how to help clients with early developmental trauma

 the reason I came across Mindful Self Compassion and CFT and mindfulness and yoga and the whole gamut of skills and training - is because I meet in my own work, adults who have severe ACE and need serious help. I also have my own experience of ACE.

remember that these are the most challenging clients that anyone is probably going to meet:

How to help in a therapy setting? (number 18 is one of my favourites) 

1. extreme kindness

2. a lot of love

3. acts of love that are 'allowed' 

4. good self care and boundaries which are flexible (so not too tight)

5. really good loving caring relationship with client

6. heart open in the most authentic sense (see 18) 

7. the humanising approach to suffering - the wonky brain and evolution and all that

8. the 'normalising' that coping methods for extreme abuse are normal in their own way etc

9. massive nurturance

10. massive encouragement to do body work: sensorimotor therapy, brain training, yoga, qi gong, tai chi, - in manageable ways (not really existing in the NHS much)

11. serious in depth self compassion training modelled by the therapist to a huge degree (the clients in this catagory will rarely have experienced this kind of human being)

12. building up warm loving support groups around the client in any way - church, sports group, hobby groups, cinema groups, local clubs, music groups, anything really to increase the chance of meeting caring individuals who can come to learn to know and love the client and be a support 

13. consistency 

14 determined self practice so that one's presence is not hollow - ie work to not talk about compassion whilst being shallow and  pretty hard on oneself or be more interested in coming across or seeming 'the great psychologist/therapist/expert'. Actually EMBODY the love, kindness and compassion so the clients picks it up at a deeper level. (see 18) 

15. Random Acts of Kindness. 

16. Tara Brach's Radical Acceptance.

17. I actually believe that it is important for certain parts of the brain to grow well that one needs to feel cherished and loved as a child, as the broken traumatised child. So - that is difficult for a young person or adult client. they still bring the broken child into therapy, and the broken child needs to feel cherished, heard and respected and loved. (see 19) 

18. I have an article that I love - will copy and paste the link

but in it Dan seigal writes of four conditions:

 (1) Insecure, ambivalent, avoidant, or disorganized early attachment experiences are real events which can substantially and destructively shape a client's emotional and relational development (the client's adult problems don't originate in childhood-based fantasies). 

(2) The attachment pattern learned in early childhood experiences will play out in psychotherapy. 

(3) The right brain/limbic (unconscious, emotional, intuitive) interaction of the psychotherapist and client is more important than cognitive or behavioral . The Attuned Therapist suggestions from the therapist; the psychotherapist's emotionally charged verbal and nonverbal, psychobiological attunement to the client and to his/her own internal triggers is critical to effective therapy. 

(4) Reparative enactments of early attachment experiences, co-constructed by therapist and client, are fundamental to healing.

see http://www.drdansiegel.com/uploads/The-attunded-therapist.pdf

19. this article speaks volumes to me: http://howtherapyworks.com/attachment-to-your-therapist/

20. commitment and the ability to hang on in there.

21. http://www.pods-online.org.uk/index.php

I like this website and the work these people are doing. clients who have deep understanding of the impact of ACE and also they offer training in how to work with such clients - with day workshops around the country. 

22 - ?

I could go on and on, and probably get to 100 so I had better stop. 

Abandonment by therapist - legal concerns

 http://naswcanews.org/termination-ending-the-therapeutic-relationship-avoiding-abandonment/

Termination: Ending the Therapeutic Relationship-Avoiding Abandonment

August 17, 2015

By Elizabeth M. Felton, JD, LICSW, Associate Counsel and Carolyn I. Polowy, JD, General Counsel© March 2015. National Association of Social Workers. All rights reserved.

Social workers’ therapeutic relationships with their clients eventually come to an end. However, the way they end and how the social worker handles terminations can have ethical and legal implications.

This article will address some of the more common issues that may arise during termination and ways to enhance client care while avoiding allegations of abandonment.

Termination

Social workers should assess a client’s ongoing treatment needs prior to initiating termination. The NASW Social Work Dictionary defines termination as: “The conclusion of the social worker –client intervention process; a systematic procedure for disengaging the working relationship. It occurs when goals are reached, when the specified time for working has ended, or when the client is no longer interested in continuing. Termination often includes evaluating the progress toward goal achievement, working through resistance, denial, and flight into illness. The termination phase also includes discussions about how to anticipate and resolve future problems and how to find additional resources to call on as future needs indicate.[1]”

There are many reasons why therapy ends. A client may terminate at any time for any reason. Ideally, termination occurs once the client and therapist agree that the treatment goals have been met or sufficient progress has been made and/or the client improves and no longer needs clinical services.  However, there are many valid reasons that are discussed below as to why the therapist-client relationship may end the treatment before it is completed. Some of those reasons include:

• Client has mental health needs that are beyond the social worker’s area of expertise. For example, the client requires a different level of treatment (e.g., inpatient or crisis intervention) or more specialized treatment (e.g., trauma or substance abuse) than the social worker provides in the practice setting.

• Therapist is unable or unwilling, for appropriate reasons, to continue to provide care (e.g., therapist is retiring/closing practice or client threatened therapist with violence).

• Conflict of interest is identified after treatment begins.

• Client fails to make adequate progress toward treatment goals or fails to comply with treatment recommendations.

• Client fails to participate in therapy (e.g., non-compliance, no shows, or cancellations).

• Lack of communication/contact from the client.

It is recommended that therapists have a final session with their clients to review the overall progress before ending therapy, but sometimes this cannot happen, e.g., when the client stops communicating with the therapist. It is suggested that therapists create a policy for their practice so that cases are routinely closed after a certain amount of time without any contact from a client, for example: “If I do not have contact or communication from you for a period of xxxx days, I will assume that you no longer intend to remain active in this therapeutic relationship and your case will be closed. You can return to therapy in the future if you decide to continue treatment.”

One way to establish that timeframe is to think about how long you want to be the therapist of record without seeing a client.

• Non-payment of agreed upon fees:

Before a social worker terminates for non-payment, the following criteria should be met:

• The financial contractual arrangements have been made clear to the client, preferably in writing.
• The client does not pose an imminent danger to self or others.
• The clinical and other consequences of the non-payment (i.e., disruption of treatment/interruption of services) have been discussed with the client. NASW Code of Ethics, 1.16c

Certain circumstances may support a delay of the termination. For instance, it is not recommended that a therapist end treatment with a client who is in crisis at the time termination is being considered. A social worker has a responsibility to see that clinical services are made available when a client is in crisis. Postponing termination is preferred, if possible, until steps are in place to handle the crisis. 

Abandonment

Abandonment is a specific form of malpractice that can occur in the context of a mental health professional’s termination of services. Abandonment, also referred to as ‘premature termination,’ occurs when a social worker is unavailable or precipitously discontinues service to a client who is in need.

In a malpractice case based on abandonment, the client alleges that the therapist was providing treatment and then unilaterally terminated treatment improperly. The client must show that he was directly harmed by the abandonment and that the harm resulted in a compensable injury.  The client’s dissatisfaction with the outcome is not sufficient to establish the therapist’s negligence. The client must also show that the termination was not his fault, e.g., that he kept his appointments, complied with treatment recommendations, and paid his bills.[2]

It is critical to be able to establish both the reason for termination and the manner in which it is carried out. After beginning a therapeutic relationship with a client, a social worker must not terminate therapy abruptly without referring the client to another mental health practitioner. If the social worker does not properly terminate the client-therapist relationship, the social worker exposes himself to allegations of abandonment which could lead to a lawsuit, a complaint to the state licensing board, or a request for professional review by the NASW Ethics Committee.[3] Proper termination that has been documented is a defense to abandonment allegations, and it supports good client care.

The NASW Code of Ethics addresses the issue of termination of services in 1.16:

1.16 Termination of Services

(a) Social workers should terminate services to clients and professional relationships with them when such services and relationships are no longer required or no longer serve the clients’ needs or interests.

(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary.

(c) Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.

(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.

(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients’ needs and preferences.

(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.

For more information, see NASW Code of Ethics.

Tips for Termination

• Prepare for termination from the beginning. Termination should be discussed early so both parties can have a number of sessions to discuss ending therapy.
• If continued treatment is needed, provide referrals to several mental health professionals, with addresses and phone numbers. Three referrals is the “rule of thumb” minimum. If possible and with the client’s consent, assist in the transition to other health care providers.
• Conduct the final session face -to-face, if possible. Avoid ending with a text, in an email or with a voicemail message.
• Make sure the client understands when, why and how therapy will be terminated.
• Document discussions about termination.
• Formalize the termination with a personalized termination letter (not a form letter).

What to include in a termination letter?

 It is good practice for a social worker to draft a termination of treatment letter to every client once treatment has ended, regardless of the reason, to formally end the therapeutic relationship. This provides clarity to the client, and it helps avoid any implication that the social worker has an ongoing therapeutic responsibility.  The termination letter would be in the form of a business letter and include:

• Client’s name
• Date treatment began
• Effective date of termination
• State the reason(s) for the termination. (e.g., treatment goals have been met, client’s needs are beyond the scope of social’s workers practice or area of expertise, non-compliance with treatment recommendations, therapist is retiring/closing practice)
• Summary of treatment, including whether you feel further treatment is recommended
• If continued treatment is needed, provide three referrals to mental health professionals, with contact information
• Present the letter in person during a session or send it with delivery tracking and confirmation of service and/or certified return receipt
• Retain a copy of the letter and delivery documentation in the client’s file
• Mark the letter “confidential”
• Don’t mention confidential therapeutic treatment information

Conclusion

Addressing the termination of treatment is an important phase of the therapeutic process. For termination to be handled properly, discussions between the social worker and client should occur in advance and be addressed in a thoughtful and sensitive manner. It is best that clients not feel that they have been abandoned, for the sake of the client as well as the social worker. If continued treatment is needed, the social worker must make an effort to assist the client in obtaining ongoing services to ensure that these needs are adequately addressed. Proper documentation of the termination of the therapeutic relationship with the client will provide support for the social workers’ effort to meet the clients’ needs as treatment ends.

Resources and References

Barbara A. Weiner, J.D. & Robert M. Wettstein, M.D., Legal Issues in Mental Health Care164-165 (1993). “Codes of Ethics on Termination in Psychotherapy and Counseling,” Zuri Institute, Inc.

NASW Code of Ethics (2008)

5 Proven Ways Posture Can Help Improve Mental Health

from :

http://www.ahealthblog.com/5-proven-ways-posture-can-help-improve-mental-health.html

5 Proven Ways Posture Can Help Improve Mental Health

We’ve always heard our parents telling us to sit up straight, to walk tall, and to have proper posture. But, why is it good posture so important? Aside from the physical health benefits good posture can provide us, it can also contribute to a better feeling of self, a happier outlook on life, and even help us make friends. Below you’ll see five ways that posture can improve mental well-being.

1. Improves your mood

Have you ever noticed that when you’re feeling down, you tend to make yourself physically smaller, maybe by curling up in bed or crossing your arms and legs. You try to make yourself as little as possible, which serves as a coping mechanism, but is also a reflection of how you see yourself. Our feelings in this cause change our posture, but our posture also changes how we feel. Doing the opposite can improve your mood! Sitting proudly at your desk and taking up space can actually make you feel better, whether you feel good or not.[1]

Put it into action: Take 30 seconds in the morning to stand up straight in front of a mirror. Put your shoulders back and smile at yourself. Stretch and make yourselfbig. Not only will this help you get your day started off on the right foot, but it will also increase blood flow, which leads us to our next point…

2. Improves blood flow to the brain

Sitting or standing properly increases blood flow throughout the whole body. If you have a desk job, having proper posture can keep the blood from pooling in your legs and making you uncomfortable. Also, good blood circulation means that it is reaching the brain, making it easier for you to think and carry-out complex tasks.[2] So, don’t get frustrated if you’re not quite on your game. Stretching and fixing your posture can help you get through that mid-day lull.

Put it into action: If you feel like your brain is a little sluggish (maybe after lunch), get up and go to the bathroom. Do some over head stretches and really get your blood flowing. Again, look in the mirror and make sure your shoulders are back and that your spine is in place. When you get back to your desk, maintain that tall posture, you’ll see the difference!

3. Helps you make friends

In general, people like happy people. If you can emit a feeling of openness, happiness, and receptiveness, people are more likely to be friendly with you.[3] An open posture may be sitting up straight, facing people and not a wall, with your arms and shoulders back and in an inviting posture. You don’t want to cross your arms or legs, as it makes you seem closed off (but this may work if you just need some time to yourself!)

Put it into action: Let’s say you’re in a new place and hoping to make friends. Go to a cafe and sit at a central table. Put your headphones and phone away, and sit with your arms resting on the table. A smile is the international sign for happiness, so a smile will make you seem friendly and open. An inviting posture should express openness, so think about what an approachable person would look like and mimic that.

4. Boosts confidence

Keeping your back erect and pushing your chest out can help boost your confidence.[4]Standing tall and feeling confident can make others perceive you as being confident.[5]Even if you’re not so sure about your class presentation or job interview, you can trick yourself into being more confident than you actually feel by making yourself as big as you can, which is called Expansive Posture. Practicing some of this expansive posture can make you feel differently about yourself and even change your state of mind.[6]

Put it into action: Imagine what a starfish looks like, arms and legs spread out as wide as possible. Do that in the bathroom before your presentation and you’re sure to feel more confident!

5. Makes you more productive

We’ve all tried to write our term paper or a big report while laying down in bed or on the couch. Yes, it is a lot more comfortable, but have you noticed that the content justisn’t as good and you have a harder time focusing? That’s because our posture affects how productive we are.[7] Sitting upright at a desk makes us take the task more seriously and helps us knock out those last 3 pages faster than we could if we were hunched over or lying down.

Put it into action: Rather than slouching in an armchair or trying to get as vertical as possible, find a desk that is the proper height for you, plant your feet on the ground, and sit up straight. Your blood will flow easier and you’ll be in the right state of mind to really get work done!

My experience of this guy as an EMDR therapist was not good: Nick Adams

I spent 18 months getting funding for EMDR for trauma (recommended in the NICE guidelines) and found a therapist Nick Adams
http://www.psychtherapy.co.uk/about-nick-adams-msc-ba-dhyp-tftdx
we did 12 sessions
and on the morning of the 13th, he called me to say he no longer would be working with me.
No referall. Nothing.
 the funding we had obtained, was linked only to him.
I was in the middle of massive trauma processing.
I insisted he refer me and we try to get the funding changed to a new name
He gave me the name of one of his supervisees who would not see me due to Nick Adams being her supervisor.

He told me and my husband that he can cure PTSD in ten minutes, or in four sessions and was adamant that he could cure all my traumas.
He actually bailed out on me with no concern for my safety.

Premature Ending of therapy: Attachment Disorder

I am meeting a lot of people who have had their therapy terminated prematurely - either to do with the NHS funding being pulled or because their therapist/psychologist has had enough of the cuts and stress and are pulling out to retire early or move to private work elsewhere. It is getting increasingly common. 

I am beginning to feel most uncomfortable (understatement) that this is not only 'allowed' but worse, it seems professionals are not considering the long term damage it can cause the client. 

I am going to cut and paste some of the comments that I am receiving from people who have experienced this in therapy. (see below).

I consider it damaging. One person told me it was worse than any of the rapes or childhood abuse that had brought her to therapy in the first place. 

another client explained that although she had to sign a contract as a client saying she will not terminate suddenly and give advance warning of cancellations, she is now considering drawing up a contract for any subsequent therapist where the therapist has to prove that they will not terminate therapy prematurely unless a huge unforeseen event occurs. Because, the client explained, it is like having a surgeon do open heart surgery and then walk away with the job half done. Leaving the poor client in no fit state to get up off the operating table. 

American friends have told me that they would lose their licence for not providing a transition to a new therapist that they have referred to, so that the client is not left half way through heart surgery. 

So people are telling me:

I did 14 months of therapy with a counsellor and she drew me out and to my shock, I discovered that I am hiding a tiny little girl inside myself and that little girl was coaxed out by the counsellor and after many months of reassurance and repeated reminders that she would not leave me when I was feeling so fragile, I felt like I stepped out and trusted and loved for the first time from that small terrified part of me. I believed her. After a few more months she sent me an email out of the blue saying she was terminating with me. I felt like I was dropped from a cliff miles high. that feeling of free fall and terror and pain kept me awake for four months. I had no name for this. No one understood. No one recognised the trauma of what had happened to me. I still feel it was worse than the traumas that had caused me to go into therapy in the first place. 

A friend emailed me and said:You describe it really well - it is the "rape of the emerging self" and it happens a lot in the name of psychotherapy- and sometimes it happens with people who are being pseudo therapists to people too, (friends who believe they mean well but haven't the wisdom or experience to continue the work and bail out early).

ending therapy early when things are only just beginning to be known or come out into the open, it feels like 

rape of the emerging self

betrayal, rape and abandonment of the emerging self. 

In it's aftermath comes horrendous pain, abandonment on a seismic level, damage to the sense of internal self and a deepening distrust and suspicion of people and especially people who say they know what they are doing and kind of seduce you into opening up.

It is like throwing in a hand grenade into the very soul/heart/core of a person's sense of their emerging self and then BOOM ! everything shatters. connection goes, self disintegrates.

It is violent, causing immense damage even years after the event. It is so destructive.  

I still don't feel any of the terms I have tried to use to tell friends and family are really conveying the destructiveness of the experience. 

I wonder if the CFT approach has this written in to the contract with clients, that they won't be opened up and then abandoned - because it needs to be recognised as abusive and not part of a compassionate approach at all. 

I am beginning to think a book needs to be written about how therapy can go terribly wrong when therapists bail out prematurely and that it is being 'allowed' to happen, causing great harm and damage to clients who are actually being abused rather than helped. 

My heart bleeds for these people. 

I suspect many of you know other cases and people whom it has happened to. I would like to know 

1. what you do to safe guard it happening to your clients 

2. whether you truly take into account the damage premature endings can cause vulnerable clients

3. whether it would be helpful to write a book with accounts from clients of the damage they have experienced from unskilful badly managed premature endings. 

a Colleague replied:

Very helpful, Sarah, to draw attention to this important issue. Especially to remind us of the client perspective. And I would not like this to happen to me. Which actually reminds me that this has happened to me. However, though puzzling thankfully it did not happen too have too great an effect on me, G

and I replied:

 it depends what you ended up in therapy for. 

The people I am encountering have had presented with  'trauma' but as therapy progresses, it becomes apparent that there was huge developmental disruption due to early trauma and so attachment was seriously compromised. I think this client group is especially vulnerable when premature termination of therapy takes place as they have been coaxed out into attaching to the therapist and actually the 'premature ending of therapy' trauma is so severe that I would go so far as to say it is negligent on the part of the therapist to 'allow' it or to initiate it in these circumstances.

Also of course, the damage is severe when the therapy has been longer term, not just a six or eight week course of sessions but one where the therapeutic relationship has been ongoing for a year or more. 

he replied

Absolutely, and thankfully I did not have that trauma and could think it through. and make sense of it.

And yes I have some clients who might well be affected greatly by such a termination. Which emphasise the need for great care indeed with how we are with clients and of what we say, and how we say something. And boundaries in many  other ways as well.

Any papers on this would be interesting and thought provoking so that awareness of this and so that we are less likely to do this in any kind of unawareness.

I wonder how the sudden changes in this country with the referendum and politics might be affecting our own security just a bit more now! And might play out with clients if we are not careful,

G 

Another colleague replied:

I share your concern about this issue.  Whilst it's hard to know what happened in this person's situation it does sound as if something went badly wrong.

If it is the case that clients are being abandoned by their therapists in this way then to my mind this represents a failure in compassionate behaviour and, importantly, also a likely breach of professional practice.  Certainly the regulatory body which oversees my practice (The Health and Care Professions Council) and the body that provides the guidelines for ethical practice for clinical psychologists in the UK (The British Psychological Society) would regard such behaviour as unethical and unacceptable.  I would suggest that any client who thinks that they have been ill-treated by a therapist seeks to raise it with the body with whom the practitioner is affiliated/registered.

With all good wishes,

W

I posted:

Several colleagues I have spoken to have admitted that they don't actually end contact with clients who need connection and attachment to be maintained and so keep in touch after formal therapy has ended, to keep the continuity and attachment that enables healing. One colleague said that some clients are in his life for life - not in a dependent way, but because the relationship is such that it requires something different and he sees that as the more compassionate approach. 

another posted:

 Phase oriented treatment reminds us that stabilization is the first phase which would include being in the present moment and building a capacity to compassionate self. 

I also want to put a plug in for therapists who are working with the most complicated clients and not getting the support they need to process the counter transference and the huge unknowns.  Having done a lot of consultations with therapists in these situations it seems important to give them a lot of compassion when they have to choose, for whatever reason, their own sanity and mental health even if it means terminating. 

D

G replies:

I am finding this conversation very helpful. Yes,it is important for us as therapists to be able to look after ourselves so that we do not end with a client early. Doing the Sensorimotor Therapy training as I am, is incredibly resourcing, I am finding in being able to be more with the depth of peoples trauma, whether it is small t(rauma) or bigger stuff. And helpful so that they can learn to be in touch with the tremendously difficult feelings clients have so that they can learn to be comfortable with them. And of course compassion is of the essence.

And this course IS very expensive, so reflects what D says. And then another issue can be that the client might have financial issues with paying, and this can impact on the relationship with us, if it breaches what we can afford to live with. So there are really big issues here which can affect endings and one way or another play consciously or unconsciously into early termination,

G

I wrote:

a student gave me permission to anonymously post this, written to me yesterday:

I can relate to this, and I'd agree with abandonment or say emotional abusive. The emotional destruction can be a million times worse. The feeling of trusting them with your inner self, especially your inner child, and having them leave is terrible. Especially if you were unable to be a child. I've experienced that situation quite a few times. I hate to say that I don't trust people but it's true and it's more than that. I realize that everyone is in their own head, in their own world, and we can't believe that they will "save" us in any sense. We can believe that they will be a temporary support, or someone who will teach us something directly or indirectly. But I don't any longer believe anyone will be there for me in the way my inner child needs and I can't do it myself so I close off inside. 

and another wrote:

The betrayal aspect of my sexual assaults was far worse than any physical effect, but the abandonment damage in two different settings when I finally let down my guard enough to risk getting close to people after that has been the worst of all. It was like having my heart ripped out and stomped on in front of me. And neither of those were the sort of closeness you're describing.

The one person with whom I have that sort of closeness now is my therapist, and the pain of even the tiniest hint of abandonment by him is immense. That feels like the entire world has ceased to exist, leaving me completely alone, cold and in pain and darkness that will never end. And that is just perceived abandonment. I honestly don't know if I could survive an actual abandonment by him, or anyone else I had opened up to that much. I certainly can't capture the depth of that pain in just a few words or find a term for it.

So it is a big issue for vulnerable clients. I have been talking to a few psychologists about this and we agree that there can be support in place for the therapist, when they feel they need to bail out, but often the client is left stranded. The therapist is often encouraged to do this premature and sudden termination but often it seems not enough thought is put into the safe guarding of the client. Sometimes, by this point of terminal rupture, the client is being labelled 'difficult' and his/her distress is somehow minimised because they are seen as being distressed anyway. Often the client is demonised, in the sense that the therapist was the one doing their best and the client's complaints are just their pathology talking. In some cases I have encouraged clients to get the therapist struck off or at least reprimanded and they have succeeded.

About six years ago I talked with some American psychologists and they said they have a general policy that a therapist must do two sessions for every six months of therapy. So if you terminate, and you have been working for two years with a client, then that would necessitate 8 sessions to end and talk it through. they also said, as I wrote above, that they could lose their license for not putting in place alternative therapy.  I am afraid I have a list too long to mention of clients who have been terminated full stop by phone or email in the UK, private and NHS. 

I would consider this disrespectful at least and negligent and dangerous at worst. 

I presume NHS psychologists are trained and taught how to end with the clients best interests at heart?  And is there a booklet about this?

D replies:

I have always liked how CFT focuses on developing an internalizing secure base. Sensorimotor Psychotherapy, as Gavin writes, provides a great map of the brain and body experientially. Diana Fosha’s AEDP model provides a great relational/attachment model as well, tracking moment to moment processes in the client as well as between therapist and client.

On top of all others have offered, a group of us in Boston wrote a book that Norton is publishing in September which is both a full review of attachment theory as well as providing a positive treatment model for remapping insecure attachment. The outcome studies were quite good.  In writing the book I brought a lot of CFT into the conversation.   Dan Brown, our mentor in attachment and main author, has researched meditation (wrote a classic with Ken Wilber and Jack Engler, Transformation of Consciousness)  and teaches Mahamudra and Dzochen.  In this book we used the concept of an Ideal Parent Figure (which in many ways is akin to the compassionate self of CFT) to support the client in developing a representation of secure attachment.  http://books.wwnorton.com/books/detail.aspx?ID=4294990790

At the same time I was also writing another book on embodying secure attachment through yoga and meditation (Norton Publishing, coming out January/February 2017) which accesses CFT as well. http://books.wwnorton.com/books/detail.aspx?id=4294992067

D

Worse than Rape -: Rape of the Emerging Self

There  is the trauma of someone coaxing out the small child self, encouraging the small child self to emerge, getting that small child part  to have a voice, show her emotions, begin to trust, begin to reach out and hold on to a finger, begin to feel that maybe she matters, begin to feel she is 'real' , that maybe her needs and sorrows and rages and confusion have a reason - having a person encourage that small child to then attach and love the person, the person who is being so adamant about how trust worthy and committed they are, how sincere and loyal and determined they are to be there for that little child, that person being so determinedly convincing in how they are going to make the child trust and emerge and attach and for it to be safe enough- and then

that person sends an email to say they have decided not to be there for her/that small child part -  anymore. Or announces they are stopping seeing the client.

that is the trauma worse than rape, for me. 

That is the trauma that does not heal. It has happened several times - in different ways with different people. Each of them I loved and trusted as only a very small child can.

this trauma is not recognised by society. there is no forum or organisation set up to support survivors of it. there is no recognition of the damage and pain and dismantling it causes me. There is no term for it even. I have no way to refer to it.  

I have wondered about calling it 'rape of the emerging self'. It needs to have a strong label, one that conveys clearly how bad it is. 

anybody got any ideas? It is severe 'child abuse' but not in the conventional sense.

It seems one can heal from rape and CSA eventually, but this particular trauma is more difficult to heal from. The wounds go deep.  I wonder if it is because people refuse to hear that it is a trauma and refuses to acknowledge how severe a trauma it is?

Borderline Personality Disorder

I have never been diagnosed with Borderline Personality Disorder but my own PTSD symptoms sometimes inflame and appear a bit close to this diagnosis but then it all subsides again. Anyhow, I found this article interesting as I do have problem with rage but infrequently and rarely - and I do feel about two years old when I am in rage mode. I know that it links to the abandonments I experienced as a child by my parents and it is helpful to read the guidance here.
http://www.guidetopsychology.com/bpd.htm

Rape and Consent. Stanford University Athlete given six months

http://www.paloaltoonline.com/news/2016/06/03/stanford-sex-assault-victim-you-took-away-my-worth

You may have read the account of the girl who was unconscious and raped behind a dumpster at a frat party at Stanford Jan 17th 2015. Her assailant got six months possibly down to three for good behaviour.

The father of a former Stanford University athlete convicted on multiple charges of sexual assault has said his son should not have to go to prison for “20 minutes of action”.

Brock Turner, a former swimmer at Stanford University, was on Thursday sentenced to six months’ imprisonment and probation for sexually assaulting an unconscious woman.

I went to Stanford.
I read the girls statement and I am sobbing. 
http://www.paloaltoonline.com/news/2016/06/03/stanford-sex-assault-victim-you-took-away-my-worth
I am sitting here sobbing. I was a student at Stanford but I refused to live in a frat house and I don't drink and I loved my time there.
  I feel ashamed that my university still has this awful attitude to rape. I went back to Stanford last summer and walked around remembering how wonderful it was for me to be there. then I went over to Berkeley campus and there were rape education posters/consent posters everywhere. I agree with this survivor. 

As a survivor of rape myself, it can take seconds to rape someone, but those seconds have changed the last three decades for me. I have been damaged in ways I never thought was possible. The message should be loud and clear: it doesn't matter who you are, how successful or entitled you feel you are, if you rape and sexually assault someone - you don't get leniency. the only way this man can really convince me he is serious about changing is if he manages to change the view of drunken students about consent. If she can't say yes to a cup of tea, then don't make her tea. If she can't say yes to intercourse, don't make her suffer intercourse - just like you wouldn't pour tea down her unconscious throat. 
see the video that we have in England: 
http://metro.co.uk/2015/10/28/this-new-sexual-consent-and-tea-video-from-the-police-is-brilliant-5466392/

Neuroscience Training Summit May 2016 organised by Sounds True

I listened to a whole ten days of neuroscience talks this month, 30 hours of information and many of the talks were really interesting.
Linda Graham, whom I have often quoted on here, was speaking on learning to bounce back from trauma and difficulty. I still find her work exceptional.
Janina Fisher talked about healing the fragmented selves of trauma survivors
http://www.janinafisher.com/tmodel.php
and David Grand talked about Brain Spotting, the modality that he says treats multiple trauma clients better than EMDR does.
https://brainspotting.pro/page/what-brainspotting

This last one is really intriguing and I have ordered his book so that I can try to understand it better.

I haven't written on here for a while. I actually forgot that I started this blog!

I have been working on inner child healing and doing a few teaching sessions voluntarily and the occasional conference presentation on compassion.
I have been working on self compassion at an intensive level and trying very hard to create a nurturing and healing daily routine for myself.
I have just completed the neuroscience training summit by Sounds True - 20 ninety minute presentations on the latest cutting edge ideas on how to heal trauma and attachment issues. It makes me realise how backward the UK is in this field on the whole.
I have a plan to train as a teacher of the self compassion 8 week course. I would feel good passing that kind of information on, especially as I have learned to do it at the coal face so to speak.