1. Mary Jo Barrett www.centerforcontextualchange.org
Walking the Delicate Balance: Sexual Abuse in the Family-How did this happen and what can we do to survive
Mary Jo Barrett

2. Awareness and Attunement
The range of what we think and do Is limited by what we fail to notice And because we fail to notice That we fail to notice There is little we can do To Change Until we notice How failing to notice Shapes our thoughts and deeds -R.D.Laing

3. What’s Already There? Narrative Bias
Myth- about incest and about the treatment of incest

4. Goal of Workshop To take Incest our of the closet.
To get therapist out of Trauma Mindstate around incest
To stop blaming the victim
To Name in the room what it truly is- why do we make it generic
It is Taboo
Shrouded in shame
Treatment is not radically different, it is the energy around it that matters

5. Four Levels of Stress Reactivity
TRAUMATIC STRESS
PTSD
COMPLEX DEVELOPMENTAL TRAUMA
Any demand on the body system.
Consequence of exposure to trauma. Interruption to flow
Feelings
Fear
Helplessness
Urgency
Anxiety
Anger
Sadness
Urges
Fight or Flight or Freeze
Exposure to events that are experienced as life threatening, intolerable or could cause injury or death.
Experience of trauma becomes more intrusive. Avoidance of cues in the six senses (sight, sound, smell, taste, touch, mind) Hyper-arousal to triggers
Result of Multiple Traumatic Events and reaction to Event
Traumatic events begin in childhood-
Complexity
Multiple victimization
Interacting contextual effects
Depression
Emotional deregulation
Intrusive thoughts and feelings
Identity disturbance
Efforts to avoid /numb
Relational Disturbance
Hyper-arousal to both internal and external events

6. Working Definition of Incest

7. Working Definition of Incest
Any sexual contact
Touching, with intention to sexually arouse the victim and/or the perpetrator
Kissing in a prolonged manner and with the above intention
Fondling of genitals or other body parts in a sexual manner
Overt sexual contact, such as oral-genital contact, manual stimulation of genitals or intercourse
Any behavior intended to stimulate the victim sexually, or to stimulate the offending adult relative through the use of the child. This could include showing the child erotic material, taking sexual photographs of the victim, or erotic comments.
Incestuous behaviors would be initiated by an adult relative or an adolescent or child relative who is more than a few years older than the child. Incestuous behaviors that are not consensual are considered incestuous abuse.

8. Trauma-Survival Mindstate
Unmanageable stress and the freeze response
When we are unable to organize our experiences and make meaning of them in a way that makes predictable sense; our development, growth, and learning are impacted. Complex traumatic histories impair affect regulation, ego adaptive capacities, impulse control, and attachment patterns.
Difficulty controlling emotions, cognitions, behavior, and relationship

9. Sexual Abuse/ Incest Interpersonal in nature Style of interaction
Disruption in attachment in significant relationships
Often various types- of incest
Over time- grooming
Involving all forms of violations
Revictimization through reactions, as well as, actions

10. Survival Skills of Abuse Survivors-Adults and Children (Avoidance)
Mistrust of others
Flashbacks
Anxiety, terror and panic
Shame, guilt, self-hatred
Cognitive distortions
Depression, passivity
Dissociation
Disturbed relatedness
Difficulty attaching
Detachment, numbing or withdrawal
Sexual promiscuity or aversion to sex
Drug and alcohol abuse
Eating disorders
Suicide
Self-mutilation
Anger and aggressive behavior
Perfectionism
Alienation from their bodies
Personality disorders, mental illness

11. The Effects of Abuse and Complex Trauma
I experience myself as powerless
Symptoms as attempted solutions
I am disconnected from myself, others, and the world around me
Interactional Cycle of Survival
I experience myself as devalued
I am out of control

12. Vulnerability and Resource Model of Assessment
Social/Political Contexts
Community Gender Media Economic
Religious Cultural Racial Ability
Sexual Orientation Age
Familial Contexts
Hierarchy Communication Patterns
Style Rules Roles
Adaptability Boundaries
Transgenerational Patterns
Individual Context
Physiological/Biological Patterns
Neurological
Temperament
Victim/Survivor Cycle
Coping Mechanisms
Impulse Control
Addictions
Power Control Attachment Value
*T. Trepper & M.J. Barrett 1985, 1989

13. Resources: Where we find energy and possibility
Awareness/Realism- honestly looking at self
Creativity- in options and meaning
Humor
Courage/Initiative
Flexibility/Adaptability
Faith/Trust
Social Support

14. Fundamental Elements of Trauma
Powerlessness
Disconnection
Devaluing
Out of Control

15. Healing, Growth, and Change
Healing, change and growth comes from a process of encircling a person/system with a sense of being valued and empowered.
This is done by identifying and engaging with them through their own natural resources and their cycles of growth. Co-creating Refuge and Collaboratively gathering resources from within a person, their family and their community

16. Engaged Mindstate
In an engaged mindstate individuals have access to and incorporate tools that regulate; their affect, cognitions, behavior, and relationships. They experience themselves as powerful, in control, valued, and connected to themselves, a support system and to the world around them. They are aware of their strengths, their resources and their vulnerabilities and have developed a skill set to deal with stress. When people are acting from an engaged mindstate, they have self-awareness and other awareness, can engaged in supportive relationships, and have a meaningful vision of the future.

17. A mirror neuron is a neuron that fires both when a person acts and when the person observes the same action performed by another
You each become the reflection and extension of the other
A back and forth energy emerges between you- liken to an electrical energy flow
Positive resonance needs certain ingredients to exist-positive energy in each domain which is created in treatment

18. What is Therapeutic Change
A Differentiation of a Trauma/Survival Mindstate and an Engaged Mindstate which is Based on Present Experience
Development of Collaborative Based Therapeutic Goals
Effort and Strategies to Build New Patterns of Action-Mind and Body to meet the Collaborative Goals

19. Moving from Chaos to Coherence
Aware and Attune
Acknowledge and Accept What’s Already There
Self-Regulation
Reflect and Explore
Mindful and Appropriate Interventions
Reorganization and Integration

20. Traumatized people need to have physical & sensory experiences to:
Unlock their bodies
Activate effective fight/flight
Tolerate their sensations
Befriend their inner experiences
Cultivate new action patterns

21. Five Essential Ingredients for Healing
Attachment and Connection: To build and rebuild relationships where there is a felt sense of belonging, mutual curiosity, compassion, empathy, connecting to a deep set of values to self and other that provide a meaningful vision.
Safety and Empowerment: Building a Safe context/boundaries/structure within and between themselves and their relationships- collaboration and predictability
Value: Thru Collaboration/Strength based guidance/Understanding and Identifying Vulnerability and Resources/ and Recognizing the universal nature of challenge and change
Skills: Learning and Experience -Psycho educational and experiences/cognitive behavioral/neuro-mind-body/communication/mindfulness/self-regulation within and between
Hope: Creation of workable realities – experiencing the possibility of change

22. Enhance client capabilities Improve client motivation for treatment
Five Tenets of an Integrated and
Comprehensive Treatment Model-Guidelines for Standards of Care
Enhance client capabilities
Improve client motivation for treatment
Structure the environment
Generalization to the environment
Enhance therapist’s motivation to provide effective treatment

23. Enhancing client’s capabilities
Skills training- interpersonal and self
Interpersonal regulation- in family, social, work
Stabilization of sense of self and emotion regulation

24. Improve the client’s motivation for change
Collaboration: understanding of process of change, designing process and goals-hence engaging in process, and investing in outcome.
Interventions that help quickly, that are practical and understandable
Clear and Predictable Treatment Plan- Order to putting life in Order

25. Assure generalization to natural environment
Homework assignments and practice outside of sessions
In session Practice of Skills and Experience and Process
Family and Relationship Involvement in the Process

26. Therapist Own Self: Enhance therapist’s capabilities & therapist’s motivation to treat effectively
Therapist Use of Self- understanding therapeutic giving and receiving
Mindfulness and Ethical Attunement
Therapeutic Fitness
Collaboration
An Effective Model to build therapist’s confidence and self empowerment

27. CCM Provides A Structured Environment
Clarity of Model
Understanding Attachment
Emphasis on Safety
Clear Boundaries
Predictability
Structure of natural cycle of change
Clear stategies to teach and practice skills

28. The Collaborative Change Model is a Fractal Model of Change
A fractal is a never-ending pattern. Fractals are infinitely complex patterns that are self-similar across different scales. They are created by repeating a simple process over and over in an ongoing feedback loop Barrett and Stone Fish

29. What the caterpillar calls the end of the world,
the masters call a butterfly.
- Richard Bach

30. Collaborative Change Model- A Concept driven Model for Change
Creating a Context for Change- Refuge, Attachment, Assessment, Direction, Acknowledgement
Challenging Patterns/Cycles and Expanding Realities- Give us the opportunity to recognize- Vulnerabilities and Resources-Obstacles and Possibilities-
Consolidation- Combining experience to make it stronger more solid for next Repetition. Not an ending rather creating the possibility of evolution

31. Environment for Change
Safe- creating refuge; unlikely to be in danger Seen-Heard-Understood Soothe-lack of stress Secure-assured and steadied 31

32. Being a “neurobiological regulator”
Being a neurobiological regulator requires that the therapist stay attuned to both the regulating and dysregulating effects of the therapeutic encounter. Like a “good enough” mother, we must strive to create an optimal level of arousal from moment to moment.

33. Regulator (cont’d)
Effective neurobiological regulating on the part of therapists requires paying more attention to how we are affecting autonomic arousal than we pay to the content of the patient’s communication and with how to maintain an optimal level of arousal in the room.
Janina Fisher,

34. Daniel J. Seigel, MD The Mindful Therapist
Knowing ourselves is the first place to start as we try to widen our windows of tolerance for a broad variety of states in ourselves. We need to learn the art of monitoring our internal world so that we can sense when we’re moving inflexibly far from the plane of possibility. Without such a refined awareness on our part, we may project a feeling of impending chaos or rigidity onto our clients, inappropriately try to move them to their safe place in an attempt to keep them in the window, and directly give them the sense that they, too, are unable to tolerate whatever feeling our memory is emerging at the time. This is how our own internal state of distress can influence our clients’ states.

35. Relationships- Interactional Patterns
Restructure where necessary
Increase trust
Improve communication
Increase connection and intimacy
Understand sexual dynamics
Understand interactional cycles
Interruption of interactional cycles
Continue to learn, refine and practice skills- mind, body, in context
Practice
Incest is transactional and happens in the context of attachment and relationship
Goal of treatment to move individuals and the family system into engaged mind state from the chaos of traumatic mind state

36. Mirroring = Attunement
To foster a “felt sense” of connection, we mirror the client’s words and body language, hoping to evoke a visceral sense of being joined, a shared space, a sense of the therapist’s interest and ability to get it.
Mirroring is not about WHAT we say, but HOW we say it: interest, body language, choice of words, tone.
It is also dyadic dancing: as we mirror clients for signs of resonance, we adjust our words and presence to maximize their ability to stay present and socially engaged. Like parents. Our moment to moment adjustments help clients to regulate and keep their frontal lobes online as much or more as any skill we could teach them.
Janina Fisher, PhD