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1 Sensorimotor Psychotherapy > Laia Consults > Flashcards

Laia Consults Flashcards

1
Q

How do we do trauma sequencing if the client does not have an explicit memory/narrative?

A

We work with the client to create a fabricated image/story that represents their feelings, image/story fragments, imagination of what happened. Then use that just like we would an explicit memory/narrative

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2
Q

What can happen with body activation if trauma occurred when client was young?

A

If the child was very young when it happened there’s a sense the body doesn’t know to direct the activation downwards and instead the body kind of flails around unproductively in an attempt to discharge the activation.

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3
Q

What three techniques does Laia use to help a client intuitively sense to direct their trauma activation energy downward?

A
  1. She puts a heavy blanket on the client
  2. Puts pressure on the feet
  3. Puts pressure on the back of the neck
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4
Q

What are two different functions of muscular tension? And what’s two ways to distinguish between these?

A
  1. Precursor of mobilizing defensive action
  2. Strategy designed to stop the client from feeling an emotion perceived as overwhelming (either current emotion or bracing for future possibility)

To distinguish, you can:

  1. Ask the client if this movement were to complete, what would it do?
  2. Experiment with tensing and then relaxing - if during relaxing there’s a sense of increased activation, you know the tension falls in bucket #2 above
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5
Q

What’s the upper level of intensity (what number out of 10) we want for trauma work and what’s two ways of adjusting the trauma story/imagery to help with this?

A

If the intensity is above a 7/8, we start
1. earlier in the story
2. create distance between client and the people in the story (imagine your dad and his friend in a car on the other side of town)

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6
Q

Laia’s suggestions to balance client venting with other sensorimotor work?

A
  • Check in on how it feels before and after - feel relieved or more tired/heavy?
  • Check in on the space the client has to do this during the week - if our sessions are helpful, encourage client to bring more of this helpfulness throughout the week - e.g. imagining a little Brandon with them
  • Validate the importance of venting but name that there is a second project which is to go to the source of the emotions and resolve. Collaborate on how to divide time in session towards both projects.
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7
Q

Is it important to do positive resourcing work before trauma so that client has a sense of positive life direction and self-esteem?

A
  • enough to keep them from harming themselves
  • The sooner we can do trauma work the better to help improve sense of life direction and self-esteem. That meaning making comes more naturally when we feel better in the body
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8
Q

How can we do RAD without the client even moving? What’re the pros/cons of doing RAD with or without movement?

A

If client is able to tract the activation, they can just track it through to completion. Movement is helpful for clients that have a hard time tracking the activation but if they can track then just tracking the activation without moving is more efficient.

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9
Q

How can we use mental imagery to help prime an involuntary movement?

A

If the client names an energy wants to do some action, then asking them if that action could happen, what would it look like.

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10
Q

Laia’s suggestions for working with a client who is just starting to come into their body and experiencing distressing trauma memories/activation? (Includes out of session homework)

A

In session we work to establish the ability to tolerate waves of activation and be OK.

Outside of session, we give clients homework to get into pleasurable (and safe) things in the body and then if the trauma memories/activation find a process to shut them down

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11
Q

One possible way to help a shut down trauma memories/activation outside of session (3 steps)

A
  1. Imagine the memory/activation as a substance
  2. Put it into a box
  3. Distract yourself/do something else
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12
Q

Four ways to work with body sensation that is too activating/intense/painful to stay with

A
  1. Titration/pendulation: going into that area for a short period and then going to something neutral/positive
  2. Imagining it as an entity outside the body and slowing that entity down to study it
  3. Noticing the limits/boundaries of the activated area
  4. Imagining an empty space surrounding the area/ softening the areas around the distress
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13
Q

Experiment to study how saying No to the therapist may be for the client

A

Therapist says Yes with different tones (timid, demanding, desparate) and client studies what its like to say No

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14
Q

What are the 5 things that we need to have in-place before doing trauma processing?

A
  1. Client able identify and stay with body sensations (regardless of positive neutral negative)
  2. Client can say no/exert influence over process (may require giving parts stuck in “no” a “remote control”)
  3. Client has ability to notice where they are within window of tolerance and tools to modulate arousal up and down
  4. Therapist has addressed concerns/fears about the process, esp from managers and fight parts
  5. Develop skills and plans (if necessary) to ensure the work does not destabilize client’s life
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15
Q

What three things do we need to do to help client avoid destabilizing their life while doing trauma processing and possibly even developmental injury?

A
  1. Ensure client has skills to contain trauma parts between sessions
  2. Tracking if clients are leaving session in a functional state, ready to transition to next thing
  3. Ensure client has ability to notice and manage urges for unhealthy coping mechanisms
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16
Q

What three things are necessary before being able to do developmental injury work?

A
  1. Resolved trauma that could be activated
  2. Able to mindfully notice a part and stay in Self (dual awareness) while understanding the importance of doing so
  3. Client trusts the therapist to hold their vulnerable parts with skill and care
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17
Q

What is Laia’s definition of active rest?

A

Mindfulness + restfulness (e.g. breathing while doing puzzles)

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18
Q

5 ways to help ensure the client’s adult is engaged so the client’s child parts don’t become dependent the therapist

A
  1. Ensure the client understands why dual awareness is important
  2. Monitor client to ensure they are in dual awareness
  3. Always ask the adult to report back on the child
  4. Be clear to which part you are speaking to (adult or child)
  5. Discuss with client how they can integrate learnings from you on how to support their child
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19
Q

Before doing developmental injury work, is it necesarry that the client is generally living in Self during the week?

A

No. The therapist can help them unblend in session and foster dual awareness.

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20
Q

Before doing developmental injury work, does the client need to believe there are positive aspects of themselves?

A

No

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21
Q

What are two ways therapists can help increase trust before getting into vulnerable areas of developmental injury work?

A
  1. Studying adaptive strategies
  2. Building client knowledge of how SP works
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22
Q

What do we do if the client feels conflicted about the active defense? (e.g. “it’d make things worse”)

A

Put distance between stimulus and client and have the active defense happen then. E.g. go back to a point in the story before it was “too late”

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23
Q

Is it important to track the client’s breath when doing sequencing, why? What can we do about it?

A

Yes - clients can hold their breath. Have them synchronize their action (E.g. push) with breathing

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24
Q

What 5 things does Laia suggest to help encourage clients to do trauma work and make it smoother?

A
  1. Avoid describing it in terms that paint it as hard. Do not want to build reasons for them to avoid.
  2. Explain we are helping the body release and it’s important and it feels good at the end
  3. Want to avoid avoidance - name it and work to build up there.
  4. Suggest doing 2x weekly sessions so things don’t drag.
  5. List the targets so client can see how they are progressing
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25
Q

What’s another defense we can try if running or fighting doesn’t work?

A

Client imagining they are a ghost – the perpetrator just moves right through them. Client is mindfully dissociating.

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26
Q

Above what level of disturbance (out of 10) tells us the trauma memory is not yet fully settled (or maybe a different connected trauma)?

A

Above 1 or 2. Client should be able to put it away.

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27
Q

What are 3 techniques clients can use if intrusive CSA memories come in during normal sex?

A
  1. Distinguish past and present
  2. Remind themselves this is sex among adults, their kid is not welcome in the room.
  3. Ensure they have safety & ability to control with partner (e.g. pause, stop, adjust)
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28
Q

3 suggestions to work with dystonia

A
  1. Identify any specific triggers
  2. Sequence the tension
  3. Self-massage into the areas that feel neutral to raise awareness
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29
Q

Psychoeducation for clients on the four categories of ways they can deal with something upsetting

A
  1. Avoidance - no acknowledgement, results in shame building, out of control
  2. Distraction - acknoweldgement and limits. Must regulate or process afterwards.
  3. Regulation (soothing) - doing something nice for myself, deeper impact
  4. Processing - must have a time limit and be done with available skills/ resources/tolerance

All these can be done at cognitive, emotional, body and relational level

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30
Q

When doing trauma processing when do we pause to resource, RAD or sequence? Then when do we move forward?

A

Stop when:
1. Any time they leave the window
2. Anytime the arousal spikes

Continue when:
1. Come back into window
2. Arousal spike resolves

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31
Q

What is two ways to desensitize to annoying/bothersome external stimuli?

A
  1. Goal is to have client practice ground, open and regulate themselves during it (to break procedural patterns of resistance).
  2. Imagine a barrier between themselves and the sound that is able to turn the sound down a little bit, synchronized with each breath
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32
Q

What are the basics of working with dissociated parts using the inner circle/outer circle metaphor? (4 parts)

A
  1. Imagine parts seated in two circles – inner circle, and outer circle. Inner circle is parts that tend to come up more (more than 50% of the time)
  2. Ask ANP of client to notice what parts are in the inner circle and see their face/posture
  3. When anything significant happens, you can ask client to observing what is happening for a particular part or the overall circle
  4. Client can also imagining changing seats and embodying a different part (More advanced/potentially energy taxing or challenging for highly judged parts)
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33
Q

What can we do when client shows up to therapy with just a child part being embodied?

A

Ask if they can feel sense of core self or observer

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34
Q

What 3rd element can we bring in to help if fragmented client feels too overwhelmed to acknowledge a part? (hint: relational)

A

Bring in me or future wise self or some other person/spiritual being

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35
Q

2 key points of psychoed to clients on why an adult part needs to be in charge instead of a child part

A
  1. Not a world for a kid to be out on their own
  2. Child lacking key skills like picking up cues of safety/danger, paying attention to the needs of the world, containing themselves
36
Q

Two ways for a client’s adult to address their child part’s fear of suppression

A
  1. Adult willing to maintain consistent communication with child to build trust
  2. Adult willing to let the parts of the child out in small bits when it is appropriate
37
Q

How to handle cases where the child part wants to take over/act out but the adult is still in control?

A

Help the adult find ways of satisfying/honoring the child without needing to act out

38
Q

2 different ways to prioritize ordering of developmental wounds

A
  1. Core wound goes first (core belief feels the youngest)
  2. Most painful goes first
39
Q

What is the chapterbook analogy for structuring traum and/or dev injury work? How does it help the therapist? How does it help the client?

A

As the client develops a narrative of their life, think about what each chapter would be. The chapters highlight themes that can help therapist extract core beliefs. Helps client wrap their head around it, see progress and indicate preferences.

40
Q

6 ways to work with cry for help

A
  1. Transform the words of the cry into gestures and vice versa
  2. Reaching for the arms with a specific posture - e.g. laying downward and reaching upward. Have the client imagine the situation to know.
  3. If not in-person, could have them grab onto something or grab their own hand – this may not really work
  4. Can also work on sequencing activation in muscles associated with reach
  5. Laia also does sequencing in vocal chords.
  6. Instead of making noise, use face and breath to express that cry. Breath length is supportive of the length of time the energy needs to be let. Know that throat gets tired pretty easily.
41
Q

Which parts of trauma narrative do we need to visit? What can we skip? How do we communicate this to the client (two examples)?

A

All the possible moments of activation that create a different active defense. Can skip subsequent moments that activate same defense.
What is the next thing that catches your breath? Imagine a camera, what would it be focusing on next?

42
Q

When a second trauma comes up while working with the first, what two criteria do we follow to decide whether to go into that or stay?

A
  1. Is current trauma SUD at 1 or 2?
  2. Is new trauma linked to the same theme?
43
Q

What three things does Laia suggest doing for clients that pop out during 5 stepping?

A
  1. Let them pop out a bit and redirect in with a lot of context
  2. If that doesn’t work then there’s probably a deeper defensive - make contact statements about that pattern e.g. “Hard to stay in it, huh?”
  3. Look to see if I have hesitation that the clients may be unconsciously interpreting
44
Q

If a sliver doesn’t go down after RAD/SMS, what could be the cause?

A

Extra emotional material that needs to be processed

45
Q

What if a client wants to go into emotional stuff after processing a sliver of trauma memory?

A

That’s OK - follow the organicity and go into it with them

46
Q

What are two different ways Laia checks to see that the sliver was fully resolved once the activation around it settles?

A
  1. Go back through the story once all the slivers have been processed
  2. If it was a particularly intense sliver, revisit it before going forward
47
Q

For a sensation/impulse that begins and ends too quickly to sequence (since client can’t hang out in it) what does Laia do instead?

A

Repeat the frame many times to desensitize and let settle

48
Q

What 3 ways does Laia work with folks who have feelings of organs/body parts all mixed up or not in the right place?

A
  1. Practice yielding in the internal organs with breathing
  2. Bring clients awareness to the structure - bone, muscle, skin. Start with a place that feels accessible.
  3. Verbally have the client touch the body part, name it and say it belongs to me
49
Q

What two indicators does Laia track to make sure they aren’t going too deep? What does she say to ask explicitly?

A
  1. Are they able to maintain dual awareness
  2. Gut feeling of the resonance of the other person’s nervous system. She needs to be able to resonate with where they are in the pain.
  3. Is it too much or enough?
50
Q

Three pieces of psychoeducation about the Big Self that Laia explains to clients

A
  1. Self comes when you deeply connect with something bigger than yourself (strong love, something took your breath away because of the beauty, awe)
  2. It is underneath and beyond everything.
  3. Self can contain all parts
51
Q

Two things on the cognitive level we can do with DID clients who just switched parts?

A
  1. Naming the switch and inviting client to observe it before moving forward
  2. Observing what was the trigger and what was the context?
52
Q

What’s Laia’s definition of positive/therepeutic exposures?

A

Exposures are stress with success

53
Q

When a client is encountering something that is important to be able to do but feels too difficult at the time, how does Laia encourage them forward (without going into dev injury/trauma stuff)?

A
  1. Ask them to think about the stress on a level 0-100
  2. Lead them to identify something that is a short/smaller/less risky version that they could do successfully
54
Q

What 2 cognitive strategies/psychoed does Laia use with DID parts that want to be the only one in the system and may be taking too much control?

A
  1. Look at the cost of being the only one and taking so much control (E.g. burden, loneliness, resentment)
  2. Encourage it to be a team player - every part is necessary for optimal functioning as every part has wisdom and something to contibute
55
Q

In a present time cognitive way (no dev injury/trauma), what can we do to help soften a client’s self-judgement/shame about aspects of themselves? (3 ways)

A
  1. Try to change the response from fear/shame to curiosity, appreciation and capacity to hold
  2. Reframe to look at the strengths of those aspects
  3. Normalizing and validating through psychoeducation
56
Q

How to offer support to trauma holding parts who want to share the story without going into the story or doing trauma processing?

A

Hear the distress and not the story (focusing on soothing instead of processing)

57
Q

What is the timeframe for resolving unsafety in the body due to developmental trauma?

A

Could be months in the case the client practices soothing the trauma daily. Less practice makes it longer.

58
Q

Before taking a physical action, what two things can be helpful to ensure that its bottom up?

A
  1. Notice any precursors to the action in the body (tension, etc.)
  2. Ask the client to imagine how it might look and see what comes up
59
Q

What are the two steps in the cycle of attunement?

A
  1. Noticing and soothing distress
  2. Child yielding and feeling safe
60
Q

What technique from family constellations can help a client see the needs their parent didn’t get as a child and recognize how they may have been picking up on that unconsciously from their parent when they were a child? (4 steps)

A
  1. Invite client and their inner parts to find a big neutral space (e.g. meadow) and sit down at one end.
  2. Have them imagine a silent move to see the generational dynamics playing out with their parent as child
  3. See what is missing or needed by the child. Imagine the child giving voice to that need.
  4. Imagine grandparents responding to what the parent needed
61
Q

What is the somatic conversation technique? (5 steps)

A
  1. Imagine the person in front of you
  2. Say what you want to say
  3. Imagine dad receiving it, observing how its received in the body but not words.
  4. Say what you want to say in response to that
  5. Repeat until there’s settling and acceptance
62
Q

How can yielding be used for a client that’s feeling over-taxed with pain?

A

Guide client to give distress to something bigger - letting it flow with the right rhythm. Not pushing or having anxiety.

63
Q

Instead of opposing or trying to get rid of their pain, how do we want to encourage clients to relate? (3 points)

A
  1. Get curious about it - what message does it have for you?
  2. Change attitude to tolerance – “you’re going to be here a long time and that’s OK”
  3. Listening to it and honoring and agreeing with its message - e.g. “oh yes…” or “thank you…”
64
Q

If a client can’t go into the body to process trauma, what can be done with that memory?

A

Can ask client to re-imagine it with a healing/positive ending - e.g. magical stranger or therapist steps in to help

65
Q

How can we help clients deepen into experience of being seen by therapist in their pain? (2 questions)

A
  1. Can you feel me feeling you?
  2. What happens when you’re aware of me holding this with you?
66
Q

What 5 adjunctive therapies (outside of psychotherapy) does Laia recommend to clients and why?

A
  • Acupuncture
  • Psychical Therapists - pelvic floor, diaphragm and myofascial release,
  • Body workers/massage therapists - depression, grief, need to be touched
  • Safe and Sound Protocol - PTSD, autistic presentations,
  • Yoga nidra
67
Q

What fact about how long psychotherapy’s effects last does Laia weave into her ways of encouraging clients to do work outside of session?

A

Changes in therapy last for a few hours to a few days.

68
Q

For a client with a holding-in strategy, what is one body-focused intervention and how is it applied in three different contexts?

A

Yielding.
1. Yielding the internal organs
2. Yielding into environment
3. Yielding into a relationship

69
Q

What function does collapse serve for somebody stuck in the holding in strategy?

A

Its the way to get relaxation

70
Q

What’s one way to collaboratively frame a pre-emptive conversation around how to handle a relationship disrupt that will likely occur?

A

How are we going to address that moment where X happens?

71
Q

What is some psychoeducation we can give to clients about chronic pain? (3)

A
  1. Brain imaging shows that chronic pain can move from sensorial areas to hippocampus - meaning it becomes a learned response
  2. Feeling of pain is real but its coming more from hippocampus and less from present moment sensations
  3. Pain may have structural elements but lets attend to and support the other layers
72
Q

What is one way to cognitively interrupt procedural pattern of mind reading? (2 steps)

A
  1. Recognize the procedural belief as a trauma thought
  2. Find at least 2 other ways to explain what actually occurred
73
Q

What’s an easy-to-approach way to help a person practice recognizing the different between the different core organizers? (2 steps)

A
  1. Have them imagine something pleasant in front of them (food/drink)
  2. Notice what comes up in the core organizers.
74
Q

What does Laia say to clients to explain the concept of dual awareness without using that phrase directly?

A

Help you experience that you fall apart and at the same time still feel your integrity and capacity and strength to hold it.

75
Q

Ways a client can play with making mistakes (2 examples and a place to look for more)

A

Trivia
Darts
Exposure therapy has other examples

76
Q

When a client says “I can’t trust X” , what can be helpful to say to help them orient to what they can trust?

A

“What can you trust right now?”

77
Q

For a client that had trauma activated by washing butt crack, what did Laia suggest to activate that if usual means (imagining the triggering event) did not work?

A

Place hand on belly and imagining the projection on the backside of the body

78
Q

How can we help a client restore active defenses around sexual violations? (3 parts)

A
  1. have them imagine something that can represent the intrusion (object, shadow, presence, etc)
  2. Invite them to push the object away either mentally and/or physically (gently but firm)
  3. Have them push until they feel a settling or neutrality
79
Q

What is repatterning self touch and what is one situation where its important?

A
  1. Unlinking trauma triggers with touch
  2. Connecting with positive benefits of self-touch

Important where touch was unwanted or problematic

80
Q

What are two ways of repatterning self-touch?

A
  1. Experimenting with different types of touch (firm vs light) and locations on the body (back and extremeties easier)
  2. Exposure therapy for triggering self-touch
81
Q

When a client is high on dsyregulation scale, are they more likely to need self or interactive relation?

A

Interactive (something external – physical containment, my presence, ideal parent, etc)

82
Q

How can we help a DID system sense out the right option among disparate opinions offered by parts?

A

Regulate and get quiet enough to sense Self intuition

83
Q

What three skills help a DID client manage overwhelm from demanding child parts?

A
  1. Going slower
  2. Compartmentalization
  3. Distance
84
Q

What helps a DID client compartmentalize an overly intrusive part

`

A
  1. Telling the part “I hear you”
  2. Negotiating with part when client will come back to them
  3. Taking an internal pause away from the part
  4. Returning back to the part in a reliable way
85
Q

What’s important to know about parts stated needs/desires? (2 things)

A
  1. We don’t have to fulfill all the parts needs/desires all the time
  2. Need to fulfill enough of the actual core need on a reasonable enough basis in a reliable timeframe (you can do that tomorrow)

1 Sensorimotor Psychotherapy (23 decks)

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