Episode 140 - VBT Study Hall: What Does “Trauma-Informed” Mean?

Trauma-informed therapy is…what, exactly? And is trauma actually stored in the body, or is that just a clever narrative that a few enterprising gurus have used to sell books and trainings? We dig deep into the research on trauma to answer these questions and more, and Carrie introduces her breakthrough trauma-focused treatment: dog therapy.

Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Sentio Counseling Center– high-quality, low-fee online therapy in California with immediate availability for new clients.

Show Notes:

• Trauma-Informed Care in Behavioral Health Services: Appendix C – Historical Account of Trauma

• Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions

• Key Ingredients for Successful Trauma-Informed Care Implementation

• What Is Trauma-Informed Therapy?

• Is Your Therapist ‘Trauma-Informed’? (And Why It Matters)

• Envisioning a trauma-informed service system: A vital paradigm shift

• Trauma-Informed Care (Encyclopedia of Social Work)

• Why Trauma-Informed Care Matters

• Trauma- and violence-informed care (Wikipedia)

• Trauma-Informed Care in Behavioral Health Services: Chapter 1 – Trauma-Informed Care: A Sociocultural Perspective

• The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct comparisons

• APA Clinical Practice Guidelines for Treatment of Posttraumatic Stress Disorder in Adults

• APA Clinical Practice Guidelines PTSD Treatment Recommendations

• Clinical Practice Guidelines: Beneficial Development or Bad Therapy?

• Relationships and Responsiveness in the Psychological Treatment of Trauma: The Tragedy of the APA Clinical Practice Guideline

• Our Primitive Response to Stress

• Debunking Myths About Trauma and Memory

• The Return of the Repressed: The Persistent and Problematic Claims of Long-Forgotten Trauma

• Belief in Unconscious Repressed Memory Persists

• Exploring the Controversy of Polyvagal Theory

• The Brilliant Marketing of Bessel van der Kolk and Stephen Porges and His Polyvagal Theory

• Polyvagal Theory – Useful Narrative but Still Just a Theory

• The Problem with The Polyvagal Theory

• Domestication of the dog (Wikipedia)

• Dogs as Pets: How Dogs May Have Helped Homo Sapiens Triumph Over Neanderthals

• What Happened to Mirror Neurons?

• What is Interpersonal Neurobiology (IPNB)?

• Transcript

  Carrie Wiita [00:00:00]:

  Welcome to Very Bad Therapy, a closer look at what goes wrong in the counseling room and how it could go better, as told by the clients who survived. From Los Angeles, I'm Caroline Wiita.

  Ben Fineman [00:00:11]:

  And I'm Ben Fineman. Legally encouraged to say that this podcast does not constitute therapeutic advice, but it will get interesting. Let's get started.

  Carrie Wiita [00:00:24]:

  You?

  Ben Fineman [00:00:25]:

  I okay. Carrie, how would you describe the episode we're about to record, just based on our preliminary conversations and all of the texts and capital letters you've sent me over the last week?

  Carrie Wiita [00:00:37]:

  I describe it as so depressing and so annoying. That's how I would describe it. I am so depressed right now. I am so depressed about the state of our field.

  Ben Fineman [00:00:52]:

  Do you want to give a teaser about why or should we jump in and let it unfold as we talk about all yeah.

  Carrie Wiita [00:00:57]:

  Let's do that. That one. That one.

  Ben Fineman [00:01:00]:

  Well, if you're up for it, I would like to give a bit of an outline on how we're going to present this information.

  Carrie Wiita [00:01:06]:

  Yeah, let's do it.

  Ben Fineman [00:01:07]:

  Because I think for the first, maybe half of the episode, it may not seem obvious why you are so depressed in response to all of this information. I'm actually not sure. So the first half is the research I did on the definitions of trauma in our field, the history of how trauma has been thought of in our field, the definition, history of the idea of something being trauma informed, and then also what research has suggested to this day on what is the best way to treat trauma. If being trauma informed implicit in that means it's the best way to treat trauma, what do all of the smartest people in our field say to actually do with clients? And that's where I stopped. And that's only moderately depressing, but I know the second half of this episode. What exactly will you be bringing everybody down with?

  Carrie Wiita [00:01:58]:

  I tried to find the answer to what does it actually mean for trauma to be stored in your body? That's what's fucking depressing is the answer. No, it's not. The answer is not what's? That's not what's depressing. What's depressing is the absolute journey I had to go on to sort through the absolute chaos that is this topic and arriving at very, very unsatisfying conclusions. And that's what's depressing. So I'm going to take you all down with me.

  Ben Fineman [00:02:36]:

  Do we need to do some grounding exercises?

  Carrie Wiita [00:02:39]:

  Oh, shut up. Today. I am so team CBT. I have never been more Team CBT in my entire life than today. This is where trauma informed therapy has brought me.

  Ben Fineman [00:02:55]:

  As we'll get to in a little while, you are squarely on the side of the APA. And Scott Lilienfield, you're also very much against Bruce Wampold and Jonathan Schedler as we'll get into unsurprisingly. This is an unsolved puzzle in our field, right? There are very smart people on either.

  Carrie Wiita [00:03:16]:

  Side of what there are really good people on both sides anyway.

  Ben Fineman [00:03:22]:

  Should we zoom way out and just talk about trauma? And what is trauma in the context of mental health?

  Carrie Wiita [00:03:29]:

  Yes, that's a good starting point.

  Ben Fineman [00:03:31]:

  So I think the best place to start is using the DSM definition of trauma because I think that anchors what we are told to think of when we hear the word trauma as therapists.

  Carrie Wiita [00:03:42]:

  Yes.

  Ben Fineman [00:03:43]:

  So here's what the DSM defines trauma as exposure to actual or threatened events involving death, serious injury or sexual violation in one or more of the following ways directly experiencing the events. Witnessing the events in person as they occurred to others learning that the events occurred to a close family member or friend or experiencing repeated or extreme exposure to adverse details of the events. So how did we get here? How is this the definition of trauma based on where we've been in our field? And it starts with World War I unsurprisingly back when the idea of trauma or PTSD was called shell shock. And this was a more physiological idea of what trauma is that something happens on the battlefield and it has some impact in a soldier's functioning after the war is over. Interestingly. And Carrie, this is something that you and I didn't really get into when we were looking at the history of the DSM. Around the same time as the idea of shellshock was becoming popular, the Industrial Revolution was kind of well underway. And so we had other kinds of dramatic catastrophes, like industrial accidents, railway accidents and other scenarios where it's not just people coming back from war that are experiencing shell shock, but people who have been in some kind of accident that wouldn't have happened a couple of hundred years ago because the technology hadn't developed. And so now here we are in the early to mid 20th century, finding a need to describe what is happening to people when they experience some psychological impact of this kind of stuff.

  Carrie Wiita [00:05:23]:

  But wait up though. Hold up. Just to push back on that point, I feel like the Catholic Church instilled a lot of trauma during the Inquisition.

  Ben Fineman [00:05:32]:

  So you're saying trauma has been part of human history long before the last couple of hundred years?

  Carrie Wiita [00:05:38]:

  Yeah, I don't think we can tie it directly to the Industrial Revolution.

  Ben Fineman [00:05:43]:

  Oh, sure. Yes. And something that is obvious when you look into the history of trauma and the idea of being trauma informed is that quite obviously, trauma did not just develop. It's not a new invention. Nor is being trauma informed. Just because we have a word for it now doesn't mean that people weren't doing trauma informed things decades or even potentially centuries ago.

  Carrie Wiita [00:06:04]:

  Right, good point.

  Ben Fineman [00:06:06]:

  Okay, so early mid 20th century, we're still kind of associating this idea of trauma with war, with big catastrophic events. And so during the Korean and Vietnam Wars, there was a shift where the US Department of Veterans Affairs, which back then was called the Veterans Administration started to look at how can talk therapy be used to help people suffering from what is now PTSD. And so this is when you saw the first groups being developed for PTSD, and it was still very much tied to these kinds of traumatic experiences from war. So in 1980, the DSM Three was published, and this was the first time PTSD was in the DSM as a diagnosis, and it was inspired by symptoms presented by veterans of the Vietnam War. And so to qualify for a diagnosis of PTSD under the DSM Three, there needed to be a very specific stressor, a catastrophic stressor that was outside the range of usual human experience. And then in 1994, when the DSM Four was released, the definition of trauma broadened in terms of what the identified stressor could be. And so you see, this evolution from this is just what happened with men coming back from war to a bit wider in terms of what might be impacting people who are now struggling to now what the DSM Five? Defines it as which is it could happen to you. It could happen to somebody else. It could happen to somebody and then you hear about it. It is still rooted in a very catastrophic specific stressor, but it broadened over time. And so when you're talking about trauma from, like, a DSM perspective, there has to be something specific that caused it. But what that is doesn't have to be rooted in wartime maladies or anything like that.

  Carrie Wiita [00:07:48]:

  Right, okay. That makes sense.

  Ben Fineman [00:07:50]:

  Yeah. And as we get into this and we talk about trauma, as far as I know, the best research that I came across says that about ten to 20% of people who experience a trauma will develop PTSD symptoms afterward. And I think that's also important because as therapists, when we hear the idea of trauma, we're usually hearing it in the context of somebody who's in therapy. Therefore, they likely have some or many symptoms of PTSD. But the vast majority of people who experience a trauma do not develop PTSD symptoms. And I think trauma is one of those terms that has kind of lost all meaning because it simultaneously means I was held up at gunpoint and almost died.

  Carrie Wiita [00:08:32]:

  Right.

  Ben Fineman [00:08:32]:

  And also, oh, my God, traffic was so bad. I was so traumatized this morning trying to get my Starbucks.

  Carrie Wiita [00:08:37]:

  Right. Wait. Quick question, though. So if you are held up at gunpoint and you don't have symptoms of PTSD, if it doesn't stick around with you, it doesn't negatively affect you, is it still trauma?

  Ben Fineman [00:08:50]:

  I think it depends on where you look, but yes, it is a trauma. But you do not have post traumatic stress disorder because you may not develop those symptoms after the trauma itself.

  Carrie Wiita [00:09:02]:

  Right. Okay, cool. And then for somebody who maybe has a fear of clowns, say, and they get stuck in a room, like on an elevator with a clown say, to most of us, I'd be more worried about the elevator. But that probably wouldn't be considered a traumatic event for most people, but for this person, that it would be a trauma because it was a traumatic experience and it did result in trauma symptoms. Is that right? Am I following this correctly?

  Ben Fineman [00:09:41]:

  It's a great question. I'm so glad you asked it, because I think it gets to the problem contained within that DSM diagnosis is according to the DSM diagnosis, what you just described would not qualify somebody for PTSD, because it's not like, hold on, let me find the definition. There was no actual or threatened death. There was no threatened or actual serious injury or sexual violation. So note, this person could not qualify for PTSD. This would not be considered a trauma. But you might hear that and say, okay, but that's a bit of an unusual example, so maybe we can brush that off. Sure, but what if you're listening and you say, okay, but what if somebody was raised in a very challenging childhood environment where there was no threatened death, there was no threatened harm or violence, but maybe they experienced some neglect, or they had unreliable parents, maybe they had parents with addiction issues. Shouldn't there be some trauma that we're looking at? And according to the DSM diagnosis, the answer is no, and this has been a long fight. Bessel Vanderk was at the forefront of this, of getting developmental trauma or complex trauma included in a future edition of the DSM. But when we talk about trauma in the field of mental health, that stuff counts, even if it doesn't count in the DSM, at least colloquially. You don't hear somebody say, my client has so much trauma and think, okay, they probably had a perfect childhood. You think, well, that might include challenges in their childhood. And so this is where the Asus study is so important. And the Asus study stands for adverse childhood experiences. And this was a massive study in California. They started collecting data in the mid 90s from over 17,000 patients, and so they got lots of personal and family history. But also participants were asked about their experiences of abuse in childhood, neglect, family dysfunction, sexual and physical abuse, exposure to violence in the household, et cetera. And so the researchers found that the more of these types of experiences that somebody had, the more likely that they would have lifelong problems, not just psychologically, but also physically with their health. And so that really speaks to the clown hypothesis. Carrie which is something might not fit in that DSM definition of trauma. But when we talk about trauma in our field, we are almost always including this kind of stuff because it's so pervasive in terms of how it impacts people in the later parts of their life. So I have two other definitions that we can kind of put alongside the DSM. One, that I think speak to this more broad idea of what trauma is when we think of how do we define it. So one is from Bessel Vanderkolk and he talks about trauma as an experience and response to exposure to one or more overwhelming dangers, which causes harm to neurobiological functioning and leaves a person with impaired ability to identify and manage dangers. This leaves them constantly fighting unseen dangers. So it's a bit more broad and I think that gets more to what we talk about when we say trauma in our field. Another definition comes from SAMHSA, which is the Substance Abuse and Mental Health Services Administration. And I like this one a lot. Individual trauma results from an event, series of events or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well being. Examples of trauma include but are not limited to experiencing or observing physical, sexual and emotional abuse, childhood neglect, having a family member with a mental health or substance use disorder, experiencing or witnessing violence in the community or while serving in the military, and poverty and systemic discrimination. So when people are saying trauma informed, that's what they're usually referring to. Not just, I know the DSM criteria, right, and I've passed my law and ethics class in grad school, but that people can be impacted by a wide variety of events and those impacts can linger well into adulthood and beyond throughout the rest of their life, really. And we think of that as a trauma to some degree. Don't mean to keep going or are you just like eager for me to be done so you can get to your no stuff about the polyvagal theory?

  Carrie Wiita [00:13:55]:

  No, that's the thing is I'm hoping that you're going to like I'm hoping something you say just solves everything for me, but not so much. No, but what I really appreciate about what you've said so far is I think it points me and I see the path now to how we're getting to trauma informed psychotherapy. I'm starting to get what it means. Trauma informed therapy doesn't necessarily mean EMDR or whatever. It's this bigger thing that you're talking about.

  Ben Fineman [00:14:30]:

  I love this. You're like one step ahead of me every time. This is great.

  Carrie Wiita [00:14:33]:

  You're really good at leading me to water.

  Ben Fineman [00:14:35]:

  Thank you. So let's define trauma informed and then let's talk about the history of that term in our field. Okay, so I tried to figure out is there an agreed upon definition of trauma informed and this might actually end up giving you a bit of hope.

  Carrie Wiita [00:14:49]:

  Oh, okay.

  Ben Fineman [00:14:51]:

  So first let me start by not giving you some hope.

  Carrie Wiita [00:14:55]:

  Okay.

  Ben Fineman [00:14:56]:

  I found a few definitions in various places and I want to read through them because you might be asking yourself, is this just one of those terms that doesn't actually mean anything, right? That when you say it to another therapist, there is no objective definition. But you know what they mean. Even if you don't know the words, you could feel it in the body, almost like somatic holding space. Yeah, exactly. It's like holding space. You know what that means? I know what it means, but what does it actually mean?

  Carrie Wiita [00:15:24]:

  Right.

  Ben Fineman [00:15:25]:

  Okay, so first, a definition of trauma informed care from Bessel Vanderkolk, a framework for working with and relating to people who have experienced negative consequences after exposure to dangerous experiences. So he's simply saying trauma informed care is working with people who have trauma. Not that deep.

  Carrie Wiita [00:15:42]:

  Right.

  Ben Fineman [00:15:43]:

  Another one I found from the website. Very well. Mind traumainformed therapy is not about a specific intervention, but rather tailoring interventions in the context of the individual's trauma history, triggers, and specific needs. It is a lens through which therapist views their clients, taking into account the impact of trauma on emotions, regulation, and behavior. They will also consider the effect of intergenerational trauma on clients.

  Carrie Wiita [00:16:06]:

  You are giving me hope. Keep going.

  Ben Fineman [00:16:08]:

  Oh, am I?

  Carrie Wiita [00:16:09]:

  Yeah.

  Ben Fineman [00:16:10]:

  So there they're saying that trauma informed therapy isn't just like this one thing you do, but like an idea. It's a stance. It's knowing that trauma impacts people and stays with them throughout their life until it gets resolved. And so trauma informed care is kind of knowing that it doesn't really say what you do, but that's the idea. Okay, then there's an article from Psychology Today kind of reinforces that. It says trauma informed care is not about specific therapeutic techniques. It is an overall approach, a philosophy of providing care. Let's look at some of the key principles of trauma informed care. A safe therapeutic environment is essential to aid in recovery. Trauma related symptoms and behaviors originate from adapting to traumatic experiences. Recovery from trauma is identified as a goal in treatment. Resiliency and trauma resistant skills training are part of treatment. Trauma informed care includes a focus on strengths rather than pathology. And lastly, trauma recovery is a collaborative effort. And I see you giving me the thumbs up. What's going on?

  Carrie Wiita [00:17:12]:

  Yes, this is giving me hope, because I went into this being like, I'm pretty sure that I'm in favor of trauma informed care. I'm not against it, but I felt like my problem was really that I didn't understand it and that I hadn't taken the time. I had been, like, an irresponsible therapist. And when the neuroscience stuff started going, I just kind of, like, zoned out, and I should have been paying attention. And so that's why I don't understand really what trauma informed care is.

  Ben Fineman [00:17:43]:

  I have the same feeling deep down, and I think so many people hearing this are like, oh, my God, it's not just me.

  Carrie Wiita [00:17:47]:

  No, it's not. You did not. And what's giving me hope is the sad part. I looked at that, I forced myself to take that pill and really try to pay attention to the quote unquote neuroscience stuff. And that's the part that made me depressed. And so what you are offering me here is a definition of Trauma Informed Care that is hitting all of the things that resonated for me that I think are important. As a therapist, I'm in favor of all of that shit. And it sure sounds like you can do it without doing any of the approaches that I'm going to talk about later, which I now feel like super conflicted about all of them.

  Ben Fineman [00:18:28]:

  Yeah, I think we're really on the same page about this. So let me give you even more optimism here.

  Carrie Wiita [00:18:33]:

  Oh, good. I love this. Way to save it then.

  Ben Fineman [00:18:36]:

  Well feel like most of our study hall episodes end with like, nothing's real. So we will pop the balloon.

  Carrie Wiita [00:18:44]:

  We'll get there.

  Ben Fineman [00:18:45]:

  Okay, so you didn't miss what Trauma Informed Care is as a specific thing, but there is like a codified idea of what it is. We just weren't taught it. And people aren't really taught it because I don't know why, but I'm going to tell you about it. So the people who came up with the term Trauma Informed Care as it pertains to mental health, maxine Harris and Roger Fallow. Fallot. F-A-L-L-O-T. How would you pronounce that, Carrie?

  Carrie Wiita [00:19:14]:

  Oh, that could go either way. Fallow or fallot. I don't know.

  Ben Fineman [00:19:18]:

  We'll go with fallot.

  Carrie Wiita [00:19:19]:

  All right.

  Ben Fineman [00:19:19]:

  So they had a paper in 2001, and this was when Trauma Informed Care, the term showed up in our field. The paper was called Envisioning. A trauma informed service system. A vital paradigm shift. And what those two have presented over the years is that Trauma Informed Care is built on five core values. And this isn't just like a random thing I found. The CDC has this. A lot of other places have this. So unless they're all just doing that thing where they copy somebody else's work.

  Carrie Wiita [00:19:47]:

  I don't think the CDC really does that much.

  Ben Fineman [00:19:50]:

  I think what Fallow and Harris came up with is considered the standard for what Trauma Informed Care is.

  Carrie Wiita [00:19:55]:

  Great.

  Ben Fineman [00:19:55]:

  And so they say it's built on five core values. And I'm going to read the values and then get a bit into each of them. Number one is safety. Number two is trustworthiness. Number three is choice. Number four is collaboration. And number five is empowerment. So they explain safety means both physical and emotional safety. So in therapy, obviously, it's a safe physical space, but a safe emotional space as well. That's straightforward. Trustworthiness relates to the clarity of expectations, providing consistent service delivery, and maintaining boundaries so the client knows what to expect and they get what they expect. That's trauma informed.

  Carrie Wiita [00:20:30]:

  Right, okay.

  Ben Fineman [00:20:31]:

  So the third one is choice. And they say this is important because it gives the consumer control over the services they receive. And relevant to this is the fact that as a victim of trauma control was taken from them during the traumatic event. So you're giving the client the ability to opt in or out of certain things at any time and not just say, we're doing X, Y, and Z. Tell me about your trauma right now. The client maintains a sense of control and choice over what's happening. Number four is collaboration. So client involvement and sharing of power obviously a very trauma informed stance. And then number five is empowerment, which they say relates to the development and enhancement of skills. In a sense, you're not just making someone dependent on you. You're empowering them to deal with their struggle on their own. So it's not just relying on a therapist.

  Carrie Wiita [00:21:17]:

  I just had, like, a light bulb moment. You're reading this, and you're connecting it to therapy, and I'm realizing, I think, part of what was so fucking confusing to me about trauma informed care because I heard about it first in grad school as it applies to psychotherapy, I couldn't really figure out I was like, Isn't that therapy? Isn't that exactly what we do? Isn't that what the whole point of this field? Nobody doesn't do it like that. I couldn't figure out I was like, what is different about this concept that we need this other term for it? But what you're describing to me sounds it's making me realize that a lot of the literature that I was looking up was coming out of, like, nursing journals or something, that trauma informed care probably is a bigger shift for the medical community than for the therapeutic community necessarily. And that if you're talking about if you go back and read that list that you just read, and if you're not trying to think about therapy but you're trying to think about doctoring, you're trying to think about a patient in a hospital, a lot of those are starkly different than I think how a lot of medical experiences are experienced by patients.

  Ben Fineman [00:22:32]:

  Once more, you're just a few steps ahead of me.

  Carrie Wiita [00:22:34]:

  Shut up. Really? God damn, you're good, Ben. It's all you.

  Ben Fineman [00:22:38]:

  No, you're good, because I just compiled what existed, and you're already figuring out exactly what's next.

  Carrie Wiita [00:22:44]:

  We're a perfect team.

  Ben Fineman [00:22:46]:

  Yes. Before we get there. So I mentioned the CDC.

  Carrie Wiita [00:22:51]:

  Yes.

  Ben Fineman [00:22:51]:

  So they don't have quite the exact same list, but it's basically the same. They combine empowerment and choice, and then they add two. They add peer support, but that's more focused on kind of like, health care as a whole on an organizational level. But they also add cultural, historical, and gender issues. So Fallow and Harris didn't quite get that far, but the CDC and other places where you look online to see what does trauma inform mean? Will include a trauma informed therapist will be mindful of cultural, historical, and gender issues, which, again, isn't that just what a good therapist will do? And the answer is yes. So before we get to the history of trauma informed as a term in our field. Quick aside, Carrie, do you know the difference between trauma informed therapy and trauma focused therapy? Because I'm a bit embarrassed to say I did. Not until I looked this up.

  Carrie Wiita [00:23:40]:

  No. I can hazard a guess, but I don't think I've ever stopped and been like, oh, those are two different terms.

  Ben Fineman [00:23:48]:

  Yeah, they are. Do you want to guess?

  Carrie Wiita [00:23:52]:

  Right, I'm guessing. Well, you've given me a lot of context clues here, Ben, so I'm assuming that trauma informed is like everything that you've just described. You're, like, holding all of this as you are going through your caretaking, caregiving responsibilities, whatever. But I would assume then that must mean that trauma focused care is that the care is deliberately focused, like in therapy, deliberately focused on the trauma. Yeah. So good. So good at this game.

  Ben Fineman [00:24:26]:

  Isn't it weird, I wonder if you and I are alone in this and everybody's like, of course, but isn't it weird you and I just never knew this. It's so obvious.

  Carrie Wiita [00:24:36]:

  I swear to God, Ben, it was like one of those things that I chalked up to. I put it in a folder in my head that was like, figure this out later. I just didn't get to it.

  Ben Fineman [00:24:49]:

  Yeah. So if anybody else out there is like, oh, holy shit. There you go. Okay, so this term trauma informed, as I mentioned, the term trauma informed care showed up in 2001.

  Carrie Wiita [00:25:02]:

  Okay.

  Ben Fineman [00:25:02]:

  And obviously people have been doing trauma informed care in various contexts. Nurses, as you were mentioning for a long time, have you ever Googled something and you see the little box in the corner that shows the trajectory, like the popularity of the term over the years?

  Carrie Wiita [00:25:17]:

  Yes.

  Ben Fineman [00:25:17]:

  If you look at trauma informed, it basically didn't exist until about 2010. So the term itself is really like 13 years old in terms of being even remotely popular. And since then it's just been on a steady climb. Yeah, but let's go back. Let's go back a bit, a couple of decades. I'm just going to read this because I think this is all great here and it speaks to what you were saying long before anybody used the term trauma informed. Like, before 2001, caring professionals and committed volunteers were instinctively acting in a traumainformed manner. Much of this was influenced by the emergence of the feminist movement and the increasingly influential voice of survivors of interpersonal trauma, as seen in the rape crisis centers and the domestic violence movements of the 1970s, and the dramatic growth of child advocacy advocacy centers and multidisciplinary teams in child abuse in the 1980s. These natural incubators for traumainformed innovation and practice were married in the 1990s with the growing body of science and trauma specific empirical research into how human beings respond in the aftermath of traumatic events and how professionals and concerned activists could help them move toward recovery. That stream of research began with interest in combat related PTSD after the Vietnam War, and by the mid 1980s, the focus had expanded and was adopted by the wider mental health community as a relevant construct for understanding the cascade of symptoms often noted after rapes, shootings, and other major traumatic life events. In 1985, the International Society for Traumatic Stress was founded in the United States and served as a focal point for professionals searching for answers to support highly traumatized populations. By 1989, the United States Department of Veterans Affairs had created the National Center for Post Traumatic Stress Disorder. And in the 1990s, SAMHSA within the US. Department of Health and Human Services recognized the role of trauma in a significant number of women's issues and gender specific treatments. And over the next 20 years, a huge expansion of knowledge about trauma and traumatic stress occurred. So all of that kind of leads up to 2001, when Fallow and Harris kind of put the term trauma informed care out there. But obviously, trauma informed care goes back. Probably as long as there's been trauma, somebody's been there being like, take your time. You can tell me about it. When you're ready, I'm here for you. That must be really hard. I'm sure that awful thing, like, we almost got run over by a donkey when you were seven is still impacting you. That was around people were doing this stuff, right? Yeah. So just to complete the timeline here, since we're now caught up to the early 2000s, researchers and government agencies immediately began expanding on this concept of trauma informed care. In the mid 2000s, SAMHSA started measuring the effectiveness of trauma informed care programs because you had a lot of data coming out. And so in 2011, SAMHSA issued a policy statement that all mental health service systems should identify and apply trauma informed care principles. And this has since expanded into education, child welfare agencies, homeless shelters, domestic violence services, et cetera. And it's just continued to expand. And we talked about the Asus study where it wasn't just trauma is people coming back from war. Adult women are kind of left out of this equation because the people coming back from war are disproportionately men. The Asus Study, the Adverse Childhood Experiences Study, looks at what happens when people experience, quote unquote, trauma in childhood. So there was a very, very significant study in the early 2000s called the Women Co Occurring Disorders and Violence Study. And this looked at the relationship between traumatic experiences and mental health among women. And what they found was that women who have severe mental illness have rates of lifetime physical or sexual assault ranging from 51% to 97%. Dang so now you're seeing the link between people experiencing traumatic things on the battlefield and that lingering childhood experiences and that lingering. Women experiencing physical or sexual assault, and that lingering. And all of this is swelling right around the same time, social media is becoming a thing and exploding. And so it's getting a lot. More attention and people are able to talk. And so you have a perfect storm for the word trauma taking over and becoming a buzzword, because now everybody is aware that trauma can impact everybody and can say things like, oh, my God, traffic to get to Starbucks was so.

  Carrie Wiita [00:29:40]:

  Traumatic this morning, right?

  Ben Fineman [00:29:42]:

  And now here we are.

  Carrie Wiita [00:29:43]:

  Yeah.

  Ben Fineman [00:29:44]:

  All right, so let's talk about with all of this knowledge and all of this cultural awareness and all of these studies, how do we treat trauma now that we have an idea of what trauma informed care is, what is the best way to do it?

  Carrie Wiita [00:29:55]:

  Right.

  Ben Fineman [00:29:56]:

  So, very obviously, this falls off a cliff, because if we knew this answer, we wouldn't have to talk about it. We'd just say, Go do EMDR. So we'll start with the common factors, because anybody who's listening to this podcast knows that you and I are big proponents of the common factors. And so in 2007, Bruce Wampold and a few others published a metaanalysis that found that there was no difference in treatment effects or treatment effectiveness among bona fide therapies for PTSD. And that's exactly what you'd expect Bruce Wampold to write a paper on, which is to say, we found that the modality doesn't matter as long as it's a bona fide therapy, it's going to be just as effective. And that sounds great, and I want to believe that. And I think you and I have talked about that as, like, a truth in the past.

  Carrie Wiita [00:30:44]:

  Right?

  Ben Fineman [00:30:45]:

  But things get really kind of fucked up. In 2017, the APA released a 700 plus page document, clinical Practice Guidelines for Treating PTSD in Adults. Okay, so they did as comprehensive of an analysis as could be possible. They considered four factors in their recommendations for how to treat PTSD. Those four factors were the overall strength of the evidence for the treatment, the balance of benefits versus harms or burdens, patient values and preferences for treatment, and the applicability. It's one of those words that I forget.

  Carrie Wiita [00:31:24]:

  You nailed it.

  Ben Fineman [00:31:25]:

  I read it and it lost meaning.

  Carrie Wiita [00:31:26]:

  You nailed it.

  Ben Fineman [00:31:27]:

  Applicability of evidence to various populations. So the APA is basically doing exactly what you'd want them to do when making recommendations. Do you want to guess what the APA said the best ways to treat trauma are?

  Carrie Wiita [00:31:42]:

  No, I don't.

  Ben Fineman [00:31:44]:

  Okay, so they have two categories strongly recommends and conditionally recommends.

  Carrie Wiita [00:31:49]:

  You know what? I will make one guess. CBT is at the top of the list.

  Ben Fineman [00:31:53]:

  Oh, CBT is at the top of the list with a lot of its friends. Okay.

  Carrie Wiita [00:31:59]:

  CBT has friends.

  Ben Fineman [00:32:01]:

  You'll see four treatments. Four treatments are in the strongly recommends category. CBT, so cognitive behavioral therapy, cognitive Processing therapy, cognitive therapy, and prolonged exposure. So the strongly recommended treatments for PTSD are all kind of in the CBT universe.

  Carrie Wiita [00:32:22]:

  Yeah. Okay.

  Ben Fineman [00:32:23]:

  Conditionally recommended are brief, eclectic psychotherapy. I assume that just means, like, a few sessions of random stuff.

  Carrie Wiita [00:32:33]:

  I don't know that's literally the definition.

  Ben Fineman [00:32:35]:

  A few sessions of random stuff EMDR conditionally recommended by the APA narrative Exposure Therapy. I don't know what that is.

  Carrie Wiita [00:32:47]:

  Yeah, I don't think it's narrative therapy.

  Ben Fineman [00:32:50]:

  And then they also added four medications they said they conditionally recommend.

  Carrie Wiita [00:32:54]:

  Oh, interesting.

  Ben Fineman [00:32:55]:

  So we have all of this data, all of this research, all of these narratives around trauma, and the APA says you should probably do things that are, like, mostly CBT ish right. Controversy exploded.

  Carrie Wiita [00:33:08]:

  And I'm going to take that.

  Ben Fineman [00:33:10]:

  I'm going to take this from Scott Miller's blog. He wrote a great post about this.

  Carrie Wiita [00:33:13]:

  Okay.

  Ben Fineman [00:33:14]:

  He said almost immediately, controversy broke out on the Psychology Today blog. Clinical Associate Professor Jonathan Schedler advised practitioners and patients to ignore the new guidelines, labeling them, quote, bad therapy.

  Carrie Wiita [00:33:26]:

  Whoa.

  Ben Fineman [00:33:27]:

  Within a week, Professors Dean McKay and Scott Lillianfeld responded, lauding the guidelines, quote, a significant advance for psychotherapy practice, while repeatedly accusing Schedler of committing logical fallacies and misrepresenting the evidence. Schedler's argument was that the APA was basing all of this on studies that were available on RCTs.

  Carrie Wiita [00:33:49]:

  Yeah.

  Ben Fineman [00:33:50]:

  As you and I have kind of hemmed and thought about, if the only thing that are available are RCTs and the studies that are best fit into that way of doing it are on CBT and those more manualized treatments, you're going to have data that says these are the most trustworthy. But are they the most trustworthy, or are they the most research? That was Shuttler's argument that the APA overlooked all that in making their assessments. And then McKay and Lillianfeld, and by the way, these are all, like, very reputable people that when they disagree, you're like, oh, no, it's like, my parents are fighting. They kind of tore down Schedler's argument and basically said, yes, it's an imperfect way of looking at the research, but it's the best we got, so why don't we start with this? And it's kind of like all the stuff you and I have said over the years. What do we fucking do with this information?

  Carrie Wiita [00:34:42]:

  I hate it here. I fucking hate it here. Ben, why do we always end up here?

  Ben Fineman [00:34:47]:

  So one more bit of controversy coming out of those APA guidelines. In 2019, John Norcross and Bruce Wampold again, people that you and I love published a paper that I still laugh when I read it. The title is Relationships and Responsiveness in the Psychological Treatment of Trauma. The Tragedy of the APA Clinical Practice Guideline.

  Carrie Wiita [00:35:08]:

  Whoa.

  Ben Fineman [00:35:09]:

  They called it a tragedy. And their argument is exactly what you'd expect if you know Norcross and Walpole. They said, you're missing the common factors here. And if you tell people to go to these specific methods, people are going to assume that's what heals trauma, and they're going to ignore the fact that what really heals trauma is the common factors. So it's tragic to be putting this out into the world. I just want to read the first sentence, a couple of sentences of the paper, because it's hilarious to me. I swear this is how it begins. The early Greek Tragedies typically featured a single actor wearing a mask, allowing him to impersonate a god or demigod in the performance. As the genre evolved, tragedies presented main characters on Noble quests with unhappy endings, particularly concerning the downfall of the main characters. Hubris, greed, and rigidity frequently served as the protagonist's fatal flaws. The American Psychological Association's clinical practice guideline on posttraumatic stress disorder in adults strikes us as such an unfortunate tragedy. And so here's my conclusion from all this drama, is that if we were to name ten or 20 people that we look up to the most in this field, that we trust and sort of them by how they feel about this issue, you'd probably have, like, ten on each side.

  Carrie Wiita [00:36:30]:

  Exactly. Fucking exactly.

  Ben Fineman [00:36:32]:

  I get the sense that trauma is kind of like everything else in our field, where nothing is definitive, but people get very adamant that their perspective is right.

  Carrie Wiita [00:36:40]:

  Right.

  Ben Fineman [00:36:41]:

  So what is trauma? Informal therapy. I don't know.

  Carrie Wiita [00:36:49]:

  I'm depressed again. Ben?

  Ben Fineman [00:36:51]:

  Yes. I knew I'd bring you back here. You want to do a quick support pitch, and then, Carrie, you can just sort of burst everyone's bubble about all of the sacred cows in trauma Informed Therapy and the lack of empirical support. This episode is brought to you by Sentio Counseling Center. And Carrie, if you are looking for trauma informed therapy as defined, however we've defined it, sent You Counseling Center is a low fee online therapy clinic in California, seeing clients for as low as $30 per session, immediate availability for individuals, couples, and teens. And Carrie, this is where I work full time as the clinic director. So if you are a therapist looking for a reliable low fee center to refer clients to, or if you're a client looking for high quality, low fee traumainformed therapy, visit Cynthiocc.org and you'll be able to get started shortly after filling out our very brief online intake form.

  Carrie Wiita [00:37:48]:

  And if you are a fan of Unmitigated Chaos and me and Ben, you could come join us over on the Patreon page, where we have recently posted our second episode of Bad Therapist Facebook.

  Ben Fineman [00:38:06]:

  Posts, many of which have to do with trauma informed therapy, I think, actually.

  Carrie Wiita [00:38:10]:

  Surprisingly yeah, unsurprisingly, I'll add surprisingly. You can check that out@patreon.com. Verybadtherapy. And of course, as always, we always appreciate when you were able to rate and review the show on Apple podcast, Spotify, wherever you get your podcast.

  Ben Fineman [00:38:30]:

  All right, time for part two of this episode. And Carrie, when I come up with my initial outline of all the stuff I just went over, I had a question that I once looked into, which is, is the idea that trauma is stored in the body? What does that mean? And I looked a little bit, and I was like, you know what? This would be a seven hour episode. I'm just going to assume that we don't know and we'll figure it out. And then you texted me and you said, do you want me to look into this? And I was so happy because I didn't want to. And because I really want the answer to this because it sounds great. The idea that trauma, it makes sense. It sounds great. It fits perfectly with this idea that you do like, bottom up processing with clients because it's hard for them to access certain things from a top down method. And then you started sending me texts ranging from despair to anger to delirium. So I'm very curious what on earth you found.

  Carrie Wiita [00:39:33]:

  Well, Ben, you are not the only person I texted this week. I actually was coming at this from a more, I think, pessimistic angle than you. The idea that trauma is starting the body, it never sounded right to me. It doesn't sound like it makes sense because I can't even fathom what mechanism that is, like what we're talking about. So I started, as I do most of the research for the show, Googling. I kind of turned to chat GPT for a second, hot second, but I was Googling trying to and what happens when I do these Googles is you find a lot of crap right away, but the reliable stuff that everyone cites starts kind of coming up to the surface. You can grab onto those and you won't drown. And it's good now I just felt like a pinball in a pinball machine. I was bouncing from source to source and every single one said something totally different and they were so passionate about it. So I was just trying to look for something that was dispassionate, impartial. They could just explain at my level because the more dispassionate the things were that I found, the also more technical and medical they got. And I couldn't understand it. So I texted my brother friend of the show, dr. Patrick Wida, dr. Pat exclamation point, who is a psychiatrist, and I texted him. I said, I'm losing my mind. If a doctor wanted to understand the claim trauma is stored in the body after work one night, what would said doctor do first? Patrick responded, before or after swimming in his coin filled Scrooge McDuck swimming pool? I said seriously. I am going to start crying. Patrick responded, yeah, it's mostly garbage. And that's kind of what I was gathering at this point. I said, I suspect that, but I need citations I can understand and explain on a podcast. And Patrick responded, that's a logical fallacy. It's an argument from ignorance. This is like pseudoscience 101. So I had to go look up what argument from ignorance was. Just in case you also don't know what that is. This fallacy occurs when you argue that your conclusion must be true because there is no evidence against it. This fallacy wrongly shifts the burden of proof away from the one making the claim.

  Ben Fineman [00:42:09]:

  So if somebody says trauma is stored in the body and here's the whole modality around it, and you say, I don't think that's true, and they say, well, show me research that says it's not it doesn't exist because you can't disprove what am I am I on the right track here?

  Carrie Wiita [00:42:27]:

  You're 100%. You're 100% right. Okay. And that's what I was coming up against. So I honest to God, I can't give you an explication of this right now because I'm not a biologist. And I think this is the fucking problem, Ben, is that we are not biologists. We are not neuroscientists. We are not doctors. We did not get equipped with the level of education or not even level of education, just foundation. We got a different foundation. I'm sure if our grad programs were full of biology and neurology classes that we might be able to get this a little bit better, but they're not.

  Ben Fineman [00:43:09]:

  So devil's advocate, but like Peter Levine and Steven Porges and Francine Shapiro and Richard Swart, like those are I believe they all have doctor in their name.

  Carrie Wiita [00:43:20]:

  Yeah, they sure should do.

  Ben Fineman [00:43:21]:

  So why not just trust the doctors if they're telling us the trauma is stored in the body and there is a way to treat it?

  Carrie Wiita [00:43:28]:

  I mean, that's why I'm so depressed, because I did. Because I went into this being like, well, of course, first of all, who in good faith would put shit out into the world knowing it shit, number one. Number two, they do. They all have doctors, doctorate, but not all. Some of them are, I think, Bessel Vanderkolk, I think, is a psychiatrist, I think, but some of them aren't. I don't know. I don't know. I trusted them, too, and I think that's what I'm mad about. So, again, I can't explain it in detail, but trauma is stored in the body. Right. I took that. No, let's just forget what I thought. There's a difference between trauma has physiological impacts and trauma is literally stored in the body somehow in, like, a locker. Okay, sure, right. Because the thing is that trauma is somehow involved, like, somehow affects the body. That always made perfect sense to me. I couldn't understand how it got stored in the body. And that's what I was really looking for, was, like, an explanation of that, and that's what I couldn't find. But there is plenty of evidence for the idea that trauma has physiological impacts. When they say the body, honestly, most of the time they're talking about the brain specifically and how brain activity gets shifted by trauma. Brain structures, I think, might look differently when trauma has happened, et cetera. We know also for sure, it's established that chemicals can influence hormone levels. So if you are constantly under threat, then you are constantly dumping cortisol into your body. And that has negative health effects. It could cause all kinds of illnesses and things. You mentioned the Aces study. That's a lot of like what they think is going on with the Aces. And we also know, I mean, this is still like just like this is new science, so it's not like we really get it. But there are epigenetic changes that we know of and have evidence for, which is this idea that there can be things that happen in your environment that actually change your gene expression and then you can pass those changes down. So it's like we know a lot of this stuff that does happen. So then I tried to find, okay, but what are they talking about when they say trauma is literally stored in the body? What does that part mean? Where does it get stored? How does it get stored? If it's stored, what does it do while it's sitting there? And then are you supposed to get it out? Like, does it have to come out and on what timeline? These are the questions I have about this idea of trauma being stored in the body. Now, when you start looking at this stuff, a lot of the times they go from these articles and trainings and whatever, they start from stuff we know, like this stuff that I just said. Also stuff about evolution, stuff that we know about our fight or flight response and how that's so well documented in all of the animal kingdom. And they'll talk about our lizard brain and whatever. Like all this stuff, which is all true. It's all true. It's all established. And then they segue into stuff like, well, we know that there are certain ways the body does remember things that happen. So like memory T cells in the immune system, which is a thing that we actually know of. They quote, unquote. Remember the things that come into the body that you had to attack, right? And they'll remember that for next time. So that's legit. That's a thing that happens. Or how muscle memory, quote unquote is a thing. I mean, everybody knows that's a thing. Like you do a movement over and over again, you're going to get better at it for the most part and it becomes second nature. So you don't really need to think about doing it. But the problem then in all these resources is there is this leap from we know all of this stuff. We also know that there is similar stuff that kind of is true about the body and then they just leap to so it makes sense then, right, that trauma could also be stored in your muscles and your fascia, which is legitimately a sentence I read that trauma gets stored in your muscles and fascia. But what's lacking when they say these things are any actual document I just wanted one fucking link to a biology textbook I could understand that would explain this mechanism. But it doesn't exist. It doesn't exist because it doesn't exist because we don't know that that's true. We don't know that energy or that the trauma gets stored in the muscle or whatever.

  Ben Fineman [00:48:49]:

  It just sounds good. It's a narrative that sounds really good.

  Carrie Wiita [00:48:53]:

  Yes.

  Ben Fineman [00:48:54]:

  And it's like holding space. Yes, I know what that means. But also nobody knows what that means.

  Carrie Wiita [00:49:00]:

  Exactly. I'm glad you said the word narrative because it is. It is a story. And turns out there are tons of different people who have different stories about trauma and the body. And also, they all have ways they can fix it for you for money, which is so convenient. But for example, acupuncturists call it stuck chi key. It might be key. I actually don't know how you pronounce it, but it's spelled C-H-I chiropractors. They argue that chiropractic adjustments release tension, store trauma tension in the muscles and spine. And if you go get frequent adjustments, that helps open the pathways of the nervous system, which allows information to flow unobstructed.

  Ben Fineman [00:49:51]:

  I'm so glad you mentioned chiropractors because this week Justin got hooked on a new show called Crack Addicts.

  Carrie Wiita [00:49:58]:

  What?

  Ben Fineman [00:49:59]:

  Which is a show about chiropractor.

  Carrie Wiita [00:50:00]:

  Chiropractor. Oh, my God.

  Ben Fineman [00:50:02]:

  Get it? Because they cracked the neck.

  Carrie Wiita [00:50:03]:

  Get it? I get it. Are they real? Is it like a reality show? Oh, my God.

  Ben Fineman [00:50:10]:

  It's a reality show. And so simultaneously, you were texting me about all the stuff you were finding. Then I'm watching this show and I'm thinking, is there any difference? Is this the same shit?

  Carrie Wiita [00:50:19]:

  No, it's the same fucking shit. It's the same fucking shit. But because chiropractors don't have a therapy room, chiropractors have a fucking chair that they put lay people on their solution and their explanation and solution is different than ours. But so because we're therapists and we're not chiropractors and we don't have a chair like that and we're not supposed to touch our clients, we came up with different explanations.

  Ben Fineman [00:50:43]:

  The only reason trauma informed care exists is because we're not allowed to touch our clients. So we needed some other kind of placebo to get people to believe that we were doing something worth $200.

  Carrie Wiita [00:50:55]:

  It goes back to the common factors myth and rationale for treatment. Right? Okay. I tried, and I've been reading fucking constantly all week. Bessel vanderkolk. For example. This is so reductionistic. Reductionist. This is just so that we don't it's not an eight hour episode. He kind of says one of his things at least, is that your brain, like, when you experience a trauma, your brain may not craft a narrative around it. So it might not store a narrative about the trauma, but on some level, your brain does remember it in implicit memory. And so it stays in your brain somewhere even though you don't have a story for it. And there are these explanations for the mechanism for that mechanism, but they're not explanations that have been proven in any way, shape or form. They're stories that connect dots, like we see a lot of dots, and then this story comes in to connect them, but we haven't proven those connections at all. I think a really good example of this is the polyvagal theory, which, again, this is the one where I think I probably encountered it in grad school somewhere. And I took one look at, like, the handout that was like a diagram of, like, the parasympathetic and the sympathetic nervous system. And I was like, no, I can't. I just can't. But so this this idea is that, okay, we all know, and we've been on for a very long time, the sympathetic nervous system, fight or flight, and then the parasympathetic nervous system is your rest and digest system. We've seen them. We have them. It's documented in the medical literature. We have these things. Well, then this guy, Steven Porsche's, I think, came along and was like, wait, there's a third one that we never knew about. It's called the social engagement system. And it's, like, run by the vagus nerve, but then the vagus nerve splits into these two different there's a dorsal and a ventral thing, and they do different things. He says, hold on, I have it written down here. Yeah, one of them is involved in social engagement, and then the other is involved in the freeze response. And so the story that comes out of this because there is a vagus nerve. It's a thing, and it's in your brain. And then there's also a sympathetic nervous system and a parasympathetic. We've seen those. We've seen the fucking fucking fibers that are all connected together. We know that. So it's like this shit is there. It's just that he says that there are these states and that if you can learn to understand these states and move between them, individuals can learn to manage their responses to stress and trauma. He proposes therapeutic techniques which foster feelings of safety and connection, which he argues help strengthen the functioning of the vagal dorsal, vagal something or other. So that's why there's these therapy ideas, and they say, you should do this, you should do these therapies it will improve your emotional regulation and social engagement because it's strengthening the functioning of this vagal whatever system. But it turns out that nobody in the medical community thinks this is real.

  Ben Fineman [00:54:41]:

  I love this line you have here. The neurophysiological mechanisms that Dr. Porges Posits, however, are not supported by the neuroscience community. That's amazing.

  Carrie Wiita [00:54:52]:

  Like, at all. This was in a journal. This is in a published journal. Oh, wait, no, maybe that part wasn't oh, no, this part wasn't. This part actually okay, so for this, I came across this great website, shout out to let's Playtherapy.org, because this was like a play therapist. I'm not sure if it's a practice or what, but they had a lunch and learned with a doctor. And it was really cool because whoever the person was who wrote it is obviously speaking from a therapist's perspective. And they were writing like saying, we bought into this, this sounded all really good. Well, turns out no one believes it. But yeah, apparently there is no here's, this is the official answer. This is from a journal article that was published in 2021. I believe there is no support for the continuing polyvagal assertion that the dorsal vagal motor nucleus mediates massive brady cardia in mammals and may be responsible for vasovagal syncopy or trauma related dissociative or emotional freezing responses. This article, this is what I was trying to read. This is what I'm trying to fucking understand. And so what I kind of came down to with the polyvagal theory is that the proponents of the polyvagal theory have come up with a very complicated story about what this does and how it works and how it impacts our actions and behaviors and feelings. And then they built therapies to address those things. And by all accounts the therapy just like any therapies that are based on Bessel vanderkok's work and every fucking else other thing, it all works. These therapies work, they work as well as anything we have right now, but they don't work because of the fucking vagus nerve. Blah, blah, blah, blah, blah. Manages the heart rate or what the fuck ever. Wait, no, go ahead.

  Ben Fineman [00:56:51]:

  I can't hold it in any longer. I'm so eager to read the Facebook exchange.

  Carrie Wiita [00:56:59]:

  Wait, let me read one last one and then I want you to read that Facebook exchange. Okay. Then there's somatic experiencing and I'm sharing this because it turns out that was one of my major confusions was trauma informed care and trauma focused therapies, whatever. Trauma informed care, they're not just talking about one thing. Everyone has like a different idea. Trauma lives in the body. Everyone has a different story about what that means. So then there's somatic experiencing and this idea is that when your fight or flight response isn't completed, like shaken off the way it is by animals, there are all these fucking videos. There's like a deer who is getting chased by a cheetah and then it falls over dead. It's dead. And then the cheetah walks away or what the fuck ever. And then the deer gets up and then shakes, has these spastic shakes and then runs off and it's fine. So people took that and said, okay, so what's happening here is when the fight or flight response, for it to be completed, you have to discharge the energy that comes out of the fight or flight response. And so for a deer, for example, what they're doing is they've got all this energy that goes up to fight or run or whatever, and then they go dead instead. And so they have all this energy and so they have to shake it out, right? And so the argument is that people have evolved to be able to control their fight or flight responses. And so trauma symptoms are a result of that discharged energy being stored somewhere in US. It depends on the people who are putting this out there. Depends on how far you believe in it, because some of them most of it, it's like it's quote, unquote, stored, like, in your brain or something. But some people are like, no, that energy, the discharged energy gets stored in your tissues, and then by bringing awareness to bodily sensations, individuals can release traumatic energy and restore the body's equilibrium. Obviously, none of that is provable or true right now. I mean, we don't know any of that. And a large of it, something I kept seeing was like, this is largely unverifiable. We can't prove some of this shit. But so, yeah, what.

  Ben Fineman [00:59:27]:

  The very brief conversation we had before we hit record yeah. You were asking, are all these gurus, do they know that they're just misrepresenting all of this? And I think where you and I came down on was like, let's say there's a dozen would be gurus out there, and half of them look into this and say, we don't know. It sounds great, but we don't know. And then the other half doesn't say, oh, my God, I have this idea, and I'm pretty sure it's right. The six people who are hedging and who are honestly saying more research needed aren't going to get keynotes. They're not going to get praised, they're not going to get book deals.

  Carrie Wiita [01:00:11]:

  Right.

  Ben Fineman [01:00:11]:

  So I think the reason why people ascend to the status of guru is because they had the conviction that they were right. And you don't have gurus who say, we don't know, because those people don't become gurus. They're too busy, like, rechecking their work and scrapping a first draft because they realize it's not factual. Yeah, I think that's where we're at. That the reason why these are the theories and nobody's out there saying, we don't fucking know is because those people don't end up getting the publicity and the big names. Yeah.

  Carrie Wiita [01:00:42]:

  Well, I guess what really frustrates me this is what's depressed me and what has been so disappointing is that so much of the explanations that I was able to come across speak in such certain teas, right? They say the vagus nerve has a dorsal end eventual, blah, blah, blah, blah, blah, and then this is the thing it does, and this is what the other one does. And they just say that full stop, with a period at the end of the sentence.

  Ben Fineman [01:01:13]:

  Yeah.

  Carrie Wiita [01:01:14]:

  No citation to go find. Like, look at the study where they described this in plus One or whatever medical journal it got published when they discovered this vagus nerve system. No. And so I'm very disappointed to discover that so much of what is being put out there as, like, this is how it is to therapists, right? Because therapists are being told this. You're going to trainings where they say, this is how it works. This is. How the body works. How are we supposed to know differently? We didn't get anatomy in grad school. That's what I'm so mad about.

  Ben Fineman [01:01:59]:

  And then you end up with people like this, I'm sure this wonderfully, well intentioned person. But you posted on Facebook that you basically said, hey, can somebody give me resources to find out what it means that trauma is stored in the body.

  Carrie Wiita [01:02:15]:

  Yes.

  Ben Fineman [01:02:15]:

  And this person said, Try Googling polyvagal theory.

  Carrie Wiita [01:02:18]:

  Yes.

  Ben Fineman [01:02:19]:

  And you said I have. It seems that there's no actual research to support this. And her response blew my mind. But I think it so speaks to what happens in our field. She said it's largely been debunked. Yes. But it does a wonderful job of explaining how the nervous system impacts different areas of our bodies. So she's saying it's not real, but it's a great story. And so that's what I'm going to recommend. As opposed to like, there is no answer. No, this is the answer. Even if we can't prove it, it just sounds too good to not say this is the answer.

  Carrie Wiita [01:02:54]:

  Exactly. Which it comes back to drag it back to the common factors argument. Right. Bruce Wamhold's contextual model of the common factors. He argues that there are three pathways that every single therapy, no matter what approach you take, there are these three pathways by which therapeutic change is affected. There are these three things that have to happen to end up with successful therapy. One of them is the relationship. You have to have this close relationship, a real relationship, quote unquote. And then there's the specific ingredients. Well, these two are what's happening here. There's the creation of expectations by sharing a meth and rationale for treatment. And so that's telling the story, providing a convincing story for the client's distress.

  Ben Fineman [01:03:48]:

  Yeah, your vagus nerve is all fucked up. So we're going to unfuck your Vegas nerve.

  Carrie Wiita [01:03:52]:

  We're going to unfuck the Vegas.

  Ben Fineman [01:03:53]:

  Then your trauma is healed.

  Carrie Wiita [01:03:55]:

  Yes. And then we are going to the third pathway is the specific ingredients. It's the ritual of whatever your brand or flavor of therapy is. So like, yeah, the explanation is the vagus nervous fucked. So what we're going to do, trauma got stored in your body, end there. That's the explanation. Trauma got stored in your body. And so then the specific ingredients pathway. Wampole it makes a lot of sense to me. He says first there's tasks and goals. It's a three part pathway. The first one is tasks and goals of therapy. So if trauma is stored in your body and it's bad that it's stored in your body because that's the presupposition, right. Then one of the tasks or goals of therapy has to be get the trauma out of your body. Right. So then the second step in that pathway is what's called therapeutic actions. And so this is the intervention. Right. And so say the intervention is I swear to God, this is an actual intervention. I looked up. I believe this is from somatic experiencing. I could be wrong. Don't send me angry emails. We're going to try neurogenic tremoring. This is real. This approach involves shaking the body to release tension and trauma, helping to regulate the nervous system. The shaking or vibrating helps to release muscular tension, burn excess adrenaline, and calm the nervous system to its neutral state, thereby managing stress levels in the body. Shaking the body can help ease an overstimulated nervous system and calm the body back down, aiding in stress management and potentially preventing the development of symptoms of anxiety, trauma or depression or treating the symptoms of trauma. So that's our therapeutic action is we're going to shake, we're going to do neurogenic tremoring and we're going to do our shakes. Well, Wampold argues that that's not really what's doing it. He says that intervention induces a healthy action that's probably trans theoretically like a good thing to do anyway. I'm not sure what that would be when we're talking about shaking neurogenic tremoring. I'm not entirely sure.

  Ben Fineman [01:06:08]:

  Carrie, do you know what the difference is between shaking a client and doing neurogenic tremoring?

  Carrie Wiita [01:06:13]:

  A lawsuit.

  Ben Fineman [01:06:14]:

  It's about $125 an hour.

  Carrie Wiita [01:06:18]:

  Exactly. But this is the thing, right? The literature shows us that if you believe the therapy as the therapist, if you believe therapy you're providing to your client that you get better outcomes than if you are just like doing whatever. We're back at this fucking place I don't want to be at anymore. Okay? We know this isn't true and now I'm dragging everyone down with me. Everyone listening knows now that trauma is not stored in the body, not technically. So now you're faced with a problem like knowing that now, but knowing the trauma therapy that you've been doing has been shown to work. It's an evidence based practice. Do you still go in to the room and share this explanation that has been debunked and then go do the treatment that works or do you not? I don't know. I don't fucking know. I want to say that I'm not against these treatments. I'm not. They've been shown to work and a lot of for a lot of clients like this resonates on like such a deep level and it's like great. I just don't understand why it has to be taught and purveyed to us with such fucking certainty.

  Ben Fineman [01:07:48]:

  Yeah, that's kind of where I land here. Is it's the certainty that bothers me? Not the fact that we don't know. Not the fact that people like things like somatic experiencing or EMDR or whatever. It's the certainty. And one of my takeaways is the question are the treatments that are specifically designed for trauma the best? For trauma like SMAG, experiencing, EMDR, trauma focused CBT? Right. The APA says no. The meta analyses say no. I say no. But they do I will like to their credit, they do incorporate trauma informed principles that's just built into the education of therapists when they're learning about these approaches. But here's where I get frustrated and maybe even hopeful at the same time that any approach to therapy can be trauma informed. Because to be trauma informed, it doesn't mean you've taken a training in somatic experiencing or EMDR or polyvagal theory. To be trauma informed means you have a common sense understanding of how trauma can impact people after the traumatic event or events are over.

  Carrie Wiita [01:08:53]:

  Yes.

  Ben Fineman [01:08:54]:

  It also means going back to Fallot or Fallow and Harris's five core values of safety trustworthiness, choice, collaboration, empowerment. Then you throw in the cultural, historical, and gender issues. If you are a therapist who is aware that trauma is a thing that impacts clients and you do these basic principles in session, you are doing trauma informed therapy no matter what certifications you do or don't have. And I am confident, Carrie, that there are plenty of therapists out there who have never taken a specific training on trauma that do more and better, quote unquote, trauma informed work than therapists who are trained in however many approaches.

  Carrie Wiita [01:09:36]:

  Right.

  Ben Fineman [01:09:36]:

  Because you can learn all of this stuff but still fumble it with a client. And I think about a recent episode with Ruth where she had a therapist who ruth decided she wanted a therapist who was more trauma informed. And I think it's possible that that therapist could have been trained in everything. Who knows? But that therapist couldn't get out of her own way and kept convincing Ruth that her politics were wrong. And that's not trauma informed because you're not creating a safe emotional space, you're not giving a client control. You're missing all of those key values. Even if you can tell a great story about the polyvagal theory yes. And that's it. Trauma informed therapy isn't I got trained in these things. Trauma informed therapy. In a lot of ways, it's just common sense, good therapy that's that's been done long before 2001 when the term trauma informed came to be in our field.

  Carrie Wiita [01:10:23]:

  Yes. I think that my takeaway. Do you want to know my take? Here's my takeaway. I was not going to share this, but I'm now going to throw it in here at the end. My takeaway is it is shocking and unnerving how easy it is to come up with a brand of therapy, trauma therapy, that has exactly as much scientific basis as the ones that are out there, as polyvagal theory, as somatic experiencing as any of them. I came up with one. Do you want to hear about it?

  Ben Fineman [01:11:03]:

  You made your own I made my own theory. I can't do this as a patreon episode. I thought it'd be great if we made our own trauma theory.

  Carrie Wiita [01:11:10]:

  Oh, it wouldn't make a whole episode. It took me ten minutes. It took me ten minutes. I came up with an entire fucking and I could charge $10,000 for this, to get trained in it. And it has the exact same level of scientific backing.

  Ben Fineman [01:11:28]:

  Does it have a name?

  Carrie Wiita [01:11:29]:

  Yeah, it's called dog therapy.

  Ben Fineman [01:11:34]:

  So dogs does dogs stand for something?

  Carrie Wiita [01:11:37]:

  No, it's like the animal, the dog, the canine, the man's best friend. So I don't know if you know, but dogs were domesticated between 20 and 30,000 years ago, like, before agriculture was a thing. So this was in a hunter gatherer society. So that's just facts. That's historical facts. We know that from the fossil record. We also know that dogs are good for our nervous systems. We know that, too. There's plenty of studies that demonstrate the pending dogs reduces anxiety, releases endorphins oxytocin, good for bonding. All this stuff we know from interpersonal neurobiology, right, that that works in therapy. Dan Siegel says in therapy, clients use their mirror neurons to borrow the integrated neural state of the therapist, which helps in processing hard stuff. Dogs have mirror neurons just like humans do. So there's no reason to not believe that dogs can't be involved in interpersonal neurobiology.

  Ben Fineman [01:12:30]:

  Well, it's interpersonal.

  Carrie Wiita [01:12:32]:

  What?

  Ben Fineman [01:12:34]:

  You need a new word, inter?

  Carrie Wiita [01:12:35]:

  No, you don't, because actually, mirror neurons were discovered in chimpanzees monkey. Some kind of monkey, I believe, first, so before we found out that we had them. So my conclusion from this very scientific evidence is that domesticated dogs are actually the first therapists. We probably had time since 20, 30,000 years ago, we had time to evolve, to need them to regulate. When our intimate, personal human relationships that we normally turn to in times of needing connection, when those relationships are in turmoil, we need something else. And so we develop dogs. We domesticated dogs in order to fill that need. And in fact, I think it's possible that this ability to regulate humans and this increased social harmony that came out of it is actually what allowed us to build complex agricultural societies without dogs there to regulate folks who were family members at each other's throats, without dogs to regulate, it would have all fallen apart. So I have developed an entire therapy built around dog cohabitation. My therapy is really, actually built on the idea that you need to have a dog in your household. So it's the only way you're going to recover from your trauma. And, in fact, it's the only way to have a healthy, stable, integrated neural state. So first you have to get trained in how to train the dog to successfully cohabitate and regulate. Right. Then once you get trained to do that, then you need to get trained how to train your clients to successfully cohabitate and co regulate. So, Ben, I'm happy to offer you level one training. It's my beta test, alpha test of the program. Normally, I charge $10,000 for a level One, but for you, I will cut it down to five. And it comes with CES.

  Ben Fineman [01:14:42]:

  It does come with does it come with a dog?

  Carrie Wiita [01:14:45]:

  No, you have to provide your own dog.

  Ben Fineman [01:14:48]:

  My dog doesn't want to be trained in this.

  Carrie Wiita [01:14:50]:

  It doesn't matter what your dog wants. I'm going to tell you. Remember, it's just like EMDR. Just do it harder. Train harder. It doesn't work the first time. Train harder.

  Ben Fineman [01:15:01]:

  Dog therapy. You know, my first ever experience was doing animal assisted therapy with kids.

  Carrie Wiita [01:15:08]:

  I remember that. I was so jealous.

  Ben Fineman [01:15:11]:

  Little did I know I was a trauma expert.

  Carrie Wiita [01:15:13]:

  Back then you didn't know. Now you know. Yeah, now you know. You saw it in action.

  Ben Fineman [01:15:19]:

  I'm here for dog therapy.

  Carrie Wiita [01:15:20]:

  I'm telling you, it's got a good evidence base already, so you just got to tell the right story, man.

  Ben Fineman [01:15:27]:

  Actually a fascinating idea.

  Carrie Wiita [01:15:29]:

  I know, but that's what I'm saying, Ben. It took me ten minutes. Give me five dots. I'll connect them in ten different ways.

  Ben Fineman [01:15:39]:

  I can feel my polyvagal nerve or my vagus nerve settling already.

  Carrie Wiita [01:15:43]:

  I need to go shake neurogenic tremor.

  Ben Fineman [01:15:47]:

  Yeah, the neurogenic tremors is done by licensed therapists. Shaking therapy is done by the pre licensed therapist. The only difference is the name and the extra money you pay to do it.

  Carrie Wiita [01:15:57]:

  You can't do it without that letter after your name.

  Ben Fineman [01:16:02]:

  Well, should we mercifully wrap this up with some very appropriate listener Ale?

  Carrie Wiita [01:16:07]:

  Oh, yes. Let's do it.

  Ben Fineman [01:16:10]:

  This comes from Monica Kramer. And she writes, Hi, Ben and Carrie. I'm a Master in counseling student from the University of Lethbridge and have been really enjoying your podcast. Episode 47 about recovered memories was an eye opener for me. I was in my 20s, in the 1980s, and I distinctly remember being aware that I had all the, quote, symptoms of having been sexually abused frigidity, fear of sexual relations, et cetera. Yet I had no memory. Listening to your episode reminded me that we are fish who do not see the water in which we swim. Your episode about the cultural creation of notions of repressed memory reemerging at that time and dating back to Freud's theories, was most enlightening. It is only in hindsight that I see the social psychological culture in which I was living at the time. I've since learned that my mother, grandmother, and great grandmother were all raped or sexually abused during wartime. Maybe what I experienced was genetic memory. Interestingly enough, I've been following the work of Thomas Hueball lately and was surprised to see many counselors and therapists from around the world in the ancestral healing journey course he just completed. He's also known for his collective trauma summit. He's about to start a course with Internal Family Systems founder Richard Schwartz. I often wonder what people will say about the practice of psychology and psychiatry, particularly pharmacological treatments, in 100 years time from now. I wonder if we're currently living in the Dark Ages.

  Carrie Wiita [01:17:27]:

  I could not agree with that more.

  Ben Fineman [01:17:29]:

  Amen. So thank you, Monica, for rating in. I think we are certainly in the Dark Ages when it comes to understanding.

  Carrie Wiita [01:17:36]:

  All of this except for dog therapy. We know all we need to know.

  Ben Fineman [01:17:40]:

  You know what they had in the Dark Ages, don't you?

  Carrie Wiita [01:17:41]:

  They had fucking dogs. They had fucking dogs. Thank you. Thank you for listening to very Bad Therapy. The views and opinions expressed do not constitute therapeutic or legal advice, nor do they represent any entity other than ourselves or our guests.

  Ben Fineman [01:18:00]:

  Visit us@verybadtherapy.com for more content, ways to support the podcast or to let us know if you have a story you'd like to share on the show. If you'd like to join our patreon community and get access to our monthly bonus episodes, check us out@patreon.com verybadtherapy.