On Tuesday 4th December 2018 Naomi Halpern’s workshop “Working with Complex Trauma: The Snow White Model” was delivered at the Royal Brisbane and Women’s Hospital. I was amongst the small group of mental health nurses and social workers who joined the workshop via videoconference from Cairns Hospital. Here are my notes/tweets:
1.
Hi ho, Hi ho, It’s off to work I go… to videoconference into the @halpernnaomi1 workshop, “Working with Complex Trauma: The Snow White Model” https://t.co/YNwoZRaZv1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 3, 2018
2.
Childhood onset of complex trauma often occurs when the people who were meant to be protective turn out to be harmful to the child = insecure, disorganised attachment @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 3, 2018
3.
Ed Tronick’s still face experiment referred to by @halpernnaomi1 #ComplexTrauma (it’s pretty distressing to watch the baby freak out when Mum stops reacting) https://t.co/ytVR18XZs9
— Paul McNamara (@meta4RN) December 3, 2018
4.
#bePNDaware even REALLY young babies engage in social interaction; see The Still Face Experiment http://t.co/26YCdmHH
— Paul McNamara (@meta4RN) February 8, 2013
5.
Caregiver behaviour and the influence of child attachment styles @halpernnaomi1 #ComplexTrauma pic.twitter.com/mURiLrf96l
— Paul McNamara (@meta4RN) December 3, 2018
6.
“What we know about mental health professionals is that we’re not immune to childhood trauma… we need to be aware of our own attachment style and how that influences our work” @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 3, 2018
7.
“A diagram like this is really helpful for our clients so they can understand why they respond they way they do. Psycheducation is an important part of our work.” @halpernnaomi1 #ComplexTrauma pic.twitter.com/oebNMTU2Ol
— Paul McNamara (@meta4RN) December 3, 2018
8.
Psychoeducational Flip Chart recommended by @halpernnaomi1 “you’ll find yourself using it again and again” https://t.co/tIrdX7Jr6q #ComplexTrauma
— Paul McNamara (@meta4RN) December 3, 2018
9.
“Our responses are hardwired: fight, flight, freeze and submit (tend and befriend).” Aims of psychoeducation are understanding and to address/overcome shame. @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 3, 2018
10.
Here’s a pearl from @halpernnaomi1: co-write the notes at the end of the session, eg: “What do you think the most important part of today’s session?” Copy it down verbatim, address any misunderstandings on the spot. #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
11.
What’s Snow White got to do with #ComplexTrauma? For starters:
– mother dies at birth
– father grieving, is emotionally absent
– remarries: the step-mother has a few problems
– narcissist step-mother mistreats + attempts to kill Snow White
– father isn’t protective@halpernnaomi1 pic.twitter.com/1WMM3f5FiX— Paul McNamara (@meta4RN) December 4, 2018
12.
New (to me): maladaptive daydreaming = prolonged, induced daydreaming which interrupts/prevents IRL relationships. Often (not always) includes disassociation @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
13.
Snow White’s trauma symptoms include fantasy, psychosis, self-blame, crime, shacking-up with seven male strangers and over-riding her intuitive danger responses @halpernnaomi1 #ComplexTrauma pic.twitter.com/hAwr9KHaoA
— Paul McNamara (@meta4RN) December 4, 2018
14.
Another @halpernnaomi1 #ComplexTrauma pearl: We all have parts of self, and working with parts can be very helpful. eg: “That’s what the scared part of you feels Are there other parts of you that aren’t so scared? Parts of you that can think about things differently?”
— Paul McNamara (@meta4RN) December 4, 2018
15.
This section of the @halpernnaomi1 #ComplexTrauma workshop explores the different parts of Snow White: Doc, Grumpy, Happy, Sneezy, Bashful, Dopey, Sleepy, Dead Snow White, Prince Charming, Step-Mother, Huntsman, Father.
Terrific, interesting concept/frame. Too detailed to Tweet.— Paul McNamara (@meta4RN) December 4, 2018
16.
Impulse control is more difficult for people a history of #ComplexTrauma. Behaviours like drinking too much, starving yourself and self-harm serve to soothe and distract. @halpernnaomi1
— Paul McNamara (@meta4RN) December 4, 2018
17.
This distressing short video shown during the @halpernnaomi1 #ComplexTrauma workshop explains Resignation Syndrome “she’s like dead Snow White” https://t.co/56W3giMZ2N
— Paul McNamara (@meta4RN) December 4, 2018
18.
An elaboration:
People who experience #ComplexTrauma develop survival skills that work quickly in times of distress. They need to. @halpernnaomi1
Therapy is slow. That’s why substance abuse, eating disorders and self-harm behaviours persist/co-exist with therapy. https://t.co/aJSackTkew
— Paul McNamara (@meta4RN) December 4, 2018
19.
The problem isn’t the problem.
The substance abuse/eating disorder/self-harm looks like the problem, but that’s the survival skill.
The problem is the trauma: not “what’s wrong with you?”, but “what happened to you?” @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
20.
“The problem is not the problem, it’s a solution to another problem.” @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
21.
New (to me): the concept of “fire season” where the client/therapist/service moves from crisis to crisis to crisis.
When there’s ALWAYS an emergency response, there’s no time for cleaning-up, back-burning, learning lessons and future planning. @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
22.
Concept: chaos/crisis/flashbacks/reoccurring-maladaptive-behaviours as a memorial to the perpetrator or trauma.
ie: If yesterday’s pain is not expressed today, will the trauma or perpetrator just be forgotten?@halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
23.
If we focus on the solution to the problem (eg: substance abuse, eating disorder or self-harm) we might be missing the point. Those behaviours are being used for distress reduction.
Are there other ways of reducing distress? Let’s learn them first. @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
24.
Advice from @halpernnaomi1 re #ComplexTrauma therapy: “You might think of it in terms of stages, but this is what it looks like: pic.twitter.com/7Xsbi3tXTt
— Paul McNamara (@meta4RN) December 4, 2018
25.
It can be difficult to see and understand where you and your client are on Karpman’s drama triangle. It’s helpful when managing transference, countertransference and outside relationships. @halpernnaomi1 #ComplexTrauma pic.twitter.com/210PZWnf9P
— Paul McNamara (@meta4RN) December 4, 2018
26.
A small cheer goes up in the Cairns Hospital videoconference site when @halpernnaomi1 emphasises the importance of clinical supervision when we work with people who have experienced #ComplexTrauma (there are some @CSorgau peeps here 🙂)
— Paul McNamara (@meta4RN) December 4, 2018
27.
Another good @halpernnaomi1 #ComplexTrauma tip: Don’t be afraid to use props (cushion, ball, drawings, movement) in therapy, especially if the client is numbed/shut-down. Just practice what you’ll use/do with a colleague first.
— Paul McNamara (@meta4RN) December 4, 2018
28.
Re therapeutic use of self: it’s a relationship that can assist rewiring the brain through co-regulation, attunement, present moments @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
29.
Both the therapeutic relationship and the client’s informed consent will need to be renegotiated. The client needs to feel in control. @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
30.
Another @halpernnaomi1 #ComplexTrauma tip: Use writing to articulate internal communication/dialogue.
Ask the question by writing with your dominant hand.
Answer it by writing with you non-dominant hand.Start with something benign. Take time before tackling distressing stuff.
— Paul McNamara (@meta4RN) December 4, 2018
31.
The psychoeducation, insight and reflection, mindfulness and mentalization aspects of therapy are the work of the prefrontal cortex. @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
32.
How to train your monkey mind https://t.co/xYTZWmak6e HT @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
33.
Cookie Kid https://t.co/lNBhZ4UUQJ this video introduces mentalization (ie: see ourselves as others see us, and others as they see themselves) @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
34.
A goal of therapy is to make the implicit explicit, the unconscious conscious and the incoherent coherent.
There’s no “one size fits all” approach – develop a tool kit. @halpernnaomi1 #ComplexTrauma
— Paul McNamara (@meta4RN) December 4, 2018
35.
“Working with Complex Trauma: The Snow White Model” ends with a reminder that the wicked Queen dies, Prince Charming arrives, and Snow White becomes fully integrated and lives happily ever after.
A terrific #ComplexTrauma workshop. Thanks @halpernnaomi1! 🙂— Paul McNamara (@meta4RN) December 4, 2018
What’s all this then?
Some people take notes in workshops using ye olde method of pen and paper. I’m not criticising – pen and paper are cute and quaint. But how on earth do they find their notes quickly and easily after the workshop has ended?.
I tweet my notes. They’re quickly and easily retrieved via phone, tablet or computer at anytime. Sometimes, if the presenter is OK with it, I collate workshop/conference tweets and plonk them all on my webpage for even quicker and easier future reference. That’s what this is all about.
Also, sometimes I have trouble explaining to other health professionals why I’m enthusiastic about Twitter for work-related stuff. It’s easier to show examples of how I use it, rather than just chin-wagging and flapping-about like a chook in a cyclone.
End
Sincere thanks to Naomi Halpern (aka @halpernnaomi1) for an engaging, informative workshop. For a single person to hold the attention and interest of those of us who were joining via videoconference for a whole day is very impressive. Also, I’m grateful to Naomi for agreeing to my request to collate these tweets here.
That’s it. As always, your feedback is welcome via the comments section below.
Paul McNamara, 8th December 2018
Short URL: meta4RN.com/SnowWhite
meta4RN 