Healing World Trauma with the Therapeutic Spiral Model. Группа авторов
we have been privileged to be allowed entry into pained hearts and minds, so it is with appreciation, respect, and humility that we recount these many stories.
And it is with a sense of bounteousness and sharing that we invite you to touch down with us into diverse countries and cultures and into the varied applied modalities and the healing power of TSM. This is a journey of spontaneity and creativity that revitalizes bodies, minds, hearts, and spirits when we join together to face the trauma of the past and enter the future with hope.
In many ways, TSM can be considered an “open source” model of theory, research, and practice of experiential psychotherapy to treat Post-Traumatic Stress Disorder (PTSD). While Kate Hudgins is credited with being its initiator (Hudgins 2000, 2002, 2007a, b) and Francesca Toscani the primary co-developer (Toscani and Hudgins 1993, 1995; Toscani 1995a, b, 1998), TSM has, in fact, been deeply enriched by what many others—students, colleagues, teachers, clients, and patients alike—have brought to it over several decades of healing.
This book is a personal as well as a professional recounting and therefore is written oftentimes in storytelling style using first names. It allows the original threads to be seen as they evolved from Kate’s experience as a clinical psychologist, certified trainer in psychodrama, and a woman with a history of PTSD herself. Francesca joined Kate in the early 1990s and by 1995 projected the model into use as a healing method for cultural or collective, as well as personal, trauma. As shown here in these stories from the frontlines, many others have added their experiences and expertise to propel TSM into a seminal, experiential psychotherapy to treat the effects of trauma in the global community.
The Therapeutic Spiral Model
The Whole Person—Not Just the Brain
PTSD has been recognized as a condition as long as there have been wars and trauma, but only recently has it been labeled as that and its symptomatic picture diagnosed as we know it today (DSM III 1980 – DSM IV-R 2000) (American Psychological Association 2000). Through the ages it has had several names that we recognize: stress reaction (Vietnam War), combat or battle fatigue (WWII and Korean War), and shell shock during WWI. However, a name given for this combination of symptoms during the American Civil War is one that rings true for TSM work—a condition then called “soldier’s heart,” because it is from the heart that TSM practitioners approach the work and connect with those who suffer from all types of trauma.
Moreno is known to have said that all patients are doctors and that group members being auxiliaries for each other is actually the impetus for healing (Moreno 2008, personal communication). Classical psychodrama affirms the importance of interpersonal healing through personal sharing at the close of a drama. As TSM practitioners we carry on this personal touch, noting clearly that trauma survivors need to be met human-to-human and not doctor-to-patient—that the power of healing lies in the sharing of restorative stories and the connection from the heart. However, TSM emphasizes intrapsychic change as its primary focus in order to stabilize personality structure before interpersonal encounter.
The Clinical System of the Therapeutic Spiral Model
TSM is a clinical system or map of experiential psychotherapy to treat PTSD and other psychiatric disorders, as well as more general psychological problems in living, from an intrapsychic perspective. Predating recent trauma theory and trauma neurobiology, yet incorporating them, the operational underpinnings of TSM are founded in classical psychodrama (Moreno and Moreno 1969) and in clinical psychology. Beyond these elements, TSM practitioners have brought various theoretical and spiritual disciplines as even broader containers for the work.
Trying to understand these relationships, one new trainee clearly and visually noted, “It’s as if there are three nesting bowls.” The first is classical psychodrama with its theory and experiential techniques. Holding it, the TSM bowl provides an extensive clinical framework or map yielding a more elucidated methodology for trauma. The largest bowl, encompassing the others, is the broader philosophical or spiritual orientation of the therapist. Seen as concentric circles, these modalities do not fight each other but co-exist with a constant give-and-take that nourishes.
While TSM began as a Western model of treatment, today its roots tap into Native American and Eastern philosophies and practices as well, continuing to evolve as practitioners integrate their knowledge into the basic trauma template of the Therapeutic Spiral Model. Utilizing this potent and vibrant combination has allowed TSM to provide safe and effective experiential psychotherapy for people with even the most severe diagnoses. Preliminary research has shown that TSM can significantly reduce anxiety, depression, dissociation, and general symptoms of trauma in three sessions of individual or group psychotherapy, as well as in community organizations (Hudgins, Drucker, and Metcalf 2000; Hudgins, Culbertson, and Hug 2009).
Additionally, through constant feedback on evaluation forms, therapist follow-up, open discussions in training groups, and shared leadership as trainers, TSM has been able to continue to develop and mature. This book reflects the ways that students and colleagues take TSM and “make it their own,” adding to it their areas of expertise and knowledge—which, in turn, influences the model to change, grow, and develop into an even better system of experiential psychotherapy. The reciprocity, the give-and-take, creates a broader yet more specific base from which to treat PTSD, addiction, eating disorders, and other stress and psychiatric ills in today’s world.
The Spiral Image
The spiral image emerged from Kate’s experience as a clinical psychologist and psychodrama trainer with her own history of sexual trauma. Having had PTSD before it was a diagnostic category, she knew first-hand the internal experience of chaos, of body memories, flashbacks, and other disruptive symptoms that felt like a tornado. When they would come on unexpectedly, the personal experience was one of being buffeted by wild winds swooping in from every direction. As all untreated survivors know, this sense of being totally out of control and helpless is internally generated, unlike the original trauma, which was interpersonal.
Working with trauma survivors as a clinical psychologist, Kate chose a spiral of energy as a way to begin to channel and focus the chaos without repression. She sought to give clients a step toward safety and containment, to move one step from a tornado to a spiral that could begin to be consciously controlled. Kate knew that the chaos could not be immediately stopped, so she taught survivors a tangible and workable tool to anchor them in the here-and-now reality of safety. The tornado now becomes a spiral of energy containment.
Second, timeless images of spirals are found collectively as healing symbols, from ancient cave paintings in France to shamanic use in Native American cultures to modern medicine’s Hermes’ caduceus, which originally had ribbons (TSM ribbons?) instead of serpents winding around the rod. In TSM, the spiraling energy represents the journey of a trauma survivor from hell to healing. Because PTSD, by American Psychiatric Association (APA) definition, is a condition beyond normal human experience, we join with other therapeutic and spiritual traditions in that one of the Spiral’s core threads ties survivors into a transpersonal or spiritual dimension of healing.
TSM also recognizes classical psychodrama, which has as its mode of action the Psychodramatic Spiral (Goldman and Morrison 1984). This spiral is about approaching a drama from periphery to the center—a circular motion of metaphorically walking around and slowly closing in on an issue. While not exactly the same, TSM’s modus operandi is to approach traumatic experiences by setting up strengths and safety first through a series of roles and then, with deepening dramas over time, to descend gradually to the core issue—for safety reasons, never slicing through to the quick.
Spiral Threads
The fabric of TSM is strong, woven by many hands, while the Spiral’s three strands represent the three basic and far-reaching elements of the work—Containment, Experiencing, and Meaning-Making.
Containment: keeps