Vicarious Trauma: Impact on Therapist’s Capacity to Witness Trauma, Dissociation and Enactment - Pathways to Reparative Moments and Self-Care Dr George Halasz Adjunct Senior Lecturer Department of Psychiatry, MONASH UNIVERSITY

Vicarious Trauma: Impact on Therapist’s Capacity to Witness Trauma, Dissociation ’STRESS & TRAUMA’ VICARIOUS TRUAMA - DISSOCIATION

‘Vicarious Traumatization’ (Pearlman & Mac Ian 1995) Transformation occurs Within therapists Due to empathic engagement Listening or Witnessing Client’s Traumatic Experiences

THEN & NOW - H Kohut (1971) —> A Schore (2012) POINTS OF LEVERAGE IN THERAPY: ’VERTICAL & HORIZONTAL’ REPRESSION or DISSOCIATION?

‘amygdala hijack’

<THERAPIST / PATIENT as Relationship> COUNTER-Transference - Vicarious Trauma <THERAPIST / PATIENT> Dissociative Attunement <THERAPIST / PATIENT as Relationship> Reciprocal / Bi-Directional Trauma- Dissociation

Vicarious Trauma: Impact on Therapist’s Capacity to Witness Trauma, Dissociation Sub scales that focused on ‘safety’ and ‘self’ related issues: Safety: the belief that one is secure and reasonably invulnerable (immune, resilient, ‘unshockable’ )- Canfield, 2005, p. 97) to harm 1. Self-Esteem: the belief that one is valuable 2. Other-Esteem: the belief that others are valuable 3. Self-Trust: the belief that one can trust one’s own judgement and perceptions 4. Other-Trust: the belief that one can rely on others 5. Self-Intimacy: the belief that one can feel (not be) connected with oneself 6. Other-Intimacy: the belief that one can feel (not be) connected to others (ref: Pearlman & Mac Ian, 1995, my italics)

Trauma Informed Care (T.I.C.) Basic Principle : Trauma-dissociation (triggers) ‘bottom-line-defence’ - Fight-Flight-Freeze-Faint-‘cry’ - > brain, body and metabolic changes: ‘survival instincts’ ‘Relational trauma-dissociation’ is reciprocal - bi(x2)- directional - hence ‘vicarious trauma’ and dissociative attunement’ T.I.C. offers Reparative ‘experience-near moment-to- moment’ (witnessing) with power to restore dissociative mechanisms -see ‘amygdala hijack’

Trauma Informed Care (T.I.C.) Safety and Self-Care: basic principles of the new T.I.C paradigm - organizing principle to regulate ‘relational trauma’ in both our personal and professional relationships. (Halasz, 2017)

Trauma Informed Care-Intervention-Therapy (T.I.C.I.T.) The challenging clinical question we confront: whether a T.I.C.I.T therapeutic re-exposure to our patient’s previous life-changing trauma (even if inter-generational) risked impairing, or perhaps improving current ‘well-enough’ being? Or, to risk the relative shared safety of conventional therapy - non-T.I.C.I.T. - to bypass the ‘re/de’-traumatising enactments, to settle for non-trauma informed therapies? (Halasz & Gordon, 2015, 2016) Is non-trauma informed therapy for patients with trauma history an ethical practice?

Trauma Informed Care-Intervention-Therapy (T.I.C.I.T.) SAFETY & SELF-CARE between the therapy sessions: To reduce Vicarious Trauma symptom severity 1. reduce number and severity of trauma patients seen 2. attend to personal history of trauma 3. attend to professional history of trauma 4. increase adequate and updated training in T.I.C.I.T. 5. never work alone - peer supervision and/or consultation 6. availability of social supports 7. self-care and leisure 8. stress-buffers - - sense of humour, healthy life-style, life-balance, nourishing spiritual self - God/Higher Power (Canfield 2005, p. 94) (Modified from Jordan, 2010)

Trauma Informed Care-Intervention-Therapy (T.I.C.I.T.) SAFETY & SELF-CARE within the therapy session: 1. Focused awareness, breath by breath – inhale (sympathetic trigger), pause, slowly exhale (parasympathetic trigger) – to find my way back to my fully conscious self after ‘drifting’, ‘day-dreaming’= dissociation 2. Interrogate my sensory response, posture & prosody to patient & visual images of narrative – visceral self-monitoring – (Right brain focus) 3 Points of Leverage as critical points where I am on the verge of dissociation. I used an additional aid Fit-Bit pulse monitoring as a mental photographs to fill in my dissociative gaps, my self-repaired nachträglichkeit moments, afterwards. (see Freud’s concept updated as micro - nachträglichkeit) (Halasz, 2017)

SUMMARY: T.I.C.I.T. Vicarious Trauma-Dissociation CONCEPTUAL ‘GAME CHANGE’ in TRAUMA INFORMED CARE (T.I.C.I.T.) THEN NOW 1970’s - psychoanalytic frame 2000’s - neurobiology frame ‘psychic trauma’ as construct ‘real trauma’ as right-brain dysregulation Defences Repression (Vertical/ Horizontal) Dissociation (Vertical/Horizontal): Transference - Vicarious Trauma <THERAPIST / PATIENT> Dissociative Attunement splitting, projection/identification Right Brain Limbic - Networks & A.N.S. repression, isolation, negation, ENACTMENTS - Swiss Cheese ‘Holes’ ‘denial’, ‘amnesia’, ’regression’ vs DISSOCIATION/bottom-line-defence (F. F. F. F. ‘Cry’ )

DSM-5 (2013)