Transcript THE GOLDEN RULES OF TRAUMA PSYCHOTHERAPY BY REASSOCIATION

T.P.R.
TRAUMA PSYCHOTHERAPY
BY
REASSOCIATION
THE GOLDEN RULES OF PTSD TREATMENT
Gerald Brassine, psychotherapist. director of
M.H.Erickson Institute of Belgium.
Los Angeles, december 11, 2014
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T.P.R - THE GOLDEN RULES OF PTSD TREATMENT
Part 1 - Conversationnal Hypnosis définition
• Golden Rule No 1: Prevent reviviscence or secondary victimisation
• Golden Rule No 2: Concept of « Conversational Hypnosis »
• Golden Rule No 3: No pain
Part 2 - How does one create a conversationnal hypnosis ?
Part 3 - « Dissociatives Protections ». A specificity of TPR
• Golden Rule No 4: Systematic, paradoxical and radical use of of all
« Dissociative Protections »
Part 4 - The game of change trough metaphoric co-creation
• Golden Rule No 5: Metaphorical Co-Creation for a Gentle Tranceformation of Mental and Physical Memories
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T.P.R - THE GOLDEN RULES OF PTSD TREATMENT
Part 1 - Conversationnal Hypnosis définition
Golden Rule No 1: Prevent reviviscence or secondary victimisation
• No the need to relive a traumatic scene. Even slightly !
• The altered state of consciousness involved in any revivification
accentuates the symptomatology
• The traumatic event and its current resurgences should be filtered,
reprocessed in an almost permanent comfort
• Any painful revivification should ideally be excluded or immediately
transformed !
• This is essential for a full desensitization and facilitates retrieval of all
forgotten memories
• This presentation offers several practical ways to achieve it.
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Golden Rule No 2: Concept of « Conversational Hypnosis »
This hypnosis is
• Active
Patient learns to control his autonomic nervous system.
• Interactional
The hypnotherapist invites and teaches the patient to speak, to describe
his condition, to try some of the proposals.
• Participative
The patient is encouraged to use his own ideas to master and control
his symptoms, even painful ones.
The patient speaks at all times (which also deepens the trance): an usual
conversation is established between patient and therapist.
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Description of « Conversational Hypnosis » (continued)
• Important to agree on the meaning of the language used about
“conversational hypnosis”.
• Past 20 years definition of conversational hypnosis: the hypnosis is
done without announcing it or declaring it, the patient being
surprised into hypnosis; result of a monologue (sometimes even a
soliloquy) of the hypnotherapist through the use of metaphors or via
the "Hypnotist sleepy tone of voice" from classic hypnosis.
Hypnosis "without hypnosis".
• Misunderstanding/generalisation of the Milton Erickson’s famous
case : “The man with tomato plant induction"? “Interpersal technique“:
indirectly and without an explicit declaration of hypnosis.
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T.P.R - THE GOLDEN RULES OF PTSD TREATMENT
Description of « Conversational Hypnosis » (continued)
• “Conversational hypnosis” now: nothing is done without the patient’s
awareness (it is also the patient’s responsibility)
• Interactional and well adapted to the treatment of traumas because it
provides to the patients control and permits to avoid reliving the
trauma (first Golden Rule).
• With regards to heavily traumatized persons, the therapist has to
demonstrate that he knows about the hypnotic phenomena that are
scary and invasive.
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Knowledge that the Therapist should demonstrate to the patient.
1) On the phone – Presence of a « Baby sitter » (Story)
2)That he is not afraid and knows about hypnotic phenomena present
in PTSD symtoms
• Dissociation, anesthesia, depersonalisation
• Intrusions
• Catalepsia
• Guilt
• Pleasure
• Psychosomatic
• Depression low self esteem
3) Avoidance of Revivification while taking info
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Part 2 - How does one create a conversationnal hypnosis ?
Definition and induction of Hypnosis:
• Day dreaming in which you gain power on Autonomous Nervous
System (Emotions, sensations, psychosomatics…)
• This is based on the fact that the brain cannot make a difference
between imaginary and reality (If an imaginary sun, hormone
melanine )
• You remain independant from me :
1) your « good moments »
2) oppose, do not to follow some of my proposals, adapt my
proposals
3) 2 things that you will not reveal, not share with me
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Induction per se
• A good moment choosen by the person : (on the beach, pregnancy,
dancing, sport) is pretext an occasion to:
- Demonstrate the beginning of mastering the Autonomous Nervous
System, by « enlarging - expanding » the good sensation and reducing
anxiety or else…
- Invite and teach the patient that he can speak while in a transe, react,
etc , which deepens and stabilizes transe
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Induction per se (Continued)
• Training in different Hypnotic Phenomena. MHE
1) Dissociation : flying above oneself (Peter Pan) or being a giant as big as
King Kong or Gulliver
2) Depersonnalisation : as if he was someone else
3) Physical Anesthesia : notice that in his hands, feet change in sensation,
play with it , master and intergrate it.
4) Emotional Anesthesia : switch off
5) Thanks for contribution, for refusals, for what they do, for trying
phenomena, etc (MHE)
• This whole procedure is enhancing the possibility of deep hypnosis.
« It is the small difference that is making all the difference ! » G.
Bateson
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Golden Rule No 3: No pain
-Situation of non-pain and preferably even amusing:
efficient and amazingly fast resolution of extremely difficult or painful
memories and their current symptomatic corollaries
-Friendly and firm guidance of the patient:
constantly conversational, so the therapist is at all times informed of the
progress patient is doing on "sensitive plates of his traumatic memories"
and that in a state of maximum comfort. Even more effective are the
moments of fun and pleasure during which the patient is actively
involved.
Constant back and forth to the starting comfort position (long prepared
and hypnotically developed with the patient in advance) will allow for
healing if comfort is eroded during desensitization. This serves as
training and learning room for different hypnotic phenomena to reprocess
past and still present pains (including current somatic pain)
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Golden Rule No 3: No pain (continued)
• The therapist’s directivity and creativity are essential in the phases
of gradual desensitization
• Example: the elements of the traumatic event, however small, can be
brought separately in the place of safety
• Gradually, other elements of the memory will be brought to this place
of comfort . The patient has been previously invited to numb and
dissociate himself from the scene.
• All available creative ways and hypnotic skills will be involved at all
times, to bring a permanent comfort during the process. The more this
rule is respected, the more the work will be done quickly.
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Part 3 - « Dissociatives Protections ». A specificity of TPR
Golden Rule No 4: Use of paradoxical systematic and radical of all
« Dissociative Protections »
• David Cheek: the altered state of consciousness that occurs at the
moment of the traumatic incident is probably the cause of the wide
variety of PTSD symptoms and the hypnotic component thereof.
Amnesia, various dissociations, anesthesia, depersonalizations,
psychosomatic conversions are there to testify.
• The hypnotic phenomena became symptom or vehicle of
symptoms.
• We propose that these symptoms be used, paradoxically developed
to better overcome them and to desensitize the content and memories
they serve to protect. David Cheek said that if an hypnotic state is the
cause of the trauma, then later an altered state of consciousness is
required to eradicate the symptoms that are listed on this specific level
of consciousness. Hypnotherapists can only agree with this view.
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Golden Rule No 4: Use of paradoxical systematic and radical of all
« Dissociative Protections » (Continued)
• A lot of authors express the fact that the traumatic incident activates an
imprinting mechanism which long extends beyond the time of the
initiating trauma. Emotions, sensations and cognitions are fixed and
remain intense (even under amnesia) they are expressed in the usual
symptoms of PTSD sufferers. The therapist's job is to “de-freeze”
gently and hypnotically desensitize these phenomena captured in the
heart and body of patients.
• The traumatized person is an expert in the use of hypnotic /
dissociative defense mechanisms/ “Dissociative Protections”.
These are only “Poor crafts quality or Do-it-yourself job” of the
unconscious, they have protected the person somehow so that she may
survive and will continue to do so as long as the traumatic pain fire
has not been extinguished. However, these protections have their
setback since living anesthetized, dissociated and enduring
psychosomatic illnesses is nothing enviable...
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Golden Rule No 4: Use of paradoxical systematic and radical of all
« Dissociative Protections » (Continued)
• And we do not forget amnesia that protects the pain of memory, which
some novice therapists still think is better not to touch: any amnesia is
the hidden face of serious symptoms including psychosomatic
diseases which are just one example of dissociated occurrence.
However, if the therapist ensures constant patient comfort during the
procedure of desensitization of the trauma, removing the amnesia will
be painless and will eliminate the associated symptoms.
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Golden Rule No 4: Use of paradoxical systematic and radical of all
« Dissociative Protections » (Continued)
• This fourth point is one of the most important innovations of Trauma
Psychotherapy by Reassociation (TPR) that we designed in the light of
the golden rules described in this article. The most useful concept from
which are declined different techniques to ensure comfort and safety of
the patient, is to use, develop and amplify the spontaneous (or not)
hypnotic phenomena, which originated at the time of traumatic incident,
to better revisit and safely correct active traumatic injuries and
current pain. The utilized symptom or hypnotic phenomenon carrier of the
symptom will also disappear as a protective device.
• Example: the raped person will no more dissociate, or being numb,
or suffer from psychosomatic pain whenever in the arms of the
loved and chosen ones.
+ spécial mention on psychosomatics spécificities with TPR
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Part 4 - The game of change through metaphoric co-creation
AT ALL TIMES IT IS A DANCE OF TWO PERSONS
• Change anything and everything from the different aspects images of
the trauma ; emotions sensations smels, taste, etc…
• Expression of the repressed emotions , rage, anger sadness, etc.
• Ignition of autonomous processes to « self treatment »
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Golden Rule No 5: Metaphorical Co-Creation for a Gentle Tranceformation of Mental and Physical Memories
• Refers to the use of appropriate means to ensure this important comfort.
• Our technique, developed since the early 2000s, is to use and amplify the
spontaneous (or not) hypnotic phenomena, which had their origin at the
time of the traumatic incident, to better revisit and safely correct active
traumatic injuries.
• The idea is to use all available metaphorical tools, all
filters, ​distances and transformations made, performed through
dissociative protections
• They reflect the fun and creative aspects used by a patient fully
aware of the importance of personal involvement. This co-creation
will make this flying-high therapy like child's play in which patient and
therapist will have fun together!
• As a result deep hypnosis phenomena will often develop spontaneously.
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CONCLUSION
&
Q&A
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