Psychotherapy Fads: The Case of Trauma-Informed Therapy

[DynamicDidactic]

I thought this hit the nail on the hammer on this current fad. The video also touches on a lot of other points. Either way, thought it was worth sharing:

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[WisNeuro]

I have a buddy who works as a research director for one of the big chain pharmacies. They recently had to attend a "Trauma-informed leadership" seminar. "Trauma-informed" jumped the shark a loooonggg time ago.

 

[Sanman]

I have a buddy who works as a research director for one of the big chain pharmacies. They recently had to attend a "Trauma-informed leadership" seminar. "Trauma-informed" jumped the shark a loooonggg time ago.

"You're fired", "being let go", "need improvement", and "you are not getting a bonus" are my trigger words. As trauma informed leaders, please learn to manage me without ever using these terms. Thank you.

 

[WisNeuro]

"You're fired", "being let go", "need improvement", and "you are not getting a bonus" are my trigger words. As trauma informed leaders, please learn to manage me without ever using these terms. Thank you.

You're in the VA, you'll never hear "you're fired," but you will hear "you are not getting a bonus" quite a bit. 🙂

 

[R. Matey]

Yeah, I think trauma-focused everything is a very simple way to understand the whole of psychopathology. For therapists that receive insufficient training in psychopathology during graduate school (e.g., most of them), I could see why it's such an easy reach.

 

[Sanman]

You're in the VA, you'll never hear "you're fired," but you will hear "you are not getting a bonus" quite a bit. 🙂

Actually, did quite well in the bonus department this year.

 

[calimich]

lol, and this just came across a listserv I'm on which encourages new members to introduce themselves; first I've heard of NARM

"I’m a trauma informed therapist, trained in a variety of approaches. EMDR is a main focus right now but recently was trained in NARM. I use somatic and mindfulness techniques. I’m collaborative in my approach."

 

[R. Matey]

lol, and this just came across a listserv I'm on which encourages new members to introduce themselves; first I've heard of NARM

"I’m a trauma informed therapist, trained in a variety of approaches. EMDR is a main focus right now but recently was trained in NARM. I use somatic and mindfulness techniques. I’m collaborative in my approach."

 

[WisNeuro]

Actually, did quite well in the bonus department this year.

Come work for me, I'll beat it 😉

lol, and this just came across a listserv I'm on which encourages new members to introduce themselves; first I've heard of NARM

"I’m a trauma informed therapist, trained in a variety of approaches. EMDR is a main focus right now but recently was trained in NARM. I use somatic and mindfulness techniques. I’m collaborative in my approach."

People love to throw in neuro-gibberish to make their pseudoscience sound more empirical. I'm not surprised that some ***** who bought into EMDR also bought into the next neuro/trauma fad.

 

[WisNeuro]

Seriously, why is M oron a banned word?

 

[Fan_of_Meehl]

Seriously, why is M oron a banned word?

The auto-censor thanks you for your cooperation. We are sure that you agree that it is of the utmost importance that the message board maintain a SAFE and non-triggering environment for ALL users. Besides, if we allowed you to use that 'no-no' word it may serve as a Criterion A traumatic stressor for someone who reads it and then we would be liable. You will receive your complimentary Nerf jumpsuit in the mail in 4-6 weeks. Thank you again for making SDN a super, duper, fun and safe place to be!

 

[borne_before]

 

[AcronymAllergy]

I honestly don't know if I could define what "trauma-informed" means at this point...?

 

[Fan_of_Meehl]

I honestly don't know if I could define what "trauma-informed" means at this point...?

On the other hand, I'm dead certain what "trauma-misinformed" means after working for many years in the Veterans Affairs system, lol.

 

[tr]

lol, and this just came across a listserv I'm on which encourages new members to introduce themselves; first I've heard of NARM

"I’m a trauma informed therapist, trained in a variety of approaches. EMDR is a main focus right now but recently was trained in NARM. I use somatic and mindfulness techniques. I’m collaborative in my approach."

The description at the link seems like it describes regular old psychodynamic therapy though. Maybe they thought using an acronym would give them more cachet?

 

[calimich]

The description at the link seems like it describes regular old psychodynamic therapy though. Maybe they thought using an acronym would give them more cachet?

What has been will be again, what has been done will be done again; there is nothing new under the sun.

 

[smalltownpsych]

A least when the therapists who are using trauma as a catch all to describe patients who have had difficulty dealing with negative experiences such as a rude coworker or unreasonable and mean boss, they are not doing what they usually do with my real traumatized patients and making them worse. Also, many of my patients with traumatic experiences have difficulty with being chronically invalidated and equating something like a negative work environment with being threatened with serious injury to life or limb or being sexually assaulted or molested is one more way of a reenactment of childhood stuff. Its bad enough I have to help patients unpack and challenge the unhealthy messages of bad parents or society, but it really makes me angry when I have to do that with messages from prior therapists.

 

[smalltownpsych]

Also just wanted to add that as a mostly psychodynamic therapist, I don’t have to throw research and science out the window and behavioral principles and neuroscience that underpin a lot of what happens is a good foundation for that. Just one example is that I integrate principles and techniques from Object Relations for Borderline and DBT in my treatment of Borderline PD and it works well. The psychodynamic stuff tends to be used by myself more to guide my own understanding and conceptualizing and the DBT tends to be more of the actual intervention and how I explain to patient and others.

 

[Sanman]

A least when the therapists who are using trauma as a catch all to describe patients who have had difficulty dealing with negative experiences such as a rude coworker or unreasonable and mean boss, they are not doing what they usually do with my real traumatized patients and making them worse. Also, many of my patients with traumatic experiences have difficulty with being chronically invalidated and equating something like a negative work environment with being threatened with serious injury to life or limb or being sexually assaulted or molested is one more way of a reenactment of childhood stuff. Its bad enough I have to help patients unpack and challenge the unhealthy messages of bad parents or society, but it really makes me angry when I have to do that with messages from prior therapists.

Some of these people just need to familiarize themselves with the four noble truths.

 

[Fan_of_Meehl]

A least when the therapists who are using trauma as a catch all to describe patients who have had difficulty dealing with negative experiences such as a rude coworker or unreasonable and mean boss, they are not doing what they usually do with my real traumatized patients and making them worse. Also, many of my patients with traumatic experiences have difficulty with being chronically invalidated and equating something like a negative work environment with being threatened with serious injury to life or limb or being sexually assaulted or molested is one more way of a reenactment of childhood stuff. Its bad enough I have to help patients unpack and challenge the unhealthy messages of bad parents or society, but it really makes me angry when I have to do that with messages from prior therapists.

I think we've really done the notion of 'trauma,' per se, a disservice by continually broadening Criterion A (bracket creep) over the years. I keep seeing articles in otherwise reputable professional journals apparently arguing the need to broaden it even more to the point of including interpersonal comment/transactions that one may experience as 'invalidating' or offensive.

As Richard McNally famously observed, 'the more we expand the concept of trauma, the less plausibly we can assign causal significance to the stressor itself, and the more we must emphasize vulnerability factors. Diagnosing PTSD in people exposed to seemingly minor events produces a background-foreground inversion whereby risk factors move into the causal foreground while the trauma recedes into the background. Shifting the causal emphasis away from the stressor undermines the very rationale for having a diagnosis of PTSD in the first place.'

In other words, if EVERYTHING is 'traumatic' then NOTHING is.

 

[clausewitz2]

Was working in residency at an IOP mostly aimed at folks with BPD. Did an intake on a new patient who said that they had "so many traumas." When I asked for an example of one, they cited the fact that the elevator was out and they had to walk up three flights of stairs to get to the clinic. There was not a hint or trace of irony.

True story

 

[WisNeuro]

Was working in residency at an IOP mostly aimed at folks with BPD. Did an intake on a new patient who said that they had "so many traumas." When I asked for an example of one, they cited the fact that the elevator was out and they had to walk up three flights of stairs to get to the clinic. There was not a hint or trace of irony.

True story

Due to pending litigation and the weird specificity, I can't give some examples of the ridiculous things that people allege have caused their "PTSD." But plenty of things akin to something of a minor injury like turning an ankle, having an argument with a boss/coworker.

 

[PsyDr]

1890s psychologist: "Abreaction and catharsis don't seem to work"

1950-1970s psychologist: "We need to expose you to that type of trauma until you no longer care. You're afraid of cars? Let me drive you around you around LA for a few days until you're over it."

2020s psychologist: "You can't do that thing you dislikes, because you went through something bad. Sorry to bring it up."

 

[tr]

I think we've really done the notion of 'trauma,' per se, a disservice by continually broadening Criterion A (bracket creep) over the years. I keep seeing articles in otherwise reputable professional journals apparently arguing the need to broaden it even more to the point of including interpersonal comment/transactions that one may experience as 'invalidating' or offensive.

As Richard McNally famously observed, 'the more we expand the concept of trauma, the less plausibly we can assign causal significance to the stressor itself, and the more we must emphasize vulnerability factors. Diagnosing PTSD in people exposed to seemingly minor events produces a background-foreground inversion whereby risk factors move into the causal foreground while the trauma recedes into the background. Shifting the causal emphasis away from the stressor undermines the very rationale for having a diagnosis of PTSD in the first place.'

In other words, if EVERYTHING is 'traumatic' then NOTHING is.

I agree with this, but would also like to point out that the vulnerability factors are still really important. Most people exposed to a Criterion A experience do not end up with PTSD. People who do end up with PTSD more commonly were people who went into the trauma with other risk factors like a pre-existing mental health history, family history of PTSD, hx childhood adversity, and other measurables like poor coping style, etc.

 

[Fan_of_Meehl]

I agree with this, but would also like to point out that the vulnerability factors are still really important. Most people exposed to a Criterion A experience do not end up with PTSD. People who do end up with PTSD more commonly were people who went into the trauma with other risk factors like a pre-existing mental health history, family history of PTSD, hx childhood adversity, and other measurables like poor coping style, etc.

True this. The good ole diathesis-stress model.

 

[WisNeuro]

I agree with this, but would also like to point out that the vulnerability factors are still really important. Most people exposed to a Criterion A experience do not end up with PTSD. People who do end up with PTSD more commonly were people who went into the trauma with other risk factors like a pre-existing mental health history, family history of PTSD, hx childhood adversity, and other measurables like poor coping style, etc.

Yes, but even in childhoods with many adverse events and conditions, the modal response is still overwhelmingly resilience, se eteh longitudinal work of people like Rutter and Frederickson.

 

[borne_before]

Some of these people just need to familiarize themselves with the four noble truths.

What’s that?

 

[borne_before]

1890s psychologist: "Abreaction and catharsis don't seem to work"

1950-1970s psychologist: "We need to expose you to that type of trauma until you no longer care. You're afraid of cars? Let me drive you around you around LA for a few days until you're over it."

2020s psychologist: "You can't do that thing you dislikes, because you went through something bad. Sorry to bring it up."

In the 2020 psych, can you add “watch my 90 second insta about it.”

 

[Sanman]

What’s that?

The Four Noble Truths

The first noble truth is the most important for these folks: life contains inevitable, unavoidable suffering

 

[WisNeuro]

The Four Noble Truths

The first noble truth is the most important for these folks: life contains inevitable, unavoidable suffering

Pain is inevitable and unavoidable, suffering is optional.

 

[Sanman]

Pain is inevitable and unavoidable, suffering is optional.

The trick is in the not minding.

However, you really are skipping to Truths 3 and 4 there.

 

[WisNeuro]

The trick is in the not minding.

However, you really are skipping to Truths 3 and 4 there.

I'm just a fast reader, might as well get to the good stuff.

 

[Sanman]

I'm just a fast reader, might as well get to the good stuff.

Should be required reading for anyone practicing ACT, IMO.

 

[borne_before]

Should be required reading for anyone practicing ACT, IMO.

I was gonna say... sounds like ACT. I'm gonna DL a copy.

 

[Sanman]

I was gonna say... sounds like ACT. I'm gonna DL a copy.

https://journals.sagepub.com/doi/pd...promote spiritual awakening and enlightenment.

This may be of interest to you as well.

 

[clausewitz2]

Should be required reading for anyone practicing ACT, IMO.

When I start edging into ACT-y territory with anyone who is really into yoga or otherwise sympathetic to Eastern religions/philosophies, out comes the dukkha

 

[MiniLop]

Just because I can't stop ranting about this: The other day a long-term client told me that the NP that manages their psych meds diagnosed them with PTSD. No symptom measure, no screening for criterion A event. The rationale? The NP said that it was "abnormal" that client had no memories from before age 5 and that this probably meant they were repressing traumatic memories.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[WisNeuro]

Just because I can't stop ranting about this: The other day a long-term client told me that the NP that manages their psych meds diagnosed them with PTSD. No symptom measure, no screening for criterion A event. The rationale? The NP said that it was "abnormal" that client had no memories from before age 5 and that this probably meant they were repressing traumatic memories.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Ah, we got a repressed memory crusader here, huh? Is that starting to make a comeback, are we going to start hearing about an epidemic of Satanic Sex Cults?

 

[Sanman]

When I start edging into ACT-y territory with anyone who is really into yoga or otherwise sympathetic to Eastern religions/philosophies, out comes the dukkha

Hey, it happens. Not just ACT either. Psychology/medicine have been looking to Buddhism since the 1970s with mindfulness based stress reduction and related concepts.

 

[futureapppsy2]

I was gonna say... sounds like ACT. I'm gonna DL a copy.

I've long said that converting to Buddhism would cover about 70% of ACT.

 

[Fan_of_Meehl]

Just because I can't stop ranting about this: The other day a long-term client told me that the NP that manages their psych meds diagnosed them with PTSD. No symptom measure, no screening for criterion A event. The rationale? The NP said that it was "abnormal" that client had no memories from before age 5 and that this probably meant they were repressing traumatic memories.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Damn...that's like bad bad.

 

[WisNeuro]

Damn...that's like bad bad.

I had a psych NP try to get me to change my conclusions, to add that the person had ADHD. The NPs argument was that the PTSD actually improved the patient's ADHD sx, so it was harder to see on clinical interview. Now, coincidentally, this person was also fired for selling prescriptions for controlled substances...

 

[clausewitz2]

Ah, we got a repressed memory crusader here, huh? Is that starting to make a comeback, are we going to start hearing about an epidemic of Satanic Sex Cults?

It might be, recently did an intake with a really unfortunate 15 year old who unfortunately fell in with a therapist a couple years ago who managed to give her a bunch of recovered memories AND diagnosis her with DID. I don't know if the therapist in question is an OG believer or a new convert.

 

[AcronymAllergy]

It might be, recently did an intake with a really unfortunate 15 year old who unfortunately fell in with a therapist a couple years ago who managed to give her a bunch of recovered memories AND diagnosis her with DID. I don't know if the therapist in question is an OG believer or a new convert.

This is almost reportable to the board in terms of negligence. I'm only slightly exaggerating.

The number of "PTSD" diagnoses I've either seen from other providers or had patients tell me about that relate to non-Criterion A events (e.g., having a mean boss, being yelled at by parents) is pretty staggering.

And yes, the number of providers who are now approaching treatment from the perspective of, "we shouldn't ever discuss anything that makes you uncomfortable, and life in general shouldn't be allowed to make you uncomfortable" is disturbing.

 

[cara susanna]

I don't have time to listen to this now but will check it out later! I guess it makes sense if you think EVERYTHING is trauma. Speaking of, I'm in a PE group on social media that has been talking about TikTok and all of the anti-CBT for PTSD videos on there, basically spreading all of the misinformation promoted by van der Kolk and his camp. It's horrifying.

Btw, suffering vs. pain is also covered in DBT!

 

[borne_before]

This is almost reportable to the board in terms of negligence. I'm only slightly exaggerating.

The number of "PTSD" diagnoses I've either seen from other providers or had patients tell me about that relate to non-Criterion A events (e.g., having a mean boss, being yelled at by parents) is pretty staggering.

And yes, the number of providers who are now approaching treatment from the perspective of, "we shouldn't ever discuss anything that makes you uncomfortable, and life in general shouldn't be allowed to make you uncomfortable" is disturbing.

We know it's happening. But, why does there seem to be such an influx in victim identity? I'm only being partially rhetorical.

 

[AcronymAllergy]

I guess it makes sense if you think EVERYTHING is trauma. I don't have time to listen to this now but will check it out later!

By that same token, also could make sense if you think having any sort of negative reaction to a stressful event, including that the memory of the stressful event is negative, is PTSD.

 

[clausewitz2]

I don't have time to listen to this now but will check it out later! I guess it makes sense if you think EVERYTHING is trauma. Speaking of, I'm in a PE group on social media that has been talking about TikTok and all of the anti-CBT for PTSD videos on there, basically spreading all of the misinformation promoted by van der Kolk and his camp. It's horrifying.

Btw, suffering vs. pain is also covered in DBT!

I hadn't realize there was a real anti-CBT community and so got quite a shock this morning when I started googling. Gem of the first hit I got was "CBT as a modality is based around gaslighting."

No, the source does not really explain the sense in which this is the case.

 

[ExecutiveDysfunction]

We know it's happening. But, why does there seem to be such an influx in victim identity? I'm only being partially rhetorical.

Without going too far off thread, I’ve always imagined this had to do with behavior that was always present amplified by the connection of the internet. everyone wants something to explain their behavior and many find solace in a condition to explain their shortcomings. Further, people who feel like they are different were traditionally isolated in their experiences but now they can find like minded individuals easier than ever. A perfect storm I guess.

 

[smalltownpsych]

I didn’t know van der Kolk was anti-CBT. I use techniques from CBT and DBT, CPT, psychodynamic, and client-centered. I just pick whichever one the patient doesn’t hate. Sort of only half joking.