Perspectives & Approaches

Philosophical Perspective 
I trust every individual brings unique gifts and talents to this world. We can become stuck without realizing these abilities due to current stressful situations or histories of trauma, abuse, neglect, or other painful experiences. Often people develop coping mechanisms to adapt or survive in insecure and sometimes dangerous environments. Originally, these coping mechanisms may have helped serve a purpose, such as using drugs or alcohol to sooth anxiety and pain, or isolating oneself from others to avoid being hurt, but sometimes what once was helpful may prevent people from thriving in their current relationships and environment. These behaviors may include the overuse of alcohol or drugs, issues with over or under eating, involvement in unhealthy and toxic relationships, or other self-harming behaviors. I work closely with individuals to work on changing behaviors that are not working so well and prevent them from living a life that is rich, meaningful, and inline with their values. Therapy can help individuals identify how disruptive past and present experiences have impacted their physical and emotional wellbeing as well as their thinking patterns and core beliefs. This insight may lead to the development of new ways of living that nurture and cultivate holistic well-being. I encourage individuals who are working with me to set realistic goals that focus on the mind, body, and spirit. I believe that recovery requires self-empowerment and the realization of a person’s strengths and unique contributions to this world.

Trauma-Informed Care

Historically, people have been dismissed, ignored, or retraumatized when trying to access help, therefore I accept Trauma-Informed Care as my central treatment paradigm. Trauma-informed care is a system-wide approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives (National Center for Trauma-Informed Care, 2017). For more information on Trauma-Informed Care please review my website or review the Substance Abuse and Mental Health Services Administration’s (SAMHSA).

Advocacy

Many of the people with whom I work have reported feeling unheard or not believed when accessing medical and mental health care. This mistreatment has left many people feeling unsafe when trying to access treatment. As a social worker it is my job to help Advocate for clients who are receiving inadequate care and whose rights are being violated by systems that are supposed to help. 

Dysregulated Nervous Systems 

I believe that most “mental illnesses, substance abuse, and eating disorders” are the result of dysregulated nervous systems. Unresolved trauma, neglect, abuse, chronic stress, inconsistent parenting, chronic pain, traumatic-brain injuries (TBIs), and traumatic births are common root causes that lead to systemic dysregulation and are the likely culprits for mental health diagnoses, addictions, eating disorders, chronic physical illnesses, toxic workplaces, and relationship discord.  

Humans possess an autonomic nervous system (ANS) that helps maintain physiological regulation.  Part of the ANS never sleeps and continuously scans the environment looking for safety and threats through a process known as Neuroception.  If the nervous system interprets a situation, relationship, or environment as safe, then a person can maintain a physiological and emotional state of balance that allows him/her/them to move towards healthy connection with themselves and others.  This is known as “ventral vagal-parasympathetic” also knowns as social engagement system regulation and what Dan Siegel refers to as “The Window of Tolerance” (1999). People must be in a regulated state to engage with others, learn, be creative, have humor and feel safe in their bodies. The more regulated a person is the more they are able to cope with unsettling thoughts, emotions, and physical sensations. If the ANS interprets the experience as unsafe then the ANS activates the survival response leading it to respond in a way that ensures the highest likelihood of survival including the hierarchal responses of fight or flight or shutdown and dissociation. This process is what Siegal refers to as “going out of the Window of Tolerance”.  I am learning more about somatic approaches to working with dysregulated nervous systems using the works of Stephen Porgess and Deb Dana and am starting to incorporate these approaches into my practice. I think it is import to teach clients about their nervous systems and help them explore safe ways to feel safer or more comfortable within their bodies, relationships, and communities.

This might explain while children or survivors of violence may struggle more with chronic post-traumatic stress disorder (PTSD) as their nervous system was unable to follow through with a response that allows them to “shake off” the trauma, just as an animal would do in the wild if it was able to escape a predator (Levine, 2012). How our ANS responds is often an unconscious decision which can lead people to feel shame about how their body physiologically responded to a trigger or stressful event. This shame is often exacerbated by how friends, family, and society respond to the survivor of trauma. If the survivors receive unconditional support from their support system and community, then they have the greatest likelihood of resolving the trauma and restoring a sense of balance and equilibrium. If survivors are dismissed, not believed, accused of being at fault, or not supported their support system, then this can lead to hypervigilance or a state of chronic fear.

Trauma, abuse, neglect, and stressful events impacts people’s nervous system leaving it in a chronic state of hypervigilance looking for the next upcoming threat.  This hypervigilance can lead people’s nervous systems to be in a chronic dysregulated state where the fear response is coupled with unpleasant or painful physical sensations, emotions, memories, and thoughts, also referred to as “private, unwanted or fear-invoking experiences”. The purpose of good trauma therapy is to uncouple the fear response from these unwanted experiences. This is sometimes referred to as “Widening the Window of Tolerance. According to van der Kolk (2014), this can be done through three different approaches including 1. Medication, 2. The top-down approach, and 3. The bottom-up approach. 

Medications, such as psychotropic medication, supplements, and cutting-edge psychedelic treatments, have shown to be successful in lessening the symptoms associated with the trauma response. I work with people who are open to trying these methods and people who prefer to not incorporate them into their healing journey. I provide information on the efficacy, pros, and cons of taking medication to the people I meet, but also respect if someone does not want to try this approach. 

A top-down approach to working with trauma that I practice and teach is Acceptance and Commitment Therapy (ACT).  Our brains are designed to solve problems even when there are no problems to be solved. We struggle internally with these unwanted private experiences but often it is not so much the unwanted thoughts, emotions, or negative feelings in our body that we experience, but our struggle with trying to get rid of them. ACT is one of the third-wave cognitive therapies that incorporates mindfulness, value clarification, and committed action so we may allow ourselves the space to accept these unwanted private experiences as part of the human experience.  By incorporating mindfulness, we can learn to not be ruled by our negative unwanted private experiences or our countless efforts to get rid of them.  Values exploration and clarification is a great way to discover what is most important in life.  Our values can serve as a compass to help guide us through the most trying experiences. Through committed action towards valued living we can find ways to a rich and fulfilling life. For more information on ACT visit https://contextualscience.org/act

I am currently learing more bottom-up approaches to working with my clients using the works of Deb Dana, Diane Poole, and Lisa Wimberger, to help them develop skills around self nurture and self-care discipline. Helping clients learn how their own nervous system takes in information from the environment through multiple sensory inputs (neuroception) and how their body perceives this information as safe or dangerous (interoception) is an important process of the healing journey from trauma, neglect, abuse, and chronic stress.

Eye movement desensitization and reprocessing (EMDR) is an evidence-based, integrative treatment that helps individuals process distressing events so they can move on and not be triggered by stimuli in his/her environment. I consider this intervention to be both a top-down and bottom-up approach to working with trauma and stress. I have seen amazing results in my practice when using EMDR for issues of trauma, abandonment, and addictions. For more information on EMDR please visit www.emdr.com or www.emdria.org.

Often, painful events occur before we are preverbal and unable to seek help from others. Children who experience chronic stress during this crucial life phase are at higher risk of struggling with somatic symptoms, meaning in the body, because of unresolved trauma. Somatic approaches, often referred to as bottom-up approaches to working with trauma, have shown to be helpful for people who struggle with trauma that manifests through painful physical sensations. Victor Frankl stated in his book “Man Search for Meaning” that “An abnormal reaction to an abnormal situation is normal behavior” (1946). I teach people about their nervous systems through psychoeducation and find that people feel less shame about how they respond to painful events after they find out that their response are normal. During our work together we can assess your unique window of tolerance, create awareness and insight into how your nervous system responds to current stressful events or past traumatic experiences, and explore effective ways to widen your window of tolerance so you can spend more of your life in a regulated balanced state.

I also believe Harm Reduction (reducing the harm to oneself) to be a more realistic method when working with individuals dealing with co-occurring trauma and addiction. Sometimes it is unrealistic to expect people to completely stop the use of all drugs and alcohol when these substances have been used to cope with unwanted thoughts, feelings, or physical sensations such as boredom, anxiety, or fear. Sometimes certain aspects of behaviors can be changed so that people do not have to completely stop the behavior but can-do things to reduce the negative impacts of it. For example, I would much rather see people use marijuana instead of methamphetamine, heroin, or alcohol as marijuana tends to be safer choice for a variety of reasons. If I had a client who was using marijuana to help reduce their use of other more dangerous substances, then that would be a great success! Counseling is an opportunity for people to work towards developing safer coping skills that can start to reduce or even replace unsafe coping skills such as overuse of drugs or alcohol. It is important to note that until a person wants to make those changes it is more appropriate to help that person reduce the harm around his or her substance use. For more information on Harm Reduction please visit The National Harm Reduction Coalition. 

Thank you for taking the time to read about my philosophical perspective and treatment approaches.  Please vist the resources page for more information including research and other helpful resources.