Author: Brad Kammer

4 active posts

How to Work with Clients that are Stuck in Therapy

As clinical consultants over many years, we have found that therapists usually have on their caseloads a few clients that are especially frustrating because of their lack of progress in therapy, in addition to clients who make good progress, only to regress back to old, stuck patterns of self-sabotage, hopelessness and despair.  These are usually the clients that therapists bring to consultation.  The question we get asked repeatedly – how can I most effectively help this client?

To answer this, let’s revisit The ACEs Study (Adverse Childhood Experiences).  The ACEs Study has a fascinating origin.  Originally, it was designed as a weight-loss program until the head of the program, Dr. Vincent Felitti, observed that despite making successful gains toward their weight-loss goals, nearly 50% of the participants were dropping out.  This did not make sense to Dr. Felitti at the time: why participants would leave the program as they were losing weight and coming close to meeting their weight-loss goals.  He created a questionnaire to understand this phenomenon and discovered that a majority of those that dropped-out had experienced childhood trauma.  Thus began the monumental research project we now refer to as the ACEs Study.

One fascinating aspect here is the underlying mechanism of self-sabotage.  One would think that the closer a participant got to their goals the more motivated they would be to complete their program.  But whether it’s weight loss, or a student dropping out their senior year of college just a few credits shy of graduating, or someone who has been sober and returns to their substance use, we see so many examples of people getting closer to health, wellness and success turn to behaviors that are self-sabotaging and self-destructive.

Working in the field of unresolved developmental trauma, this does not surprise us.  We have come to recognize the “survival” function of shame and self-hatred.  As young children, everything revolves around staying connected to our caregivers – what we refer to in our field as attachment – this is essential for our basic survival and well-being.  When there has been failure, whether from our caregivers or from the environment, our basic survival is threatened.  Children are unable to experience themselves as being good people in a bad situation.  Therefore, unconsciously, psychobiological mechanisms turn on to assure our basic survival.  A main survival strategy is what we might refer to as shame and self-hatred; that children experience themselves as bad as a way to protect themselves from their failures of their caregivers and/or environment.

So what does this look like clinically?  When the therapeutic process gets thwarted, when clients use strategies like avoidance, distraction, self-criticism, and acting-out, when clients begin to get better and then repeatedly have set-backs or sabotage it in a number of ways, we can begin to recognize that shame and self-hatred are acting as glue keeping them stuck from moving forward.  Going back to the original weight-loss program, something is threatening about moving forward in life toward greater health and well-being.  That something is the way we learned to protect our early caregivers and environment through foreclosing fundamental aspects of ourselves, even if those fundamental aspects are positive like growth, healing and aliveness.

These early failures are what Oprah Winfrey recently referred to as the “hole in the soul”.  If we don’t recognize the underlying shame-based wounds that have led to dysfunctional strategies, behaviors and symptoms, we will miss out on how to support our clients to continually move forward.

The NeuroAffective Relational Model (NARM) is a therapeutic approach designed to work with the unresolved wounds and patterns leftover from attachment, relational and developmental trauma.

In NARM one of the clinical skills we use is what we refer to as “Tracking Connection-Disconnection”, which helps support clients in understanding and working with these unconscious binds.  This integrated “top-down” (psychodynamic) and “bottom-up” (somatic) approach works with the psychobiological patterns of shame and self-hatred that have been laid down from early trauma.  In NARM, we recognize it is not enough to just identify and understand these patterns of self-sabotage and self-destruction, we also have to shift the physiological and emotional patterns that are fueling the self-limiting beliefs and behaviors.  Then, our clients have a possibility of moving forward unencumbered by these unconscious survival strategies that have come to dominate their lives.  Freedom from childhood trauma is possible.

If you have clients that are struggling from unresolved early trauma, and would like more information on how to provide more effective therapeutic support for your clients, we invite you to learn more about the NeuroAffective Relational Model in our online or live training formats.  For more information and training in NARM, please visit our website at: www.narmtraining.com.

The Interplay of Complex Trauma and Substance Abuse

Due to all the political noise in the United States many of us missed something potentially very positive coming out of our government – on October 24, a bipartisan law was signed into effect entitled The Support for Patients and Communities Act (previously titled the Opioid Crisis Response Act).  While some activists believe this bill doesn’t go far enough to treat the widespread Opioid problem in our country, those of us who work with trauma should take notice. 

Embedded within this law are significant sections of a bill that was introduced into the Senate entitled: Trauma-Informed Care for Children and Families Act.  This act does, among other things, create an interagency task force to identify trauma-informed best practices and provides funding for trauma-informed practices in schools.  In addition, it recognizes the link between unresolved early trauma and substance abuse.

For those of us working clinically with complex trauma, we know how many of our clients have dealt with or are dealing with the challenges of substance abuse (and when we refer to substance abuse, we cast a wide net to include eating and other compulsive behaviors that lead to distress and symptoms).  Likewise, there are many drug and alcohol counselors who are working hard to manage the effects of substance abuse who recognize that so many of their clients have dealt with early trauma.  Based on the ACEs study (Adverse Childhood Experiences) and other current research, there is a direct link between unresolved trauma and substance abuse.

The question is, do we have treatments within the mental health and recovery fields that can identify the early trauma and work with the harmful effects, including substance abuse?  So many of us we have been seeking. 

My colleagues and I have been singularly focused on bringing to clinicians and counselors around the world a comprehensive approach for resolving developmental trauma, in the form of the NeuroAffective Relational Model (NARM).  NARM addresses the unresolved psychobiological disruptions that lead to mental health and substance abuse issues.  We use the symptoms – whether mental health or substance-related – as a guide to get to the root of the problem, which is so often based in unrecognized early trauma and neglect.  This therapeutic model has huge implications not only for individuals, but also families, communities, and on a larger scale where we are dealing globally with symptoms of ongoing conflict, injustice and violence. 

The research is clear – unresolved early trauma can disrupt our lives in so many ways.  At the NARM Training Institute, we are excited to be part of this trauma-informed movement that could bring hope and healing to so many people who are currently suffering from wounds often invisible to them – unresolved early trauma.

For more information and training in NARM, please visit our website at: www.narmtraining.com where you can learn about our online and live training opportunities.

Introducing a Revolutionary Diagnosis: Complex PTSD

In June 2018, nearly 40 years after the APA controversially yet officially recognized Post-Traumatic Stress Disorder (PTSD) as a mental disorder that required clinical treatment, the World Health Organization released the ICD-11 including a new diagnosis: Complex Post-Traumatic Stress Disorder (C-PTSD).

This diagnosis has the potential to completely revolutionize the world of mental health.

Understanding the long-term impact of unresolved early trauma is indeed a world health issue.  Attachment, relational and developmental trauma – which crosses all cultures, religions and communities – impacts the neurobiological development of children and creates life-long patterns of disorganization within the body, mind and relationships.  Perhaps a greater understanding of Complex Trauma can help us understand the underlying causes of the disorders our clients are struggling with, in addition to the increasing social challenges like substance abuse, systemic injustice and violence. A trauma-responsive perspective brings great hope.

While PTSD evolved the field of psychology in a major way nearly 40 years ago, those of us that have worked in this field know that there are limitations to the diagnosis and the treatments addressing it.  C-PTSD helps us evolve our understanding of trauma. Now that C-PSTD has been officially recognized, the next step is to finding treatments that are specifically geared to addressing Complex Trauma.

Many of us have experienced frustration with clients dealing with complex trauma due to their lack of progress in therapy, as well as those clients who make good progress only to regress back to old, stuck patterns of self-sabotage, hopelessness and despair.  These are usually the clients that therapists bring to consultation.

The question we as NARM consultants get asked repeatedly – how can I most effectively help my client?

To answer this, let’s revisit The ACEs Study (Adverse Childhood Experiences).  The ACEs Study has a fascinating origin. Originally, it was designed as a weight-loss program until the head of the program, Dr. Vincent Felitti, observed that despite making successful gains toward their weight-loss goals, nearly 50% of the participants were dropping out.  This did not make sense to Dr. Felitti at the time: why participants would leave the program as they were losing weight and coming close to meeting their weight-loss goals. He created a questionnaire to understand this phenomenon and discovered that a majority of those that dropped-out had experienced childhood trauma.  Thus began the monumental research project we now refer to as the ACEs Study.

One fascinating aspect here is the underlying mechanism of self-sabotage.  One would think that the closer a participant got to their goals the more motivated they would be to complete their program.  But whether it’s weight loss, or a student dropping out their senior year of college just a few credits shy of graduating, or someone who has been sober and returns to their substance use, we see so many examples of people getting closer to health, wellness and success turn to behaviors that are self-sabotaging and self-destructive.

We are now unwinding this puzzle through recognizing the “survival” function of shame and self-hatred.  As young children, everything revolves around staying connected to our caregivers via attachment – this is essential for our basic survival and well-being.  When there has been failure, whether from our caregivers or from the environment, our basic survival is threatened. A child is unable to experience themselves as being a good person in a bad situation.  Therefore, unconsciously, psychobiological mechanisms turn on to assure our basic survival. A main survival strategy is what we might refer to as shame and self-hatred; that children experience themselves as bad as a way to protect themselves from their failures of their caregivers and/or environment.

One of the things we have observed in consulting many somatic-oriented therapists internationally is that despite very effective and powerful somatic work, therapeutic progress still gets thwarted without recognizing and working directly with the survival-based developmental strategies.  Clients begin to get better and then repeatedly have set-backs or sabotage it in a number of ways. Going back to the original weight-loss program, something is threatening about moving forward in life toward greater health and well-being. That something is the way we learned to protect our early caregivers and environment through foreclosing fundamental aspects of ourselves, even if those fundamental aspects are positive like growth, healing and aliveness.

So what does this have to do with somatic therapy?  What happens when a client is moving toward greater embodiment, self-regulation and empowerment (“bottom-up”), but we fail to recognize the underlying shame-based wounds that have led to the dysfunctional strategies, behaviors and symptoms?  Or for traditional, talk-based therapists, what happens when we work with the psychodynamics of shame, self-hatred and self-sabotage (“top-down”) without shifting the physiological and emotional patterns that are fueling the self-limiting beliefs and behaviors?  And, what happens when we are working with early attachment wounds and don’t recognize our own countertransference (our own unresolved trauma patterns and triggers) and how this impacts the therapeutic process?

The NeuroAffective Relational Model (NARM) is a therapeutic approach designed to work with the unresolved wounds and patterns leftover from early trauma.  This integrated “top-down” (psychodynamic-based) and “bottom-up” (somatic-based) approach works with the psychobiological patterns of shame and self-hatred within a deeply mindful, relational context.  With a framework that identifies the developmental wounds from early trauma, our clients have a possibility of moving forward unencumbered by these unconscious survival strategies that have come to dominate their lives.  Freedom from childhood trauma is possible.

While research on this is still in its infancy, we at the NARM Training Institute are buoyed by clinical reports and early research demonstrating how effective the NeuroAffective Relational Model (NARM) is in resolving attachment, relational and developmental trauma.  We have trained thousands of mental health clinicians throughout North America and Europe, and are rapidly expanding our NARM training programs throughout the world and online.

If you have clients that are struggling from unresolved early trauma and would like more information on how to provide more effective therapeutic support for your clients, we invite you to learn more about the NeuroAffective Relational Model in our online or live training formats.

To learn more about this revolutionary method to treat this paradigm-shifting diagnosis, please visit our website at: www.narmtraining.com.

 

The Trauma-Informed Revolution: Oprah, Healing Developmental Trauma & NARM

Something big happened last Sunday – big for countless individuals who are struggling in their lives, but also big for our society. Thanks to Oprah Winfrey, the world was introduced to the concept of Developmental Trauma (on CBS 60 Minutes).

Oprah calls this a “game changer”.  As she writes: “This is one of the most life changing stories I’ve ever done. I hope it starts a Revolution in helping people.”

A similar game changer occurred in the early 1980s when Post-Traumatic Stress Disorder (PTSD) was introduced. PTSD helped us conceptualize what happens to individuals and societies in the aftermath of life-threatening events like war, environmental catastrophes, and human-made disasters like school shootings, car accidents and sexual assaults.

But Developmental Trauma is unique and different than PTSD. There are even new proposed mental health diagnoses to capture this – what we refer to as Developmental Trauma Disorder or C-PTSD (Complex PTSD).

Oprah has tapped into a movement that we refer to as “Trauma-Informed Care”trauma-informed psychological treatment, schools, hospitals, even organizational systems. Looking through trauma-informed lenses is changing the way we view how humans develop, how they manage life challenges, and what they need to best support them for learning, healing and growth.

Based on ground-breaking research known as the ACEs Study (Adverse Childhood Experiences), we now recognize the long-term effects of early, childhood trauma. The effects often look different than how PTSD looks, and often present as anxiety, depression, learning difficulties, ADHD, eating and substance abuse disorders, relational challenges and various medical symptoms and disorders. Because there has been no recognition of developmental trauma, we have often treated these symptoms and disorders without recognizing the cause of them – early childhood trauma.

Although most childhood trauma was not immediately life-threatening, these experiences still caused great damage and long-lasting wounds. For many people hearing this for the first time it might sound scary. And the next thought may be, “do I have to relive my childhood to heal from these patterns?” Most of us don’t want to revisit our trauma; we want to move beyond it.

Thankfully, there are therapeutic models that are specifically designed to help individuals heal their developmental trauma. And one such model, the NeuroAffective Relational Model (NARM), does not require individuals to revisit or relive their past, but instead, focuses on the patterns that are affecting us right here, right now in our present lives.

NARM is an integrative, body-mind approach that helps individuals shift these life-long patterns emerging from relational and developmental trauma. As outlined in the book, Healing Developmental Trauma, NARM presents a map for this trauma-informed movement. Individuals who have received NARM treatment often report feeling more balanced, present, mindful, regulated, open and available for deeper connection to oneself and others.

While trauma can have devastating effects, there is hope. We recognize that the healing of developmental trauma can be a pathway to personal and social transformation.

The trauma-informed revolution has arrived – and it is a “game changer”.  Fortunately, there are also game-changing healing approaches that will address developmental trauma, and we believe, lead to greater healing and peace in our world.  Thank you Oprah!