Healing World Trauma with the Therapeutic Spiral Model. Группа авторов

      Foreword

      Therapeutic Spiral Model as a Type of Psychotherapeutic “Heart Surgery”

      As the authors demonstrate and describe in the first few chapters, trauma is qualitatively different from ordinary neurosis and as such it requires a more intensive approach. The treatment of Post Traumatic Stress Disorder (PTSD) hardly responds to talk therapy. The therapy that counters this complex must be correspondingly deep and more elaborate. I view it from my background as a physician—some people respond to medicines, and some people need major surgery. For trauma, the Therapeutic Spiral Method™ (TSM) offers a complex of techniques that represents the equivalent of heart surgery for trauma survivors.

      About 22 years ago Kate started this work, with Francesca coming in 20 years ago to co-develop TSM as a clinical model of experiential work that integrates the best of psychodrama with other action processes. Several articles, chapters in books, and books have been written since then, and many colleagues have found this approach relevant and effective. Since 1995 TSM has been brought to the international scene and this book offers a further report about how the process has matured and been adapted for use by different populations.

      One of the problems of classical psychodrama is that if it isn’t used with great wisdom, it has the potential to re-traumatize the main player (the protagonist, the one whose drama is being explored). TSM has the advantages of using psychodramatic methods while also meticulously avoiding the pitfalls of re-traumatization. Indeed, this approach specifically works with the fragility and defenses in a way that makes use of the many developments in psychotherapy, including more recent trends that integrate neurobiology. The point is to help the clients or main players to develop skills that can help them better integrate all that was dissociated.

      Being a retired psychiatrist who was trained at a time and place when psychotherapy was a key component, and becoming interested in comparing the underlying elements in psychotherapy as I sought to generate a rationale for my maverick venturing into psychodrama, I enjoy noticing the parallels. Even though there are precursors, I do consider this work to be truly innovative!

      At the core of TSM is the Trauma Survivor’s Intrapsychic Role Atom (TSIRA), a template of roles that the client or protagonist carries within. It involves the notion of adding supportive and creative roles to the protagonist’s role repertoire. But there are other roles, too: trauma-based roles and transformative roles. The TSIRA is thus an active application of what psychoanalysts call “object relations theory.” We all unconsciously imagine and play out scenes deep in our minds; we “hear” at some deep level what the significant others would “say”; we “see” the expressions on their faces. And then we compare this more or less with the real responses and sometimes dismiss what is really being said.

      The TSIRA makes this more explicit, identifies other roles that for most people remain vague, even unconscious, and, by naming them, calls them into active operation. It can give more power to positive inner functions and help to neutralize the power of negative introjects. This is sometimes a creative process, suggesting, for example, the presence and operation of an inner, neutral observer (the Observing Ego role) in people for whom that role had never operated. Creating such a role might help to replace old mental habits of negative self-judging. People can be helped to generate and cultivate these internal supports. Healthy people do this to some degree, and, indeed, that may account for a good deal of why they are mentally healthy! Troubled people have had no modeling, and the culture doesn’t lay out how to do this. However, creating positive inner roles is noted in the chapters on applied role theory in my Foundations of Psychodrama (4th edition, 2000). And with TSM these positive roles are “prescribed” in the TSIRA before approaching any trauma material.

      In TSM two processes meet and reinforce each other: experiential learning (including un-learning old patterns and dysfunctional but deeply held values while re-learning more refined and life-affirming values and skills) and the power of support by others (the TSM action team and the group itself). Lest this seem obvious, note that for much of early life most people are acculturated into a type of learning that is instructional rather than experiential, and a type of learning that is individualistic and even competitive rather than collaborative. So discovering that others can help (and want to help) and in turn appreciate that by doing this process the client is helping the others in the group—this is what Franz Alexander called a “corrective healing experience.”

      TSM utilizes these principles of synergy and support, along with several other fundamental themes. Within the TSIRA template a spiritual or transpersonal context is established—one that is open to individual interpretation and personal religious belief systems, however they may be true for each person. Second, there is a clear sense of purpose: healing, a movement towards wholeness, is suggested, and the person who is the focus of the healing at the time participates and is thus empowered, rather than receiving in some passive mode. This activity adds to what is needed for recovery. Third, the mind is activated in a safe way, with others supporting and even playing the parts of the inner mind, offering reminders of support, of grounding, of time and room to maneuver, of faith in access to creativity, in pursuit of re-integration in a healthier fashion.

      Several elements combine into a potent and compelling ritual, one that can effectively counter the powerful layers of defensive dissociation that operate in trauma: one is the energy of the group, especially a group in action—not just sitting around and talking. There is a kind of vitality of a group doing things, laying down scarves, moving into position—like the activity of nurses and surgeons in an operating room. It is very reassuring, as if to give the protagonist the suggestion that all this is being done just for him or her! Then there is the power of sharing—and the protagonist is reminded that all these caring other people have also been wounded and healed.

      TSM offers a semi-hypnotic ritual process, and it embodies voices faintly heard—spoken by those who play the various types of double roles. Saying the words out loud makes them more vivid in the mind. It seems as if the forces of good are slowly getting louder, drowning out the forces of evil, the other negative voices that say things such as “I can’t, it’s too much, just leave me alone, I want to escape into sleep or booze or drugs, I want to cut myself, or hit my spouse or kids.” Those kinds of inner voices at one point seemed seductively and magically effective in relieving the inner tension, but the new voices recognize these frightened responses, accept them, but also offer healing alternatives.

      Protagonists experience an engagement with, rather than an escape from, the truth of their memories, the trauma, and so they feel a little braver. But it is nicely buffered so they don’t have to be overwhelmed as they were originally. TSM thus operates to offer a little distance, somewhat like a light anesthetic. Yet the protagonists feel involved, they feel that it is they who are “doing” it. They think/feel something akin to “I’m feeling active in healing myself—yes, with help—but at least I’m not so passive anymore.” That is good, too.

      There is great strength in the presence of kind, powerful, caring people, enough of them so they can’t be dismissed as being mean or not empathic enough. (This is a disadvantage of one-to-one therapy, in which therapists too easily become an object of transference or projection.) TSM is also a method that protagonists can track, stay oriented with at a cognitive level. Yet the processes and symbols heal also at more unconscious