and conceptual framework on which to begin a peer ...€¦ · Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected] Slide 3 Overview of complex

Equine Facilitated Psychotherapy for Treatment of Complex Trauma

2013 PATH Intl. Conference Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]

Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]

Slide 1

Laurie A. Benton, Psy.D. The Forensic Psychology Department at The Chicago SchoolElizabeth Freund, Healing Tales School of Equine Facilitated Learning

Slide 2

• Facilitate collaborative exchange between equine facilitated and trauma professionals

• Offer a theoretical foundation and conceptual framework on which to begin a peer-reviewed discussion of equine facilitated change in complex trauma




Slide 3

• Overview of complex trauma

• Overview of therapeutic approaches to trauma

• Discuss benefits

• Offer a theoretical foundation and conceptual framework

of equine facilitated change in complex trauma

• Provide a brief review of research approach

Slide 4

“Children’s experiences of multiple traumatic events that occur within the caregiving system” (Cook, et al., 2003, p.5).

Complex trauma has had several labels over time:• Disorders of Extreme Distress, Not Otherwise Specified• Complex PTSD• Developmental Trauma Disorder

These experiences are chronic and begin in early childhood

Cumulative Impact of Multiple Adverse Childhood Experiences

Emotional, Physical & Sexual Abuse Neglect

Exposure to Violence Witness to Domestic Violence

Incarceration of Parent Parental Substance Abuse/Mental Illness




Slide 5

Current System

• Frequent misdiagnosis

• Unnecessary multiple diagnoses

• Never diagnosed

• Focusing on the behavior rather than the underlying problems that are causing the behavior

Complex Trauma

• Enhanced description of clinical presentation

• Assists clinicians with effective interventions

• Impairments of complex trauma go beyond DSM-IV PTSD diagnostic criterion

• Includes disruption in capacity for self-regulation and secure attachment

• Includes potential impact on individual’s ability to self-regulate, self-organize, or draw upon relationships to regain self-integrity

• Focuses on new research & importance of neurobiological differences of complex trauma

Slide 6

1.Visual

2.Association/ST Memory/Equilibrium/Emotion

3. Motor Function

4. Muscles/speech

5. Auditory

6. Emotion/pain/hunger/fight & flight

7. Sensory Association

8. Olfafactory

9. Sensory/skin

10.Somatosensory

11. Language Comp

12.Motor Function/orientation

13.Higher Mental Function

14.Motor Function

The brain is organized in a

hierarchical fashion:

All information first enters the lower

brain

The “survivor brain”

Lower brain in charge of regulatory

functions

Upper brain more complex thinking,

planning

Upper and lower need to

communicate

Clinical Implication: A young child

growing up in a home and

community with pervasive threat

may create a set of associations,

quite outside of awareness, for

threat. Thus, many cues will trigger

the fight or flight response and alter

behavior, emotions, and physiology.




Slide 7

1.Visual


3. Motor Function

4. Muscles/speech

5. Auditory



8. Olfafactory

9. Sensory/skin

10.Somatosensory

11. Language Comp



14.Motor Function

The brain develops from the

bottom up and inside out

The brain grows during

development and becomes more

organized

The stress response system

originates in the lower parts of

the brain to help regulate and

organize higher parts of the

brain

Clinical Implication: If the lower

part of the brain is poorly

organized and regulated, upper

parts of the brain will be

dysregulated. Traumatic stress

will result in patterned,

repetitive stress response that

will negatively impact thinking

and emotions

Slide 8

The brain develops in a

sequential fashion

Success of one phase depends

on success of the previous

phase

Clinical Implication: If the lower

part of the brain is poorly

organized and regulated, upper

parts of the brain will be

dysregulated. Traumatic stress

will result in patterned,

repetitive stress response that

will negatively impact thinking

and emotions

1.Visual


3. Motor Function

4. Muscles/speech

5. Auditory



8. Olfafactory

9. Sensory/skin

10.Somatosensory

11. Language Comp



14.Motor Function




Slide 9

Neurons change in a use

dependent fashion

Typical development

requires attentive,

attuned, caregiving and

rich array of relational

opportunities

Clinical Implication: A

child exposed to neglect,

chaos, and constant fear

will have an increased

risk for significant

problems in all domains

of development

1.Visual


3. Motor Function

4. Muscles/speech

5. Auditory



8. Olfafactory

9. Sensory/skin

10.Somatosensory

11. Language Comp



14.Motor Function

Slide

10

The brain develops most rapidly

in early life

Clinical Implication: Early

childhood trauma or

maltreatment has a

disproportionate capacity to

cause significant dysfunction

1.Visual


3. Motor Function

4. Muscles/speech

5. Auditory



8. Olfafactory

9. Sensory/skin

10.Somatosensory

11. Language Comp



14.Motor Function




Slide

11

Intrapersonal and Interpersonal Domains of Impairment

Biology

Affect Regulation

Dissociation

Cognition

Self Concept

Behavior Control

Attachment & Relationships

•Sensorimotor Analgesia Coordination

•Balance Somatization Medical Issues

•Emotional Regulation Label & Express Feelings Label & Describe Internal States

•Communicate Wishes & Needs Anger turns into Aggression Sadness turns into Suicidality orSelf Injury

•Amnesia Depersonalization De-Realization

•Attention Regulation 2 or more States of Consciousness Impaired Memory of Events

•Executive Functions Sustained Curiosity Planning

•Understanding Responsibility Task Focus & Completion Language

•Learning Time & Space Orientation

•Body Image Guilt Shame

•Self Esteem Self-Efficacy Unstable of Self

•Impulse Control Self-Destructive Behavior Aggression

•Understanding & Complying with Rules Excessive Compliance or Defiance Sleep Patterns

•Re-enactment of Trauma Behaviors (Sexual Abuse)

•Boundaries Trust Suspiciousness

•Relationships not used for Self-Soothing Social Isolation Interpersonal Style

•Relationships not used for Self-Regulation Emotional Regulation Perspective Taking

Slide

12

• The brain can change, but some systems

are easier than others

The upper brain is quite open to change

The lower brain is not as easy to change

• Trauma related symptoms are related to

lower brain function. These areas less open

to change

• Traditional therapy does not target them

directly




Slide

13

• Experiential

• Novel

• Sensory

• Emotional

• Social/Relational

• Cognitive

• Variable Contexts

• Variable Applications

Slide

14

•Explains how & why change occurs

•Predicts what change will occur

•Offers common ground for discussion

•Offers the rhyme and reason for innovative, goal-directed, evidence based

practice.

•Contributes to the development of standards for application, evaluation,

research and innovation.




Slide

15

• Social animals

• Prey animals

Primal Symbiotic Potential

• Safety• Influence• Attunement• Trust

Relationship • Experience

• Sequence

• Pattern

• Repetition Intrapersonal skills

Interpersonal skills

Slide

16 Primal symbiotic potential of horses & complex trauma survivors




Slide

17 Horse-Survivor Relationship

Slide

18 Social Learning




Slide

19

Shared instincts of social prey animals disrupt automated

defense behaviors of complex trauma survivors and offer

powerful motivation for learning. The survivor-horse

relationship provides a developmental context for social

learning experiences that lead to changes in intrapersonal and

interpersonal skills.

• Social animals

• Prey animals

Primal Symbiotic Potential

• Safety• Influence• Attunement• Trust

Relationship • Experience

• Sequence

• Pattern

• Repetition Intrapersonal skills

Interpersonal skills

Theory of Equine Facilitated Change in Complex Trauma

Slide

20

• Use it to improve your practice or use your practical

experience to improve this theory

• Use it to set goals, design new activities and develop new

programs

• Use it to measure the outcomes of your students/clients,

monitor progress, refine programming & build evidence of

success

• Use it to begin participation in a peer reviewed discussion and

contribute to the knowledge base

How can you use this theory?




Slide

21 • Complex trauma alters neurobiology

• Altered neurobiology poses therapeutic obstacles

• As a therapy or adjunct, the horse-survivor relationship can

overcome therapeutic obstacles and enhance traditional trauma

therapy

•A published theoretical foundation and conceptual framework

fosters collaboration, enhances application, evaluation and

research. Discussion contributes to the knowledge base and

supports information exchange between disciplines

•The most useful theories are continually refined by those who

use them—Use it and help us refine it

In Conclusion

Slide

22

Questions or Comments?

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and conceptual framework on which to begin a peer ...€¦ · Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected] Slide 3 Overview of complex

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