The Real Common Treatable Podcast

Trauma and Accelerated Resolution Therapy With Shana Frenkel LCSW-C

February 09, 2022 Clint Mally Season 1 Episode 28
The Real Common Treatable Podcast
Trauma and Accelerated Resolution Therapy With Shana Frenkel LCSW-C
Show Notes Transcript

In this episode you'll learn from Shana Frenkel LCSW-C, we take a deep dive into what trauma is and different forms of therapy to treat it. You'll learn:

  • The difference between big "T" Trauma and little "t" trauma
  • Where studies of trauma originated
  • What Accelerated Resolution Therapy is

And More...

As a dynamic, bright, insightful, intuitive counselor, Shana Frenkel, LCSW-C, specializes in working with trauma and its related disorders, including the intersection between trauma, anxiety, depression, and eating disorders.  She integrates a holistic model in treating and working to reduce successfully post-traumatic stress (PTSD) symptoms with children, adolescents, and adults. 

 She also has training and experience in working with military couples and military service-related issues for service members and their families. Shana’s clients have described her work as “an inspiration,” facilitating personal growth and internal health. Shana brings creativity and above all else sincere caring for her clients to her counseling sessions.  In addition to her specialty, Shana also has experience with play therapy with children, sandtray therapy with children, meditation, social anxiety, self-esteem, and couples counseling. 

Shana received a B.A. from the University of Massachusetts Amherst in Therapy Through Creative Expression and her M.S.W. from University of Pennsylvania. She is trained in CBT (cognitive behavioral therapy) and CPT (cognitive processing therapy), is certified as an IS-ART therapist (accelerated resolution therapy) and is certified PCIT  therapist (parent-child interactive therapy). 

There is this idea that much of what we do in say, how we build in social situations, how we react to stress is a result of one thing, trauma. Some people who have trauma, push it down deep inside, they are not even aware of it, it becomes the invisible strings that control us. And sometimes these strings make us feel and act in ways that are good for us. But what if there was a way to identify these trauma strings and cut them? What if there was a way to take back control of your life and learn new coping skills on your own terms? My name is Clint Mally. And I'm Ryan burden. And this is real common treatable. A real talk podcast about overcoming mental health, substance abuse and addiction challenges. It's time for you to meet my friend Shawna Frankel. She's a licensed clinical social worker and counselor, and the owner of Healing harmony, health and wellness with Shauna, her practice works with children, teens, individuals, couples and families. But it doesn't take long to learn that one of the things that Shawna is most passionate about is trauma work. Part of what we do is we do trauma work and trauma work is hard work, but good work. And when you do a lot of intense work at around trauma, it allows us to like move through stuff that we didn't even know we move through. Sometimes we develop behaviors or patterns or things we think are normal. And other people point out and say what are you doing? And like, why are you doing this? Or sometimes we even asked ourselves that question, why are we doing that. And so what we do as a private practice, we're focused on trading the intersection of trauma, depression, anxiety, and also eating and our relationship with food. We also work with people who have also had a history of substance use as well. First off, not all trauma is created equal, you spilling your Starbucks is not the same as getting in a car wreck. So first, we need to unpack the difference between big T trauma and little T trauma. Trauma is when you have an event. And there's two different kinds of traumas, there's little T trauma and big T trauma, but I'm going to just describe trauma itself. And then I'll explain what I mean by both of those teams. So trauma is something that shatters our world completely changes the way we relate to ourselves, ourselves in the world, the world with us and everything in between. Sometimes we don't even know that something has shattered it. But we no longer feel like who we were, something has changed inherently inside of us. It's almost as if you would take this beautiful window, and yes, slam it and then all the shards come down and all that is left are the shards on the floor. And that is what trauma does to a person. So little T trauma is trauma that doesn't result in post traumatic stress disorder, but does result in something that still changes the way we engage in the world. And big T trauma is what is PTSD, post traumatic stress disorder. And what we experience as this this thing that everyone seems to identify that's become much more popularized more recently, big T trauma, or PTSD is still being understood. But we first started learning about it through soldiers coming back from the battlefield. It was called shell shock. And that was originally when they started noticing what this trauma thing was where all of a sudden soldiers who seemed fine pre engagement in war now came back seeming different seeming like a whole of themselves shell of themselves. And they weren't able to reregulate the way another soldier was, and they started really looking into what is this and nowadays, it's no longer just tied to our servicemembers and their families. And it's also tied to other like just civilians and everybody else, because they realize that trauma, at least PTSD can happen if there's physical trauma, sexual trauma, emotional trauma, but that one gets a little bit trickier in terms of being diagnosed with PTSD unless it has some of these other features and characteristics. And they all circle back to having something that completely shatters your world. When you think about PTSD, it can feel easy to think that little T trauma is not a big deal. Like you should be able to handle it on your own. A little T trauma work is just as important. I think the cool thing about doing trauma work even when it's little T trauma, and especially when it's little T trauma is that a lot of times we don't realize that some of the behaviors we have are just to compensate for something that broke inside of us. Right. Sometimes it's a move sometimes it's a friendship, sometimes it's a family member, sometimes it's family, sometimes it's whatever else it could be. And so all of this is super stressful to people, and then they develop all of these like patterns and things and behave years and ways of engaging in the world or like the one that's always the best is like people's trust, right? A lot of times people have such a difficult to call time trusting other people because their trust was broken. And then it's really hard to rebuild that sense of trust, because we're always looking at well, who's going to hurt me next, right? That same thing that often plays out in romantic relationships, or even on the flip side, we were talking about the food component of trauma is there also then people are eating to synthetically create feelings that they can't organically create on their own? Okay, now this is hitting kind of close to home. Everyone has had their trust broken by someone before, but how they cope with it isn't always the same. There is a coping mechanism that I've got to feel in most people can connect with do. So sometimes they're eating those comfort foods, like those cookies, those cakes, those everything else, because they're trying to feel that safety, that warmth, that security, or on the flipside there might be eating like the crackers and the chips and the Doritos and like the crunchy foods, because they're getting out this excess, like frustration, anxiety, anger, something of that nature. And then they don't know how to regulate those feelings or express those feelings organically. I don't know about you, but I've never connected me crashing a bag of Doritos with regulating anger. But what about when we reach for stuff that could have more side effects than calories? What about when we reach for drugs and alcohol? When we use substance, it's connected to this. I can't manage it on my own. So now I need something else to step in to create this feeling of numbness or this feeling of happiness or euphoria or just feeling okay. Because they don't know how to feel okay, because things in their world broke so much that okay is not a feeling that exists anymore. Have you ever known someone who's gone through something really terrible? And then you ask them a question that you probably already know the answer to? Are you okay? Yep, that's the one. And when you ask it, they're like, Oh, I'm fine. Or I'm okay. Even when you know that they're not. This can be a sign that someone hasn't developed the language process to feel their feelings. But sometimes we don't know what we're feeling. So then it's really hard to show what I'm feeling. If all I feel is fine, and everything is fine, and nothing feels okay, because everything is fine. Oh, that's exhausting to have everything feel fine all the time. Fine. It's like one of my really good friends says is just freaked out insecure, neurotic and emotional. sure everyone's fine, right? If that's what we're going to define finance, right? It means that you're not actually sitting with what's really going on. It's really you're sitting with, I don't want to sit with what I'm feeling. So I'll just tell you, everything's fine. So when we talk about nuancing emotion, and this is also a lot of what we do in our work, is we help, like, tease out and differentiate. And that's really separating all the different kinds of like umbrella terms, right? Because we think about like happy as an umbrella we think about sad as an umbrella. We think about stress as an umbrella. And what I mean by Umbrella, it means it covers a lot of different emotions, but we use this as like the base Trump. And so we learn how to differentiate of what are the sub feelings that are happening under our big umbrella of I'm happy, or I'm sad, or I'm tired, even tired is a big one, right? Or I'm bored. Bored is the best one, right? Or everyone's like, I'm just bored. I have nothing to do. I've nothing to say I'm just bored. I'm like, okay, cool. So it means you're like uninvested. I'm interested, not wanting to engage kind of giving up on self on world cool. What does board mean to you? Right? Which is very different than how we typically look at board really just like a board. It's like, nothing's entertaining. But why do I need to be entertained? What's the purpose of being entertained? Or why am I not being able to be present in this moment? What am I trying to get out of, and now all of a sudden board no longer looks so simple. It's actually a really complicated feeling. But we don't look at the sub feelings under board, we just look at onboard. Make me entertained. Yeah, and, and when we don't let those feelings out, we either find another way to process those feelings, or return them completely off. I think that there's a lot of times people get lost where they're feeling, and a lot and it's very, very common. One of the like, most common things when someone's diagnosed with trauma, or someone's gone through trauma is something called dissociation where you feel like there's a separation between self and feelings where sometimes people describe it as numbness, or someone's not home, or it just feels like I'm going about almost feeling kind of robotic, where you feel like you're going about but you're not really connected. Even my favorite is when people say I can't cry. I'm like, Cool. That's like the biggest sign of like, you're super dissociated, because your body does not know how to even let yourself experience what you're feeling. And then nine times out of 10, we don't want us so we shove it away. But it's not your fault. You're actually kind of hardwired to think this way from an evolutionary survival standpoint. So the most common thing with trauma is our brain is typically trying to self Preserve. And so why would it want to sit with a thing that broke us because that's not self preservation? That's not even remotely connected to self-preservation If we're constantly reliving the very thing that broke us. So instead, we try every way possible to stay as far away. So we don't have to sit with what hurts the most. We're kind of like a window. Sometimes trauma makes a crack in the window. And we don't even realize we have a problem until someone comes alongside us and points it out, or it gets bigger and bigger over time. Sometimes trauma shatters the glass. But this doesn't mean that it's too late. It trauma trained therapists can actually help you make something beautiful, we start picking up the pieces, and instead what we're going to learn how to build because we can never rebuild the window that was broken. But we can create a stained glass window. And stained glass windows, as we know are beautiful. And they're stunning and often much stronger than a single pane window. And so what we do is we sift through the shards and we say what are the shards we want to keep when the shards that are me and one of the shards that no longer serve me. And sometimes when we sit through the shards, it hurts, and we hurt ourselves, and maybe we scrape ourselves up. And that's why that's the hard work that happens in trauma. But then we distill it and we synthesize it, and then we put it together. And the more we build this window, the more wholesome we feel. And yes, there might be times where the where we see the cracks from what we are building in and we see the lines of the pieces that weren't always together. But when we look at the hole, it's much more beautiful than it was before. So we're not fixing you and returning into a state that existed before. We're helping you find a new state that gives you a new sense of wellness that's much more beautiful and can withstand so much more. Maybe you're like, Okay, I know trauma therapy is important and good. But there are also a ton of different therapies that everyone says is the way to deal with trauma. When we come back from the break, we're going to do a crash course on the different trauma therapies so that you can figure out which one is right for you. This podcast is brought to you by sandstone care. They provide an incredible full continuum of care for teen and young adult addiction and mental health treatment, go to sandstone, to live chat, or call the number in the show notes to talk to a real human who will get to know you and your situation and connect you with the support you need. Even if it's not with them. Change is possible and sandstone care is here to help. Well, let's start with Old Faithful CBT or cognitive behavioral therapy. There's a couple of different modalities that are really good at treating trauma. And the first one that's really great that people love to use is they like to use CBT cognitive behavioral therapy for trauma. It's called TF CBT. Trauma Informed cognitive behavioral therapy we're using like cognitive behavioral therapy techniques. So cognitive either means you're restructuring thoughts, behavior means you're restructuring like the things you do. And then therapy mean drugs getting what you're learning how to do, and then it's trauma informed, which means you're learning how to specifically do it as a result of something that's coming up. So that's a piece and a treatment that people like to use. So your dad was CBT. But do you know CPT, we like to use in our practice, all of our clinicians are training this is something called CPT Cognitive Processing Therapy, or cognitive processing therapy is a really cool therapy. So when we think about trauma, our brain basically, if you think of it as like a circuit breaker, and your brain basically gets fried, and everything like just goes all over the place. And there's a bunch of chords, some of them are connected, some of them aren't connected, everything's just all over the place. So what we want to do in trauma therapy is we want to like retake our chords, figure out like what's supposed to be connected, what's supposed to go, what may be a safety hazard, and what like it actually belong. And we start sorting through all those cores that we can put our circuit breaker back together and keep all the things that actually make it work working. So cognitive processing therapy actually helps process through, move through taking that what you went through, and go from the beginning to the end of the trauma, and sort through it. So that way, your brain no longer keeps replaying the thoughts over and over and over again, it takes that open ended circuitry and closes it. And so that's ultimately what you want to do in any kind of trauma work is you take that open ended circuitry and you close it because typically when people get nightmares or flashbacks, or resurging of emotions or feelings or whatever else, it may be disassociation, that feeling of like I don't feel good enough in the world, the anger that comes like at random intervals. Now I'm really talking about PTSD itself rather than only little T trauma. I'm talking more about Big T trauma right now, is we want to figure out what's going on our brain and our body's way of saying there's a lot happening here and I need it to like, go somewhere. And it happens when we're awake. It happens when we're asleep. It happens when we want to avoid the thing that happened when we were like see the thing and then all of a sudden it brings all the memories and so ultimately what we're doing with CPT is we're taking all of those symptoms. We're like plugging that circuit breaker back together, we're taking those cords separating everything out and figuring out what belongs what doesn't belong, and then retraining the brain to teach it how to have that sense of security, how to have that sense of safety, how to have that feeling of belonging how to start taking away that That which our brain is trying to make sense of, and actually make sense of it and retrain, and basically rebuild exactly as we gave that other analogy, our stained glass window, because now we're actually doing concrete techniques to move that. So what that's what CPT does, and I love it, I think it's so powerful, it can be done amazingly well. There's written parts to it for those who like written work, and it really just does incredible work. So I'm a big fan of CPT, I think the gold standard of trauma treatment, and often under underused and underutilized and I think really needs to be more used than been necessary. If you have heard about trauma therapies before, you've probably heard of EMDR. And those Shauna doesn't explain it in depth here, we're dedicating a whole episode that will cover that topic in the future. So look out for that. But in the meantime, this should give you the gist. EMDR is eye movement desensitization reprocessing, where it uses your eyes to track your eyes, follow a finger or a light or a tactile cue, from the left side of your body to the right, back and forth, as you're telling a trauma story. And then once the feelings come up, you kind of put the feelings on pause, and you just start sitting with the sensations happening in your body. And ultimately, like helping move those sensations through. So you're processing. And so this is a different form of processing. And you're doing it both through like moving your eyes, and also moving the sensations through your body. So that's called EMDR. So when the feelings come up, then instead of continuing the story forward, you pause, and then you put that aside, and then you work through it, we have one more trauma therapy for you to consider one that is a little less known. It's called accelerated resolution therapy. And it's the one that Shawn has most liked about accelerated resolution therapy. Currently at our practice, I'm the only one trained in it. But I look forward to when my associates also get trained in it. And right now, it's still an in person treatment. And what it does is it takes EMDR, so that eye movement processing, it takes cognitive. There's like a Cognitive Processing Therapy component, there's something called Gestalt Therapy, which really just means kind of like role playing, and like playing out something in your mind. There's in vivo therapy, which is that exposure, almost prolonged therapy that we talked about, that comes with prolonged exposure therapy. And what it does is it rewires your brain. And it's, it's a process based therapy, rather than a content based therapy. So unlike CPT, where you talk out what you're going through, AR t you don't you talk about what is your feeling in your body, so it's a sensation based therapy. And you're basically what you're doing is you're playing the movie of the trauma in your head, twice, sometimes more. But ultimately, you're playing the movie of what you went through in your head. And then you pause at the direction of the therapist. And there's a lot more to the, to the to the treatment itself. But this is just an over or overarching way of talking about it as you pause to talk about what you're physically feeling in your body to move those feelings along. So that way, by the time you get to the end of like the the trauma, the video, if you will the movie, if you and it's not to say that this is a light way of saying it, this is just how they describe the therapy itself, then by the time you get to the second playing of that movie, it's no longer brings up the same impossible feeling, and then gives you a way to then reach reshape that story. And so I think there's room for AR t and I love using it. I've used it with people who have had nightmares that are so bad that I cannot function and have been able to put away those nightmares or put away those like that just non functional and I even had clients where like, I need a magic wand. I was like, I have a magic wand. And they're like, what, who does that I'm like, I got you, I got you, we can do this, right. And there are also people who really thrive on the the content based therapy that they feel so much more sense of agency by talking it out. And so a lot of my clients really love talking about and only like using AR t is just in the form of treatment of like, as my last resort because I can't work it out this other way. Some people just come for a party because they're like, I just want this, I want this and I want this out. And I'm done. And they call it a day, which we don't cover that under insurance. There's other treatments that are covered under insurance, but ARD is not. And ultimately, the goal is for any kind of trauma treatment is to really process through what happened and to close that open ended loop or in the other analogy to like rebuild our stained glass window. That way, all the pieces are just scattered everywhere. We're now putting like an image together, we can finally see what's happening instead of just seeing there's a bunch of shards on the floor. Oh, well, sorry if I keep getting hurt. Alright, got it. So maybe you want to find a trauma therapist. How did you even do it? How do you find someone who is trained in the trauma therapy that you are looking for? Get ready to swipe left and swipe right. I tell people therapy's kind of like dating. You go through like a lot of different options. But like finding the right client, their therapist match is super important. So making sure you have a clinician who like get your needs and really understand you is as important than just being like well, I went to a therapist. I told them my story. So I guess I'm stuck. No like the person that you're speaking with whom you're speaking should be someone that you feel connected to you feel like understand their story and you feel like can actually have the tools to help you go for it. And sometimes there's a point where sometimes people hit the end of a therapy with a clinician and a provider, and then they need to seek additional services somewhere else. Or sometimes there's a lot of room for growth and opportunity. So I just wanted to answer that other question you had of like, how do I choose I'm like, it's kind of like dating, you just kind of you pick out a couple different ones, you try them out, some people like to try out a bunch of different options. Sometimes they just see what they're looking for what they're wanting, or I recently had a client who like connected me with a friend of his that was out of state. So unfortunately, wasn't able to provide services to that person, and just because their state licensing laws, but I was able to say, here are some of the key words you're looking for when you're looking for a therapist who was able to meet the need of what you're trying to see. Because sometimes, a lot of times, if you've even indicated, a lot of conventions just talk like you're talking to another clinician, rather than just talking to people who have no idea what they're looking at. So when they say all these like catchphrases, nobody has any idea what they need. And they're just like, I don't know what I'm looking at. And so So I even like gave guidance, that person I said, please reach out to me if you have additional questions, but these are some of the phrases you want to look for. So you know, you have a clinician that actually meets your needs. And so sometimes it's learning the lingo in the field to figure out who it might be. Sometimes it's just talking to them and just having like 10 or 15 minute consults, just say who are you? What's your story, telling them? Their story, having the client tell their story, and having the clinician kind of responding to see like, does that even feel like a good from the get go. Lastly, there are two sets of buzzwords, we need to be typing into Google to connect with the right person in our area. These are trauma trained and trauma informed, let's unpack the difference. So I would say trauma informed is the same way that you might get like that if you go to a store, right, and you want to go to a healthy food store. And if you go to just walk into giant, there's like the healthiest section aisle where you're like, oh, cool, there's some healthy food that I can go grab. But it's not going to have the full array, what you're really looking for, it'll have some of the pieces that if you go to the store, and they have the right ingredients, now you have your healthy food, and I can keep going. But if they don't have the healthy ingredients giant isn't gonna naturally just produce it, you have to then like, find a healthy food store that's carrying this one product that the regular store is not carrying. So that would be what trauma informed is where they're getting some training that help help them help traditional therapists that are trauma informed, not trauma trained, that maybe they've taken a couple of trainings where if you hit the right thing on the head, you can really say, Oh, I got I found this the missing product. However, if you hit something on the head that isn't in the store that's not covered under that trauma informed training, then that's going to be beyond the scope of that clinicians practice. And that's when you have to go seek a trauma trained therapists who are trained in and maybe several different trauma that really helps not only just say, Ah, there's trauma Cool, let's start working on some of those pieces. But addresses why, because a lot of times, it's not just going straight for the easy fix of like I see something that's broken, let's fix it right. If I see blood, I put a bandaid on it. But that doesn't get to the heart of like, but if it's a broken bone, no matter how many band aids you put on it, your bones still broken until you set it right. And maybe the person who said it was pretty good at what they did, which is incredible that they got you as far as they did. But if the bone didn't heal, right, we still have to go back and re break it so that we can heal properly. So sometimes when you do trauma informed care, it might not get to the heart of what you're really getting to. And that's why you might want to trauma train therapists or trauma focus, where they really are trauma base and then treating depression, anxiety, eating substance, etc. Instead of someone who treats depression, anxiety, eating, and then may have trauma informed training. Trauma is complicated. It's like this tapestry of conflicts and problems you've experienced in your life. Having someone help you sort through this stuff, or pick up the Shattered Glass and make a stained glass window or rewire your circuits so it's not a tangled hot mess. This can be the thing to help someone stop living in the past and begin to live more in the present. If you want to continue the conversation, join us in the free real common treatable Facebook group, a safe space to talk about all things mental health, substance use and addiction. Also, you can learn all about Shauna and her awesome work by checking out the links in the show notes in description box below. Also, it would mean the world to us if you would take 11 seconds to leave us a review wherever you are consuming this podcast. Once again, I'm Clint Mally, and I'm Ryan burden. And we know that this trauma thing is real, but it's also more common than you think. And it's definitely treatable.