In the last decades, psychotherapy has benefited from the integration with neuroscience research, which enables an increasingly in-depth understanding of brain functioning under physiological and traumatic conditions through the development of new research techniques. The impact of traumatic experiences on brain functioning, theorised by various psychotherapeutic approaches and confirmed by clinical experiences at all levels, is now also supported by neurophysiological investigations.

We are finally facing a moment of increasing and deep integration between different approaches and perspectives in analysing human functioning.

Clinical psychology, neuroanatomy, and the study of behaviour emphasise the crucial incidence of early life experiences in structuring the brain and developing personality. Psychotherapy is called upon to find effective repair elements to the critical fractures that developmental trauma can cause in individual development.

The experts speaking at the Congress will describe in detail different trauma intervention methods, allowing the audience to learn about the most comprehensive and up-to-date approaches on today’s international scientific scene, within the broader framework of attachment as a lens to observe individual personality development.

Part 1: The essential ingredients and guidelines for all successful trauma Psychotherapy by Mary Jo Barrett

This presentation will explore the essential ingredients for successful treatment of complex developmental trauma across the Lifespan. No two treatment models are identical; yet there are clear variables that predict the success of treatment. After exploring 50 years of treatment and evaluating success, clients across the life span and throughout the world have told Mary Jo Barrett the same thing: healthy protective attachment with therapist and social engagement is paramount for change. This presentation will explore the universal interventions necessary to assure therapeutic success. It will also affirm and invigorate the clinical work of each participant.

Part 2: Revolutionizing trauma and addiction treatment with the Felt Sense™ Polyvagal Model by Jan Winhall 

The current idea that addiction is a disorder of the brain is failing patients. Therapists need a new approach that addresses the intersection in the body between trauma and addiction. The Polyvagal Model of Felt Sense™ (Felt Sense Polyvagal Model™ or FSPM) transforms the current pathological paradigm into a strengths-based approach. When viewed through the lens of Stephen Porges’ Polyvagal Theory, typical addictive behaviours can be seen as adaptive attempts by the body to regulate itself; such behaviours act as ‘drivers’ that facilitate neurophysiological changes within the nervous system.

This presentation is an introduction to Jan Winhall’s book “Treating Trauma and Addiction with the Felt Sense Polyvagal Model“(Treating trauma and addiction with the Polyvagal Model of the Felt Sense™). During this talk, Jan will describe the theoretical framework of the model she has devised through more than forty years of work with trauma survivors. The FSPM Model guides clinicians, helping them to use a new way of working with the two main embodied processes: interoception (felt sense) and neuroception (Polyvagal Theory). You will also discover the therapeutic approach of the Focusing/Felt Sense of Gendlin and learn how to help clients connect with their bodies.

This model offers a framework that can support any therapeutic modality used by clinicians. The application of the model will be demonstrated through an introduction to the Embodied Tool for Assessment and Treatment™ (Embodied Assessment and Treatment Tool™ or EATT). This tool allows for a somatic assessment of the client’s ability to regulate their autonomic nervous system and integrate embodied experiences. With repeated use, the EATT becomes an organised treatment plan that can be stored online as a medical record. This talk will include practical demonstrations of how to use this tool. You will learn about Carnes’ Three Circles Practice, a specific treatment method for working with addiction and see clinical examples of how this approach can be applied. This presentation will be a mix of didactic information, experiential practice and clinical case examples.

Part 3: The mirror cracked: Depersonalisation, trauma and social processing by Harry Farmer

Depersonalisation (DP) is an intriguing form of altered subjective experience in which people report feelings of unreality and detachment from their sense of Self and the wider world (sometime called derealisation). While this experience on unreality occurs to most people at some points in their lives, it can become a chronic condition in the form of Depersonalization/derealization Disorder (DPDR). There is a strong link between these experiences and trauma with many theories suggesting that DPDR is caused by the overactivation of an adaptive defence mechanism within the brain. One underexplored area of research on DP experiences is their relationship to social cognition and the perception of others. In this talk, Dr Farmer will first outline work linking DP experiences to childhood trauma before exploring how DP relates to social cognition, primarily through the lens of Self-Other mirroring. In doing so, he will draw on research from cognitive neuroscience and psychology relating representations of Self and others at the level of the bodily Self: from tactile mirroring and emotional mimicry to more abstracted and advanced forms of social interaction, such as emotional empathy and compassion. In doing so he will argue that, somewhat paradoxically, the disrupted sense of Self experienced by those with high levels of DP can lead to increased mirroring of others at the bodily level.

Part 4: Implicit Psychotherapy: Theory and clinical tools to access the biology of recovery by Abi Blakeslee

Physical, emotional, and social distress can arise from unresolved attachment and trauma. Yet recovery is not about thinking our way out of the past. This presentation will outline the biology of recovery from the unique perspective of working directly with non-consciously encoded memory, also known as implicit memory. Several branches of implicit memory are involved with the autonomic nervous system, the threat response cycle, and primitive states of regulation. Why can’t clients change the emotional and behavioral patterns they know are hurting themselves and others? In this lecture, participants will learn how interoception, or conscious awareness of bodily sensation, is used in therapy. Learning how to observe and change ongoing survival physiological states as well as learning how to guide clients to repair relational ruptures on an implicit level, can lead to long lasting and deep states of change. Participants will also learn exercises that can be used for themselves and their clients right away. Drawing on trauma informed approaches such as Implicit Psychotherapy, Somatic Experiencing, Relationship Repair, and Sensorimotor Psychotherapy, this presentation combines science, theory and practice with clarity. Working with implicit memory is a pathway to reinstate secure attachment, increase regulation and restore a person’s sense of essential self.

Part 5: Panel discussion 1 

Panel discussion with Abi Blakeslee, Harry Farmer, Jan Winhall and Mary Jo Barrett. In which they discuss their therapeutic approaches in relation to each other.

Part 6: Imagery rescripting and the use of the therapy relationship to provide corrective emotional experiences for traumatized patients by Remco Van der Wijngaart

Imagery rescripting is nowadays regarded as an evidence-based technique for treating different disorders, such as PTSD, social anxiety disorder, and personality disorders (Morina et al., 2017). The therapeutic goal is to generate corrective emotional experiences in aversive memories/images using mental imagery. However, it is not always easy to identify and target the core need in the image effectively. For example, an image of childhood abuse can be rescripted in many ways. Should the client strive for safety or for rebuttal in the image? When should they imagine themselves halting the antagonist, or is it better for the therapist to provide a corrective emotional experience by stepping into the mental image and change the outcome of the visualized events? This presentation will focus on the use of the therapy relationship when applying this technique; the therapist stepping into the image to serve as a role model when rescripting the visualized events. In doing so, therapists might be confronted with different challenges when doing imagery rescripting, e.g. the question whether it is better to wait till the most traumatic parts of the experience, or if it will be wiser to step in at an earlier stage? This presentation uses the model of basic emotional needs as a guiding compass for effective imagery rescripting. The presentation focuses on three components:

• Correctly identifying and targeting the basic emotional needs in the image;
• Identifying the right moment for rescripting; rescripting;
• Dealing with some of the most common challenges.

This presentation contains instruction, demonstration (role-play/video), and room for questions and comments.

Part 7: Walking the Tiger and Letting it Sleep: Training the brain to quiet fear in developmental trauma by Sebern Fisher

When a friend handed Sebern Fisher Peter Levine’s book, she misread the title and she imagined this beautiful wild creature walking peacefully in front of her on a leash. Since beginning to integrate neurofeedback into her treatment of trauma survivors in the late 90s, she has been looking for ways to quiet the beast of fear. In that same period, neuroscience research began to identify ‘fear structures’ and fear circuitry in the brain. (In 2013, NIMH suggested that fear circuitry might be a “common factor” in seemingly discreet mental illnesses.) Just as therapists were getting used to the amygdala as the fear generator, research is showing them that it is the periaqueductal gray (PAG), the reptilian threat detector in the brainstem, that instigates the fear reactivity. Therapists can help patients understand this, can provide them skills to manage this, can help them soothe this with their presence but they can’t quiet this pulse of fear that begins deep in the brain with talk therapy alone. What someone has learned and what they have failed to learn are held in the vast electrical network that is the human brain. Most people with these histories have learned terror, rage and shame and not learned to regulate affect. Sebern Fisher will review the frequency or functional failure modes that show up in the brains of people with histories of attachment disruption and abuse in early childhood and, using research findings, case vignettes and videos, show that, with computer generated feedback, the brain can learn to quiet fear and to let the tiger sleep.

Part 8: Treating ‘difficult dissociative patients’: Transference and countertransference by Suzette Boon 

Difficult or sometimes even ‘impossible’ dissociative patients may project feelings of guilt, rage, shame, humiliation, helplessness, and incompetency into therapists. Whatever you do doesn’t help or isn’t good enough and these patients seem to resist virtually any efforts toward progress. In the face of massive resistance, clinicians may retreat into destructive enmeshment, overinvolvement, wishing to ‘save this patient’ by engaging in different non-therapeutic actions. And if all their well-meant efforts fail, they may distance themselves, get enraged or even punish the patient. The actual prognosis of a ‘difficult or impossible’ patient depends to some degree on the fit between patient and therapist, and on the skills and experience of the therapist. Certain prognostic indicators that should be used to screen for appropriateness for outpatient psychotherapy and make a workable treatment plan. The ‘difficult or impossible’ patient typically has problems in several related areas: (1) chronic defenses against perceived relational threat (e.g., criticism, rejection, abandonment, or control); (2) chronic defenses against inner experience (e.g., affects, cognitions, physical sensations, wishes, needs); and (3) difficulties in self-regulation (4) dissociation as ultimate defense to avoid relational threat and inner experiences. Interventions are first directed to the therapist, who must learn to deal with intense countertransference feelings. It is sometimes very hard not to feel hurt or under attack by a ‘difficult’ patient. Therapists must learn to empathically understand the patient’s behavior, and act with reflection rather than with reaction. This reflective stance is a treatment strategy in itself for the patient, and paves the way for further interventions. Strategies for the therapist and patient will be discussed in this presentation.

Part 9: Re-Thinking Borderline Personality Disorder as a Traumatic Attachment Disorder by Janina Fisher

Thirty years of research has repeatedly shown a clear relationship between a history of childhood abuse and a later diagnosis of Borderline Personality Disorder. Rather than experiencing others as a haven of safety, traumatized individuals are driven by powerful wishes and fears of relationships. Their intense emotions and impulsive behavior make them vulnerable to being labeled ‘borderline’ and thus feared or dreaded by the therapists from whom they seek help. In this presentation, we will address understanding ‘borderline personality’ as a trauma-related disorder, reflecting the impact of traumatic attachment on the ability to tolerate emotion and relationships. The borderline client is not at war with the therapist. He or she is caught up into an internal battle: Do I trust or not trust? Do I live or do I die? Do I love or do I hate? Understanding these clients as fragmented and at war with themselves transforms the therapeutic relationship and the treatment. New approaches and interventions drawn from Sensorimotor Psychotherapy, Internal Family Systems, and Trauma-Informed Stabilization Treatment (TIST) can transform what it means to treat a ‘borderline’ client.

Part 10: Panel Discussion 2

Panel discussion between Janina Fisher, Remco Van der Wijngaart, Sebern Fisher, Suzette Boon about their different therapeutic approaches.

Part 11: Mindful Interbeing Mirror Therapy: Beyond the recovery from trauma by Alessandro Carmelita and Marina Cirio

In the last decades, psychotherapy has oriented towards treating trauma and its psychological consequences. Most of the attention is given to the influence of the attachment trauma on the development of personality and individual functioning. If the origin of the problems is to be researched at the beginnings of the individual’s relational life, it becomes crucial to find a way to intervene at that level, operating on the early brain parts, which work beyond words and the higher cognitive systems.

The Mindful Interbeing Mirror Therapy (MIMT) shows itself as an innovative therapy focused on restructuring the Self in a coherent and integrated way, through deeply reparative relational experiences in the therapeutic relation. It employs neurobiological co-regulation techniques between the therapist and the patient, consistent with the principles of the Polyvagal Theory, which support the record of the safety/danger axis in determining the development of personality starting from the earliest moments of life.

The unique setting of the MIMT allows, by using a mirror, to work on the procedural memory of the patient in a powerful and fast way, by restructuring the continued experiences of lack of attunement with the attachment figure, at the origin of the deepest and earliest evolutionary trauma.

Part 12: Lessons from Psychedelic-Assisted Psychotherapy: Healing Attachment Wounds and Treating Trauma by Ronald Siegel 

Research on psychedelic-assisted psychotherapy is advancing rapidly and is showing particular promise for trauma treatment. With proper preparation and support, individuals with troubled attachment histories and developmental trauma are often able to experience safety and love for the first time. What can clinicians learn from these investigations? How can the latter inform their therapy practice even if they are not participating in the research? This presentation will explore ways to help traumatized clients begin to integrate split-off traumatic memories, open their hearts, embrace vulnerability, surrender to the flow of ever-changing experience, and move from isolation to connection with people and nature—perhaps for the first time in their lives.

Part 13: From trauma to connection: The healing power of relationships by Terry Real 

The toxic culture of individualism and patriarchy rests on the delusions that human beings stand apart from nature and are in control of it. Whether the ‘nature’ they are trying to control is their partner, their kids, their bodies (“I must lose 10 pounds!”) or their own minds (“I must be less negative!”). The autonomic nervous system scans the body 4 times a second: “am I safe?”, “am I safe?”, “am I safe?”, “am I safe?”. If the answer is “yes, I feel safe”, individuals remain seated in the wise adult part of themselves, the prefrontal cortex. They remember the whole, the relationship. But when the answer is “no, I feel in danger”, they shift into subcortical parts of the brain, knee-jerk automatic responses in which they see the world as an “I win-you lose” power struggle.

The key issue is trauma. While individuals may be objectively safe, things in the present can trigger past wounds and their adaptations to those wounds. They automatically repeat their survival strategies, making a mess of their current relationships. All trauma is relational trauma and all healing is relational healing. People pick partners they imagine will deliver them from old wounds, yet they wind up with partners who send them directly back into those old wounds. The question is: “What do they do then?” Reaching for something new while triggered has the potential to heal relationships and heal trauma in the same beautiful moment. In heated moments, individuals lose the wisdom of themselves. Therapists need to equip their clients to cultivate the ongoing practice of relational mindfulness: shifting from the you-and-me consciousness into the centered adult parts of themselves. Remembering love, and that the person they are speaking to is someone they care about and is not the enemy. This is the critical first step, the first skill from which all other skills depend. Once clients are equipped to think ecologically and relationally, all of the terms change. For example, the relational answer to the question “who is right and who is wrong?” is “who cares?” The real question is: “how are you and I going to work on this as a team?”. During this presentation, Terry Real will explore how to help people deal with their own trauma effectively without inflicting it on their families.

Part 14: Panel discussion 

Panel discussion between experts Abi Blakeslee,  Marina Cirio, Mary Jo Barrett,  Ronald Siegel and Terry Real about their different therapeutic approaches.