PESI 2 - Trauma Module 1: PTSD: The View From Research

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Objectives

1. Theorize the psychometric soundness of assessment instruments used to diagnose PTSD, including tools for structured interviews, self-report scales, and psycho-physiological assessment methods.
2. Distinguish between the neurobiological changes associated with PTSD that occur in the amygdala, anterior cingulate cortex, prefrontal cortex and hippocampus.
3. Evaluate the effectiveness of popular individual therapies for treating PTSD.
4. Inspect research studies on couples therapy methods for treating PTSD.
5. Defend the practice of conducting conjoint therapy to address PTSD during couples therapy by referencing the relevant research findings on the impact of PTSD on relationships, as well as the relationship outcomes associated with individual PTSD treatment.
6. Employ clinical strategies that help “surface” trauma when working with a couple with PTSD.
7. Utilize clinical interventions that help “explore” trauma at a deeper level once it has surfaced.
8. Determine how to facilitate movement from the individual to the dyad when processing a trauma.
9. Demonstrate how to teach couples to conduct a Stress-Reducing Conversation when PTSD is involved.
10. Demonstrate how to teach couples to conduct an Aftermath of a Regrettable Incident Exercise when PTSD is involved.
11. Differentiate popular therapies for treating infidelity.
12. Assess how the 24 steps of the “Gottman-Rusbult-Glass” cascade toward betrayal lead to a blurring of boundaries between self and potential others.
13. Assess how a betrayed partner may develop PTSD as a result of their partner’s affair.
14. Utilize the Gottman Method Couples Therapy Assessment process with couples who have experienced an affair.
15. Integrate appropriate additional details when conducting an Assessment feedback session for treating affairs.
16. Facilitate the Atonement phase of Gottman Method Couples Therapy for affairs.
17. Defend the practice of allowing the hurt partner to express anger, insecurity, resentment, fear and feelings of rejection, rather down-regulating their expression of emotion.
18. Utilize appropriate clinical tools to strengthen an affair couple’s Attunement to each other.
19. Practice techniques with affair couples to effectively process Regrettable Incidents.
20. Utilize appropriate clinical interventions to deepen an affair couple’s Attachment to one another.
21. Apply effective clinical strategies to help affair couples prevent relapse.

Outline

• DSM 5 Criteria
• Assessment of PTSD
• Epidemiology of PTSD
• What theory explains PTSD
• Research on effectiveness of individual therapies for PTSD
• Why conjoint treatment for PTSD?
• Research on effectiveness of conjoint therapies for PTSD

• How PTSD Affects a Relationship

• Effects of trauma on the PTSD partner
• Effects of trauma on the non-PTSD partner
• Effects of PTSD on Love Maps
• Effects of PTSD on Fondness and Admiration
• Effects of PTSD on Turning Toward
• Effects of PTD on Conflict Management
• Effects of PTSD on Honoring Each Other’s Dreams
• Effects of PTSD on Creating Shared Meaning

• The Therapist’s Stance on Emotion
• The Therapist’s Stance on Cognitions
• The Therapist’s Behavioral Stance
• The Therapist’s Spiritual Stance

• Review of sessions that include PTSD partner
• Film 01:  1 PTSD:  “Paul and Shantel Assessment: Updated Oral History Interview 
• Feedback Session

• Surfacing the trauma – 
• Film 02: 2 PTSD:  “Mike and Marilyn – Surfacing (Military Trauma: Strengthening Love maps and Turning towards – Step 1)” 
• Exploration
• Returning to the couple interaction in the moment
• Film 03: 3 PTSD:  “Mike and Marilyn –  Exploring (Military Trauma: Turning toward – Step 2)” 
• Reviewing couple dynamics and how they have been affected by PTSD
• How to handle PTSD symptoms in the future
• Creating meaning

• SRH image (Brief overview)
• Love Maps
• Fondness and Admiration
• Turning Toward
• The Stress-Reducing Conversation 
• Film 04: 4 PTSD:  “Paul and Shantel: Turning Toward in Session”

• The Gottman-Rapoport Exercise
• The Dream Within Conflict Exercise
• The Compromise Exercise
• The Aftermath of a Fight Exercise
• Film 05:  5 PTSD:  “Paul and Shantel – Aftermath of a Fight” 
• Rituals of Connection

• What is an affair?
• Notes on Monogamy
• Social monogamy
• Genetic monogamy
• Sexual monogamy
• Biology of sex-differences in non-monogamy
• The advantages of committed social and sexual monogamy
• Secular trends

• Very few affairs become relationships
• Affairs are not about sex – most are about loneliness

• Esther Perel
• Shirley Glass
• Doug Snyder and Donald Baucom

• What leads to affairs?
• Trust, betrayal and fairness
• Gottman-Rusbult-Glass cascade towards betrayal
• Atonement Phase overview
• Attunement Phase overview: Goal Trust
• Attachment Phase Overview: Goal Commitment

• Narrative 
• Oral History Interview
• Film 06: Affairs 1-  “Assessment:  Mike and Marilyn’s Narrative” and  “Assessment: Mike and Marilyn’s Oral History Interview” 
• Conflict discussion
• Film 07: Affairs 3 – “Assessment: Conflict Discussion”  
• Individual session
• Film 08: Affairs 4 – “Assessment:  Individual Focus (with partner present)” 
• Feedback session
• Film 9: Affairs 5 -  “Assessment: Feedback (Therapist Describes Co-Morbidities and Affairs Treatment)”  
• Q and A

• Role of physiology
• Goals
• Tools
• Atone Goal #1: Facilitate expression of remorse
• Atone Goal #2: Facilitate transparency
• Atone Goal #3: Create verification
• Atone Goal #4: Move towards acceptance and Phase 2 of treatment
• Doing a Dan Wile
• Film 10: Atonement (Marilyn Asks Questions and Expresses Feelings) 
• Q and A

• Goals
• Tools
• How to be a great listener
• Attune Goal #1: Express needs & connect emotionally in a calm manner
• Attune Goal #2: Teach Constructive Conflict:
  • Mutual Understanding via The Gottman-Rapoport Conflict Exercise 
  • Film 11:  Affairs 7-  “Attunement: The Gottman-Rapoport Exercise” (26 min.)
  • Attune: Teach Constructive Conflict: The Art of Compromise
  • Film 12: Affairs 8 -  “Attunement: Compromise” (The Two Oval Method) ( 16 min.)  
• Attune Goal #2 Teach Constructive conflict, continued: 
  • Dream-Within-Conflict Exercise for Gridlocked Issues 
• Film 13: Affairs 9 – “Attunement: Dream-Within-Conflict” (22 min.)
• Flooding
  • Flight/flight/freeze
  • Effective break ritual
• Attune Goal #3: Process Past Emotional Wounds and Regrettable Incidents, Exercise
• Film 14 : Affairs 10 – “Attunement: Aftermath of a Regrettable Incident” (36 min.)
• Attune Goal #4: Celebrate Positive Events, Exercise
• Attune Goal #5: Process failed bids
• Attune Goal #6: Ask Open-Ended Questions
• Film 15: Affairs 11 – Attunement: Open-Ended Questions  (16 min.)

• Overview – Goal – Create Commitment
• Tools for Attach Phase
• Attach Goal #1: Explore New Shared Meanings (exercise)
• Attach Goal #2: Establish New Rituals of Connections
• Attach Goal #3: Build Ritual of Stress-reducing Conversation
• Attach Goal #4: Ritualize Cherishing: Build Fondness, Admiration and Appreciation
• Film 16: Affairs 12 – Attachment: Fondness and Admiration        (7 min.) 
• Attach Goal #5: Create Personal Sex and Intimate Trust
  • The Art & Science of Lovemaking Exercises
• Attach Goal #6: Cost for subsequent betrayal
• Attach Goal #7: Ritualize the “Sacred” One-Hour State of the Union meeting
• Completing Therapy
  • Relapse prevention

Target Audience

• Addiction Counselors
• Counselors
• Marriage and Family Therapists
• Nurses
• Psychologists
• Physicians
• Social Workers
• Other Mental Health Professionals