‘What trauma means today’ published in ‘The Psychologist’, October 2022

 

Michael J. Scott on books that shaped his thinking around ‘mental time travel’ for his own new offering, Personalising Trauma Treatment: Reframing and Reimagining (Routledge)

Personalising Trauma Treatment: Reframing and Reimagining by [Michael J Scott]

The classic dictum underlying cognitive behaviour therapy (CBT) is that ‘men are disturbed not by things, but by the views which they take of things’. This is attributed to the Stoic Philosopher Epictetus (The Enchiridion Epictetus, translated by Higginson, 2020), who discussed it in the context of death. Epictetus was born into slavery and endured a permanent physical disability. In essence the Stoic philosophers were ‘centralists’ in taking the person’s view of matters as playing a pivotal role in distress. Unlike the trauma-focused CBT theorists, the ancient Stoic philosophers did not see the distress as originating in the particulars of the adversity at the time – what has, in the modern era, been termed arrested information processing. In my new book Personalising Trauma Treatment, I suggest that the key focus should be on what the trauma victim takes the trauma to mean about today, rather than having the client re-live the trauma.

Moving on from Stoic philosophers, Samuel Pepys wrote in his diary on 2 September 1666 (republished in 2003) of the start of the Great Fire of London. Five months later, on 28 February 1667, he wrote ‘it is strange to think how to this very day I cannot sleep a night without great terrors of fire; and this very night I could not sleep until almost two in the morning through thoughts of fire’. From the Restorative CBT (RCBT) perspective evinced in the book, the sights, sounds, smells of what Pepys had seen would be acknowledged and the question of what they mean for today would be asked. In essence, how relevant are these memories? Do they mean that he can’t walk the streets of London? The therapeutic focus would be on helping him realise he was safe. A prime RCBT target is helping the person regain their sense of self by gradually doing what they did before; for Pepys, writing about his daily encounters and the restoration/rebuild of London.

Moving further forward in my time capsule, the Auschwitz survivor, Edith Eger – who later became a Clinical Psychologist – was, in 2017’s The Choice, askance at the idea of deliberate re-living of the trauma. ‘Work through it? I lived it, what other work is there to do? … I’ve broken the conspiracy of silence. And talking hasn’t made the fear or flashbacks go away. In fact talking seems to have made my symptoms worse… we can choose to be our own jailors or we can choose to be free’. She did revisit Auschwitz but her sister, also a survivor, declined.

What is fascinating is Eger coped with dancing in front of the Nazi doctor, Josef Mengele, by transporting herself back to the stage on which she performed ballet. A key feature of my own book is how we do that mental time travel. The RCBT is easy to disseminate and hopefully will be useful for helping the mass of psychological casualties generated by the war in Ukraine.

Dr Mike Scott

 
 

Magical Beliefs About CBT…

abound.These beliefs are inculcated by initial training and maintained by sharing ‘best practices’. For example, low intensity CBT therapists operate, on beliefs such as  ‘if I go into the CBT superstore and choose a strategy it will be potent’, ‘my clinical judgement is sufficient to make the right choices’,  and ‘improvements in test scores are sufficient basis for believing the clients needs have been met ‘.  But these beliefs are not evidence-based.

 

For the past 50 years it has been taken as axiomatic that ‘arrested information processing plays a pivotal role in debility post-trauma and should be targetted’. In Personalising Trauma Treatment: Reframing and Reimagining Routledge’  (2022)https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwj2r8v8m_j2AhWxQEEAHQrjAGgQFnoECAUQAQ&url=https%3A%2F%2Fwww.taylorfrancis.com%2Fbooks%2Fmono%2F10.4324%2F9781003178132%2F I examined this issue in detail, dissented and concluded that it is the centrality accorded to the trauma that is the driving force for debility post trauma. To the extent that clients utilise the trauma as their window on themselves and their world they are likely to suffer impairment in functioning, both personally and interpersonally. It  is a magical belief that the problem lies with the traumatic memory, rather the issue is what the person takes the memory to mean for today (see youtube video https://youtu.be/3UeJ1Lux4pU) detailing how to help the client back to their old selves post trauma – Restorative CBT (RCBT).

Personalising Trauma Treatment : Reframing and Reimagining book cover

 ‘All disorders are maintained by a negative belief system, making CBT appropriate’, this belief underpins the extension of CBT to the treatment of long-term conditions. But it would not stand up in Court. It would be suggested that the idea is promulgated to satisfy the acquisition of power by service providers. A relatively newly emergent,  magical belief is that ‘if children are taught the elements of CBT model/adaptive coping it prevents the development disorder’ this may or may not be true but dogmatism here has no place. 

In the Middle AgesIn it was believed that the earth was the centre of the universe and planets such the sun  and moon orbited it in circles. This geocentric view of the universe persisted for a long time after it became evident that the earth was not at the centre  and that orbits were elliptical rather than circular. Unfortunately the power of the current Teflonocracy will likely lead to the persistence of these magical beliefs for some time to come.

Dr Mike Scott

Post Trauma, Quality Treatment Shouldn’t Be Traumatic – New Book

Personalising Trauma Treatment is about helping trauma victims back to their old selves and focuses on altering the perception of the centrality of the trauma.

In this book, clients are taught to rediscover their sense of self by reframing the trauma. Within this new framework the focus is on the client’s mental time travel from the trauma to today and reimagining their future. The therapeutic targets are the thoughts and images (cognitions) that interfere with day-to-day functioning. It does not assume that arrested information processing lies at the heart of the development of PTSD, with a consequent need for the client to re-live the trauma. For those clients who were abused in childhood, their experiences are viewed through a particular central window, but other ‘windows’ may make for more appropriate engagement with their personal world and a reimagining of their view of themselves. Treatment delivery options from telephone consultation, group work and videoconferencing are discussed. With illustrative examples, the author highlights the pathway to recovery for a wide range of clients with the comorbidity often found in real-world settings.

The book will be essential reading for therapists and other mental health professionals working with trauma survivors.

Michael Scott identifies the paradox, coolly critiques the evidence, and illustrates and emphasises the collaborative and crucial role of the creative, empathic, and restorative therapist in enabling the client’s natural resilience and preferences for today and tomorrow, without pathologizing normality, imposing supposed processing, and unconstrained by complacent diktat. — Greg Wilkinson Formerly: Editor, The British Journal of Psychiatry and Professor of Liaison Psychiatry, The University of Liverpool; Currently, Consultant Psychiatrist, Liverpool University Dental Hospital and Liverpool University Hospitals NHS Foundation Trust.

Dr Scott offers a unique and refreshing perspective on working with those affected by trauma, particularly when they don’t neatly fit into a PTSD ‘box’ but have nevertheless come to be defined by their experiences. Taking a critical eye to evidence-based practice, and at turns thought-provoking and light-hearted, he combines up-to-date theory and clinical pearls with a robust critique of the modern realities of service delivery. Full of rich clinical examples and dialogue that brings the reader into his therapy room, he takes you step-by-step through his clinical decision making and interventions.Highly recommended! — Sharif El-Leithy, Principal Clinical Psychologist, Traumatic Stress Service  

In Personalising Trauma Treatment: Reframing and Reimagining Dr Scott delivers an approach to treatment grounded in pragmatism and real-world functioning. After considering the pitfalls of poor assessment he guides the reader through the process of detailed and accurate diagnosis questioning whether treatments work for the supposed reasons they give. This book is a must for all IAPT & CBT therapists, counsellors and clinical psychologists involved in the care of individuals suffering with trauma. — Sundeep Sembi, Consultant Clinical Neuropsychologist, Psychology Chambers Ltd

https://www.routledge.com/Personalising-Trauma-Treatment-Reframing-and-Reimagining/Scott/p/book/9781032013121 utm_source=individuals&utm_medium=shared_link&utm_campaign=B021841_ca1_1au_7pp_d875

 

Who Arrested Information Processing?

Was it Freud, Horowitz, Foa, Resick, Shapiro, Brewin or Ehlers? Arrested information processing has long been held as pivotal in the development of PTSD, but in my Workshop, ‘CBT for PTSD and Beyond’ to be delivered at the Lakeside Centre, Crosby, Liverpool on October 4th 2018 under the auspices of Merseyside BABCP I question this.

 

There is also a paper ‘PTSD An Alternative Paradigm’ in submission.

Dr Mike Scott