Creating safe therapeutic spaces for clients with complex trauma (with Dr Catherine Hynes)

[00:00:05] Bronwyn: Hey, mental workers, you're listening to the mental Work podcast. You're companion to early career psychology.

[00:00:10] I'm your host, Dr. Bronwyn Milkins and today we are talking about working with clients who experience trauma, including complex PTSD. I think this topic is so important because when I was first starting out as a psychologist, I knew that clients who came to me with, for example, an anxiety disorder, were also experiencing the impacts of trauma, but I had no idea how to help them.

[00:00:31] I did the best with what I had at the time, but I reckon that it would have been so much more helpful to have some information on how to provide a safe space, avoid re traumatization and effectively conceptualize and treat complex trauma.

[00:00:44] Here to help us out is our guest, Dr. Catherine Hynes Hi, Catherine.

[00:00:48] Catherine: Hello. Thanks for having me on the podcast.

[00:00:51] Bronwyn: Such a pleasure to have you on. Catherine, to start us off, could you please tell listeners who you are and what your non psychology passion is?

[00:00:58] Catherine: Yeah. So I'm, I'm a clinical psychologist. I'm originally from Canada, but I work in Brisbane most of the time, except this year I'm in Canada again. Um, I'm an EMDR consultant and the clinical work that I do is primarily with adults who've experienced adversity at some point in their lives, but frequently adversity throughout childhood. So, um, people who've had, um, traumas during development and then perhaps also into adulthood.

[00:01:27] My background before I was a therapist is in, Neuroscience. So I did my PhD studying the sort of neural substrates of empathy and social skills. I'm still really interested in that stuff. And before I was a neuroscientist, I was studying the philosophy of consciousness and was particularly interested in the the self and identity.

[00:01:49] So the work that I do today kind of gathers up all those different interests because I work a lot with people who have fragmented senses of self and some of the people I work with will have multiple identities. And so I'm sort of bringing a lot of that philosophy, neuroscience, clinical practice into my work.

[00:02:06] Bronwyn: That's so amazing. With the philosophy, is that a lot of Descartes or is that something else?

[00:02:11] Catherine: Um, well, I suppose post Descartes, I guess. Um, so I was interested in the more modern stuff. John Searle. Um, I read Daniel Dennett. I wouldn't say I was a big fan, but looking at theories of consciousness and trying to figure out how we could possibly explain what we know we do. And, um, that was what led me into neuroscience because I didn't think the philosophy was really answering those questions.

[00:02:34] Bronwyn: Wow. That's so interesting. So cool. I love philosophy. And I feel like that's going to be my next like career move. Cause I already did a PhD and I was like, I'd never do another PhD, but then I'm like, maybe philosophy. Um, so that is awesome. I love how you integrate all of those things into your professional self.

[00:02:51] Catherine: Thanks. Yeah, it's a lot of fun. Keeps it interesting.

[00:02:54] Bronwyn: Yeah. And what is your non psychology passion?

[00:02:58] Catherine: Yeah, I mean, I'm, I'm pretty geeky, so I do spend a lot of time in my psychology passion and, um, and I guess my other passions are people, which is a bit psychological, but I'm a real people person and just love meeting people, getting to know people, hang out with people.

[00:03:12] And the other thing that really, um, excites me is, um, nature. So being in a forest, being near the water, I'm living right now on the banks of the Gananoque River, which is just so gorgeous that I can see the water flowing by every day. And that really restores me. It's just lovely.

[00:03:27] Bronwyn: Wow, that's so beautiful. That's amazing. Well, Catherine, thank you so much for coming on. And I'll tell listeners as well that, you know what, I actually used your resources when I was a provisional psych. So that was about five years ago. And on your website, you have a few resources. And I remember looking around and clicking around and hoping that I would find something.

[00:03:45] So you've been helpful to me for a number of years. Thank you.

[00:03:48] Catherine: My pleasure. I'm so glad to know that the website's helping people.

[00:03:51] Bronwyn: Yeah, it absolutely does, and then I've recently done your dissociation course. Um, and that's been fantastic as well.

[00:03:58] Catherine: That's complexity to clarity. The intro course.

[00:04:01] Bronwyn: Yeah. So let's start off with understanding trauma and complex PTSD. So maybe you could tell listeners, what is PTSD and then how does complex PTSD differ from it?

[00:04:14] Catherine: Sure, so simple post traumatic stress disorder have some so called simple post traumatic stress disorder, happens when you have one single incident in adulthood normally that happens during that incident you get overwhelmed by something and then you basically get stuck in a survival response So you get stuck in a repetitive fight or flight response, or perhaps a freeze response, or perhaps a submit or a collapse response. And the symptoms that you experience really come from your brain's effort to manage this stuckness in those survival responses. So that's simple PTSD, one incident.

[00:04:58] Complex PTSD is what happens to people when there's not just one overwhelming event, it's many, many, overwhelming events, and that's particularly true if those overwhelming events happen throughout development. So during childhood, during adolescence. And we see the, the complex PTSD presentations often involve difficulties with a person's close relationships. So where those caring relationships are not as safe, not as attentive, not as supportive as we need. That's when you're going to develop the more complex presentation of post traumatic stress disorder.

[00:05:41] Bronwyn: Okay, and maybe one thing that's firstly helpful for listeners to be able to distinguish is... I think they, well, I know, maybe I'll just speak to myself. I know that as an early career psychologist, I was like, I had read the ICD about complex trauma, and I think in the ICD, it specifically says traumas as a consequence of serious traumatic events, such as being in captivity, um, torture, war, those sorts of events. And then I was looking at my clients and I was like, well, you haven't been in war or captivity. And of course I'm not telling them you don't have serious trauma because you haven't been in these events, but it was difficult for me to, reconcile, like, is this person experiencing complex trauma if they haven't got what's in front of me in the text? Could you just speak to that?

[00:06:26] Catherine: Yeah, it's a great question, and I think that that issue causes a lot of confusion in mental health circles generally.

[00:06:35] So some definitions of trauma require that you have a life threatening concern, right? So, you know, something that that could potentially kill you. That's not the definition of trauma that I work with because I'm interested in applying treatment, right? And alleviating pain, distress, overwhelm, and helping people settle down those survival responses.

[00:07:04] Our brains will engage a survival response. If something feels threatening, whether it's life threatening or not. So for example, a significant rupture with a partner or friend who's meaningful in your life may well engage your survival system, and it's still possible to get stuck there, even though most of us don't die because of a breakup or a breakup a permanent rupture.

[00:07:29] So I use trauma in the broader sense because I think that's more useful to clinicians because we're going to see both, right? We're going to see life threatening trauma presentations and we're going to see other sorts of trauma presentations where there was no threat to life but there certainly was a threat to a person's understanding of the situation or that person got overwhelmed.

[00:07:53] Bronwyn: That makes sense. So would it be more accurate to say that, I guess, trauma is a response rather than an event?

[00:08:00] Catherine: Absolutely.

[00:08:02] Bronwyn: Okay, sure.

[00:08:02] Catherine: And that's, that's really important. So, um, the data that I know about this are pre COVID, the rates are probably higher post COVID, because we were all very stressed out during the, um, pandemic, but, uh, pre COVID, the, the rates in Australia were that, um, three quarters of people experience an event that would normally be considered a trauma. So that could be a near death experience or the death of someone else or an accident or something like this. But we don't have those, we don't have three quarters of people develop developing post traumatic stress disorder. It's quite a small subset. I, I can't actually recall the statistics was under 10%.

[00:08:41] Bronwyn: Yeah.

[00:08:42] Catherine: And so most people are able to accommodate an overwhelming experience. Um, you know, through, um, support and having some time to digest it and re regulating the body, right? So it's a subset of people who go on to develop the post traumatic stress.

[00:08:58] Bronwyn: Yeah. That makes a lot of sense. And I'll add in there because it's something that I found really helpful from your training was that part of making sense of stressful events can be rumination. And I didn't know that before doing your training. And it was like, it is healthy to ruminate and try and make sense of the trauma.

[00:09:14] Catherine: Absolutely, so if you, if you, there's many different models of trauma, right? And as a, as a, an EMDR practitioner and an EMDR consultant, I think EMDR is my, my preferred model of trauma, because it's very consistent with the neurobiology and it makes for a fairly tidy, uh, formulation in order to, to build your treatment on.

[00:09:37] EMDR therapy is developed from the adaptive information processing model which Francine Shapiro developed. And that model says if something overwhelming occurs to you and things are, are, are nothing blocks your natural recovery, your brain knows what to do and you will accommodate that event.

[00:09:58] So you'll think about it. You will ruminate about it in the immediate aftermath, you might have intrusive dreams and intrusive thoughts about it, and most of us will seek the support of friends and others and seek other supportive things like going for a walk in the woods or going for a walk where you like to go for a walk or going and doing something soothing for yourself, and eventually you'll digest that event in your neurologically. And it will get stored in the past as a bad thing that happened, but something that you made it through and you won't develop post traumatic stress.

[00:10:33] We develop this post traumatic stress disorders when something interferes with that natural information processing. So if that rumination persists, if those intrusive memories persist for a long time, if, nobody's helping you make sense of what happened. If things keep happening, I think of the people in the world right now who are in war zones, right, where the threat has been persistent for years, right, that prevents that natural information processing in our brains from doing what it would normally do, and that's where we end up with post traumatic stress.

[00:11:08] Bronwyn: Yeah, so if a client walks into the room, what are some of the signs that we're going to see, or maybe hear from them, so the symptoms, that they may have a trauma response?

[00:11:19] Catherine: Yeah, it's a great question. So I believe that trauma in the broad sense that I've defined it here today is in the background of a significant proportion, probably a majority of mental health presentations. Um, so it's really important to, to be, you know, trauma informed and to be curious about that with with people who come in.

[00:11:43] It's sometimes difficult to recognize because the presentations, particularly with complex trauma, are so variable, right? There's no one presentation. So what we learn with with, um, you know, simple single incident post traumatic stress is that people will be in a state typically of hyper arousal, they'll be agitated, um, and, and, and experiencing a lot of sympathetic, uh, distress and that's definitely a presentation you can see. So anyone who's presenting with anxiety as you suggested. Um, you know, that that's it's worth considering whether there's some trauma overwhelming the system.

[00:12:21] We can also see a hypo aroused presentation. So people who've really shut down and they're in that more submit, uh, space and or a collapsed space where they're very numb and very detached and that can be harder to identify as trauma sometimes because they're not presenting with that typical agitation.

[00:12:43] Bronwyn: Yeah. And I think that's helpful for early career listeners to hear as well, because I'm just thinking of myself in the room, like a few years ago, and maybe if someone had described to me, I've experienced a sexual trauma, but maybe they're presenting as able to still go to work and still functioning, in air quotes, in their relationships. And they don't appear distressed when they're talking about it. I might say, Oh, it appears that this person is. I guess processing the trauma well, not realizing that they may be in a hyper aroused state.

[00:13:14] Catherine: That's right, where they're numb and cut off. And so they're still functioning, but they're not having a normal emotional range and not a full emotional engagement in their lives. And they also would benefit from trauma focused treatment.

[00:13:27] Bronwyn: Yeah.

[00:13:28] Catherine: Some other presentations that that we see, um, that don't fit nicely into what Our standard tertiary education trains us to recognize as trauma are people who have very inconsistent presentations. So people who, uh, you know, in one moment are quite, um, emotional and another moment are quite cut off or, uh, having difficulty joining up a narrative and expressing consistently what therapy goals are, what their history, um, is. Um, so anyone who has a challenge telling you the timeline of their life, I would be curious about trauma because, uh, non digested material often interrupts our sense of narrative continuity.

[00:14:12] People who present as quite confusing. So where they're describing something that is, you know, for a majority of people, quite distressing, but they don't appear to be distressed. That can be a sign of fragmentation associated with trauma.

[00:14:29] People who present as relationally odd, so just having difficulty establishing rapport, or over familiarity in that first session, or yo yoing between distance and familiarity, that can be an indication of trauma.

[00:14:46] And the other thing that I look for a lot is evidence of lots of internal conflict and self criticism. So people who have narratives about themselves that are very negative or critical, or they have difficulty, um, I guess agreeing with themselves and making decisions, right. And they'll be really clearly pulled in different directions. That's often a sign of complexity. trauma as well. So you can see it's a lot of things that end up in that bag.

[00:15:15] Bronwyn: Yeah. There is a lot of things and I guess I'm thinking like, do you find that it's important to listen to your own feelings when you're in the room with a client maybe for the first time? Like I imagine it could be important that if you feel confused by something to listen to that inside of you and be like, huh, I wonder if that is.

[00:15:35] Catherine: Absolutely. So when we're first meeting someone, we're collecting a lot of data from a lot of different sources, right? So we're looking at, you know, the mental state exam, how they're presenting very specifically. We're looking at how they're telling their story, what their goals are for treatment. And we're looking at how they relate and how we feel relating to them. And so what's going in on in our bodies also is, uh, you know, a stream of data to contribute.

[00:16:04] Knowing that your podcast is geared at early career psychologists, I don't want people to feel overwhelmed by having to track all those things in the first session, right? You got to get this story down. You've got to do your assessments, but those are some, and it's not going to be possible to pay attention to every single aspect of that right away, but those are some things that you might bring into focus as sessions evolve, right? How do I feel with this person?

[00:16:31] Bronwyn: Yeah, totally. Um, and I remember being an early career psych and just being with a client and being like, I have no idea what happened here, and then bringing that to supervision and being like to my supervisor, I have no idea what happened here. I felt, I don't know, I think confused. And then they would help me unpack that. And then we would get into this. So yeah, just to reiterate to listeners, you don't have to know everything from the get go. It's really being like, okay, what is happening for this person and seeking support where needed.

[00:16:58] Catherine: That's right. And, and giving yourself some time to really assess and formulate and not putting a lot of pressure on yourself to do it all in that first session. You'll get the gist of it in the first session, and then you're going to go and do your, your further assessments.

[00:17:14] I think that when you feel confused, as a therapist, or you feel unusual as a therapist, that your way of relating to this person is different than the way you normally relate to clients, that's data. That's something you should be interested in and curious about and following up for your formulation.

[00:17:35] Bronwyn: Mm. So maybe we can talk about now what a safe space involves. Like, let's say we've got somebody coming in. I mean, we strive to create a safe space for everybody who comes through our door, but I'm wondering if there's particular things that we need to be aware of when we're working with folks who have experienced trauma.

[00:17:53] Catherine: Absolutely. So, you know, the, all the boundaries about the therapeutic relationship that we learn about in our traditional training programs are very, very important here because we're there to listen and be a safe support to someone who's, possibly going to tell us some of the worst things that have happened to them. So it's important to really have, um, to be on time, to be clear, to be empathic, um, and to, and to really define the role of the therapist really well. So those are things that I would assume that your listeners would know.

[00:18:29] The, the, the things that I keep in mind, for a trauma context, um, really come from, from Dan Siegel and, and the developing brain. It's about how we create a, a safe attachment space. So we don't want to create an attachment relationship for our clients because attachment relationships are inherently power dynamics, right? They're for little children to attach to their parents to be able to get the support that they need from their parents. We want to create a collaborative relationship, a peer to peer relationship with our clients. But the best way to do that is by being mindful of what creates a healthy attachment relationship.

[00:19:12] And so Dan Siegel says you're securely attached if three things happen for you, if you're safe in your childhood, if you're soothed during your childhood and you're seen, right? Safe, seen and soothed. And so this is what we want to provide. So we want to be safe for our clients by being predictable, reliable, being really clear about what we do as therapists and what, what the client's role is as a client and how that therapy, what therapy is going to look like. We make sure that our clients feel seen by really listening to them and trying as hard as we can to understand their experience of their life and what's distressing them. And we want to teach the client how to soothe themselves in the best way that's going to work for them. Right. And so we don't do the soothing, but we're there to collaborate with them about upskilling them in terms of doing that soothing.

[00:20:08] Bronwyn: Yeah. I do a lot of schema therapy and one of the schema therapy techniques that we're taught is called limited reparenting. I'm sure you've heard of it and aware of it. And I was just curious, like when you were saying the peer to peer relationship, I just wondered what your perspective on the limited reparenting as providing a corrective emotional experience is.

[00:20:27] Catherine: Yeah, I have a lot of respect for schema therapy and it certainly was one of the early therapies that, um, that I took on in order to be able to work with complex trauma. And today I still use lots of elements of schema therapy, but I'm not a schema therapy purist, I don't think I'm any sort of purist to be honest. I'm a quite quite an integrative therapist really.

[00:20:54] And so the two things that I don't do The way schema therapists do things. I don't do any battling with any part of a person's mind, right? so there are um a lot of instructions in schema therapy to um To banish the critic, to battle the dysfunctional parent states and all of that. And it's quite, the language used is quite combative. And I don't believe in creating more conflict within the nervous system. I believe in harmonizing the nervous system.

[00:21:34] So we really listen to the trauma time function of the critic or the internalized parent or the, um, whatever, whatever maladaptive as they would put it in schema therapy, um, protector part we're working with. You really listen to the purpose of that and show some gratitude for that protection that was offered during trauma time and then move gradually towards a role that's more appropriate to the present. So that's one way I depart from uh, schema therapy that's quite important.

[00:22:04] And I also do depart a little bit with the limited reparenting. I used to do more of it, and what I've learned over time is that it's ideal to really have the client take on the reparenting role rather than you do it. Um, and so I have all sorts of experiential strategies to get people in touch with what good parenting looks like, but in general, I don't provide myself as that good parent. I provide myself more as a conduit for information and opportunity to learn and the reason that I've moved away from the limited reparenting and that sort of attachment based work towards a more collaborative peer to peer, arrangement is that for some clients that limited reparenting creates a bit of dependence, and I have found it difficult to transition from doing the reparenting to delivering the parenting to the client. So I'm much more cautious about having the client taking the, the, the lead on that earlier in the piece.

[00:23:21] Bronwyn: And do you feel like that's particularly important say for folks who have experienced complex trauma and perhaps you are the first safe person they've ever had in their lives? And so that might create, I guess more of a vulnerability to having dependents on you?

[00:23:36] Catherine: Complex trauma is certainly the source of, uh, of dependent structures in people's coping. But complex trauma is a bit of a wild card because there are people who have avoidant attachment styles that are not creating a dependence. Yeah, it's, it's, it's one way that complex trauma can manifest for sure.

[00:23:58] Bronwyn: Yeah. Yeah. No, I loved hearing that as well because, um, one of the episodes I'm going to release on the podcast is about how I've done, like I kind of say, I've done backflips on a few things since starting out five years ago. And I love how you're describing the development of your therapeutic approach across time because I think a lot of early career psychs are anxious that it's like, well, I have to do this and that's how I'll continue on. But you learn and you evolve over time.

[00:24:23] Catherine: Absolutely. And the, and the context that you work in change and that might change require a therapeutic change. And I will just say, I think that the way that that that Geoffrey Young and others wrote about limited reparenting is actually very nuanced. And they were aware of the risks of dependence in certain clients. And so they would encourage you to notice that tendency and then challenge it and work with it. And I, so it's not as though they're unaware of this problem.

[00:24:54] Yeah, but I guess I've, the way that I've evolved is to, it, perhaps it's partly because I, I work exclusively with adults... I've really, yeah, I guess I've evolved to having the client take the first steps in that direction rather than me, because I think it's easier not to have to do that transition than to start off.

[00:25:16] Bronwyn: Yeah. Like every chapter I've read on limited reparenting or every time I see it written, it's always like therapists provide a limited reparenting connection in the context of a boundary professional relationship. So I think, like you say, they're very aware.

[00:25:29] Catherine: That's right. Yeah, so it, yes. So it's, if you're doing it that way, absolutely. It's a very legitimate approach and I don't want to come across, uh, suggesting that there's one way to do things. Yeah. you got to do what works for you.

[00:25:41] Bronwyn: Totally. I wanted to move on to, um, avoiding retraumatization for the client. Um, because if we're unsure whether this person may have a trauma history, like if they are presenting with the avoidant attachment and hypo aroused state... what are, what are your perspectives on like some of the things that we can do to avoid, I guess like reactivating or, or having a negative experience. I don't even know if it's possible, in therapy.

[00:26:07] Catherine: Well, we have to figure out how to do therapy in a way that isn't retraumatizing. That's our duty. Right. And unfortunately, many clients that I've met do have treatment related trauma, right? And so it's, it's a real thing and it is something to be aware of. So I think that the best way to avoid, uh, re traumatizing clients is to have quite a good sense of the physiology of trauma. So that as a person is telling you what it is that they want assistance with in therapy, you can pay attention to how their body is tolerating. What they're telling you, right? And so when a client comes in thinking that it would be of assistance to them to tell me what all the traumas are so that I know what I'm dealing with.

[00:26:55] And I can see that it's some people can do that. And that's absolutely fine for others. If, if I can see them getting over aroused and leaving their window of tolerance, then I'll interrupt them and say, I'm going to stop you there because I noticed that your body is getting a bit uncomfortable and we have lots of time where you can tell me the specifics later. What I want to do today is just get an overview of what's going on so that we can plan the treatment. So it's being really proactive about modeling that soothing that's required and staying in that window of tolerance is really, really helpful, and many clients will express relief when we, you know, when we do that.

[00:27:39] Bronwyn: Is window of tolerance something you introduced to clients quite early on then?

[00:27:43] Catherine: Uh, yes. So, so I, uh, cause I, you know, I work in private practice and in, in my own clinical setting, I have the luxury of deciding how long my appointments are. I know not everybody's in that situation. I did used to work 50 minute appointments. I work 80 minute appointments now.

[00:28:01] And so in that first session with somebody, at after 60 minutes, almost no matter where we are, right? I will interrupt them at that point and say, "so, you know, it's difficult to summarize a life and an hour and a half. And so you've definitely got more to tell me, and there will be other opportunities for you to tell me that, but I'm just aware you've covered a lot and that that might be disturbing to you now, and it might be disturbing to you later. So I'd like to spend the last bit of the session showing you some ways of managing that".

[00:28:34] And in that moment, I will talk to them about I will teach them about a window of tolerance and show them how to do grounding. And I do grounding in a reasonably, um, robust way where I'll get them to, instead of just naming things in the room, lots of people do three, three, three, stuff like that, I get them to do, to really evaluate the environment and redecorate my clinic or whatever it is that is interesting to them so that they're really, really cognitively engaged in the task. Um, because that tends to bring people much more into the present than just naming things. Naming is hard for really small children, but for most adults, you can do it kind of automatically.

[00:29:15] And at the same time as I teach grounding, I will also teach containment, right? So, uh, an imaginary container exercise using the power of mental imagery to really put aside what it is that's disturbing them so that they can work on some skills for soothing the nervous system so that they can prepare to deal with whatever that intensity is that brought them into the clinic in the first place. And that teaching skills right in the first session and being really clear on the neurobiology of trauma and how we're going to work that's part of not traumatizing people.

[00:29:53] Bronwyn: Yeah. Yeah. And I may just to add to that, I, I've found doing my own therapy so helpful in this aspect. So a few years ago, I was really excited to do my own EMDR therapy and it was a great experience. But one of the things that I noticed after the first session was that, I thought the person asked me for more details about the events and I thought I was okay, so I gave them lots of detail.

[00:30:16] And then in like two hours after that first session, I was shaking like full body shakes, which I realized was, I guess, an arousal thing, trying to regulate myself, and I was like, wow, I actually... and I didn't receive, um, containment strategies. I think there might've been a therapist effect. Like we might overestimate how much therapists are able to tolerate, or they, they must have their own skills. I didn't know about containment.

[00:30:38] Um, and so I was like, Oh, wow, this is really interesting. So it really is great to hear from you that that's really important to be able to teach clients those skills, um, so that they're aware of how to regulate themselves after that first session.

[00:30:52] Catherine: Yeah, absolutely. I think, I think it's, it's really important and really foundational. I offer treatment to a lot of, um, health professionals, including mental health professionals. And my, and I always say this to the healthcare professionals who come to see me, I know that you know a lot about the stuff that I'm doing. Um, and if I'm, you know, going too slowly or telling you things you already know, please just let me know and I won't waste your time, but I'm going to treat you like any other client who comes into this room. And I'm not going to presume that, you know, things because we know that there is a pretty significant distinction between knowing something in your, you know, semantic knowledge and doing something, and therapy is a doing, right? And so I want to make sure that we start at the beginning and work all the foundations up.

[00:31:44] So I think that's, that's quite important for stabilization and just, and just for knowing that whatever comes up in therapy, you're going to have a place to deal with it. Yeah. So we want to teach that right in the beginning.

[00:31:56] Bronwyn: Yeah, is there anything else that we can do to avoid re traumatising our clients in therapy?

[00:32:02] Catherine: Well, I think that we want to be really good listeners and we, when we're listening, it's important that we listen as much process as for content. We need to understand how does this person exist within themselves? How do they support themselves? Do they know how to support themselves? How does this person relate to me? How do they relate to the task of telling their story or acquiring skills? Because all of that is really what you're going to be working on more than what actually happened to that person.

[00:32:36] Of course, what happened to them is important, but it's how they relate to what happened, how, how that changed their relationship with themselves. That's what we're working on in trauma recovery. And so we want to be listening for that really, really closely. And I think as we listen to that and we feedback to our clients, what we're understanding of their experience, and we help them to make. sense of themselves, that is de traumatizing in and of itself, because the end goal of trauma therapy, however you do it, whether you do it with CBT or EMDR or narrative therapy or anything else, the end goal is to make meaning that's healthy. Out of what happened. And so by helping people to make meaning out of their experiences, we're calming them down.

[00:33:32] Bronwyn: That's really beautiful and I think really reassuring for listeners because I hope listeners will be like, I can listen. Um, and listening is so involved. It's, it's deeply like cognitively you have to be there, but I think it's something that early career psychs are really good at doing. So that's reassuring to know that. That in of itself can be de traumatizing for clients.

[00:33:52] Catherine: Absolutely. As long as you know when to interrupt, uh, the, the listening, the, the sharing, if, if their physiology is getting...

[00:33:59] Bronwyn: Totally. And just on that, I wanted to ask you about vicarious trauma and preventing that. And I know you've got a course on this. I've done your self care course, so I know it's like quite involved. Something that I learned, um, early on as an early career psychologist was, not giving the client the impression that you're unable to hear what they've experienced, but at the same time saying to them, I don't need all the details, both to protect them, but to protect yourself.

[00:34:26] Um, maybe you could speak to that. Like, is that a good way to go about it? Or is there something else that we can do to help ourselves, um, from being vicariously traumatized?

[00:34:35] Catherine: I would like the early career psychologists who are listening to this to take away from this question is you will experience some level of vicarious traumatization in our work. It's unavoidable, right?

[00:34:55] So our job involves us hearing about some of the bleakest things that happen to human beings. And it involves being right there with the people who've experienced that while they're emoting about that. And you can't be unaffected by that over time.

[00:35:18] And while you're being a therapist, you've got your own life going on, don't you? And you might experience, um, other, you will experience other adversities in your life alongside the adversities that you're there showing up to hear about and, and help people work through so you can't avoid it. That's reality, right? And I think a lot of us when we're young, and I certainly was like this, think of that's not gonna happen to me because I'm, I've got really good self care. I'm really tough or...

[00:35:49] Bronwyn: Oh my God. That's the exact thought.

[00:35:51] Catherine: Yeah, but you two are human, right? You two are human. And so how do we, so, so the quest that the, the, the project is not, in my view, to avoid vicarious traumatization. It's to manage the vicarious traumatization that you are going to experience. So how do you manage it?

[00:36:11] Bronwyn: Okay, sure. Mm.

[00:36:13] Catherine: So yes, what you suggested is really helpful, that you can limit, what is shared? And so it is important... so what I would say to the client is you can share anything that you wish to share that would help you recover from this, and I'm ready to hear it. Alright, I have my processes in place, talk about those in a moment, and I'm ready to hear it.

[00:36:35] And also, you don't have to share things that you don't want to share. Now, that's possible with EMDR therapy. It's a little bit less possible with, um, trauma focused CBT, um, because you have to go through all of the details. Um, and that's probably a reason to have EMDR in your kit bag, because you can protect yourself from some of the stuff. Um, so, um, That you might yourself struggle to hear.

[00:36:58] So I always make that really clear and I, and I make it really clear that the sharing. Is about their healing. So sometimes they just need you to know a particular detail and it can be a disturbing detail because they will, because that ties a whole bunch of symptoms together or something like that.

[00:37:13] So you have to be prepared for that, but there's no need in certainly in the EMDR context to go through any of the details that, you know, um, for, for any specific reason.

[00:37:23] Bronwyn: Mm.

[00:37:23] Catherine: So what we need in place besides good messaging like that and a diversity of therapeutic approaches so that we can, you know, manage our own trauma load. We need really good supervision. We need really good peer support outside of supervision. We need really good personal support outside of work. We need a healthy, fun life where we're participating in what's joyful and beautiful about the world, and we need to do more of that than the average person because we are so exposed to what's dark about the world.

[00:38:04] And we need to have, lots of time, I think, to figure out what it is that's, needing attention because if we're go from appointment to appointment to appointment all through the week and then go back to our busy families and go back to our busy lives and never have a moment of reflection, all that stuff is going to build up in our bodies and it's going to come out some way, right? So we need a bit of time to reflect and just think, well, that was a really big session today and I do feel a little bit disturbed. What am I going to do about that? And in some cases it's going to be, I'm going to write about it and that'll help me, or I'm going to go and take that one to supervision. I'm going to take that one to therapy. We need to figure it out. And I would really encourage people who work with trauma clients, and it's all of us in mental health work with trauma clients, whether you're at a trauma setting or not, to really build that time in to, to, to think about it and debrief it with yourself.

[00:38:57] And certainly when I was, again, when I was younger, I didn't do that because I was busy and building a private practice or doing this or that. And, and it caught up to me, right? So no one is immune.

[00:39:08] Bronwyn: Mm. Thank you for sharing that. We often talk about, how many clients, um, is helpful to see in a day for one of the reasons you described, which is that it's so important to have that time out to reflect on how you are feeling, integrate your learning, but as well for trauma presentations, yeah, to really give yourself time out to regulate and make sense of what is happening.

[00:39:31] And so that's really helpful to hear because a lot of early career psychs, they are just pushing through to get their hours so that they can get to registration as fast as possible, completely understandable, but in the process, they might not realize like how much of a toll it is taking on their physiology. Um, and so that's why we encourage this, this slowness and this reflection to, to help take care of yourself.

[00:39:52] Catherine: Absolutely. And that's that, that course that you've done the online one safety planning for practitioners. That's what it's all about, right? Is raising your awareness to the ways that your trauma work is traumatizing you and just figuring out some, you know, self care and some good strategies that you can build into your regular work week so that you're not getting hurt by the work.

[00:40:12] Bronwyn: Hmm. Yeah. Which I really loved and I'll make sure that I pop the link to that in the show notes as well. Listeners highly recommend it.

[00:40:18] Catherine, I want to move on to some therapeutic approaches that you find effective when working with clients who have experienced, um, complex trauma or trauma in itself. Could you take us through, a few?

[00:40:30] Catherine: So overall, I think that having a diverse, uh, skill set is really an asset. And so following your heart with whatever it is that you particularly love is going to be a- assistance, right? So it's got to be a therapy that really harmonizes with your way of thinking and feels meaningful to you and having a few, I think, is really useful.

[00:40:55] My preferred therapies are therapies that work really... I guess that are that are structured on neurobiology and physiology, right? Because trauma is a problem of memory storage that then dysregulates the body. And so I'm interested in therapies that map themselves on to the survival responses and then work physiologically.

[00:41:22] So my absolute, go to is EMDR therapy. I would say that my primary framework for working with, um, with people is EMDR. That adaptive information processing that I just model that I described earlier is such a beautiful model because it built into it is our inherent capacity to heal. And really what we're doing with EMDR is we're, we're, we're unblocking, that natural healing capacity in people's brains and bodies and letting them, um, get on with it, right?

[00:41:57] And one of the reasons that I love EMDR so much is that the, the data are so powerful that when you have a smooth EMDR course, which isn't always the case with complex trauma, which is why you need more than just EMDR to be able to, you know, be an effective therapist, but when EMDR is successful for a person, the trauma is resolved in a way that the gains that people make are effortlessly maintained over time, and the data show on follow up... If you follow people up for a year, they get better and better over that year.

[00:42:34] Bronwyn: That's so cool.

[00:42:35] Catherine: Yeah, yeah, because you've, you've just released their natural information processing. And so they're just doing that and they're getting better and better.

[00:42:43] And so I think that's just beautiful. Yeah. So, so my, you know, utopian future fantasies are that EMDR is part of basic communication. standard tertiary education for practicing psychologists that, you know, so I would really encourage people to get some EMDR training sooner rather than later.

[00:43:02] Bronwyn: Well, I have to say like EMDR was actually, okay, so I got registered and then the first training that I signed up for was EMDR training, because, and I'm sure many other early career psychs can relate, I really wanted a structured therapy and that's the only thing that I knew about EMDR. I knew that it was a structured therapy with phases. And so I was like, this will be great because as an early career psych, I have no confidence. So you'll tell me what to do and when to do it. And I was like, great. I'm very happy to adhere to a structure.

[00:43:29] But it was so much more than that. When I did the training, it was Uh, a great, insight into the adaptive processing model, um, and trauma in itself, like so much information that I did not have, which was so helpful. Um, and then of course the training in the, in EMDR, which involved a lot of role plays and going through it, which I found really, really helpful as well. So I feel like that was great to do as an early career psych.

[00:43:54] Catherine: Yeah. And I think this structure is really containing, um, for, for, yeah, for a lot of people, but there's a lot of elements to EMDR. So it's certainly a therapy that it takes a while to internalize a couple of years, I would say it takes to internalize, but it's very worth it because it's so powerful.

[00:44:14] When you've internalized EMDR and you're working with people with complex trauma presentations, you're going to realize that there are some limits, to EMDR and where I go next then, I guess, is, is to the therapies that work with structural dissociation, um, and so, Kathy Steele and colleagues who wrote the model of structural dissociation, that I think is the foundational work for doing parts work. And what I mean by parts work is work that integrates any of those dissociated parts, any of those inner conflicts that people will experience, work on integrating those. I think that the model of structural dissociation is the one that's most harmonious with the biology and most complete. So they wrote to kind of great textbook, um, for that and, um, are in and of themselves, great trainers.

[00:45:07] And then I would add to that... And I think in Australia we don't do this as well in, in our tertiary training... some therapy doesn't matter which, right. But that, that works with embodiment. So we've really gone down the cognitive behavior therapy road because it's got this, you know, the, the, the most, um, significant evidence base, um, partly because it's really easy to study,

[00:45:34] Bronwyn: Yeah,

[00:45:35] Catherine: Some of these other therapies where you have more individual formulations don't lend themselves as well to, to, to manualize treatment.

[00:45:42] But doing, say, sensory motor psychotherapy or some training in polyvagal therapy or in somatosensory therapy or any of those body based therapies, I think is really a powerful adjunct because trauma manifests in the body. And so we really need to be working, you know, not so much at a cognitive level until the trauma is settled. We need to be really working in an embodied space. And so something there is important.

[00:46:11] Bronwyn: Yeah, I'm smiling because it's like, when you said we don't get much exposure to it, I'm like, yeah, like no exposure in my tertiary training. The most I was reflecting on that I got is like in a CBT model, how you might ask a client, what are your body sensations in this situation? But then it's just like, okay, thanks. I'll add that to the model. So the thoughts affect the feelings, affect the body sensations, and that's the most you do with it. And so, yeah, it's, it's been so lacking.

[00:46:36] Catherine: Yeah, I agree. And I think, I think when we, when we, we learned, cause we're really in that there's, there's, uh, there's a culture of, um, psychology and we, we, we were in a cultural moment of real cognitive therapy, right? And so most of the, um, approaches that I learned, including when I was learning parts work are very top down, right? So, you know, cognitively, you know, talking to the therapist, learning some skills and then applying them top down.

[00:47:05] But I think what we need to do is every single thing that we teach, we want to teach a bottom up as well as top down, right? So we need to be really working with the body and noticing how does that feel in the body. So even if you're talking about a concept like, oh, I need to make more friends as an idea. Right. And, what, you know, we can talk all day about how important it is to make friends but what we need to know with our clients is how does your body experience that idea of making friends? Because if they're feeling queasy at the prospect of making friends, we need to be really curious about that, right? Because that's a protective response that says people are dangerous and it's a very powerful protective response. Whereas if it's just a little bit of nervousness, you're going to do something different, right? So we really need to work more bottom up, um, than we're trained to do at the moment.

[00:47:56] Bronwyn: Yeah, and I mean, just to echo what you're saying, it has been such a pleasure doing your dissociation course because, the reason why I enrolled in it was because suddenly I had this caseload full of complex trauma, and I realized I needed something else within my skill set to assist, and it's been such a pleasure to be able to work with clients in this bottom up approach, and they'd never heard of it before, they'd never experienced it in any therapy, but they found it so helpful, and the stuff that I was seeing in these clients was them being able to really stay with their body sensations, like they were less frightened of them, and to be able to tap into them in social situations even, and then say to other people, this is what's happening for me and this is what I need, which I thought was just like hugely significant for so many clients. So it is a real delight to be able to, experience that and to be able to be helpful in this way for folks with complex trauma.

[00:48:48] Catherine: Hmm. Yeah.

[00:48:50] Bronwyn: Yeah.

[00:48:50] Catherine, you've been so helpful in giving such great insight into working with folks who have experienced trauma. What advice would you give to early career psychs who are beginning to work with clients experiencing trauma and complex PTSD and it might be things that you've already said that you just want to reiterate or it might be something else?

[00:49:09] Catherine: Yeah. I think where I want to start is take really good care of yourself. Get really good at self care and develop a really sophisticated plan for de traumatizing yourself as you go, because vicarious trauma will happen to you, even if you're full of enthusiasm now, it is insidious in its onset. It will, it will come and we really want you here. We have a shortage of psychologists. We need every single one of you to be well and thriving. So take care of yourself.

[00:49:39] The other thing I would say is, um, go and find really good peer support and mentorship because we learned so much, um, that way. And I think that it's just a foundation for enjoying um, this work that is so beautiful and so difficult at the same time.

[00:50:00] The other thing I'd say is learn one thing at a time. Just know you've got a long career ahead of you. You can't learn everything, right now. And I think it's more effective to take on one new therapy and really internalize it and get it, you know, um, before you take on something else, because if we learn a whole bunch of things at the same time, it just gets confusing what we're doing, when and how. And I think it's hard to put those new therapies into our formulation. So slow down because you'll get there faster.

[00:50:41] And I, I think something that I wish someone had told me 20 years ago is, you know, just radically accept that there's lifelong learning in our profession. Things change, new information comes out, the data changes and we have to update all the time. And it's really okay to be at the stage that you're at. You can't know now what you will know in 20 years. And that's totally okay. It's just part of being a person.

[00:51:10] Bronwyn: Yeah, and something that I'm asking more experienced practitioners now in the podcast is, because in realizing like I am five years into like being registered and there's been multiple times where I've been like, I don't know if I can continue in this career for, you know, 20 years. And so I'm wanting to ask folks who are more experienced, like, what do you think has been integral to be, to being able to stay in this career, particularly for you as someone who has worked predominantly with trauma?

[00:51:41] Catherine: Well, everybody is gong to have a different answer to that. And so, you know, my answer might not be the one that fits everybody else. Um, but for me, it's been about diversifying what my working week looks like. So I don't see complex trauma clients five days a week. I don't work five days a week. I have Fridays off. And I do a lot of consultation with colleagues, supervision, and I do a lot of training, um, of colleagues, and that sort of changing how I'm practicing these skills and taking myself out of the really emotionally intense space of therapy, which I do love doing, but in a reasonable dose, which for me is two days in clinic a week, and that's enough for me.

[00:52:31] Um, and then doing other things, that has been really helpful. And I had a conversation with a, an old friend of mine from here in Canada, catching up with old friends. And she said, well, have you considered doing, you know, maybe some, some lighter psychology work? And I said, no, that's, that's not where my heart's at, right? Like, this is the work I really love doing, but I just have to get the dose right for, for me.

[00:52:56] Bronwyn: No, perfect. Thank you. And I wanted to ask you as well, like, I'm sure you've got a top 50 list, but what are some of your favorite books or resources that if you had to say like you're on a Desert Island and you need to bring this book with you, what would it be? Um, I like on trauma, on psychology. Um, anything you think is influential.

[00:53:16] Catherine: Okay, I'm gonna, I'm gonna give you five. Okay, my top five, not my top 50.

[00:53:20] Okay, so for really thinking with the early career folk in mind, right? Um, so, uh, Babette Rothschild's "The Body Remembers", um, and she has the, the text and also the case book. That is a really beautiful thing to read because she is a great writer. Um, she talks about the body and she really validates being an integrative therapist. So she's like, learn a bit of this, learn a bit of that, learn a bit of this. You need it all because different things are going to resonate with different people. And so that's a really lovely, very validating trauma framework.

[00:53:57] I think that, um, a classic in trauma is, um, Judith Lewis Herman's Trauma and Recovery. Um, I think that's a must read.

[00:54:07] I would say that, um, Francine Shapiro, EMDR Therapy, um, is, uh, a really valuable text. And what's so lovely about that book, so that the, the, the last edition, um, is 2018, which is the year before she passed away. She, it's everything she wants you to know about how her therapy works in one space. So it's one you're going to go back to, and go back to, and go back to.

[00:54:30] With the complex trauma in mind, so for those who feel quite comfortable with the, with the, the single incident trauma, but are looking to really stretch themselves, if you're an EMDR therapist and you're going to read one more book, it's Jim Knipes, the EMDR toolbox, that has the majority of the modifications that you'll need to make your work effective with most complex trauma clients.

[00:54:55] And for dissociation, it would be Kathy Steele and colleagues, um, treating trauma related dissociation. I would argue that the more recent book is a lot, um, easier to read and internalize than, uh, The Haunted Self, which is a bit dense.

[00:55:11] Bronwyn: Thank you so much, all really influential. I just, I literally last week got Babette's book because she also has a book on like a helping the helper type book, which is really clear and direct. And I was like, God, I'm loving this.

[00:55:23] Catherine: Yeah, Help for the Helper, Babette Rothschild's book, that is a really beautiful book that gives you so many strategies to, uh, manage vicarious traumatization. I think it's, I think, I think everybody should read that book. It's... Yeah, it's great.

[00:55:39] Bronwyn: Yeah. Thank you so much, Catherine, for coming on. If listeners want to know more about you or get in touch, where can they find you?

[00:55:46] Catherine: Um, the, the, everything's on my website, so catherinehynes.net, um, I'm just about to redo the, um, training page, so in, probably in September, October, there'll be a new training page up that will have everything I'm up to., um, but that's the place, and it's got a contact form and everything, so that's the place to find me. Yeah.

[00:56:04] Bronwyn: And are you open to supervision or EMDR consultation?

[00:56:09] Catherine: Um, so this year, while I'm in Canada, definitely not.

[00:56:13] Bronwyn: Okay.

[00:56:13] Catherine: And, um, uh, because I'm on leave. Um, but, uh, there, there may be some possibilities for some group consults and that kind of thing in 2025. And so the place to, to, to inquire about that would be through the contact form on the website.

[00:56:28] Bronwyn: Excellent. I'll make sure I pop that in the show notes as well. Catherine, it's been such a delight to speak with you. Thank you so much for your expertise. It's been honestly like really enlightening, really informative, and I'm sure listeners will get a lot out of this conversation.

[00:56:40] Catherine: Thanks so much. It's been really fun chatting with you and I, I hope that your listeners get lots out of it. It's a really fun profession. So, um, definitely worth it.

[00:56:50] Bronwyn: Totally.

[00:56:50] And listeners, thank you for listening. If you enjoyed this episode, make sure that you put it into somebody else's ears is the best way to get the podcast out there, and I'm sure they'll really benefit from it too. Thanks so much for listening on the Mental Work Podcast. Have a good one. Catch you next time. Bye.