Trauma Treatment – Medical vs. Behavioral
We discuss both similarities and differences between medical and clinical trauma approaches within addiction treatment.
What happened when both medical and behavioral treatment joined and the patterns that started to emerge.
The relationship between the physiological and the psychological effects of trauma
The direction of medical to clinical
Why building resilience in early recovery is so important
In stabilization and in this early recovery process we have to take the time to empower, encourage, and guide them to build resilience so they can do that deeper work. Or we relegate them to simply giving up. How many people go to the gym in January and do this big workout and are so sore that they never go back. That’s exactly the risk we run by going too quickly before clients build enough resilience to tolerate that deeper work, that is why we don’t do it at the beginning.
so we had what i think is a new and insightful conversation last episode about trauma in particular trauma-informed care and i think allen brings a new perspective uh in that regard that i think is worth engaging the audience in and a little bit after the episode yesterday we kept going forward with trauma-informed language and so forth and there were a couple of topics that we touched upon that i thought would be important just to continue to discuss with you all as well moving forward so uh in that regard one of the things that was brought up was sort of this collision course in time that you’ve experienced and been witness to about you know sort of clinical and medical interventions taking place you know in my minimal reading of addiction treatment in its history one of those collisions was the bringing in of insurance benefit plans that started dictating care in the early 70s in that regard and i think that’s where we can probably maybe start as to where we see these clinical and medical interventions sort of colliding in that way and so i guess the question is uh what did that look like for you and what have you seen in time alan that this collision course has been on a path of and then in relationship to trauma specifically through that lens how did that take place in your eyes wow that’s a big question yeah so compacted great uh well what comes up for me as you’re talking is what i said toward the end of our last conversation that i think that when medical and behavioral joined they had not a lot of language in common except trauma and so that became the basis for the collaboration that we built we’ve built an entire system based on this notion of trauma being the common element between medical and clinical and and that’s a great idea except
except that physical trauma is actually a physical stress to the body and that seems pretty clear i mean you hurt yourself you’re trying that’s a trauma in the medical world emotional trauma is a stress that happens emotionally but also requires perception physical trauma doesn’t require perception it’s simply your body reacts to it and it’s a physical response emotional trauma requires perception a person has to perceive that they were traumatized and i think that that’s that’s gotten us off into the weeds a little bit absolutely that we’ve made some assumptions that trauma is trauma and all trauma isn’t the same there’s a pretty specific difference and we’ve also started to really look at ways that trauma is physical right i think we’ve really we’ve created a trajectory of trauma and trauma therapy even within the behavioral health world that treats emotional trauma as a physical trauma and not to say that trauma doesn’t present itself in the body or present physiologically however we again it’s just sort of reinforcing what you’re saying that we’ve really looked at trauma as a sort of physical thing and we’ve really continued to lean into that even today but the physical trauma usually resolves itself right usually resolves itself the emotional trauma that requires perception often then gets encapsulated and that’s why i said that that in the last episode that i really prefer to work with guilt and shame because i believe that the moment what encapsulates emotional trauma past the physical aspect of it the physical trauma gets resolved the emotional piece you know we talk in terms of big t little t trauma trauma then gets encapsulated in well what i’ll call history but what history gives it is guilt and shame that the moment that an emotional trauma is perceived as trauma what happens the very next theme is that it gets encapsulated in judgment and shame so so it sounds like i guess i’m just not entirely uh this is all great and it’s important i feel the direction i feel the energy of brewing here about it but there seems to be that subjective emotional feature tied to it and then so because we’re talking about the collision of of medical and clinical so what what is that bridge as far as that collision goes that we’re sort of concerned about here now was there an over step maybe on the medical side to call that something physical um a sort of brain state that has taken form in that regard or how should how can we you know think about it in terms of that actual collision taking place like what’s the problem here
that’s a good question i’m not sure what the thinking was what the outcome has been is that the medical community views emotional trauma as you said still as a physical ailment and treats it as such we apply medication to it we we absolutely and i think into a certain degree clinically we do as well we treat it as a sort of like terminal trauma to the body but we it’s a terminal trauma to like the emotional mind right that’s what i think clinically how we approach it as well it looks um they i think that you know it goes back to like you were saying this building for behavioral health and insurance i think that we had to look for you know the the behavioral health model or the wellness model is really does not overlap well necessarily with the medical model you are looking at a tension between subjective and objective and medical does not do subjective extremely well and and the behavioral health world doesn’t do objective very well you know so trying to find that common ground and it really it was up to behavioral health to adopt the medical language in order to be able to sort of justify services and payment and again i think that that continues to um and this is you know i’m a huge proponent of the interdisciplinary medical model in conjunction with behavioral health model however what what happens is you start like alan was trying to was saying is that the medical model starts to inform or at least or almost dictate the trajectory of the behavioral health approaches and the behavioral health intervention strategies so as an unlicensed registered psychotherapist it’s a mouthful and means nearly nothing here in colorado other than a 300 fee every year in that regard i’m aware minimally of somatic experience and it seems like within that therapeutic intervention the trauma modality that it is correct me if i’m wrong here i think it’s stating something right that emotional space that traumatic event that we’re calling encapsulated in time here is then sort of pushed into the body it seems like we’re really trying to draw a hard physiological approach that it’s in us maybe even all over us in that regard and so one is my reading of somatic experience correct and two is that seems to be the connecting piece between like the clinical and medical bridge that there is some physical thing that is actually taking place absolutely i mean i think it’s a perfect example of the way in which those two and i don’t know that it’s actually uh that’s i have um my knowledge and experience with somatic experience i’m not a somatic experienced therapist so i i have limited understanding as well even as a clinician but and i think that there is some uh there is some obviously like evidence-based uh work behind it that shows that there is efficacy to that level of treatment but i think it’s a perfect example of the way in which the medical model has really started to inform particularly the world of trauma and really and almost i don’t want to say hijacked but certainly over-informed the actual approaches and treatment that would be sort of my personal perspective of it i think alan could probably speak to sc a little bit better than i can so well i do want to draw the correlation between se and emdr for example that emdr is designed to create bilateral stimulation it’s to design to create if we were it’s not exactly electricity but it’s kind of like electricity that flows between the hemispheres the purpose of that for emdr is to begin to it’s too big a word but dislodge the relationship thoughts and feelings that are stuck in that part of the brain so that they can be looked at discreetly se does the very same thing in the body it wants to move energy where energy has gotten congealed from the sense of i was hurt there so as he does work with physical trauma it actually bridges that gap pretty nicely because it wants to put energy into and move energy into those places where a person either a person’s mind or their body has has felt traumatized has stored trauma in it and so like that electrical impulse we’ll just call it energy if we want to be spiritual and woo wants to move that energy in the very same way the emdr wants to move that energy bilaterally right but it doesn’t actually do anything to change the narrative though right like you’re saying that we are not addressing perception which is that missing piece no it actually just gives us access to the information that’s its point it is not designed by itself sometimes having access heals but it is actually just to open a door it’s just to open a door to those rooms so it seems like then because we’re moving in the language of correlation and now introducing cause-and-effect causal relationships here where there’s certainly a correlative feature of trauma in which the energy is displaced in the body the mind or somewhere within this thing called the human body in that regard and then we trigger that it opens up the door so it feels like there’s a cause and effect relationship between those therapeutic interventions for trauma that give us access to that so there’s a cause and effect there but the correlative nature of why i or the cause and effect nature of why i use drugs and alcohol to sort of quell those things what does that look like you know in this regard i think we’re i don’t think i best stated that question but i think we’re inching towards where we want to go here about these cause-and-effect relationships when somebody says i use because i have trauma you know um well now we’ve opened up that door it’s it’s still encapsulated maybe it’s open it’s not encapsulated anymore but it’s gonna still be stuck in time right so i think a more gabor mate says it best we don’t we don’t use because we have trauma we don’t use for any of those reasons we use because we’re suffering absolutely that we don’t feel good we fee and suffering is a big word absolutely so we use because we’re suffering i think you make an interesting made an interesting point though that there is a it’s still just a correlation right like the experience of pain and uh the idea of suffering it’s not the reason specifically why people use but there is a core to live correlative relationship between the reason between suffering and the reason why people use i actually i would disagree a little bit with mates just because that sounds like cause and effect right i’m suffering i use yeah so okay so i think i think i think this is wonderful you know for the viewers and thinking about the cause and effect the correlative features the dive deep so we have what sounds like to me two different instances of an individual coming into treatment the first individual comes in and says i’m very aware and have access to what my trauma experiences are and we have another individual who comes in who goes i know i’m traumatized and maybe they disassociated from a violent event or something that took place in their life or something along those lines that sort of has it as a distance where it feels meaningful then to pull out of the tool kit emdr scp as experiences as therapeutic interventions and deliver though in this way and then there’s this individual where it seems like maybe the balance in that isn’t really required to approach with emdr and scp in that regard so but for both instances whether you do the deep dive pull the trauma out get those doors accessible and whether they’re already accessible it sounds like we’ve done at that point the medical thing and insert now clinical behavioral health care right now we’re working on that shame and guilt is that an accurate display of the balance there that’s taking place yeah it sounds like pretty accurate yeah and i think that um i i think the one thing i would add to that or just the one caveat is that regardless of if those doors are open or those doors are closed you can actually still work on trauma which is i think at what allen’s saying through the the lens of guilt and shame like i think in fact using guilt and shame it can be a good access point you don’t always have to go the emdr s e route the deep dive isn’t always necessary sometimes bringing a light and sort of loosening up the the sort of um the binds of shame and of shame and guilt will actually start to help access those uh those doors or open those doors sort of organically got you so it’s not just directional right we can go the other way absolutely it also reminds me why we’ve gotten a little off track between medical and and behavioral in some ways because there’s not a stigma to having physical trauma right unless it’s profound in other words you can be stigmatized by having a tbi you can be stigmatized by some kind of physical trauma but for the most part our society does not stigmatize physical trauma but we have managed to stigmatize emotional trauma profoundly so it becomes really intransigent to treatment in some ways people want to avoid it or want to have very selective access to that in a way that you go into an emergency room and anybody can look at your physical trauma that’s well depending on where it is but anybody can do that sorry yeah that’s all right yeah yeah they have curtains but i think that’s one of the one of the ways that by globalizing our approach to trauma we’re doing somewhat of a disservice right because we forget that emotional trauma is held really differently and now our society holds it really differently right and it’s become a more i don’t know it’s uh we’ve complicated it to a certain degree i think because of that yeah there’s an extreme complication because of that and i think that’s why we’re discussing this with the viewers and why you know seemingly like these concepts of trauma and boundaries are just so influential and why i keep talking about it on behalf of the viewers you know that are out there because it is complex and it’s greatly oversimplified and i think rightfully so by you know patients who inform families i’m relapsing because of this trauma stuff that’s undealt with you know at the end of the day but it seems like in that regard that the cause and effect there’s no cause and effect relationship that ties the use together and that what we want to say differently is i continue to experience shame and guilt from your behaviors for the experiences around the trauma and i’ve told myself a really big story you know that’s not true at the end of the day and that piece seems the cause and effect relationship when that is nurtured or more closely to the cause and effect relationship when we start nurturing that shame story and those guild strategies it seems to reduce the propensity or the intensity toward use absolutely is that accurate yeah i think that’s true absolutely so um so i i’m hearing the balance in all of this um so you know again too to stabilization models and approaches it seems like for somebody who has um not significant distress tolerance in early recovery journeys the deep dive can be quite dislodging and disruptive for that individual and so in a place like peaks is a stabilization model we’re not going to go necessarily right at that right we’re going to support those stories and it’s through that shame and guilt approach that we’re creating like you said the clinical to medical side of things right as a bi-directional aspect here of opening up those doors through that narrative and allowing the individual to see not only how big the story is but the actual impact that trauma as that door opens had on that story in that narrative absolutely
so a little bit as a as a prompt as we kind of head out here again let’s just remind the viewers i do have stuff to say about this actually yeah yeah well if you have more to say about it let’s do it well i just as i was listening to you i was i go back to this notion of resilience because the truth of what you’re saying is that a client who comes into early stabilization has no resilience absolutely the substance they’ve been using would have compromised any resilience they previously had or replaced resilience yeah absolutely yeah well it certainly replaced it but not in an authentic strength building sort of way it’s like putting a cast on your arm and expecting your arm to get stronger while it’s in a cap absolutely as it atrophies yeah as it atrophies underneath so that’s what happens to our resilience when we use it replaces it but it doesn’t actually strengthen us at all it does the opposite so in early recovery our and in stabilization and this early process we have to take the time to to empower clients and encourage them and guide them to build resilience so they can do that deeper work or we relegate them to simply giving up how many people go to the gym in january and do this big workout and are so sore that they don’t go the rest of the year that’s exactly the risk we run by going too quickly before clients build enough resilience to tolerate that deeper work that’s why we don’t do it at the beginning what it doesn’t feel is i think that there is a perceptual thing from a clinical side that doesn’t feel as big right it doesn’t feel as powerful it doesn’t feel as heavy and deep and as emotional but the reality is that you have to build up to these things regardless you know as you’re working on you know like re-strengthening that arm after it’s been in a cast and working towards rebuilding those muscles and these small exercises that are helping to to sort of uh rebuild tissue and and connectivity and build muscle and you are still working on trauma you know you just don’t you don’t have to be in the emotional trenches in order to do that in fact sometimes that’s the worst place to be especially when you have no resilience which is again what at that early stabilization time model or that early stabilization period of treatment where people are so absolutely and so what comes up for me here is certain things we’re running out of times we don’t want to bore the kids on the social media and so forth they’re watching us uh in that regard but uh you know in in my time over the past five weeks or so i’ve been supporting our admissions team working admissions in this regard and it seems you know clear to me that as well too that when an individual is stating something like well they didn’t work on my trauma and their last treatment episode was six months ago and they’ve been using ever since then in that regard and now looking for care it seems like we’re sort of restarting the clock is that necessarily true uh in that regard can they have we moved again away and allowed for atrophy to take place as that cast metaphor goes by that six months of use in between making it still less accessible in the way that they’re well if i go back to the physical exercise piece the truth is that if you have exercised and gained strength even if you stop exercising those muscles remember and get stronger faster so i think that’s the same truth here that if somebody has made progress if they’ve gotten some recovery under their belt and or they’ve just gotten insight from earlier treatment even though they go back and use they still remember those things and can regain that ground faster than if they didn’t do it the first time right still however you have to go back and start you to a certain degree you start from the beginning even though like alan said you will the the sort of uh trajectory or recovery or uh repair is much more as is much quicker right because there is a level of resilience there that’s already been established there but you still start with the same weight absolutely yeah you still have to and it’s gonna feel different especially if you’ve been into it if you’ve been to a facility or a treatment center where they’re just where the deep dive is the process right it’s going to feel different in a stabilization model where it’s like where we’re much more about creating that resilience and building those containment strategies and those coping strategies and starting to rebuild the muscle basically from the ground up because the muscle that you’ve gained while you’re in um while you’re in those deep dive models are is really uh can actually kind of surround those smaller more nuanced muscles that you need for the the fine movement the sort of uh those fine point um maneuvers that you need emotionally to actually be able to sort of rewrite your story and and really um and really get rid of those old narratives that don’t work anymore absolutely well for the sake of time i mean this is fulfilled this has nurtured me in a big way and i hope it’s nurtured the viewers on the other side um but a lot of questions still arise for me and i’m hopeful that as we continue to bring this information forward it’s drawing a picture that is quite complex this this thing called addiction and mental health and trauma and all the variables of it is a complex picture that’s really difficult to navigate especially within you know limited limited treatment episodes so certainly want to call in our past videos about direction of care how important it is post stabilization models to influence care beyond the walls of a treatment program such as ours or continue with iop and so forth and i feel passionate about continuing to bring on you know guests such as alan in the future as well that can continue to help promote the complexity as well as bring forward solutions because there is hope in all of this no doubt certainly we witness recovery all the time post-programming at peak so in finalizing this um finding peaks at peaksrecovery.com send us your questions concerns thoughts ideas we would love to engage with you at a much larger level about what’s coming up for you throughout these videos or maybe bits of information you’ve missed in the past find us on the facebook the the gram spotify um check us out in the podcast and so forth and um until next time i think jason freeze and chris burns are up next um as host in that regard and i personally will see you in a few weeks and until next time take care