IST & Trauma DD conf 2017 Handout - s3-us-west …

Presenter Constance M. Romer-Quirin M.S. Psychologist - Owner, Lives In Motion LLC

P.O. Box 47, Villanova, Pa. 19085

Intensive Systems Therapy (IST): Trauma Informed

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Trauma

• Trauma can be thought of as a real or perceived threat to one’s survival.

• A trauma reaction can be thought of as a person’s response to the memory of a trauma.

Trauma Reaction

• The memory of the trauma is activated by something in a current experience.

• The person interprets and reacts to the current experience as if it is threatening survival in the moment.

• The strength of the interpretation and reaction depends on the saliency of the event.

Saliency

• The level to which something in the environment can catch and retain one’s attention.

• Affects what is remembered. • Affects what is perceived to be true. • Affects response to events in the

current environment.

Trauma Memory

• 9/11, Single, highly salient event. • Stored in detail. • Threat to various survival needs. • Distorted memory, perception, fact in a

percentage of the US population.

Intensive SystemsTherapy

• Cognitive Behavior Therapy model. • Focused on thinking determining

actions. • Identifies thinking associated with

trauma reactions. • Helps shift thinking from memory to

the present environment.

IST Helps Thinking

• Trauma thoughts predisposes people to pay attention (increase saliency) to parts of the environment associated with memory rather than the present. Their reactions are usually a poor fit with the environment.

• IST helps people think/ perceive in the present moment. The response is a better fit with the environment.

IST Strategy for Trauma

• Provide an alternate thought/ perception/ narrative for the current environment that is true and salient.

• Engage the primary social group in a regular and reliable conversation about the alternate thought/perception/narrative.

• Point out survival resources or absence of survival threats.

Focus on the Social World

• Not belonging is one of the great survival threats.

• Exclusion / loss of primary social group. • Powerlessness / lack of skill for joining

or maintaining membership in the group.

Maslow’s Hierarchy of Needs

Resources necessary for Survival

IST creates social connection

• Draws attention to social resources in the present.

• Shows the individual how to belong (aka social grooming) to a group.

• Empowers the individual to initiate social engagement that fits the setting.

• Sustains a consistent alternate experience in a positive narrative.

IST promotes structuring adaptive, deliberate thinking about self and one’s relation to the people in the environment to promote a good fit between the individual and the social

environment, whatever it might be.

Salient Belonging

IST Tools

• Weekly IST Group Sessions generally one hour a week

• Daily Activity Scheduling generally five minutes a day

• Daily Co-management generally five minutes a day

Group Protocol

A Completed IST Group Session

Check In• Mood identification • Active listening • Turn taking

(seriation) • Reciprocal social

interaction • Positive regard

(affective learning)

Issues

• Labeling • Neutral language

(emotional regulation)

• Turn taking • Shared power

Prioritization

• Logical analysis • Advice seeking • Positive

reappraisal • Turn taking

Problem Solving• Fact checking • “I” Statements • Logical analysis (Guided

Discovery) • Advice seeking • Positive reappraisal • Mutual reciprocal social

interactions • Positive regard • A sense of belonging and

relatedness to mankind (reducing the perception of danger in social interactions).

Perception of Danger and Avoidance Coping“you don’t care about me”....I’m out of here

IST relationship and logic skills

• “I” Statement - used to give people information that they may not want to hear in a manner that does not trigger volatility

• Fact Checking - description of facts related to issues rather than judgmental statements

• Guided Discovery - logical choice making towards conclusions

“I” Statement

• Therapeutic language • Used to communicate information that

could be perceived as a threat to survival.

• Two parts: FACT/FEELING and WHAT WOULD MAKE THINGS BETTER.

• Increases the saliency of the available resources in the moment.

Example

• “Mom called” • “She said that she is not coming to pick

you up for the weekend.” • “I am sad about that.” • “It would make me feel better to go out

for an ice cream sundae. Can we go out to Friendly’s and then come back and unpack?”

Example

• “Heddy (favorite staff) is taking time off”.

• “She is moving.” • “She needs time to pack her things.” • “She will be back by Halloween.” • “We all will miss her.” • “It would feel good to plan a party for

when she comes back.”

Summary

• Trauma reactions are the consequence of trauma memories distorting perception of the present.

• Trauma memories can distort the perception of the social world.

• A concrete, valid narrative about the present offers an alternate perception that is a better fit for the environment.

• A better fit validates belonging.

Thank you for listeningConstance M. Romer-Quirin M.S.

P.O. Box 47, Villanova, Pa. 19085 tel. 215-489-8640 fax 215-489-8642