Trauma Informed Treatment - Meet the Expert: Dr. Larry Anderson

I mentioned a couple of months ago that I was going to have more guest bloggers and it is my pleasure and privilege to have Dr. Larry Anderson, a colleague and friend, be my first. Take it away, doc:

A little over ten years ago I was standing in front of a group of chemically dependent clients wondering what to talk about. It was my first day of a rotation through a locked inpatient drug and alcohol treatment program at a state psychiatric hospital. For many, this was the last stop before a wet house. When I asked the group of fifteen clients what they thought would be the most beneficial for them the unanimous reply was, “you’re the expert, you tell us.” The general consensus was everyone wanted to learn how to stay sober and the number of treatment programs per client ranged from five to nineteen.

About this same time, I attended a workshop in which one of the speakers addressed the topic of trauma and its impact on drug and alcohol use. As I listened, bells were going off in my head. The model the presenter used to explain the concept of trauma was based on the work of Francine Shapiro’s Adaptive Informative Processing (AIP), which is the theoretical basis for EMDR (Eye Movement Desensitization and Reprocessing) therapy. The AIP EMDR Model states that pathology that results from trauma is based on maladaptively stored experience. Dysfunctional/pathological traits, behaviors, beliefs, affect, body sensations are therefore manifestations of the unprocessed memories. Internationally recognized leader in the field of psychological trauma, Bessel Van der Kolk, adds that the traumatized person experiences extreme emotions. Both primary emotions of fear and rage, but also secondary emotions of shame, guilt, sadness, etc. Emotions can trigger hyperarousal and, according to Van der Kolk, a sense of “never knowing just what might happen and how it will feel”.

When a traumatic memory is triggered, whether by sight, sound, smell, touch, or any other random association, the body and mind will do whatever it can to numb or avoid reliving the painfully stored memory. In the person experiencing traumatic stress, the fight or flight mechanism appears to be dysregulated, and the person may never feel safe, even when they are safe. It becomes difficult to distinguish true danger.

In the case of a traumatic memory - a person develops ways of coping with traumatic stress. These coping strategies may have been adaptive at one point but seem to become problematic over time, as is the case of substance use. A drink or two to take the edge off or to help calm down. Other coping mechanisms may show up as dissociation, avoidance, numbing out, anger and aggression, and various addictive behaviors.

When I went back to the treatment group, I conducted a very unscientific study which revealed that well over 80% of the clients had documented trauma in their personal histories. I should note here that the recorded traumas were of the big “T” variety. This is an important distinction as it is helpful to think about traumatic stress disorders on a continuum based on the nature of events involved. Big “T” is short hand for significant trauma usually associated with PTSD, violence, and abuse. On the other end of the continuum are the experiences of trauma that are often overlooked or misunderstood. They are referred to the little “t” traumas which are more emotional in nature such as significant grief and loss, preverbal trauma (birthing difficulties, adoption, abuse) occurring prior to language acquisition, shame resulting in feelings of inadequacy and/or separations from others, and betrayal which occurs when trust in violated as in the case of a parent/child, husband/wife relationship. The idea that trauma was in all likelihood the driving force behind their relapse behavior was evident.

Since my first exposure to trauma theory, I have had the privilege of consulting with a very progressive outpatient treatment. About 6 years ago the owner and I began to look at how her facility could benefit from becoming “trauma sensitive.” This organization is now, at its core, “trauma informed” with a clinical staff that is “trauma responsive,” able to understand the nature and impact of traumatic stress on the clientele. They can respond appropriately to client needs and make referrals when needed. What appears to be the biggest clinical difference and cannot be stressed enough when working with trauma and addiction is this: the focus moves from “what is wrong with you” to “what happened to you.”

Dr. Larry Anderson, is a trained psychologist from Minnesota with a recognized expertise in working with patients who have experienced trauma. He has dedicated his professional career to helping address the too-often misunderstood and misdiagnosed impact of trauma.

A full understanding of traumatic stress disorders and what happens in the brain and body is beyond this article. The field of trauma is expanding rapidly and there are many good resources and training available. I would recommend trainings offered by Bessel Van der Kolk and John Briere.

To learn more about Helping Men Recover, the first trauma-informed and gender-responsive curriculum for men, please go to www.dangriffin.com.