Rehab Kids
EMDR & Parts Work
for Treating Complex
Trauma:
Somatic Techniques to Decrease
Defensiveness and Facilitate
Trauma Processing
Arielle Schwartz, PhD, CCTP-II, E-RYT
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EMDR & Parts Work
for Treating Complex
Trauma:
Somatic Techniques to Decrease
Defensiveness and Facilitate
Trauma Processing
Arielle Schwartz, PhD, CCTP-II, E-RYT
Rehab Kids
ZNM058280
10/24
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59pp
10/24
Rehab Kids
MATERIALS PROVIDED BY
Arielle Schwartz, PhD, CCTP-II, E-RYT, is a clinical psychologist,
internationally sought-out teacher, therapeutic yoga instructor,
and leading voice in the healing of PTSD and complex trauma.
She is the author of six books based upon her integrative,
mind-body approach to trauma recovery: The Complex PTSD
Workbook; The Post Traumatic Growth Guidebook; A Practical
Guide to Complex PTSD; EMDR Therapy and Somatic Psychology;
The Complex PTSD Treatment Manual, and Therapeutic Yoga for
Trauma Recovery. Her unique blend of spirituality and science
can be found in her writings, guided trauma recovery programs,
and applied Polyvagal Theory in yoga for trauma recovery.
Dr. Schwartz is an accomplished teacher who guides therapists
in the application of EMDR, somatic psychology, parts work
therapy, and mindfulness-based interventions for the treatment
of trauma and complex trauma. She has a succinct way of
speaking about very complex topics. She is a longtime meditation
and yoga practitioner with a passion for the outdoors; all of
which she incorporates into her work as founder of the Center
for Resilience Informed Therapy in Boulder, Colorado where
she maintains a private practice providing psychotherapy,
supervision, and consultation. Dr. Schwartz believes that the
journey of trauma recovery is an awakening of the spiritual
heart. Discover more at drarielleschwartz.com.
For speaker disclosures, please see the faculty biography in activity advertising.
Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of certain professionals. As a licensed professional, you are responsible for reviewing
the scope of practice, including activities that are defined in law as beyond the boundaries of practice in
accordance with and in compliance with your profession’s standards.
10/15/24
EMDR & Parts Work
For Treating Complex Trauma
Dr. Arielle Schwartz
PESI
Scope of Practice
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Speaker Disclosures
Statement of Accuracy and Utility
-Psychology is not an exact science. The theory and neuroscience included here is
based on the knowledge available at this time. As the field evolves, our knowledge
base will change.
-The theories shared within this course are ones that this speaker has chosen based
upon her clinical experience, research about effective or evidence based trauma
treatments, and research about modalities are ineffective or potentially re-
traumatizing for clients with C-PTSD. Some modalities are on the cutting edge and
do not have an extensive research base at this point.
-Not all, therapeutic modalities are right for all clients. This is especially true when
working with dissociative clients.
-It is wise to seek further training, consultation, or supervision on any modality that is
outside of your area of competence as a clinician.
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Overall Goals
Part 1: Understanding
Complex Trauma
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Trauma
Trauma as a Continuum…
Acute Trauma: Common and relatively normal response after
exposure to a traumatic event. Physical and Psychological
symptoms.
Post-Traumatic Stress (Disorder): Symptoms of vigilance, re-
experiencing, avoidance.
Dissociative Subtype PTSD: Symptoms of derealization,
depersonalization, emotional and physical numbness.
Complex PTSD: Disorganized autonomic states, dysregulated
emotions, difficulties with self-concept, interpersonal difficulties
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C-PTSD in Developmental Trauma
(Ford & Courtois, 2009)
C-PTSD in Adult Traumas:
Refugee trauma, domestic violence, captivity,
ongoing harassment, discrimination…
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Learned Helplessness
11
Symptoms of C-PTSD
1.
2.
3.
4.
5.
6.
12
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Observing and Understanding Symptoms
13
Observing and Understanding Symptoms
Highly sensitized to cues of threat in people’s body language, facial expressions, and voice tone
14
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Observing and Understanding Symptoms
Cognitive Distortions: “There’s something wrong with me, It’s all my fault, I do not deserve to
exist, I can’t trust anyone. I am damaged.”
Mental defeat and loss of a sense of identity
15
Observing and Understanding Symptoms
16
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Additional Symptoms of C-PTSD
§
§
§
§
§
§
17
Health Problems and C-PTSD
•
•
18
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Hidden Factors in the Development
of C-PTSD
19
Window of Tolerance ~ Window of Capacity
Working in the Window of Tolerance (Dan Siegel,
1999): an optimal zone of nervous system arousal
where you can respond effectively to your
emotions and sensations
Stress or trauma: high arousal symptoms
(irritability, restlessness, panic, anxiety)
High Arousal cannot be sustained
Long term trauma (no escape): Hypo-arousal
symptoms of collapse, helplessness,
hopelessness, despair, depression)
C-PTSD: alternating between high and low arousal
states
Faux window of tolerance: involves temporarily
managing distress without fully resolving the
underlying physiological imbalance (Kain &
Terrell, 2018)
Effective Treatment: Top-Down and Bottom-Up
20
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Resolved Stress Response
Stress or Mobilization Resolution
Trauma Increased through and
Cortisol
exposure action Homeostasis
• Exposure to a stressful (or traumatic) event
• Increase in cortisol
• Mobilization Response: (fight/flight): Feel, Move, Run, Protect, Shake
• Stress activated response systems achieve homeostasis (cortisol levels return to
baseline)
• Healthy Immobilization Response: Rest, Regeneration, Renewal of the body
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Homeostatic balance
Immobilization Mobilization
22
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Unresolved Stress Response
Stress or Defensive
Increased Blocked
Trauma action
Cortisol Mobilization
exposure remains
• Exposure to a stressful (or traumatic) event
• Increase in cortisol
• Incomplete Mobilization (Thwarted Instincts)
•Remain in high activation sympathetic (Freeze, Flight, or Fight)
•Immobilization into withdrawal, urge to hide or a dorsal vagal collapse (Faint Response)
• Body and mind do not experience resolution & it feels as if threat is ongoing
23
The Autonomic Nervous System
Autonomic Nervous
System
Sympathetic Parasympathetic
Nervous System Nervous System
Threat Safety Threat Safety
Response: Response: Response: Response:
Mobilization Mobilization Immobilization Immobilization
into Fight or into Play and into Collapse into Rest and
Flight Excitement (Faint Response) Digest
24
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What Happens in Vagus…
Image Credit: Gabriel Kram
25
A Tiered Response to
Threat
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The Social Engagement
System
27
Parasympathetic Ventral Vagal “Social
Engagement System:
Safe enough, Calm, Connected
Sympathetic with Ventral Safety: Parasympathetic Dorsal Vagal with
Ventral safety:
Play, Excitement, Exercise,
Empowerment Rest and Digest
Sympathetic with Ventral in Parasympathetic with Ventral in
Threat: Threat:
Fawn and Appeasement Submit
Parasympathetic Dorsal Vagal Threat
Sympathetic Threat Response: Response:
Fight, Flight Withdrawal, Collapse, Fatigue, Feigned
death
Parasympathetic and Sympathetic in
Threat Response:
Freeze in High Alertness
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Adaptive Survival Strategies
The Defense Cascade (Kozlowska, et al. 2015)
Freeze Flight Fight Fawn Submit Faint
• Tonic • Startles easily • Tension in • Highly aware • Focused on • Collapsed
Immobility • Hyper-vigilant jaw, arms, of other’s attachment Immobility
• Increased • Breathing hands, legs somatic cues even if to the • Reduced
heartrate rapidly into • Audible • Posture leans perpetrator heartrate
• Feeling upper chest breath, forward, chin • Surrender a • Eyes downcast
frozen, • Eyes darting exerted forward will of one’s • Breath is
cannot move • Racing exhale • Eyes reaching own shallow
• Breath is thoughts • Aggressive or scanning • Longing to • Nausea,
held • Jumpy or posturing • Caretaking or belong dizziness,
• Deer in the fidgeting • Furrowed co-dependence • Loss of a blurred vision
headlights • Difficulty brow, eyes • Disconnected “sense of • Disgust, lips
• Eyes are slowing down narrowed from own body self” curled down
locked or or connecting • Can’t relax or needs • Hunched • Numbness,
still to the body. in body shoulders disconnected
• Hyper aware • Dulling of the from body
of body senses
sensations
29
Conditioned Immobilization
30
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Understanding Dissociation
§
§
§
31
Signs of a Regulated Nervous System
§
§
§
§
§
§
§
32
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Interpersonal
Neurobiology
33
Co-Regulation
34
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Practice: Co-Regulation
35
Part 2: How to Assess for a
Complex Diagnosis
36
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Trauma-Informed
Practice
37
A Foundation of Safety
38
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Case Conceptualization
39
Case Conceptualization: “Wendy”
40
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Symptoms in Context
41
The Clinical Interview
42
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Skill: Inviting Spacious Relational Awareness
§
43
History-Taking Tool: Developing a Coherent Narrative
44
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History-Taking Tool: Exploring Adverse Life Events
46
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History-Taking Tool:
Transgenerational
Trauma Inquiry
47
Clinical Interview: Resilience and Protective Factors
48
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Barriers to Case Conceptualization
49
Betrayal Trauma and Attachment to the Perptrator
•
50
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Shame and learned helplessness
51
Working
with
Shame
52
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Build Affect and
Sensation Tolerance
53
Skill: Build Affect and Sensation Tolerance
54
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Part 3: Apply
a Unified
Approach to
Parts Work
55
A Unified Approach to Parts Work Therapy: Common Factors
56
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Ego States in Therapy (Watkins &
Watkins, 1997)
57
Structural Dissociation Model
(van der Hart, Nijenhuis, Steele, 2006)
Apparently Normal Part (ANP): faces the world, going on
with normal life part, can feel disconnected, as if “going
through the motions”
Defenses: prevent awareness of unresolved
material: control, perfectionism, idealization,
intellectualization, addictions
Emotional Part (EP): emotions, sensations, or
memories associated with unresolved traumatic
event(s)
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Internal Family Systems (IFS, Schwartz,
1997)
Manager Firefighter
Self
Exile
59
Anchoring the Self
60
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Identifying Dysregulated Arousal
States as Parts
62
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Parts Awareness Questions
63
Gestalt & the Empty Chair
64
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Unblending from a Protector
65
Differentiating from an Exiled or Young Part
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IDENTIFY UNMET NEEDS
67
AT T E N D I N G TO A N U N M E T N E E D
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Building Allies for a Part
69
Repair and Rescue Scenarios
§
70
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Part 4: Moving
Clients Forward
71
A Compassionate Approach
to Treatment
72
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The greatest predictor of meaningful change
in clients with complex ptsd is the quality of
the therapeutic alliance (Courtois &
Pearlman, 2005).
73
Traumatic Memories
§
§
§
74
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What are Neural Networks?
75
Stress-Induced Neuroplasticity
76
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Neuroplasticity
77
Predictive Processing
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Reprocessing, Exposure, and Desensitization
79
Traumatic memory reprocessing and C-PTSD
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EMDR Therapy
81
Dual Attention State and
Dual Attention Stimulation
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Phase 1 History Taking and Phase 2 Preparation
Phase 1 History Taking: Develop case conceptualization of client within developmental, social,
and cultural contexts, identify trauma history, set treatment goals.
Phase 2 Preparation: Establish therapeutic relationship and Stabilization with Resource
Development Installation (RDI). Practice connecting to positive states in the body and mind:
Safe Place, Social Engagement System
Choice and Containment
Grounding, Having Boundaries, and Empowerment memories
Embodiment and Movement Resources (working with tension patterns and numbness)
Co-Regulation in Therapy
Embodying the Wise/Adult Here-and-Now Self through posture and breath support
Moments of feeling loved by or loving others
Self-Compassion and Imaginal Allies (protectors, nurturers, wise figures)
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Skill: Choice and Containment
When we have no choice, we feel trapped. When we feel trapped, the nervous system perceives a
threat. We create safety through choice. Choice is Empowering. Puts the client in the “driver’s seat”
(Rothschild, 2010)
§ “Take several deep breaths and remind yourself that you have a choice about whether this is a good
time to think about any distressing memories from your past.”
§ “Make an agreement with yourself that you will only focus on traumatic memories when you are
feel supported and resourced. Keep in mind that you might only feel safe while in therapy. Or you
might choose periods of time to journal and reflect.”
§ “If you choose to journal about traumatic events on your own, it may be instrumental to set a timer
for 10–15 minutes. When the timer goes off, check in with yourself to ensure that you feel safe with
your process. Remember, you can close your journal and know that any upsetting material will be
held safely inside until you return to therapy.”
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Skill: Choice and Containment
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The Garden of the Mind
Trauma recovery is like creating a garden. You begin by tending to the soil—adding in the right amount
of nutrients, sun, and water that create an optimal environment for growth. When planting the garden
of your mind, remember that you have a choice about what seeds you are planting. You can think of
kindness, compassion, and wisdom as flowers that come from a well-tended garden of the mind.
You must, at times, also pull up the weeds. These are the thoughts that tell you that you are not
enough, unworthy of love, or helpless to change your circumstances. In your garden, you can take the
weeds and place them into the compost. There, they can be safely held and, in time, transformed into
the rich, fertile earth.
Now that you have created this space, what new seeds would you like to plant in the garden of your
mind? What would you like to believe about yourself now? Perhaps you want to grow a new sense of
self rooted in the knowledge that you are worthy of love, kindness, and respect. You get to choose
what you want to grow and flourish in yourself and in your life.
It is important to take care of the new growth in your garden. The seeds you planted may still be fresh,
green sprouts that require protection and careful tending. Ultimately, with the sunlight of your
awareness, you can guide yourself to bloom into your full potential.
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Tending the Garden of the Mind
Blocking Beliefs: Postitive Beliefs:
• I am not enough • I am good enough
• I am unworthy • I am worthy and deserving of…
• I am unlovable • I am lovable as I am
• I am weak • I am strong
• I am helpless and powerless • I have choices now
• I cannot trust myself • I can learn to trust myself
• I cannot trust anyone
• I can choose who to trust
• I have to be perfect
• I am human, I learn from my mistakes
87
Phase 3 Assessment
88
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Phase 3 Assessment “Target Development Script”
89
Phase 4 Desensitization and Reprocessing
90
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§
§
Socratic Inquiry §
Cognitive §
Interweaves §
§
§
§
91
Relational Interweaves
§ “Notice how it feels as you hear these words:
m right here with you
m listening to you
m here to support you
m giving you as much space as you need
•I wish that I could have protected you back then…
§ I recognize that what you just experienced in this room is so different from what you experienced
as a child. What do you notice in your body now?
§ If what you just experienced in this room had been there for you when you were young, how do
you imagine that would have felt? How would your life have been different? Notice what
happens in your body when you feel this.
§ Imagine bringing this new feeling of [protection, support, closeness, being seen] to different
times in your life [age 5, age 10, etc.]. Pay attention to felt sense throughout this process.
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Parts Work therapy Interweaves
93
Somatic Interweaves
94
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Skill: Mini-Installation and the Golden Nugget
Is there one positive thing you learned today about yourself take with you from our session?
Note: If client has difficulty reflecting on something positive from the session, offer a moment that you
witnessed during the session that felt like a new awareness or positive shift as a golden nugget.
Notice how you feel in your body when you think of [new awareness or positive shift].
How could you bring this insight into your life?
Imagine coping effectively with [specific situation]. Imagine stepping into this scene and how you would
handle this situation given this new awareness of yourself. Notice what you’re thinking, feeling, and
experiencing in your body.
Note: If the client reports barriers to integration of this new insight into an area of their life, explore how they
might navigate these obstacles in a realistic yet empowered manner.
Place any remaining disturbing images, thoughts, emotions, or body sensations into an imagined
container that can hold these experiences until you return to therapy.
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Closure and
Containment
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Part 5: Fostering
Resilience
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Resilience and Post-Traumatic Growth
Resilience: Resilience is adapting well in the
face of adversity. Psychological and
Physiological capacity to flexibility respond to
difficult events.
Post Traumatic Growth: the belief in our ability
to work through feelings of terror, rage, shame,
and despair and to know that we can ultimately
discover a greater sense of freedom, wisdom,
strength, and peace. This can lead to improved
self-perceptions, enhanced relationships, and a
strengthened life philosophy.
99
Questions of Resiliency
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101
Vulnerability is Strength
102
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RESILIENCE & POST-TRAUMATIC GROWTH
The Process
• Work through vulnerable emotions with Social Support
• Challenge negative thought beliefs & explore meaning
through the cultivation of a coherent narrative
• Cultivate the Resources you need to handle adversity
• Embodiment & Empowerment
• Transform Learned Helplessness into Learned
Optimism
The Outcome
• Greater sense of Choice in the Here and Now
• Sense of freedom “I am no longer defined by the past”
• Capacity to live in accept the world as it is and take
part in creating meaningful change for an improved
future
• “This happened to me, it is over now. I am strong and
capable of handling challenge with support.”
103
6 Pillars of Resilience
104
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Growth Mindset
(Carol Dweck)
105
Emotional Intelligence
106
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Community
Connections
107
Self-Expression and
Creativity
108
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Embodiment
109
Choice and Control:
110
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Resilience and Coping with Stress
111
Resilience Practices
Exercise Read a book
Go for a walk or hike Create art
Take a yoga class Attend a community event
Spend time in nature Watch a movie or TV show
Take a bath Get together with friends
Play a game
Practice mindfulness
Drink a cup of tea
Supervision or consultation
Attend a workshop
Go to therapy
Write in a journal
Receive a massage
Enjoy a healthy, nourishing meal
Dance
Other
Play or listen to music
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Skill: Create your Resilience Recipe
113
Factors of PTG (Schwartz, 2020)
•
•
114
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Coherence
115
Over time, you take the many threads of your life
experiences and weave them into a single fabric. You
weave in your strengths and your struggles. You begin to
notice patterns and themes. Most importantly, you
recognize yourself as the weaver. You learn that you can
continue to integrate new threads at any time, for you are
an active participant in the ongoing creation of your life
story. Over time, the fabric that you create out of your life
experiences begins to feel increasingly integrated and
whole. Now your life story can help you identify new
possibilities for your future. You might even discover that
your fabric is inextricably woven into the fabric of all life.
(Schwartz, The Post Traumatic Growth Guidebook)
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Resources:
Website: www.drarielleschwartz.com
Email: [email protected]
Facebook: Dr. Arielle Schwartz
YouTube: Dr. Arielle Schwartz
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NOTES
NOTES
