Lvl1 Mod 2

Question 1

Phase-Oriented Treatment Approach ala Pierre Janet

Answer 1

Phase 1: Symptom Reduction and Stabilization

Phase 2: Treatment of Traumatic memory and non-traumatic memories that pertain to attachment

Phase 3: Personality Integration (limiting belief systems and meaning, social connection, relationship and intimacy, life issues, risk-taking, change)

Question 2

5 treatment goals throughout a phase oriented treatment

Answer 2

1. Maintain and raise capacity to function in normal life
2. Monitor and control psycho-physiological arousal (stay within window of tolerance)
3. Maintain and raise the integrative level (expand the window of tolerance)
4. Gradual re-exposure to memories and phobias with relapse prevention (of dissociation)
5. Develop the body as resource and a somatic sense of self

Question 3

Five stages of “The Process”

Answer 3

1. Build the Container
2. Accessing
3. Processing
4. Transformation
5. Integration & Completion

Question 4

7 Parts of the “Build Container” stage

Answer 4

1. Develop the relationship (details on separate flashcard)
2. Boundaries work (details separately)
3. Listen, track, contact
4. Assess how much of what’s coming up now is related to the past vs being unique?
5. Assess resources, developmental issues and traumas.
6. Hypothesize what might be possible at transformation
7. Choose access route & frame. Include psychoeducation as necessary

Question 5

3 Key steps of the Access stage?

Answer 5

1. Focus on gathering information on the core organizers using mindfulness rather than conversation
2. Define frame as it relates to theme of session/potential therapuetic outcome
3. Repeat 1-3, each time narowing the focus/refining the frame to go more deeply into less material. Reframe as needed

Question 6

7 Tasks of the Processing Stage

Answer 6

1. Develop client’s ability to maintain mindfulness and study core organizers. Encourage client interest in the organization of experience and not in the content. Used in small doses under a minute.
2. Balance resources with processing. Clients may need more development of internal resources before they can process trauma or developmental issues.
3. Modulating arousal to help maintain activation at the edge or within the window.
4. Developing somatic awareness and client willingness to feel their body. Encouraging clients to risk becoming aware of all sensations and movements in the body, particularly pleasurable ones.
5. Support the unfolding process. “Healing is coaxing nature.” Therapist supports organicity.
6. Refinement of the core techniques of tracking, contact, mindfulness questions, experiments, framing and reframing. The refinement focus depends on which of 3 Treatment Phases the client is in (developing resources, processing trauma, etc.).
7. Increase the definition and specificity of the theme of the session by refining the hypothesis of what might be possible at the transformation stage. Narrowing the focus naturally facilitates transformation.

Question 7

6 Ways to Help a Client with Integration

Answer 7

1. Focus exclusively on the transformation. As the therapist do not ask questions about topics. Redirect clients back if they stray.
2. Find or acknowledge the inner resources that support the transformation
3. Noticing what it’s like to be in relationship to therapist and imagining the transformation in relationships outside the therapy session.
4. Imagining the new resource being available in daily life.
5. Imagining or discussing the use of external resources to support transformation
6. Using art/movement/writing-based activities for client to further process/express transformation.

Question 8

2 ways to gear psychoed

Answer 8

1) to the possibilities of meeting their goals

E.g. how can specific concepts/interventions in SP help them

2) To help them get curious about how might their symptoms be related to their body

Question 9

4 Ways to Do Psychoeducation

Answer 9

1. Most important is to use your own body.
2. You can give information
3. tell success stories
4. Draw diagrams and pictures (window of tolerance, triune brain, left/right brain, etc.)

Question 10

4 important elements of Access Routes

Answer 10

1. Is an element of present experience (cognition, emotion, five‐sense perception, movement and sensation)
2. Framed in relation to something else of interest from the client’s narrative (memory, issue, theme, etc.)
3. Is collaboratively agreed upon as a focal point
4. Provides a clear avenue for mindful exploration of underlying traumatic patterns and resources

Question 11

6 different goals for routes to take when we’re tracking/contacting

Answer 11

1. What might lead to completing action or modulating arousal
2. Understand how trauma manifests through the core organizers
3. Understand how resources manifest through core organizers
4. Explore the connections between content and physical organization
5. Explore significant changes in the client’s organization related to content
6. Explore what interests the client or what is repeated

Question 12

How to begin with the end in mind when choosing a possible access route (plus two examples)

Answer 12

Choose an access route that reflects your hypothesis for what is possible in the “Transformation” stage of the process

Ex One: Hypothesis might be that tension is a precursor to action. Access Route is Tension in the arms. Transformation is experience the capacity for empowering an “Act of triumph”

Ex Two: Hypothesis might be that at the transformation stage of the process the client will experience feeling grounded. Access route: Let’s start with grounding. Tranformation: Learn the skill of grounding to bring arousal to within the window of tolerance.

Question 13

In what ways should the therapist be precise when going into the Accessing Stage? Is it important to stick to a frame?

Answer 13

The therapist should be precise in relating contact statements, experiments and mindfulness questions/directives to what has been framed. Once you’ve framed, stick with it until or unless you reframe

Question 14

What is the definition of directed mindfulness?

Answer 14

Paying attention to particular elements of internal experience (body sensation, movement, emotion, image, cognition) considered important to therapeutic goals. Awareness is directed toward specific building blocks emerging in the present moment.

Question 15

What is Mason’s framing question example?

Answer 15

“I wonder if it’s worthwhile studying that?”

Question 16

Mason’s advice on how to promote mindfulness in clients with limited intellectual capabilities

Answer 16

Giving clients a menu – “Do you feel it in the upper, middle or lower part of your body”, “Does it feel like it wants to move forward or backward, up or down?”

Question 17

Purpose of uncoupling the core organizers and three examples of what to say to client

Answer 17

Purpose: Help the client lower their level of activation

1. Put the fear aside for right now and just feel your body.
2. Instead of becoming that part, put all your attention to feeling your legs on the floor.
3. Rather than pay attention to the terror, just notice what your body wants to do.

Question 18

4 Ways to Develop/Build the Relationship (1st step of Build the Container stage)

Answer 18

1. Elicit the client’s social engagement system
2. Demonstrate understanding and respect of client
3. Hold the hope
4. Maintain boundaries and safety

Question 19

3 Parts of Boundary Work (as defined in 2nd step of Build Container stage)

Answer 19

1. Model healthy boundaries
2. Assess client boundary style
3. If needed, teach about boundaries.

Question 20

2 extra things to encourage clients with dissociated parts to be mindful of

Answer 20

1. Mindfulness of dissociative phenomena ‐ impulses to switch, go away, intrusions, numbing ‐ can help to restore mastery
2. Mindfulness of responses of all parts to interventions and stimuli (is there another part that had an experience?)

Question 21

4 Characteristics of the “Experimental Attitude”

Answer 21

1. Facilitates an awareness of the client’s internal organization of experience
2. Driven by an inquisitive mindset receptive to and interested in whatever emerges.
3. Without the kind of agenda (change, fix, get rid of) or investment in a specific outcome or attitude that renders a “right” and “wrong” outcome.
4. Reflected in prosody and body language and the phrasing of verbal skills

Question 22

4 Kinds of Experiments

Answer 22

1. The client follows or does something: follows a movement impulse, makes a gesture, turns the head or body, begins to collapse or lengthen the spine, 2. The client says a word, phrase or sentence: repeats a significant word or phrase, such as “No” or “It wasn’t my fault.” 3. The therapist does something physical: offers physical support, moves further away, reaches out, or sets a boundary. 4. The therapist says a word, phrase or sentence. This offers an alternative to cognitive distortions “It was not your fault.”

Question 23

3 steps of in-person boundary experiments + what to notice and 2 body adjustments to experiment with

Answer 23

1. Try it standing or sitting
2. Draw boundaries with arm
3. Client uses their arms to push the therapist or object out of the boundary

Notice: how far in do they let the intruder go before pushing back

Body Adjustments to experiment with: 1) spine lengthened or curved. 2) If standing, leaning in/grounding with the legs when meeting you to give them extra strength

Question 24

3 general principles to always follow to help clients sense into their body

Answer 24

1. Don’t make it a lot of work; track for what’s easy and/or pleasurable for them and start there.
2. Track carefully for when they do sense the body and give lots of positive reinforcement.
3. Use contact statements with the body, directed mindfulness questions with menus and comparisons.

Question 25

3 experiential interventions to help clients sense into their body

Answer 25

1. Ask them to remember a time when they felt good or were in touch with the body, explore that memory and deepen.
2. Find out what parts of the body they are most in touch with in the present moment and deepen.
3. Do simple experiments with self‐touch, movement or proximity with therapist to find out what feels right in their body

Question 26

4 verbal interventions to help clients sense their body

Answer 26

1. Psychoeducation
2. Ask for their cooperation to work together to sense the body.
3. Ask them what helps them be in touch with their body.
4. Ask them what makes it harder to be in touch with their body – can they think of circumstances that led to them being out of touch, any beliefs they currently have.

Question 27

How much info and what kind of info to share in psychoeducation

Answer 27

Share just enough info and the right kind of info in order to get the client interested in doing the sensorimotor interventions.

Question 28

3 examples of mindfulness directives to maintain current frame when a client wanders

Answer 28

1. “Just stay with that tension… “
2. “Just sense the sadness”
3. “Let the X be and return to ”

Question 29

What’s important to keep in mind when working with techniques that evoke dysregulating client material?

Answer 29

Do not evoke more than the client is able to integrate or gracefully work with in a given moment.

Question 30

What effects does emotional catharsis typically have?

Answer 30

It may discharge physiological dysregulation but it often repeats without resolution. Encouraging a client to express such patterned emotions can mean they are repeating experiences that take them out of their window of tolerance. This strengthens dissociation and reduces integrative capacity.

Question 31

In Sensorimotor Psychotherapy, does change occur from insight into thought patterns?

Answer 31

No, it occurs from studying and changing the organization of experience. This is why it is important to stay in mindfulness.

Question 32

5 Tasks of Transformation

Answer 32

1. Track for signs of transformation - can appear in any one or combo of core organizers, though often first shows up somatically. Look for something outside the habitual tendencies of the client/anticipate what may be a potential transformative experience.
2. Identify the transformation in a precise way through contact statements. Focus on it with mindfulness to help client deepen.
3. Ask what this transformation says about the client’s new sense of self - “what is all of this telling you about who you are?”
4. Acknowledge the grief which can come up as the client realizes all the years lived without the sense of the transformation that is now occurring. Grief is allowed to express but then client is encouraged to return to the positive feelings associated with transformation
5. Savor the positive aspects of the transformation

Question 33

5 mindfulness menu options for arm motion

Answer 33

1. push out
2. lift up
3. pull in
4. strike out
5. reach out

Question 34

3 mindfulness menu options for tension

Answer 34

1. tight
2. achy
3. kind of stuck

Question 35

7 mindfulness menu options for sensation

Answer 35

1. tingly
2. buzzy
3. trembly
4. numb
5. tense
6. relaxed
7. jittery