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Case Consultation For Therapists
Consultations, in person or via telephone, Skype or Facetime, assist both seasoned and novice therapists providing trauma therapy to:
- have the opportunity for safe, supportive and confidential exploration of the therapist’s desire to enhance skills, process his or her emotional responses and various complex concerns
- identify the unique challenges for both client and therapist
- normalize and utilize feeling de-skilled, emotionally drained and personally impacted
- address and benefit from complex transference and countertransference
- develop strategies to compassionately work with defence mechanisms and boundaries
- process powerful emotions: of both the therapist and client
Assisting individuals with a history of trauma or abuse is usually long term and at times may be challenging for both client and therapist. Trauma clients may present with a range of complex and confusing or unrecognized symptomatology.
Working on the ‘coal face’ with severely traumatized and dissociative individuals can, at times, leave even the most experienced therapist feeling de-skilled, emotionally drained, and personally impacted.
Intense transference can lead to equally intense countertransference responses, escalating to a therapeutic impasse. Either or both, the client and therapist may literally or metaphorically flee therapy or subconsciously avoid what needs to be processed.
Hostile engagement and persecutory defences, the ‘fight’ response, are easily identifiable in the client. Less comfortable to acknowledge but equally in need of empathic and non-judgmental collegial support, is engagement in the fight response by the therapist. The therapist may react to behaviour or material that challenges his/her world view and sense of competence, through active denial of the material or diagnosis or non-empathic engagement. Alternatively, both client and therapist may ‘freeze’, numbing and shutting down or out from an effective alliance.
Cultural awareness and competence plays a significant role in the development of the therapeutic alliance.
A client may be in ongoing abusive situations with their family of origin, intimate partner or other relationships. Mny will have highly entrenched protective defence mechanisms that serve to reduce stress in the short term but keep him or her vulnerable, such as substance abuse, self harm and traumatic dissociation.
One can hide in the past to avoid the present, or hide in the present to avoid the past.
Ross and Halpern
Many therapists express concern they may have unwittingly overstepped professional boundaries or under-responded to the complex needs, presentations and challenges of this client group. Powerful feelings of grief, shame and anger or alternatively, numbing and detachment, are some of the emotions therapists may experience in response to a client's challenging material or behaviour.
Unrecognized or unaddressed, these counter-transferential responses may lead to blaming or disliking a client and to a punishing or controlling engagement, with a profoundly negative impact on therapy.
Additionally, vicarious trauma and empathic strain can significantly impact the therapist’s emotional and physical well being, sense of professional competence and interpersonal relationships. When acknowledged and embraced, these normal feelings and responses can provide powerful insights and guidance to the course of therapy.
Finding the middle path, where the therapist is neither pushing a client to do work they are not ready for, nor colluding in avoidance of painful material, requires the capacity to sit back and reflect on what is occurring both in, and out of the therapy room.
Therapists have much to offer, both from a skill perspective, as well as their own life experiences and personal qualities. The therapeutic relationship is best able to facilitate healing when the therapist is committed to his or her own personal journey, recognizing the ‘wounded healer’ in us all.
As we endeavour to provide our clients with non-judgmental and empathic understanding, it is equally important for therapists to have a safe space to receive the same. Case consultation offers the opportunity to learn new skills, get back on track and reinforce or restore confidence in your capacity to assist your clients on their journey.
Ultimately, the therapist is responsible for the therapy session while the client is responsible for his or her healing.
Thesetax deductible consultations are suitable for:
- social workers
- mental health nurses
- family therapists
- expressive therapists
- medical practitioners
- allied health and related professionals
Delphi Training and Consulting provides case consultations to health care professionals working with complex trauma and severe stress. Topics for individual case consultation include:
- 4 core trauma dynamics:
– The problem is not the problem
– Locus of control shift
– Attachment to the perpetrator
– Karpman's triangle (victim–rescuer-persecutor dynamic)
- Phase oriented treatment plans
- Specific issues in PTSD, Dissociative Disorders, and Dissociative Identity Disorder: flashbacks; flooding; numbing; hearing voices; somatization; hostile; persecutory and apparent-sabotaging presentations of the client's internal intra-psychic system
- Trauma re-enactment in the counselling setting and therapeutic impasses
- Utilizing transference and counter-transference
- Navigating empathic engagement and safe boundaries for the client and health professional
- Understanding and transforming self harming behaviours
- Facilitating and supporting healthy expression of the spectrum of emotions, including difficult intense feelings such as anger and grief
- Trauma, spirituality and healing
- Self-care: Vicarious Traumatization / Secondary PTSD / Compassion Fatigue
Referrals – guidelines for people seeking a therapist
PROSPECTIVE REFERRALS: At this time we are not taking new clients. To help find a good therapist there are guidelines listed below.
A journey of a thousand miles must begin with a single step.
At different times, everyone experiences difficulties, losses and major life transitions. Many people also experience trauma as adults or children as a consequence of:
- natural disaster e.g. earthquake; bush fire; flood; tsunami; landslide etc.
- abuse e.g. emotional, physical, sexual, mental, psychological
- interpersonal and domestic violence
- violent crime
- health issues
- negligence and fraud
- poverty and deprivation
The impact of such events and experiences can have long lasting and far reaching consequences to a person’s quality of life, health, work, earning capacity and relationships. As a result of trauma or extreme stress it is not uncommon for people to experience distressing symptoms and /or engage in harmful behaviours:
- sleeping difficulties
- overwhelming feelings and / or numbing
- difficulty with emotions eg. healthy anger, grief, sorrow, shame etc.
- particular or unspecified fears
- obsessive and compulsive thoughts and behaviours
- unexplained physical symptoms
- memory difficulties
- spacing out and losing time
- imagining hearing or seeing things
- self harm
- substance abuse
- suicidal thoughts or behaviour
These experiences and behaviours can feel frightening and overwhelming. Some people may try to hide or minimize the impact of these experiences from others, fearing they are ‘crazy’ or not ‘normal’. This may be accompanied by a belief that no-one can, or would want to, help them.
In the middle of difficulty lies opportunity
We recommend those seeking assistance select a professional who understands and is skilled in working with the consequences of extreme stress and trauma. He or she can support your inherent resilience and ability to heal from extreme challenges, deep pain and sorrow. It is possible to transform these experiences in order to live well and enjoy life.
7 Points to Consider In Seeking a Therapist:
1) Does the therapist seek regular case consultations or supervision with someone experienced with trauma, dissociative disorders and PTSD (ie. has had at least several such clients and over 10 years experience with successful outcomes, or as outlined in point 4 below)?
2) Is the therapist and his or her case consultant or supervisor versed in the principles and strategies outlined in the reading list below?
3) Has the therapist attended regular training in this field with experienced local and international clinicians in the trauma field?
4) Is there an existing good relationship with a therapist who is not experienced in therapy for trauma but is willing to seek ongoing guidance through case consultation as well as attend training to develop core skills and principles of trauma-informed therapy?
5) Does the therapist provide clarity about expectation of boundaries and are these clearly communicated? This is preferable in written format to avoid confusion regarding session times, payment, cancellations, safe / any touch versus intrusive or uncomfortable, notice re holidays, agreements re contact outside of sessions should that be likely etc. A trauma informed therapist will consistently actively respect these boundaries. The rights and responsibilities of both a client and therapist deserve respect and acknowledgment.
6) Does the therapist appreciate that symptoms and experiences reflect a problem and are not the problem per se?
7) Does the therapist have skills to facilitate strategies to assist with the symptoms and process difficult emotions at a safe pace, in collaboration with what the individual is ready and willing to work with?
A reliable, experienced and compassionate therapist can provide support to navigate troubled waters. Guidance at a safe pace can assist in rebuilding what has been shaken and to transform fragmentation into a cohesive and creative expression.
Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow”.
Mary Ann Radmacher
Briere, J., & Scott, C. (2012). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment, 2nd Edition. Thousand Oaks, CA: Sage Publications.
Briere, J., & Lanktree, C. (2011). Treating Complex Trauma in Adolescents and Young Adults. Thousand Oaks, CA: Sage.
Courtois, C. (2010). Healing the Incest Wound: Adult Survivors in Therapy, 2nd Edition. WW Norton & Company.
Fisher, J. (2009). Psychoeducational Aids for Working with Psychological Trauma. 8th Edition. www.janinafisher.com
Ross, C. & Halpern, N. (2009) Trauma Model Therapy: A Treatment Approach For Trauma, Dissociation And Complex Comorbidity, Manitou Communications Inc.
van der Hart, O., Nijenhuis, E., Steele, K. (2006) The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, WW Norton & Company, New York :London
You will also find useful information about guidelines for trauma therapy on the websites below.