Latest / The Trauma Therapist / Episode 791: What It Takes To Be A Trauma Therapist with Janina Fisher, PhD

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Episode 791: What It Takes To Be A Trauma Therapist with Janina Fisher, PhD · The Trauma Therapist

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  Or welcome back to the Trauma Therapist Podcast. My name is Gamiferson. My
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  mission is to help trauma therapist be their incredible selves, to be human,
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  to be real, not just a clinician. I'm a big believer in who
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  we are is more important than what we know, and this requires cultivating authenticity,
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  genuineness, and vulnerability, and that requires intention. Can learn more about
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  my courses and workshops by going to the Trauma Therapist project dot com. That's
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  the Trauma Therapist Project dot com. Let's get started. Okay, here we
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  go. So five, four, three, two and one are folks.
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  Welcome back to the podcast. Thrilled to have it back. Doctor Janina for
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  sher Ganina, welcome, thank you. So. Janina is a licensed clinical
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  psychologist and a former instructor Harvard Medical School. An international expert on the treatment
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  of trauma. She's an advisory board member of the Trauma Research Foundation and the
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  author of three books, Healing the Fragmented Selves of Trauma Survivors, Overcoming Self
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  Alienation, Transforming the Living Legacy of Trauma, a workbook for survivors and therapists,
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  and then The Living Legacy Instructional Flip Chart. Gunia is best known for
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  her work on integrating mindfulness based interventions into trauma treatment. She's also the creator
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  of Trauma Informed Stabilization Treatment Therapy. Janina, welcome back, thank you,
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  thank you. So look, you just got off of a three hour plus
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  webinar. Give us a little snippet of what where, who what? This
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  is the two a two module webinar series for Turkish therapists. Who are you
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  know? You may not mean my not know this in the United States,
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  but the Turk, you know, Turkey has been very advanced in terms of
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  trauma research. There's been a lot of good research on dissociation on the trauma,
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  and it's a very sophisticated group of therapists, which we, you know,
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  we I think we don't appreciate in the US. So you're I mean,
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  are you still traveling all over the place only via zoom? Okay,
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  Zoom allows me to travel all over the world. It's I mean, I
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  just did a trip to to England for a series of conferences and workshops,
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  but mostly I'm I'm in the Bay Area zooming. So I just to give
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  people some context. You know, I first met you when you were teaching
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  the censor motor psycotherapy training. I did levels one and two, and then
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  I was fortunate enough to be in a small supervisory group with you. But
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  you know, as I've said before to you, I was just always str
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  immediately struck by not only your incredible knowledge and ability to work with people,
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  but Janina, your presence, you were, humor, your smile. Where
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  did that? Where does that come from? You know? I sometimes wonder
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  myself. I mean, I think it comes I think it came from my
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  father, who was a very you know he was he was somebody who also
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  loved to laugh, oh, love to smile, and love to teach,
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  and that you just kind of absorbed that and and brought that into your work.
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  Did that come naturally or is that something it comes naturally? Yeah.
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  In fact, at the beginning of my career, I always felt like if
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  any supervisor saw me smiling and laughing, I would be condemned and thrown out
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  of the profession, Like God forbid. We should enjoy our clients. Really,
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  it's it's very I mean from my perspective, it's it just immediately seems
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  to shift the tone right. It's almost like a disruptor and a state disruptor
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  and a sense that's the way it works for me. What are your thoughts.
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  Yeah, I think that's a really good observation. Yeah, that if
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  it's a it's a state changer. And and you know, I think they
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  dynamic idea that what clients want is for us to be part of their suffering,
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  right, they want us to go to the depths of their most painful
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  experience. What I've heard from clients is that's not true, that they actually
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  want a therapists who who can tolerate their pain without going there. Okay,
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  expound on that, right, Well, the feedback I've gotten from clients because
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  I you know, I've had a very very busy practice consulting to clients who
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  have questions about, you know, their progress and why they haven't gotten further,
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  and what they have liked and not liked about their therapies. And often
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  what they say is is, you know, it's bad enough that I go
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  to those places. I don't need the therapist to go there. And so
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  what's what is that? I mean, I know intellectually what that means,
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  but what does that look like? Because for a therapist to go there as
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  opposed to a therapist understanding what what's it like to be there. I guess
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  breaking down. Does that mean that a therapist they don't want a therapist to
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  obviously break down in session or emote. What does that mean? Well,
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  often they say it isn't helpful when the therapist has a strong emotional reaction because
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  it makes it makes them feel more shame, more freakish. Then if the
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  therapist is more matter of fact, when the therapist projects I've heard these things
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  before, you're not telling me something that shocks me, you know. Sadly,
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  I wish I would. I wish I could be shocked, you know.
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  But so I think the feedback I've gotten from clients is to use your
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  language, stay changing is what they want. And you're not talking about not
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  showing some kind of response, right, it's on a continuum, You're not
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  you're talking about not kind of crumbling like oh my god. But there's a
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  difference between hearing something horrific and responding to it in a measured way, right
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  exactly, exactly exactly, And you know, and I think the feeling of
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  being understood is it's more important and that and I think often that induces state
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  change. So if I say, of course, of course you feel ashamed,
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  of course, you feel responsible, how could you feel any other way?
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  And they feel understood. That helps to shift the state therein as you've
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  experienced your career and continue to you know, talk to people, talk to
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  clients, talk to other therapists. What are your thoughts on the state of
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  training in the United States and in the world. Where are we at?
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  What is important? Well, you know, I just had a conversation with
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  Ruth Laneus about this just earlier in the week, and it's very sad because
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  around the world, you know, she's from Canada. Around the world,
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  training programs for therapists still do not cover trauma. I mean, it's hard
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  to believe that you just said that. I don't. It's shocking but true,
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  and it hasn't changed. I mean I could say, well, you
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  know, in nineteen ninety or nineteen the late eighties, early nineties, when
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  I was getting my PhD, we didn't know as much about trauma. But
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  we can't say that anymore. And we have lots of research showing that trauma
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  overlaps with every diagnosis in DSM. So there's no there's no use other than
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  trauma is still a topic that many people feel uncomfortable with, and I think
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  it does disrupt the kind of mental disease model to talk about depression not as
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  a disease, but as as a condition that can be related to trauma,
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  right, and many conditions can. Now, when you say it disrupts that
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  model, what do you mean by that? Meaning? If we assume,
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  excuse me, I'm losing my voice after talking for three hours, if we
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  assume that depression is a biological disorder and therefore best treated by medication and CBT,
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  that's a very simple model. The only problem, that's only slight problem,
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  is that that there's a very high proportion of depressed individuals who don't get
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  better based on the mode. But it's a simple model, and the you
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  know, the insurance companies who drive DSM and and certainly you know the psychopharmacology
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  world prefer simpler. You know, you can't make a medication for trauma because
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  trauma includes so many symptoms of so many conditions. How has your uh,
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  your way you've worked with people skipped over the years. Well, you know,
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  I think along with the whole trauma world, you know, we've been
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  experimenting. When I entered the trauma world in nineteen ninety, we didn't have
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  any trauma treatments. The only treatment for trauma was it was the talking cure,
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  tell your story and all will be lifted from you. That obviously didn't
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  work. So back in the early nineties we would try out anything from any
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  approach and if it worked, we would call it trauma treatment. And that
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  was kind of the you know, fly by the seat of your pants and
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  try to discover it as you go along. Judy Hermann said, psycho educate
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  the clients. So we became very good at psycho education, and that seemed
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  to help a lot of people. And then Besil vander Kolk introduced the idea
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  of using mindfulness and that seemed to help a little bit. And then of
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  course came EMDR and that helped a whole bunch more, but it wasn't quite
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  enough, and so then we had the body keeps the score and sensory motor
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  psychotherapy and somatic experiencing giving us somatic techniques. So all along, I think,
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  you know, I still use psycho education. I still I'm trying to
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  retire from clinical practice because my teaching schedules so busy. But if I were
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  still doing full time clinical practice, I would still do EMDR. I would
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  still do a lot of sensory motor and then in the last ten years,
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  I've developed my own approach, which is a trauma informed parts approach that integrates
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  techniques and ideas from internal family systems, from sensory motor psychotherapy, from hypnosis,
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  from you know, everywhere and anywhere. So you're talking about the trauma
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  informed stabilization treatment. Okay, so if we could let me do this,
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  Let me just pause here for a second to thank our sponsors again. We're
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  speaking with doctor Janina Fisher. We'll be back in just a couple of seconds
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  here, all right, Gina, So first of all, why did you
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  develop this? I developed TISTS because I I found that many I had many
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  clients who couldn't tolerate EMDR, and then sensorymoter helped because many of them could
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  tolerate sensory motor psychotherapy. But there was still a subgroup who couldn't tolerate SENSORYMOTER,
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  who couldn't tolerate MDR, who usually had histories of failed treatments over many
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  years, and I became curious about how to help them, and I had
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  this idea that it might be easier for them to notice parts than notice the
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  body. So you know, EMDR requires noticing memory, which can be very
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  disrat regulating and challenging. Sensory motor ask clients to go inside the body,
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  which for some clients is wonderful experience. For other clients it's a very scary
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  place. And so I had this idea that noticing parts would be less scary
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  than noticing body experience. Yeah. I love that for me because it's kind
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  of like, Okay, there's this part out here that I can kind of
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  look at and manage and right, right gives it gives us a relationship to
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  that dressed distressing feeling or body sensation, and you know, and that's what
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  we need. We need that mindful relationship. So let's just just take a
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  moment. What would that look like if you were working with someone, How
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  would you introduce that and how would that might that unfold for that client.
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  So the example I was just using with the Turkish therapist was a young woman
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  diagnosed borderline, functioning well at work, but in a cycle in which she's
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  very easily hurt, has very strong anger rage reactions, then self harms and
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  then drinks herself to blackout day after day, and has a history of many
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  failed treatments, and so she came to see me, and and I introduced
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  her to the TIST model, which is, you know, again, it
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  integrates many approaches, including what's called the structural dissociation model, which assumes that
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  associative fragmentation is neurobiologically based and that we develop parts driven by survival responses,
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  so that typically people have a part driven by the fight response, apart driven
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  by the flight response, a part driven by the fear response, the submission
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  response, and the cry for help response. And so I introduce this young
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  woman, I say, you know, I think that you have been wrongly
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  diagnosed. I see you as having a trauma related disorder, and could I
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  show you this model that might explain the difficulties you've been having. And you
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  know, most people, as she did, immediately recognize themselves in this model,
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  so, you know, so it wasn't hard for her to identify,
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  Oh, the part of me that gets so hurt, that's my cry for
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  help part. Oh, the part of me that screams at the person who
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  hurt that part, that's my fight part. And then we could also because
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  the fight response is the only response associated with aggression, I assume that it's
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  also involved in self harm. So we were able to track this pattern where
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  she would get angry, storm off, then her self harming part would would
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  cause some type of self harm, and then her her flight part or her
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  alcoholic part would drink, would basically sedate the attached and the flight parts,
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  and she would drink herself to blackout because that stopped the cutting, and it
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  stopped the distress of the young part, and then she'd go back to work
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  the next day. Somebody would hurt the feelings, you know, and so
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  for her, I mean again, talk about stay change when we take this
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  kind of crazy, intense, dysregulated pattern that's happening over and over again.
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  Not to mention the shame of her submit part about all of this, because
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  because there's a lot of shame when when people are having these acting out patterns,
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  you know, she immediately felt relief, right, Oh it's them,
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  and I'm okay and we can help them. So was the mere identification of
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  these parts allowed her to say, I'm okay. There's there's other parts that
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  need attention, right, these parts are in deep trouble, and as a
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  result, I've been in deep trouble. And that then means that the therapist,
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  instead of being a trigger, which we often are with people who you
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  know, orderline personality disorder is in my mind, the result of traumatic attachment.
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  So the sensitivity to being hurt, dismissed, unseen is so high.
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  And so when we have a more I thou relationship as therapists and client,
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  it's very easy for the therapists to trigger this kind of pattern. But instead,
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  and what was so remarkable for this young woman, Instead the relationship becomes
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  collaborative. It's like she and I together are trying to see the parts,
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  understand what they're reacting to, and be curious about what they needed in order
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  to settle a little bit. I mean, you obviously have this wealth knowledge
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  to draw upon you when people come up to you and say, you know,
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  Genina, how do I become a trauma therapist? Where do I start?
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  What do you say? Is it necessary that? I mean, there's
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  so many modalities out there, and is it necessary that where do they start?
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  Well? I would advise, I would advise people to start with the
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  assumption that no graduate program in the world is going to teach them about trauma.
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  Unfortunately, for us, we have to acquire our own postgraduate education in
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  trauma, which is part of what you're trying to do with the podcast,
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  and hopefully it encourages people to take trainings and to take trainings not just in
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  a method, but in understanding trauma and understanding the understanding the neurobiology of trauma,
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  understanding what actually is going on with traumatized clients. I think that makes
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  a huge difference. As an EMDR consultant, I ran groups for MDR therapists
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  for twenty years, and ninety percent of their questions were about trauma treatment,
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  not about technique, about trauma treatment, not about technique, right, because
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  EMDR is actually not a difficult tech need to master. It's the challenges that
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  traumatized people present, which if you don't know about trauma, can be very
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  mystified. Give me an example, well, very typically the most common,
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  the most common thing that therapists I was going to say, complain about is
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  clients who can't feel right, non intellectualized, disconnected, alexothymic clients what off
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  of therapists call avoidant clients, and the fact that we don't understand that it's
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  not that they're avoiding. They don't feel right because they're in a parasympathetic state
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  in which they are known, in which they have no energy, in which
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  they have no access to emotion. And so a lot of em DR therapists
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  in my groups would encounter those clients. They you know, the clients would
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  be perfectly happy to try em DR, but just a few a few sets,
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  and the client would become so numb that it often felt like what's the
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  point in continuing? Or clients would get so hyperactivated that they would be overwhelmed
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  and unable to tolerate. Those are the two most frequent complaints that I hear.
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  And so that's about understanding trauma as you know, so right, so
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  as oppose to understanding the modality or being even very proficient in the modality.
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  Exactly, exactly right. I think of myself as very proficient in the modality.
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  But doesn't mean that my clients won't have the same reactions. That's very
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  interesting now in terms of therapists doing their own work, doing their own quote
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  unquote trauma work, their own therapy working. How important is that? I
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  think it depends Excuse me, I think it depends on how much the therapist
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  is suffering. How you know, how much how much the trauma of the
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  therapist. Trauma is affecting the therapists, both in therapy and out, you
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  know, I mean I I would say most therapists that I know have done
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  their own work. Maybe they haven't done it as completely as therapists often want
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  people to do their work, but they've they've done enough work that they have
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  stable, good lives. They get triggered because no amount of trauma work is
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  going to stop triggering. That's a biological you know, it's a biological phenomenon
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  that we're not going to get brains to give up. You know, even
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  psychedelics don't change the brain that much. Right. So as we kind of
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  wind down here, people are interesting in uh learning about TISTS trauma informs civilization
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  treatment. Are you offering trainings on your website or what they can read about
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  TIST on my website? The trainings are being offered through the Therapy of Academy
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  Wisdom I'm sorry, the Academy of Therapy Wisdom, which is therapy Wisdom dot
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  com. Okay, and we now have over two hundred certified graduates of the
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  first two training cycles, so around or literally from around the world. Very
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  cool, Okay, we'll have that linked up at the show notes, here
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  at the Trauma theapispodcast dot com, Therapy Wisdom dot com. Ganina, look,
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  come on, you are so friggin inspiring and you just had this beautiful
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  presence about you. I don't know what it is. It's very unique,
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  but it's uh. I love having you on here. Oh, thank you,
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  thank you. It's so nice to see you. We go back such
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  a long way we do. We do what's next for you? What do
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  you? What's next for you? In terms of work and trainings and and
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  so forth. You know, I have a lot on my plate doing.
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  I'm doing a lot of trainings for different European countries, both TISS and you
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  know, I still do some E M d R workshops. I still do
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  body centered therapy workshops. But I would say most of my energy is going
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  into developing tists and I'm hoping fingers crossed at some point to be able to
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  do some research. We were all set to do a research project on the
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  effectiveness of tists when the pandemic hit. Oh, and that canceled the studies,
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  which couldn't be postponed because the studies were being done by graduate students who
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  had a limited window of time to finish their their research and get their PhDs.
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  Well, we'll look forward to that again. We'll have your website as
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  well as therapy wisdom dot Com linked up here. Gina, thank you so
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  much. It's an honor having you on here. Oh, thank you,
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  thank you. I love to be here, appreciate that we'll be in touch.
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  Okay, great a right, good bye at happen keep rounduilding