Psychotherapy

Evaluation
Psychotherapy

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TRAUMATYS provides:

Psychotherapy, specialized and highly effective

Since 1991, TRAUMATYS has evaluated and treated thousands of persons presenting with PTSD, with co-morbidity and functional limitations. According to an independent and retrospective study by the research team of Dr Brunet at McGill University, examining 100 files randomly selected at TRAUMATYS (2004),

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psychotherapy lasts in average 9 months, ranging from few months to few years;

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at termination, using a research structured interview (SCID), the PTSD remission rate is 96%:

48 % of patial remission and 48% of full remission.

 

In addition, a prospective neurological study of individuals treated at TRAUMATYS (Dickie et al., 2011), using magnetic resonance imaging  (fMRI), showed that

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PTSD changes were associated with activity changes in key neurological centers :

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amygdala (conditioned memory, anxiety, fear, anger)

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hippocampus (non-emotional memory, integration of complex informations, etc.)

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right anterior cingulate cortex (modulation of affects and behaviors)

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after 6 to 9 months of psychotherapy (some patients had not terminated yet), using diagnoses obtained from a structured interview (CAPS), , PTSD remission rate was 65%.

 

At TRAUMATYS, psychotherapy may entail a therapeutic focus on the reexperiencing of the traumatic event, like in EMDR ou prolonged exposure (PE), but only if certain conditions are pre-established (see an neurobiological explanation here).

 

 

Psychotherapy is provided according to a dynamic integrative model (Gaston, 1995)

 

bulletGoals

The goals of psychotherapy are to eradicate PTSD and co-morbidity symptoms, to resume normal psychosocial functioning, and to prevent relapse. When an individual needs to cease working temporarily because the symptoms are interfering with the psychosocial functioning, or when there is a crisis situation, psychotherapy is provided twice a week. Otherwise, psychotherapy is provided once a week.

In order to reach these goals, the objectives of the psychotherapeutic process are to assist the individual to recognize and accept one's traumatized self and, in parallel, to regain control over one's outer and inner worlds. Subsequently, psychotherapy aims at integrating the traumatic information, both cognitively and emotionally, through an experiential revision of the traumatic event and through accommodating one's psychological structure to the newly assessed traumatic information. Finally, psychotherapy aims at practicing the newly adopted skills and attitudes, and at fostering a new sense of self. This model is based on Horowitz's model and is described elsewhere in details in Dynamic Therapy for Posttraumatic Stress Disorder (Gaston, 1995). Bowlby's and Masterson's models have been added and adjusted to treat the personality disorders associated with PTSD.

 

bulletPhases

The first phase aims at establishing the conditions to develop an alliance, at completing the psychological history, and at reviewing the details of the traumatic event along with its circumstances. In order for the individual to be able to fully explore one's traumatic experience, it is necessary to first work on the consequences of the chronicity of the psychological condition, if any, to reinforce appropriate adaptive strategies, to ensure that anxiety is not overwhelming, to encourage the seeking of valuable social support, to help resolve situational problems which contribute in maintaining the psychological condition, if possible, and to address the individual's avoidance mechanisms and their functions in order to bring them to a non-defensive level.

The second phase consists of reviewing the traumatic event at a tolerable dosage. It entails identifying the defense mechanisms interfering with its revision, and addressing the conflicts or structural deficits reactivated by the traumatic event. This review takes place in the usual waking state or under introspective hypnosis if the former does not yield the idiosyncratic meanings of the traumatic event. Afterwards, trauma-related emotions, desires and meanings are fully acknowledged, internal representations of self and others are identified and revised, and defensive and interpersonal patterns are delineated and modified. Having completed this process, the information associated with the traumatic event should be integrated within the individual's psychological structure.

If this second phase cannot be dealt with or completed given structural deficits encountered within the individual, the models of Bowlby and Masterson are applied.  Over months, the strong and benevolent figure of the psychotherapist is internalized which allows abandonment anxiety and depression to be worked through. Reinforcing the psychological structure of the person is also undertaken through some pharmacological, cognitive and behavioral tools to help the person contain the overwhelming emotions associated with PTSD and its comorbidity. Such an approach can succeed at remitting PTSD without direct therapeutic work on the traumatic experience, at bringing the person back into full functionality, and at preventing a PTSD relapse. This structural work takes longer.

In order to ensure that the psychotherapeutic gains are sustained over time and prevent relapse, the third phase strives at encouraging the individual to practice the newly acquired cognitive, behavioral and interpersonal patterns. A novel attitude toward adversity is also addressed, unless it has emerged spontaneously, so that the individual can consider life's obstacles as challenges rather than threats, and realistically assess the possibility of life's dangers. Termination of psychotherapy is discussed. Gains are recognized, while the individual's active participation in them is emphasized.

 

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Techniques

 

bulletProviding empathy vis--vis the individual's suffering and experience
bulletValidating reality and the individual's appropriate reactions to it
bulletReassuring the individual, and normalizing symptoms while educating about PTSD
bulletIdentifying problems interfering with the resolution of the PTSD (including the presence of continuous danger, administrative difficulties, participation in the judicial process, etc.)
bulletSuggesting ways of resolving these problems and developing new abilities to solve them
bulletExploring, specifically and actively, the experience of the traumatic event
bulletInterpreting the unconscious issues associated with the traumatic experience, while providing explanatory material in support of these interpretations
bulletLinking traumatic and pre-traumatic experiences (cognitions, emotions, meanings, etc.)
bulletDifferentiating reality from fantasies

 

Within this specialized approach, it is essential to help the individual regain control at all times, restore and preserve the individual's self-esteem as much as possible, and encourage an experiential review of the traumatic event. It is also important to proceed gradually, in tolerable doses, starting with peripheral reactions and heading toward the heart of the psychological wound.

 

 

Director     Clinicians    Services    Info    Contact 

 

TRAUMATYS : 1-844-633-3326 (toll free) / traumatys@gmail.com.

TRAUMATYS

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