Table Of ContentExperiential
Treatment
for PTSD
The Therapeutic Spiral Model
Kate Hudgins, PhD, is a clinical psycholo-
gist and board certified trainer in psycho-
drama, sociometry and group psycho-
therapy.Shereceivedthe2001Innovator’s
Award from the American Society of
Group Psychotherapy and Psychodrama
for creating The Therapeutic Spiral
Model, which integrates classical psycho-
drama with recent clinical advances in
trauma practice and training. She estab-
lished the nonprofit organization Thera-
peuticSpiralInternationalin2000tobring
this model of healing to underserved areas of the global community.
SheisapublishedauthorwhoseworkincludesPsychodramawithTrauma
Survivors: Acting Out Your Pain (2002). Kate travels extensively and has
trained Action Trauma Teams in Australia, Canada, England, New
Zealand, Northern Ireland, and South Africa, and has taught in many
additional countries including Israel, South Korea, and Turkey.
Experiential
Treatment
for PTSD
The
Therapeutic
Spiral Model
M. Katherine Hudgins, PhD, TEP
SPRINGER PUBLISHING COMPANY
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LibraryofCongressCataloging-in-PublicationData
Hudgins,Kate,1953–
Experiential treatment for PTSD : the therapeutic spiral model / M. Kather-
ineHudgins.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN0-8261-4942-1
1.Psychodrama. 2.Post-traumaticstressdisorder—Treatment. I.Title.
[DNLM: 1.Psychodrama—methods. 2.StressDisorders,
Post-Traumatic—therapy.
WM430.5.P8H884t2002]
RC489.P7.H8332002
616.85'21—dc21 2002017742
CIP
PrintedintheUnitedStatesofAmericabyCapitalCityPress.
Contents
Preface vii
Acknowledgments xiii
Introduction 1
Part I: Trauma and Experiential Therapy
Chapter 1 The Experiential Impact of Trauma 9
Chapter 2 Experiential Therapy With Trauma Survivors 24
Chapter 3 The Therapeutic Spiral Model: Visual Images 38
and Clinical Structures
Part II: The Unique Clinical Action Structures of TSM
Chapter 4 The Action Trauma Team 51
Chapter 5 The Trauma Survivor’s Intrapsychic Role Atom: 72
A Clinical Map for Action
Chapter 6 Types of Conscious Reexperiencing Dramas for 91
Developmental Repair
Part III: The Therapeutic Spiral Model in Action
Chapter 7 Principles of Conscious Reexperiencing With 109
Developmental Repair: Scenes 1 and 2
Chapter 8 Conscious Reexperiencing of the Victim Role: 124
Scenes 3–6
v
vi CONTENTS
Chapter 9 Processing Tricia’s Drama: Advanced Action 138
Intervention Modules in Scenes 1 and 2
Chapter 10 Enacting the Victim Role for Developmental 154
Repair: Advanced Action Intervention Modules
in Scenes 3–6
Part IV: The Future with Trauma Survivors
Chapter 11 Preventing Secondary Posttraumatic Stress 175
Disorder in the Practitioner
Chapter 12 The Future of Action Methods With Trauma 185
Survivors
References 193
Appendix A: Diagnostic Criteria for Posttraumatic
Stress Disorder 202
Appendix B: Glossary of Terms in the Therapeutic
Spiral Model 204
Appendix C: Overview of the Accreditation Process
in the Therapeutic Spiral Model 209
Index 217
Preface
Experiencingtraumaisanessentialpartofbeinghuman:
Historyiswritteninblood.(vanderKolkandMcFarlane,
1996,p.3)
Trauma is inescapable in today’s world. It is heard in the violent
soundsofgunsthatrage,studenttostudent,inU.S.highschools.
It’s seen in the sad and frightened eyes of a battered woman. It
permeates the news media that surround us all.
On September 11th, 2001, we all experienced trauma in ways we
couldnot believewerepossible untilthatmoment. Thisbook, andthe
methodoftreatingposttraumaticstressdisorder(PTSD)thatitteaches,
the Therapeutic Spiral Model, was created before “9/11.” As PTSD
reaches epidemic numbers among peoples around the world, it is my
hope that the words here can make a difference.
For the purposes of this handbook, trauma is defined as the result
ofanysingleexperienceorongoingexperiencethatfeltlife-threatening
and broke through normal coping mechanisms. Overpowering events
overwhelm the ability to defend against pain, loss, and possible death.
Cognitive processes are frozen in time as the self tries to cope with
intense emotions in the face of a real danger that made no sense. In
everydaylanguage,traumaisthefeelingthateverythingisspiralingout
of control and there is no way to make it stop.
POSTTRAUMATIC STRESS DISORDER
In the early 1980s several changes in the way mental health problems
were viewed became evident. The American Psychiatric Association
(APA) recognized that the “war neuroses” of Vietnam veterans were,
vii
viii PREFACE
infact,astress-induceddisorder.Today,theDSM-IV-TR(Diagnosticand
Statistical Manual of Mental Disorders-Revised, 2000) defines PTSD as a
problem experienced by 1 out of 10 people from a variety of stressors
(see Appendix A).
Since that time, PTSD has become an internationally recognized
problem,inthefaceofearthquakes;schoolshootings;randomviolence;
addiction; ethnic tension; and war and torture of individuals, groups,
and cultures. Psychologists, therapists, refugee and aid workers, advo-
cates,andrelieforganizationsseekfastandeffectiveinterventionatthe
time of natural and social catastrophe.
It is expected that 70% of the people who experienced and/or wit-
nessedtherecentterroristattacksontheUSAwillshowsignsofposttrau-
matic stress.Of these, 20%will go on todevelop the disorderof PTSD
6 months after the events. With the expected increase of PTSD in
the wake of these acts of terror, we need quicker and more effective
treatments that address the core of trauma experiences, not just the
symptoms they cause.
Over the past 10 years, active methods of change have come to the
fore to treat all stress-induced disorders. Grassroots groups, such as
self-help, 12-step groups embrace experiential methods in inpatient
treatmentforaddictionsandeatingdisorders.Advancesinpsychother-
apy research show experiential methods can treat trauma effectively
and more efficiently than talk therapy.
EXPERIENTIAL TREATMENT OF PTSD
MyfirstexposuretothetreatmentofPTSDusingexperientialmethods
wasduringmyNIMH(NationalInstituteforMentalHealth)internship
in psychodrama and group psychotherapy at St. Elizabeth’s Hospital,
in Washington, D.C., in the early 1980s. I was practicing my skills as a
new psychodrama director with my peer group of other interns. We
had been having a group conflict, so I told the group to “take their
imaginaryguns,buildtheircamps,andsetupthebattlelines”—enacting
agroupmetaphortomakethecovertovert.Allwentwellwiththeloud
noises of guns, much shouting, and even a few jokes. It seemed the
action structure was helping people to express anger in a safe and
playful manner.
All of a sudden, one of my peers, a Vietnam veteran, started to
experiencebodymemories.Hewasfloodedbyintensedissociatedfeel-
Preface ix
ings.Hefelltohisknees.Hewasunconsciouslyreexperiencingaflash-
back to the war. I was stunned. I had never witnessed a flashback in
thecalmconfinesoftalktherapy.Wewereall,inhisexperienceofthe
moment,unequivocablyinVietnam.Ourstagehadbecomethejungle,
and there were dead bodies of women and children around him. I
looked at my supervisor and said, “What do I do now?” She replied,
“Direct the drama.”
Takingadeepbreath,Ididdirectthedrama.Asahealingcommunity
we walked the jungles with the veteran, gathering up and burying the
woundsofhispast—themen,women,andchildrenheputinapsycho-
dramatic grave. The minister in our group did a blessing and burial.
We joined him in his keel of grief. Time shifted again.
As fellow students, we returned to the here and now of the training
groupandlookedaroundthepsychodramastage.Weheldhands,wept
andsangwithhim,integratinghimbackintoourcommunity.Nowwe,
too,directlysharedhisknowledgeoftheexperienceofthehorrorand
pain of war, and, most importantly, we all experienced healing.
I was touched with the power of classical psychodrama to truly heal
deeppsychologicalwoundsthatday.Iwasalsoscaredasanewtherapist
to use these same methods, for fear of triggering uncontrolled regres-
sionandout-of-controlaffect.Somehowthatday,theseedsofaclinically
modifiedmodelofpsychodramawithtraumabegantotakerootinmy
mind. After completing my PhD in clinical psychology, becoming a
BoardCertifiedPsychodramaTrainer,andpracticingasatherapistand
trainer with trauma survivors for over 20 years, the harvest is in.
ThisbookintroducesbothpractitionersandtrainerstotheTherapeu-
ticSpiralModel(TSM).TSMisaclinicalsystemofexperientialchange
to heal trauma induced by any overpowering life circumstance. It inte-
grates theoretical foundations from neurobiology, self-psychology, ob-
ject relations theory, experiential therapy research, and the methods
of classical psychodrama. Client stories are shared and put into action
to demonstrate the heart and art of the Therapeutic Spiral Model.
Myhopebysharingthisactionmethodinwritingistoreachagreater
number of people who work with and/or have experienced trauma
themselves. It could not be more timely.
VOICES OF SURVIVORS
Although many people have given permission to share their personal
recovery with the Therapeutic Spiral Model, our “clients” do not use
