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Presenters: Ron J. Llewelyn Psy.D. Jana C. Fulmer, MSCJ

The Treatment of Complex Posttraumatic States: From Evidenced Based Treatments to Object Relations . Presenters: Ron J. Llewelyn Psy.D. Jana C. Fulmer, MSCJ. University of Phoenix, Utah Campus American Counselors Association 2011. The Best Treatment…. Objectives.

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Presenters: Ron J. Llewelyn Psy.D. Jana C. Fulmer, MSCJ

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  1. The Treatment of Complex Posttraumatic States: From Evidenced Based Treatments to Object Relations Presenters: Ron J. Llewelyn Psy.D. Jana C. Fulmer, MSCJ University of Phoenix, Utah Campus American Counselors Association 2011

  2. The Best Treatment…

  3. Objectives

  4. The Diagnosis: Expanding Upon the Construct

  5. Terminology

  6. Dimensional Perspectives Healthy Borderline

  7. Good Reality Testing Poor Good Boundaries Poor Dimensional Perspectives of Trauma Type 2 PTSD:Internalizing/Externalizing/with significant dissociation Type 2 PTSD: With ego-syntonic features Type 1 PTSD: Found in the DSM-IV-TR Peritraumatic stress & Current traumatic stress Trauma related stress

  8. Diagnostic Comparison Type 1 - PTSD Type 2 – Complex PTSD

  9. Am I Mad?

  10. Self Perception…

  11. PTSD vs. Borderline

  12. PTSD & BPDSachsse, Vogal, & Leichsenring 2006

  13. PTSD Vs. BPD

  14. A Definition of Self

  15. A Disorder?

  16. Defensive Functioning Good Reality Contact Rigid Boundaries Borderline Permeable Boundaries Poor Reality Contact

  17. Treatment

  18. Three Treatment Modalities

  19. Three Stages

  20. Three Stages in a Social Context Intrapsychic & Therapeutic Interaction Micro Therapeutic Dynamics Macro Level Dynamics

  21. Cautions

  22. Stage one: Stabilization Primarily a personal experience Primarily a social experience

  23. Stage One:Education, Physical Well Being & Self-soothing

  24. I Feel Crazy

  25. Stage One: Psychoeducation

  26. The Neurobiology of the Fight or Flight Response This occurs before information reaches the Cortex Stressful Event Cortex Thalamus Amygdala Locus Coeruleus Hypothalamus Sympathetic NS Thyroid Pituitary Adrenal Medulla Thyroxin Adrenaline Adrenal Cortex Cortisol Noradrenalin Adapted from Preston, O’Neal, & Talaga 2010

  27. Neuro-anatomical Factors Broca’s Area Right Hemisphere

  28. Genetic Expression

  29. What Can We Do To Change This? Recondition to a pre-trauma homeostatic state

  30. Stage One: Physical Well Being

  31. Stage One:Self Soothing

  32. Stage One: Self Soothing

  33. Beyond the Pre-Frontal Cortex:Sensory Motor Trauma Therapy Nerve Stimulation

  34. Stage One:Safety, Trust & Boundaries

  35. Stage One:Psychosocial Redevelopment(Herman, 1992)

  36. Hope Oral Trust vs. Mistrust Willpower Autonomy vs. Shame & Doubt Anal Purpose Genital Initiative vs. Guilt Competence Industry vs. Inferiority Latency Fidelity Identity vs. Role Confusion Phallic Love Intimacy vs. Isolation Generativity vs. Stagnation Care Integrity vs. Despair Wisdom

  37. The Impact of Attachment

  38. Attachment(Bartholomew, 1990; Muller & Rosenkranz, 2009)

  39. Attachment & Transference:Ask Yourself

  40. Attachment & Transference:Ask Yourself:

  41. Attachment & Transference:Ask Yourself:

  42. Stage One:Safety

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