mostly secure attachment style and high internal resilience:
Type 1 – Patient who has experienced a single traumatic accident. ex., accident or assault, etc.
Type 2A – A patient who has experienced multiple adult traumas, ex. first responders, multiple accidents, etc.
Type 2B - A patient who is so overwhelmed by multiple traumas that they are unable to separate one event from another, ex. repeated sexual trauma in adulthood, combat veterans and some first responders.
Patients in track A will usually be able to tolerate direct trauma processing more quickly than those in track B and will usually require less time in treatment. There will be some patients in track A, especially type 2B listed above, which may present as very complex and require more time in treatment than others. It will also be the case that some track A patients have had trauma in their younger years. However, it remains that track A patients have a “good enough” attachment history to be able to self-regulate, self-sooth and attain CNS homeostasis and tolerate connection to others in a way that allows for adequate functioning in the absence of basic PTSD symptoms.
CPTSD Track B: Patients mostly have insecure/disorganized attachment style and low internal resilience or the trauma was so overwhelming that the patient is unable to maintain resilience (2BR).
Type 2BR - Patient with a stable background and had resources but due to the overwhelming nature of the trauma they can no longer maintain resilience, i.e. Holocaust survivor, POW/combat veterans, victims of prolonged torture, genocide, kidnapping etc.
Complex/developmental/attachment injury – DESNOS (Van der Kolk): These patients may have symptoms of PTSD but no single identifying event usually because there are countless traumatic events. These patients experienced childhood abuse/neglect and often repeat cycles of abuse in adulthood. They never fully developed resources for resilience and many have maladaptive coping strategies such as self-harm. The therapeutic relationship is in the foreground of the therapy prices with these patients as resource rebuilding in critical before directly addressing trauma. The therapeutic relationship and subsequent “corrective experiences” may be the whole of treatment in some of these cases.
Patients in track B will usually not be able to process trauma directly until internal and external resources have been strengthened using clinical intervention. Patients in track B usually require more time in therapy and will require more involvement in the therapeutic relationship and more complete aftercare services. These patients have not had “good enough” opportunities to form safe attachment in childhood and therefore have developed maladaptive ways of self-soothing, self-regulating and relating to others.