Full Course Description
The Integrated Therapist with Bessel van der Kolk, MD, Richard Schwartz, PhD, & Frank Anderson, MD
- Differentiate between models of treatment that allow for integration and “pure” modalities and elaborates on why “pure” modalities are more difficult to integrate.
- Debate whether the concept of “Self” is a trait that all people possess within themselves at all times or whether “Self” is developed through a safe, therapeutic alliance and external relationships.
- Analyze whether Phase Oriented Treatment is a necessary precursor to effective treatment or whether trauma treatment can be effective without stabilization as a foundation.
Why is Integration Important?
- Different Modalities Are Finding Different Pieces of the Puzzle
- “Pure” Models
Core Biopsychological Elements
- The Brain is Formed by Experience
- Capacity to Be “With” vs. “In” The Experience
- Internal vs. External Relationships
Phase Oriented Treatment & the Window of Tolerance
- IFS vs. Phase Oriented Treatment
- Scepticism of Phase Oriented Treatment & Stabilization
- “Self” & the Window of Tolerance
Internal Family System and the Integration of Neuroscience & Trauma Treatment
- Differentiate IFS conceptualizations of trauma treatment from traditional phase orientated treatment.
- Address extreme or self-destructive behaviours without creating reactivity.
- Structure and sequence IFS trauma interventions.
- Apply the core concepts of IFS intervention to repair the internal disconnections created by trauma.
Universal neurobiological components of trauma
Key IFS concepts and overlap with alternate therapeutic models
- Sensorimotor psychotherapy
- Cognitive Processing Therapy
- Accelerated Experiential Dynamic Processing
- Psychedelic medicine
Integrating neuroscience, trauma treatment and IFS
Basic assumptions of IFS
- Impact of trauma on system organization
- Production of symptoms
- Categories of parts
- Extreme parts that block therapeutic progress
- Self-energy – accessing through blocking parts
Steps of the IFS model
- The six F’s
- Restoring internal connections between self and parts
- Conceptualization of symptom presentation
IFS approach to managing symptoms
- Identifying triggered parts in therapists
Phase oriented treatment and IFS differences
- Dealing with extreme or self-destructive parts
- Addressing traumatic overwhelm
Comorbidities – symptomatic expressions of varied parts
- Separating biological, genetic and psychiatric symptom origins
The healing process across therapeutic orientations
EMDR & IFS: The Power of Modality Integration for Improved Treatment Outcomes
- Integrate EMDR and IFS skills with therapy clients into practice.
- Implement techniques to boost resource development and installation (RDI) with clients.
- Determine which cognitive interweaves and interventions can be used to effectively change behaviour.
Adapting EMDR to complex trauma cases
- Resource development and installation (RDI)
- Importance of RDI in trauma work
Integrating EMDR and IFS approaches
- Benefits of using EMDR and IFS together
- Helping flooded clients
- Having clients move at their own pace
- Using cognitive interweaves and interventions
- Differences of the models
- Importance of screening for dissociation
- Managing comorbidities
Cognitive Processing Therapy & IFS for Trauma Treatment: Exploring the Relationship Between Cognition Based Approaches and Parts of Self
- Describe the theory underlying cognitive processing therapy.
- Distinguish differences and similarities between CPT and IFS.
- Demonstrate how to work with distorted beliefs when treating trauma.
- Apply effective strategies to help clients activate the frontal cortex.
Overview of CPT
- Types of trauma that are treated through CPT
- Neurobiology of trauma
- Amygdala reaction and trauma
- Targeting the prefrontal cortex
- The impact of beliefs on trauma
Stages of CPT
- Stuck points
- Challenging beliefs
- Total impact
- Childhood beliefs
- Religious beliefs
- Cultural beliefs
Comorbidities and CPT
- Substance use
- Personality disorder
CPT and bodily responses to trauma
- Physical sensations as feelings
- Creating new neuropathways
- CPT and other therapies
- When it does not fit well
Accelerated Experiential Dynamic Psychotherapy (AEDP) & IFS for Trauma & Dissociation
- Utilize Accelerated Experiential Dynamic Psychotherapy and Internal Family Systems models to improve clinical outcomes for clients.
- Formulate an approach to treating people with a trauma history to improve client level of functioning.
- Integrate the client-therapist relationship to improve client engagement and alleviate symptoms of dissociation.
Models for treatment of post-traumatic dissociation
- Internal Family Systems (IFS)
- Accelerated Experiential Dynamic Psychotherapy AEDP)
- Similarities and differences in the models
- Focus on emotions, attachment, and affect, not cognitions
- Psychodynamic roots and formulation
- Includes client, therapist and client, therapist
- IFS and AEDT are aligned in this approach
- Use of self
- Strong use of therapeutic relationship to heal attachment wounds
- Appropriate self-disclosure in IFS and AEDP
- Intrarelational aspect
- Client’s dissociative self-state
- 4-state model of emotional process
- Defensive, dysregulated
- Core affect and emotional experience overlap with sensorimotor
- Fear is present in spite of safety
- Internal connection, serenity, wisdom
- Not great with bipolar 1 or psychosis
- Not compatible with cognitive-behavioural therapy (CBT)
- Inherent drive and desire for healing, expansive life, growth, mastery
Sensorimotor Psychotherapy & IFS: Trauma Informed Choices When Working Within the Mind and the Body
- Formulate key Sensorimotor Psychotherapy principles, foundations, and application.
- Determine how Sensorimotor Psychotherapy approaches can improve treatment outcomes.
- Analyze clinical choices for integrating trauma-informed treatment interventions.
- Basic premises of Sensorimotor Psychotherapy
- Working with the mind and the body
- Discerning patterns
- Evoking organicity and curiosity
- Somatic resources
- Grounding approaches
- Sensorimotor Psychotherapy and IFS
- Keeping the observant, compassionate mind
DBT & IFS strategies for Addressing Emotion Regulation, Symptom Reduction and Mindfulness
- Determine similarities and differences between DBT and IFS.
- Evaluate DBT’s four modules to put to practical use in subsequent sessions with clients.
- Employ validation and Wise Mind strategies to improve the therapeutic relationship in subsequent sessions.
History and uses of Dialectical Behavior Therapy (DBT)
- DBT history with Borderline Personality Disorder
- Flexibility of DBT
- DBT and other diagnoses
- Dialectical Philosophy. Dialectics explained
- Polarization and underlying conflicts
- Integrating views, thoughts and feelings
DBT Model Overview
- Differences between DBT and Cognitive Behavioral Therapy (CBT)
- Emotions, dysregulation, problem-solving, and validation
- DBT modules
- External environment and internal environment
- The DBT process: from validation to the corrective experience
- DBT group therapy vs. individual therapy
- Emotional Regulation
- Interpersonal Effectiveness
- Distress tolerance
- Distress Tolerance vs. Emotional Regulation
DBT and IFS Verbiage: similarities and differences in theoretical frameworks
- The role of the therapeutic relationship in DBT and IFS
- IFS Intent vs. Effect
- DBT mindfulness and acceptance and IFS self-energy
- DBT validation and IFS permission
- DBT distress tolerance and IFS firefighter and wounded reactions
- DBT stages of therapy and IFS growing trust in the Self
Integrating Psychedelic Medicines and Psychotherapy with IFS (Internal Family Systems) and Other Modalities
- Determine what patients may benefit from integrated psychedelic medicines and psychotherapy.
- Develop protocol of a session with integrated model of therapy that could include psychedelic medications.
- Assess possible pros/ cons of including psychedelic medications in integrated therapy.
- Fears within our culture
- Learning from other traditions
- Benefits that arose from these medications
Utilizing psychedelic medications as a treatment
- Personal experiences that led to change in perception
- FDA approval
- Possible treatment targets
Setup: a typical psychedelic-assisted psychotherapy session
- Set up of office
- Role of therapist
- Length of session
The (necessary!) post-integration session
- Unburdening of patient
- Move from directive role of therapist to allowing inherent wisdom to emerge
- Discussion of state of mind coming into session
Current research/limitations of psychedelic-assisted psychotherapy
- More research is ongoing
- Drug interactions with medications
- Match up patient’s presenting problem with medication
- Medication may work for patient and one point and not others
Resources to expand clinician training
- CE trainings
- California Institute of Integral Studies
- Polaris Insight Center
- Ketamine Training Center
Putting the Pieces Together: Course Closing with Frank Anderson, MD
Panel Discussion 2 - 7/7/21 Recording