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Case Consultation For Therapists

Expertise you can rely on

Consultations via Zoom, in-person or telephone, assist seasoned and therapists new to complex and relational trauma to: 


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.

Naomi Halpern provides case consultations to health care professionals working with complex trauma and severe stress. Topics for individual case consultation include:

                     The problem is not the problem
                     Locus of control shift
                     Ambivalent attachment to the perpetrator
                     Karpman's triangle (victim–rescuer-persecutor dynamic)

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. Many will have highly entrenched protective defence mechanisms that serve to reduce stress in the short term but keep her/him/they 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, 2009

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 defensive 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 their healing.

These tax deductible consultations are suitable for:

 

Recommended reading:

Anderson, F.G., (2021) Transcending Trauma: Healing Complex PTSD with Internal Family Systems Therapy, PESI

Boon, S., Steele, K., Van der Hart, O. (2011) Coping With Trauma-Related DissociationNorton

Briere, J. (2019) Treating Risky and Compulsive Behavior in Trauma SurvivorsGuilford Press

Courtois, C. (2010). Healing the Incest Wound: Adult Survivors in Therapy, 2nd EditionWW Norton & Company.

Fisher, J. (2009). Psychoeducational Aids for Working with Psychological Trauma. 8th Edition. www.janinafisher.com

Fisher, J. (2017) Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-AlienationRoutledge

Ferentz, L. (2015) Treating Self-Destructive Behaviors in Trauma Survivors: A Clinicians Guide (2nd Edition), Routledge

Ross, C. & Halpern, N. (2009) Trauma Model Therapy: A Treatment Approach For Trauma, Dissociation And Complex Comorbidity, Manitou Communications Inc.

Schwartz, R.C. Sweezy, M. (2020) Internal Family Systems Therapy (2nd Edition), The Guilford Press

van der Kolk, B. (2014) The Body Keeps The Score: Mind, Brain and Body in the Transformation of TraumaAllen Lane