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Question 1

What are peri-traumatic resources?

Answer 1

Resources that occur before, during and after the trauma. Are often very effective to discover and reinforce to help build resources before processing trauma.

Question 2

What are the 4 Alterations in the Field of Consciousness?

Answer 2

1) Overconnection (fixation): This occurs when two or more aspects of the core organizers are over connected, forming a closed system, a loop. The various components become locked together in a fixated, rigid way that excludes incoming information and self-reinforces.
2) Dominance: Occurs when a client overuses one of the core organizers at the expense of another (e.g. highly intellectual but no emotion awareness)
3) Disconnection where the core organizer (or subset within a core organizer) is out of awareness;
4) Incongruity: where core organizers are not congruent; e.g. smile when talking about grief

Question 3

What is the orienting reflex?

Answer 3

The ongoing, moment-to-moment mental and physical action that entails turning attention toward whatever is interesting or compelling to the individual at a given moment.

Question 4

What happenes to the field of conscioussness of trauma survivors?

Answer 4

It is unconsciously and reflexively narrowed to reminders of the trauma or its context (either direct or indirect)

Question 5

What are the two parts of the post-traumatic orienting response and why is changing this response essential in treatment?

Answer 5

1. Being compelled to anticipate, orient to, and react to stimuli that directly or indirectly resemble the original traumatic experience – this is a narrowed field of consciousness.
2. This narrowed field fails to perceive non-trauma-related cues indicative of safety or danger.

It is essential because orienting is fundamental to human learning and cognitive function (in my words, that’s where they’re steering their boat)

Question 6

5 examples of disruption at stages of orienting

Answer 6

1. Hypervigilance (hyper orienting) or frozen scanning response
2. Senses either dulled or hyperalert
3. Easily hyperaroused at novelty or unresponsive to novelty
4. Either assessing everything as dangerous or nothing as dangerous
5. Trouble taking action after an asssement has been made

Question 7

Example orienting exercise to increase regulation and what typesof dysregulation does it work for?

Answer 7

1. Ask client to turn head and neck and slowly scan the entire space
2. Ask client to locate objects of different colors
3. Ask them to notice the effect of orienting movements on their core organizers

Works for hypo and hyper arousal

Note: orienting to the therapist is also regulating for some clients.

Question 8

Two different aspects/axis of consciousness

Answer 8

1) Field of consciousness – number of phenomena
2) Level (intensity) of consciousness - level of mental energy and attentional focus being exerted

Question 9

How to change prosody, eye-contact, facial expression and body language to increase level (intensity) of consciousness? How to changes those things to decrease level of consciousness?

Answer 9

1. To increase level of consciousness - Prosody and language that is directive, clipped, definitive (“stay right with that”), combined with direct eye contact, erect posture, and alert leaning
2. To decrease level of consciousness - Prosody that is more open, slower, questioning (hmmmm– just take your time‐‐‐hang out with that feeling), combined with relaxed body, sitting back, soft eye contact

Question 10

3 Situations to Invite Additional Core Organizers

Answer 10

1. When installing a resource
2. When including more core organizers will stimulate orienting/defensive actions
3. To help move the therapeutic process along in some other way

Question 11

2 reasons to limit awareness of core organizers

Answer 11

1. To reduce hyperarousal caused by coupled organizers so the action can be completed
2. To stay focused on core organizers that can be integrated

Question 12

Where does the ventral vagus wind through?

Answer 12

Winds through eye and facial muscles and throat and top of chest.

Question 13

What 3 body abilities does the ventral vagal system facilitate related to safety?

Answer 13

1. Eye contact
2. Vocalization (including to engage others)
3. Facial expression

Question 14

5 Things that happen during Freeze

Answer 14

1. Rigid muscle tone
2. Feeling of paralysis
3. Frozen stare
4. May or may not have racing thoughts
5. Usually coupled with high anxiety/terror

Question 15

4 things that happen during feigned death

Answer 15

1. Flaccid muscle tone
2. Blank stare
3. Emotional and physical numbness
4. Sometimes loss of consciousness/awareness

Question 16

5 Steps of Pushing involving therapist directly

Answer 16

1. Invite client to pushe against therapist hands or a pillow held by therapist, controlling the contact and pressure
2. Make adjustments in pressure or position so that it is physically pleasurable
3. Mindfulness questions on what’s happening in the body
4. Therapist notice if the client has any areas that are holding back from using their entire body
5. Stop and MFQ on core organizers and sense of self

Pace it appropriately for the client - mindful and slow vs more playful or even aggressive for others

Question 17

Two signs of preparatory movements related to attachment/seeking help

Answer 17

1. Preparatory movements of reaching out, moving toward or seeking an attachment figure
2. Feelings of tension in throat, of something wanting to come up and out through the throat, like an impulse to call for help or make a noise

Question 18

5 examples of thoughts that can indicate orienting or defensive responses

Answer 18

1. “I feel like running away.”
2. “I wish I could have hit him back.”
3. “I want to get out of here.”
4. “Something’s not right.”
5. “It’s not safe.”

Question 19

5 example body-related client phrases that could be indicators of orienting or defensive responses

Answer 19

1. “There’s a tingling in my arms.”
2. “I have this heavy feeling in my arms.”
3. “My legs feel weird.”
4. “There’s a little vibration in my spine.”
5. “My shoulders have a buzzy feeling.”

Question 20

3 Functions of Boundaries

Answer 20

1. Protection - safeguards from harm to self and to refrain from harming others
2. Containment - helps increase our capacity to tolerate our own heightened states as well as those of others
3. Screening - helps us screen out dysregulating or background “noise” while letting in information that helps us regulate or offer new information

Question 21

8 Signs of Underbounded/overpermeable boundaries

Answer 21

1. Difficulty saying “no”
2. Difficulty identifying feelings and wants
3. Easily overwhelmed by emotions (self or others)
4. Constant state of recovering from triggers
5. Lack awareness of social space (come too close, miss boundary cues, ask or tell too much)
6. Body often collapsed, unguarded, relaxed musculature
7. Tendency to give too much in relationship, to merge or become enmeshed, external locus of control
8. Difficulty with differentiation and distance from others

Question 22

8 Signs of overbounded or overly rigid boundaries

Answer 22

1. Difficulty saying ‘yes’
2. Perception of others as threatening
3. Difficulty with trust, intimacy, vulnerability, inability to let down guard
4. Receives little nourishment from others
5. Style promotes isolation and separation
6. Insensitive or abrasive in relationship
7. Cannot take in new information
8. Body has unyielding quality of superficial musculature; unable to soften physically or emotionally

Question 23

What are pendulum boundaries?

Answer 23

When a person swings back and forth from over-to-under-bounded in response to triggers

Question 24

What are incomplete boundaries?

Answer 24

When a client has healthy boundaries in most situations but boundary dysfunction in certain situations (e.g. with lovers, authority figures, same or opposite gender)

Question 25

How are boundaries expressed in their body’s musculature when a person is triggered?

Answer 25

Client becoming either collapsed or rigid

Question 26

How much should a somatic boundary exercise be practiced?

Answer 26

It should be practiced until it becomes familiar and comfortable

Question 27

3 Steps of a boundary exercise that can be done over telehealth

Answer 27

1. Have client draw an energetic boundary with their hands
2. Install the resource
3. Practice challenging it or just hang out there

Question 28

No contact method of working with client boundaries using in-person interaction (4 steps)

Answer 28

1. Have the client switch into mindfulness.
2. Ask the client to tell you when you are too close or too far away.
3. Begin taking steps slowly either towards or away from the client
4. When the client says stop, have then notice what in their body tells them that the distance is too close or too far away.

Question 29

5 Specific Purposes of using Touch in Psychotherapy

Answer 29

1. Modulate arousal
2. Increase sensation
3. Desensitize touch phobias
4. Stimulate attachment system (E.g. holding hand)
5. Release constriction

Question 30

4 Examples of inappropriate touch

Answer 30

1. Uninvited or without consent from all parts of the client
2. Intrusive or sexualized touch
3. Touch offered by therapist without engaging the client in self-study of the effects
4. A therapist indulging client’s request for touch without first examining the client’s underlying motives

Question 31

6 Pitfalls of Using Touch in Psychotherapy

Answer 31

1. Clients may be unable to set boundaries
2. Client may be unable to communicate about the impact of touch
3. Touch can evoke unworkable transference or countertransference
4. Touch can break down needed defenses
5. Different parts of the self experience touch differently: what feels safe or desirable to one part might not to another
6. Legal issues: malpractice insurance implications, client’s previous history of taking legal action against helpers

Question 32

5 Ways to Avoid the Pitfalls of Using Touch in Psychotherapy

Answer 32

1. Take a “touch history:” what kinds of touch feel unsafe? What has been the outcome of experiences of touch in therapy? Massage? With friends and partners?
2. Have a precise therapeutic intent for every time touch is used, one that you and the client have agreed upon
3. Assume the client cannot explicitly set boundaries and be on the lookout for unstated boundaries both at the outset and throughout the processing
4. Think about the client’s situation – what might the client and each of their parts make of the touch
5. Consider using pillows, therapy balls, blankets and the client’s self touch as alternatives

Question 33

What do we do after completing one pass through the trauma memory?

Answer 33

Do it again and look for more signs of unresolved trauma.