Experts at The National Conference on Trauma, Addictions, and Mindfulness: Where Freud Meets Buddha discussed new ways to approach deep work with clients.
John Briere, PhD, director of the Psychological Trauma Program at Los Angeles County, University of Southern California Medical Center, discussed diagnosis as a theoretical model and cautioned that a diagnosis is not prescriptive as much as it is simply a label. Think of clients as people who have pain beyond their capacity to handle pain—regardless of the label.
For example, a patient that’s self-harming typically has overwhelming distress and is looking to reduce the pain. Suggesting that the patient aim to stop self-harm will likely cause him or her more stress and the potential to self harm even more. Clinicians need to look deeper at the underlying stressors and work through those first.
“When you’re in great pain, you’ll do whatever you have to to disrupt the pain. Don’ t use the impulse control label when it could be problem solving,” Briere said.
He noted that some traumatic memories from early in life are encoded in the brain as “primitive” thoughts and feelings that later might be mistakenly attributed to present-day situations. In some cases, the present-day situation is a trigger rather than a source. When the long-encoded feelings are activated, they emerge without being recognized as something from memory.
“You’re triggered, and you feel anger,” Briere said. “The trigger is there, and you don’t realize it’s a memory that has a long-ingrained code.”
He calls this a source-attribution error in the brain. One solution is a model of metacognitive awareness to manage triggers. It’s one of the largest components of mindfulness and is being considered for use with psychotic conditions, he said.
Clinicians can begin by letting clients know that there are triggers and they can accept the experience mindfully without acting. Next have them try to figure out their specific triggers, such as the sound of police sirens or experiences that involve disapproval. It might seem that there are triggers going on all the time, but they can be categorized by their relative amplitude. Higher amplitude triggers can be addressed with mindfulness and the space to tolerate the thoughts and sensations without judgment.
Remind them that “It’s just thoughts, not facts,” he said.
The Summits for Clinical Excellence bring together thought leaders on cutting-edge topics in multi-day national and regional conferences. Summits on mindfulness, trauma, process addiction, and shame appeal particularly to private practice behavioral healthcare professionals. Other Summits address the national opioid crisis from a regional perspective and engage a diverse group of stakeholders.