Lvl1 Mod 5

Question 1

What happens when trauma occurs for a person regarding their personality? (4 things)

Answer 1

1. The current undivided personality breaks into two parts
2. First part is the “going on with normal life” (Apparently normal part of the Personality)
3. The second is the “trauma bearing” part (Emotional Part of the Personality)
4. These parts are not sufficiently integrated however they share some overlapping functions

Question 2

4 Activities/Attributes of the ANP (trauma avoidant) personality part

Answer 2

1. Engaging in activities of daily life in an apparently normal way
2. Forget and detach from trauma related memories
3. Consciously and unconsciously avoid trauma related stimuli
4. Numbed to emotional and bodily experiences

Question 3

4 Activities/Attributes of the EP (trauma fixated) personality part

Answer 3

1. Encodes and stores the trauma
2. Relives the trauma in emotional and sensorimotor ways
3. Is disoriented in time, situation, and identity
4. Is fixed in mobilizing and/or immobilizing animal defenses

Question 4

What happens in Secondary and Tertiary Dissociation?

Answer 4

Secondary - The Emotional Part of the Personality becomes more compartmentalized: separate subparts evolve reflecting the different survival strategies needed in a dangerous world

Tertiary - ANP splits into more parts and potentially more EPs too

Question 5

What are 3 examples of sub-parts of the ANP that can emerge?

Answer 5

1. Caretaker ANP
2. Worker ANP
3. Social ANP

Question 6

3 different scopes of focus when providing interventions for dissociated parts and how do the goals change for each of the two more narrow scopes?

Answer 6

1. Focusing on the person as a whole system
2. Focusing on two or more parts. Goals change to focus on facilitating empathy, cooperation communication between parts.
3. Focusing on a single part. Goals change to focus on raising their integrative capacity and preparing them for exposure to other parts

Question 7

How can a client learn to identify individual parts? (2 points)

Answer 7

1. Through building an awareness of the specific core organizers that are indicators of individual parts through mindfulness and self-study.
2. Identify body organization and/or location in the body of different parts of the personality

Question 8

What 2 things can clients to do avoid getting taken over/becoming an EP?

Answer 8

1. Mindfully intervene through employing a resource that is helpful to the part
2. Remain in mindfulness and scope it down to less core organizers if necessary

Question 9

Window of tolerance model that includes EP and ANP (5 levels)

Answer 9

1. Hyperarousal - dissociation with partial or full intrusion of Eps
2. High Arousal - re-experiencing traumatic memories with noticeable EP activity
3. Within the window of tolerance of the ANP (aka client)
4. Low Arousal - emotional numbing, depression with noticeable EP activity
5. Hypoarousal - dissociation with partial or full intrusion of EPs

Question 10

Where in relation to the window of tolerance do we work to communicate with EPs and to integrate them?

Answer 10

Work on the upper edge of the window of tolerance of the ANP

Question 11

6 Ways that the presence of multiple parts adds complexity to the treatment

Answer 11

1. All dissociative parts must be included in treatment, whether they are accepted by the client or not;
2. Various dissociative parts may have quite different reactions to a given intervention, including somatic interventions
3. What is, in theory, helpful for one part may adversely affect the whole system of the individual
4. Transference will be complex, with each part having a different transference reaction to the therapist
5. Insights and changes in one part does not necessarily mean change will occur in another part
6. Treatment needs to consider the window of tolerance for all parts of the personality

Question 12

4 Ways to work with somatic resources for ANPs and EPs

Answer 12

1. Facilitate mindfulness reports about somatic resources from all parts
2. Encourage different parts to experiment with the same or different resources at the same time
3. Practice executing resources for both attachment and defense simultaneously as a way of working with disorganized attachment
4. Help ANP and EPs embody resourced states

Question 13

What is dual awareness and two reasons it is important?

Answer 13

It is being aware and processing an event in the same state in which it was originally experienced while also being aware of what is happening in the present moment

1. At the time of trauma mindfulness was impossible because of altered brain functioning and we became unable to integrate the experience. Dual awareness allows us to integrate.
2. It helps all our parts experience the truth that we are here now and we survived.

Question 14

6 parts of the “step by step” method of working with traumatic memory narratives?

Answer 14

1. Start at the beginning of the memory and not the core
2. Track and contact
3. Discover peri-traumatic resources
4. Pause moving forward in the narrative when somatic reactions occur, though you can encourage the client to revisit the current moment in the narrative if needed to stay at the optimal spot in their window of tolerance
5. Use SMS or voluntary motions to regulate the client and/or discover/complete orienting/defensive responses
6. Resume narrative and repeat 2- until reaching the end of narrative

Question 15

Should there be a successive repetition of somatic/emotional sessions one after the other?

Answer 15

No, need to balance somatic/emotional sessions with cognitive integration sessions

Question 16

2 ways to encourage a client to properly sequence an impulse

Answer 16

1. Remind them to refrain from voluntary motor movement and to instead mindfully and slowly follow a specific impulse in their body, allowing it to unfold from one moment to the next
2. Remind them that although it may be unpredictable and feel out of control, they can stop anytime

Question 17

What do we sequence vs do not sequence?

Answer 17

Sequence: core organizers possibly indicating hyperarousal, mobilizing defensive responses, orienting responses, “hot” impulses like prickly/tightness
Do not sequence (drop these): core organizers possibly indicating dread, shame, hurt, disappointment, sadness, “Cold” responses like cold, numb

Question 18

4 situations where SMS is appropriate

Answer 18

1. When spontaneous shaking or movement emerges.
2. When you are working with a traumatic memory narrative and encounter a moment when active orienting/defensive responses are present.
3. When arousal exceeds the window of tolerance
4. When the client is “looping” cognitively, somatically, or emotionally

Question 19

What are the 3.2 phases of SMS?

Answer 19

Phase 1: The beginning of sensation or micromovement
Phase 2: Mindful study and allowing of sensation and/or involuntary movement as it unfolds
Phase 3.1: Therapist tracking for the sensation or movement settling, softening, or quieting
Phase 3.2: Encouraging the client to stay with this completion to avoid re‐igniting.

Question 20

2 things to do if the client loses their attunement to the body or becomes heady

Answer 20

1. Encourage them to return to sensations in the body
2. Encourage them to return to the memory

Question 21

What is the goal of contact statements/MFQ/MFD when doing sequencing and what are 4 examples of what to say to clients?

Answer 21

The goal is to facilitate movement of sensations through time while studying what happens next.

1. “Stay with that sensation ‐ what happens next in your body?”
2. “Follow the sensation ‐ where does it go, how does it change?”
3. “As you let yourself be with the sensation, what happens next?”
4. “Stay with that, and notice what happens next”

Question 22

What is the function of expanding time and what are the 2 reasons it is important during working with traumatic memory?

Answer 22

Expanding time allows the state‐specific reactions to come to rest

1. It is important to re-establish the continuity of experience
2. It is important to allow time for processing and sequencing all the reactions, which during the original trauma time did not happen

Question 23

10 examples of statements that encourage a client to allow involuntary somatic responses

Answer 23

1. “That’s it…. just allow that trembling to happen.”
2. “As much as you’re comfortable, just allow your legs to vibrate; what happens?”
3. “Just allow that gentle movement in your neck.”
4. “Without making it larger or smaller, just allow that movement and describe what happens.”
5. “Stay with that movement—notice how it wants to happen all by itself.”
6. “Don’t try to make it any bigger or smaller than it is”
7. “Just follow the impulse.”
8. “Just let it happen.”
9. “Trust your body‐‐your body knows what to do.”
10. “As long as you are comfortable, just let that movement happen.

Question 24

Why is savoring sensations important for the traumatized client?

Answer 24

For the traumatized person, body sensation is often experienced as painful and out of control. Encouraging the enjoyment of neutral and pleasurable body sensations helps to re‐establish the body as a source of pleasure.

Question 25

How can the frequency of non-verbal/verbal contact statements be altered to help keep the client mindful and within the window?

Answer 25

Frequency can be increased

Question 26

Where to locate the sliver of memory that is most likely to ignite defensive and orienting responses (2 parts)?

Answer 26

1. Generally prior to the point of impact or overwhelm 2. At a moment when active defenses were initiated and still available

Question 27

Cognitive indicators of orienting and defensive impulses

Answer 27

Thoughts related to taking an immediate physical action

Question 28

Emotional indicators of orienting and defensive impulses

Answer 28

Emotions related to a defense (anxiety, anger)

Question 29

Five sense perception indicators of orienting and defensive impulses

Answer 29

When the client mentions images, tastes, smells, sounds related to the source of the trauma

Question 30

When tracking a micromovement what other thing is important to find?

Answer 30

A gross movement that wants to occur

Question 31

How to find movement-based indicators of orienting and defensive responses in case the client doesn't report anything

Answer 31

Track for and ask about tightening or preparatory movements. Especially in arms, legs, jaw, and neck.

Question 32

Where can defensive responses be found in the body?

Answer 32

The periphery (arms and legs)

Question 33

Where can orienting and arousal responses be found in the body?

Answer 33

The core or whole body

Question 34

What is stitching and how is it helpful

Answer 34

Stitching is relating one core organizer to another, typically to encourage a client to connect it to a somatic experience. It helps to facilitate sequencing.

Question 35

5 things to do when a movement does not complete

Answer 35

1. Name the lack of completion and invite more mindfulness 2. Ask client to study signs that might indicate how the movement might want to complete and then visualize the movement’s unfolding 3. Check which stage the active defenses are stuck in 4. Actively resource the client have them decrease the intensity of the motion 5. Rewind the tape to the state‐specific moment when defensive movements seem to be ignited

Question 36

3 Stages of Movement

Answer 36

1. Preparatory stage 2. Processing stage 3. Completion stage

Question 37

What happens when the action is guided by the mind instead of the body? What emotional/sensations are indicators that the completed action came from the body and not the mind?

Answer 37

If the action is guided by the mind, it will not complete somatically. When the action comes from the body, not the mind, executing and completing the “Act of Triumph” is sure to elicit pleasure and a bodily feeling of satisfaction.

Question 38

4 collaborative agreements prior to working with a trauma memory

Answer 38

1. Agree to notice somatic reactions and reactions of parts as you work with the memory. 2. Agree to stop when reactions are evoked and process them somatically. 3. Agree to stay within the window of tolerance, and if/when the client goes out of the window, agree to use somatic resources learned in phase 1 until back within the window. 4. Agree to work with the memory step-by-step.

Question 39

What is squeezing the frame and why is it important?

Answer 39

It's the process of adjusting the activation level through various techniques. It's important because arousal needs to be low enough so that the person does not feel overwhelmed, yet high enough so that the mobilizing defenses are activated.

Question 40

7 habits that should be discouraged because they prevent involuntary movement

Answer 40

1. Fidgeting 2. Crossing/uncrossing legs 3. Gestures 4. Squirming 5. Shifting positions 6. Turning head 7. Scratching

Question 41

How to complete attachment responses using the body

Answer 41

Interactive resourcing such as reaching, grabbing or pulling

Question 42

How to work with a freeze response using the body?

Answer 42

Find movement by experimenting

Question 43

How to work with a submit response using the body?

Answer 43

Initiate voluntary act or have the client push