Equine Facilitated Psychotherapy for Treatment of Complex Trauma

Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide 1
Laurie A. Benton, Psy.D.The Forensic Psychology Department at The Chicago School
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning
Slide 2
• Facilitate collaborative exchange
between equine facilitated and
trauma professionals
• Offer a theoretical foundation
and conceptual framework on which
to begin a peer-reviewed discussion
of equine facilitated change in
complex trauma
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide 3
• Overview of complex trauma
• Overview of therapeutic approaches to trauma
• Discuss benefits
• Offer a theoretical foundation and conceptual framework
of equine facilitated change in complex trauma
• Provide a brief review of research approach
Slide 4
“Children’s experiences of multiple traumatic events that
occur within the caregiving system” (Cook, et al., 2003, p.5).
Complex trauma has had several labels over time:
• Disorders of Extreme Distress, Not Otherwise Specified
• Complex PTSD
• Developmental Trauma Disorder
Cumulative Impact of Multiple Adverse Childhood Experiences
Emotional, Physical & Sexual Abuse
Neglect
Exposure to Violence
Witness to Domestic Violence
Incarceration of Parent
Parental Substance Abuse/Mental Illness
These experiences are chronic and begin in early childhood
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide 5
Current System
• Frequent misdiagnosis
• Unnecessary multiple diagnoses
• Never diagnosed
• Focusing on the behavior rather than the
underlying problems that are causing the
behavior
Complex Trauma
• Enhanced description of clinical
presentation
• Assists clinicians with effective
interventions
• Impairments of complex trauma go
beyond DSM-IV PTSD diagnostic
criterion
• Includes disruption in capacity for selfregulation and secure attachment
• Includes potential impact on individual’s
ability to self-regulate, self-organize, or
draw upon relationships to regain selfintegrity
• Focuses on new research & importance
of neurobiological differences of complex
trauma
Slide 6
1.Visual
2.Association/ST Memory/Equilibrium/Emotion
3. Motor Function
4. Muscles/speech
5.Auditory
6. Emotion/pain/hunger/fight & flight
7. Sensory Association
8. Olfafactory
9. Sensory/skin
10.Somatosensory
11. Language Comp
12.Motor Function/orientation
13.Higher Mental Function
14.Motor Function
The brain is organized in a
hierarchical fashion:
All information first enters the lower
brain
The “survivor brain”
Lower brain in charge of regulatory
functions
Upper brain more complex thinking,
planning
Upper and lower need to
communicate
Clinical Implication: A young child
growing up in a home and
community with pervasive threat
may create a set of associations,
quite outside of awareness, for
threat. Thus, many cues will trigger
the fight or flight response and alter
behavior, emotions, and physiology.
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide 7
1.Visual
2.Association/ST Memory/Equilibrium/Emotion
3. Motor Function
4. Muscles/speech
5.Auditory
6. Emotion/pain/hunger/fight & flight
7. Sensory Association
8. Olfafactory
9. Sensory/skin
10.Somatosensory
11. Language Comp
12.Motor Function/orientation
13.Higher Mental Function
14.Motor Function
The brain develops from the
bottom up and inside out
The brain grows during
development and becomes more
organized
The stress response system
originates in the lower parts of
the brain to help regulate and
organize higher parts of the
brain
Clinical Implication: If the lower
part of the brain is poorly
organized and regulated, upper
parts of the brain will be
dysregulated. Traumatic stress
will result in patterned,
repetitive stress response that
will negatively impact thinking
and emotions
Slide 8
The brain develops in a
sequential fashion
Success of one phase depends
on success of the previous
phase
1.Visual
2.Association/ST Memory/Equilibrium/Emotion
3. Motor Function
4. Muscles/speech
5.Auditory
6. Emotion/pain/hunger/fight & flight
7. Sensory Association
8. Olfafactory
9. Sensory/skin
10.Somatosensory
11. Language Comp
12.Motor Function/orientation
13.Higher Mental Function
14.Motor Function
Clinical Implication: If the lower
part of the brain is poorly
organized and regulated, upper
parts of the brain will be
dysregulated.Traumatic stress
will result in patterned,
repetitive stress response that
will negatively impact thinking
and emotions
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide 9
1.Visual
2.Association/ST Memory/Equilibrium/Emotion
3. Motor Function
4. Muscles/speech
5.Auditory
6. Emotion/pain/hunger/fight & flight
7. Sensory Association
8. Olfafactory
9. Sensory/skin
10.Somatosensory
11. Language Comp
12.Motor Function/orientation
13.Higher Mental Function
14.Motor Function
Neurons change in a use
dependent fashion
Typical development
requires attentive,
attuned, caregiving and
rich array of relational
opportunities
Clinical Implication: A
child exposed to neglect,
chaos, and constant fear
will have an increased
risk for significant
problems in all domains
of development
Slide
10
1.Visual
2.Association/ST Memory/Equilibrium/Emotion
3. Motor Function
4. Muscles/speech
5.Auditory
6. Emotion/pain/hunger/fight & flight
7. Sensory Association
8. Olfafactory
9. Sensory/skin
10.Somatosensory
11. Language Comp
12.Motor Function/orientation
13.Higher Mental Function
14.Motor Function
The brain develops most rapidly
in early life
Clinical Implication: Early
childhood trauma or
maltreatment has a
disproportionate capacity to
cause significant dysfunction
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide
11
Intrapersonal and Interpersonal Domains of
Impairment
Biology
Affect
Regulation
Dissociation
Cognition
Self Concept
Behavior
Control
•Sensorimotor
•Balance
Analgesia
Somatization
Coordination
Medical Issues
•Emotional Regulation
•Communicate Wishes & Needs
Label & Express Feelings
Anger turns into Aggression
Label & Describe Internal States
Sadness turns into Suicidality or
Self Injury
•Amnesia
•Attention Regulation
Depersonalization
De-Realization
2 or more States of Consciousness Impaired Memory of Events
•Executive Functions
•Understanding Responsibility
•Learning
Sustained Curiosity
Task Focus & Completion
Time & Space Orientation
Planning
Language
•Body Image
•Self Esteem
Guilt
Self-Efficacy
Shame
Unstable of Self
•Impulse Control
•Understanding & Complying with Rules
•Re-enactment of Trauma Behaviors (Sexual Abuse)
Self-Destructive Behavior
Excessive Compliance or Defiance
Aggression
Sleep Patterns
•Boundaries
•Relationships not used for Self-Soothing
Trust
Social Isolation
Emotional Regulation
Suspiciousness
Interpersonal Style
Perspective Taking
Attachment &
•Relationships not used for Self-Regulation
Relationships
Slide
12
• The brain can change, but some systems
are easier than others
The upper brain is quite open to change
The lower brain is not as easy to change
• Trauma related symptoms are related to
lower brain function. These areas less open
to change
• Traditional therapy does not target them
directly
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide
13
• Experiential
• Cognitive
• Novel
• Variable Contexts
• Sensory
• Variable Applications
• Emotional
• Social/Relational
Slide
14
•Explains how & why change occurs
•Predicts what change will occur
•Offers common ground for discussion
•Offers the rhyme and reason for innovative, goal-directed, evidence based
practice.
•Contributes to the development of standards for application, evaluation,
research and innovation.
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide
15
• Social animals
• Prey animals
Primal Symbiotic
Potential
Relationship
• Safety
• Influence
• Attunement
• Trust
•
•
•
•
Experience
Sequence
Pattern
Repetition
Intrapersonal skills
Interpersonal skills
Slide
16
Primal symbiotic potential of horses
& complex trauma survivors
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide
17
Horse-Survivor Relationship
Slide
18
Social Learning
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide
19
Theory of Equine Facilitated
Change in Complex Trauma
• Social animals
• Prey animals
Primal Symbiotic
Potential
Relationship
• Safety
• Influence
• Attunement
• Trust
•
•
•
•
Experience
Sequence
Pattern
Repetition
Intrapersonal skills
Interpersonal skills
Shared instincts of social prey animals disrupt automated
defense behaviors of complex trauma survivors and offer
powerful motivation for learning. The survivor-horse
relationship provides a developmental context for social
learning experiences that lead to changes in intrapersonal and
interpersonal skills.
Slide
20
How can you use this theory?
• Use it to improve your practice or use your practical
experience to improve this theory
• Use it to set goals, design new activities and develop new
programs
• Use it to measure the outcomes of your students/clients,
monitor progress, refine programming & build evidence of
success
• Use it to begin participation in a peer reviewed discussion and
contribute to the knowledge base
Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
Slide
21
In Conclusion
• Complex trauma alters neurobiology
• Altered neurobiology poses therapeutic obstacles
• As a therapy or adjunct, the horse-survivor relationship can
overcome therapeutic obstacles and enhance traditional trauma
therapy
• A published theoretical foundation and conceptual framework
fosters collaboration, enhances application, evaluation and
research. Discussion contributes to the knowledge base and
supports information exchange between disciplines
•The most useful theories are continually refined by those who
use them—Use it and help us refine it 
Slide
Questions or Comments?
22
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Equine Facilitated Psychotherapy for Treatment of Complex Trauma
2013 PATH Intl. Conference
Laura Benton, PsyD, The Chicago School of Professional Psychology, [email protected]
Elizabeth Freund, Healing Tales School of Equine Facilitated Learning, [email protected]
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