Did you know that there are a number of different types of trauma and that each trauma type requires specific treatment? Treatment that is relevant to the individual’s personality, the trauma type as well as the target domain most suited for that individual i.e. bottom up or top down approach.
Trauma Types – first defined by Lenore Terr (1994)
Type I – single incident type traumas. Key Emotion: Fear.
Type II – multiple trauma – victims can foresee their next traumatic experience but could not influence timing or escape the trauma.
Key Emotions: anger, shame, grief, guilt, disgust.
Type IIA – multiple traumas but with stable backgrounds that have imbued the individual with sufficient resources and ability to separate trauma incidents and address them one at a time.
Type IIB – individuals so overwhelmed with multiple traumas and cannot separate the incidents, instead quickly links one to the others. The narrative is fragmented through out the 3 domains of affect, sensory motor and cognitions.
Type IIB(R) – stable background but overwhelming trauma and cannot maintain resilience (e.g. holocaust survivors Malt and Weisaeth (1989)).
Type IIB (nR) – client never developed resources for resilience (Schore (1996).
Type I & IIA – less need for therapeutic relationship and less transference as have internalised resources. Can usually move quickly to working with trauma incidents using relevant trauma protocols.
Type IIB – need resources re-building through therapeutic relationship before addressing trauma incidents.
Type IIB(R) –(re)building/(re)acquainting resources the client has lost touch with through the therapeutic relationship is a perquisite to trauma the intervention.
Type IIB(nR) – the whole therapeutic relationship of therapy may include building resources and resilience that was never developed.
Prolonged Duress Stress Disorder (PDSD) – Scott and Stradling (1994)
PTSD symptoms but client reports no identifying events.
Chronic, prolonged stress during developmental years (from neglect, illness, dysfunctional family system) can take its toll on nervous system just short of pushing it to the point of fight, flight, freeze or flop. Symptoms present as Type IIB(nR). In both cases the therapeutic relationship has potential to infuse many of the coping skills and resilience that may have been missed during development and the treatment method is the same.
Only therapists who have a thorough knowledge of the complexities of trauma and training in relevant trauma & PTSD protocols should work with trauma clients.
For further information on the 2017 IFEAL Trauma & PTSD certified training course and CPD, for both clinic based and equine therapy practices, please contact admin@ifeal.me.
Sun Tui is a leading psychological consultant in the field of Equine Facilitated Psychotraumatology who advocates only evidenced based treatment protocols. She is currently doing her PhD at Christ Church Canterbury to evaluate inventions that employ horses for human behaviour change. Sun Tui is founder of the Dare to Live Trust working with Veterans.
