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Feb 21, 2018
Lane Pederson: Hi, I’m Dr. Lane Pederson, co-owner of Mental Health Systems and I’m here with Dr. Eboni Webb for an interview on her upcoming training on attachment and trauma.
Eboni, tell us a little bit about your background, that really got you interested in becoming an expert in attachment and trauma.
Eboni Webb: Well, once I moved to the South and started doing private practice, I started working with a lot of families that had adopted and really had not been educated that adoption inherently has trauma to it. That really expanded my need to be more educated, help parents be educated and even their children understanding why they’re experiencing the difficulties that they’re experiencing.
Lane Pederson: Sure. So, when you talk about adoption having trauma inherent in it, what are some of the traumatic situations that you see these children coming from?
Eboni Webb: Oh, well, many of them come from orphanages where there were not enough care providers to even take care of the children that are there, so there’s a lot of neglect. Poor resources, maybe even inadequate food, but then also the circumstances that necessitated being put into an orphanage often have trauma, abuse, neglect as a part of their story.
Lane Pederson: So, naturally, you’re seeing trauma starting in early childhood and really starting to go across the lifespan. At least early lifespan, with some of the clients you’re working with.
Eboni Webb: Absolutely. There are what we would call single incident traumas; accidents, major natural disasters. But then also developmental trauma. Developmental trauma will go across the lifespan and has to be addressed at every stage of development then.
Lane Pederson: For many people, even if it’s one event, in terms of how it’s experienced, it really is much greater than that event. It really sort of affects their whole course of life, so to speak.
Eboni Webb: Mm-hmm (affirmative). Yeah. Because trauma is self-perceived and it’s driven by the individual’s experiences of it, what they were able to do, what they weren’t able to do, and what other environmental resources were available to them. So, it will vary.
Lane Pederson: So there’s a lot of variants with that. One thing that I wanted to ask you about was what are some of the misconceptions that therapists have about people with trauma and misconceptions about how to treat it?
Eboni Webb: One of the big presentations that we’ll see with the client, is that they may be very activated in a session, which makes it very difficult to connect with them. Or they may be very checked out, which a therapist may initially perceive as a person who’s not interested or not invested in the work. And that is a common misperception until you understand that they’re often defending and that their traumatic response has just permeated their life.
Lane Pederson: Right. So, as a therapist, how do you overcome those type of barriers?
Eboni Webb: I think one, educating the client about what’s happening to them. They may not be conscious of it because trauma based defenses are no conscious by very design, right? So, we have to educate and then to be able to help them normalize and feel safe in the therapeutic environment to let those defenses down.
Lane Pederson: Sure. So, a part of it is just orienting the client to what the therapy is about and what their sort of natural, if you will, response will be and educating them about that and that helps set up more therapeutic success.
Eboni Webb: That’s right. Mm-hmm (affirmative).
Lane Pederson: Okay. Along with misconceptions, what are some of the mistakes that people sometimes make? By people, I mean therapists. What are some of the mistakes that therapists make when they’re working with trauma?
Eboni Webb: I think even one of the primary problems that a therapist can do in terms of the therapeutic space, is assume that this space is aesthetically pleasing, the client will feel comfortable in it. But with trauma as a factor, proximity matters. So, even the spacing of seats can be a problem or it can keep them feeling safe and secure. Tone of voice, inflection. Also, I think therapists often personalize how the client is presenting and making sure that they’re mindful constantly that this is how they are defending and that they really cannot help it. And just as I’ve said before, their brain cannot discern between real and perceived threat. So, a therapist may be doing something unintentionally that is perceived as threatening, and that can create a disconnect in the relationship.
Lane Pederson: Sure. So, really I’m hearing a few things there. One is that therapists sometimes are not aware enough of their clients and how their clients are presenting. And at the same time, therapists can sometimes take how their clients are presenting as being very personal, which of course is … We’ll use the word countertransference. Having countertransference get in the way, rather than be useful in the therapy. And then just kind of those environmental things; how the office is set up, use of space, what’s a safe or comfortable environment for one client versus another.
Eboni Webb: Mm-hmm (affirmative). Yeah. And when I think about doing trauma treatment, I pull into those three concepts of basically healthy parenting, right? So, proximity maintenance, and the safe haven, and the secure base. Those are issues that have to be negotiated between therapist and client because those are the areas that have been affected by trauma.
Lane Pederson: Sure, sure. Now, when you think about working with people, what are some of the tools or strategies you think are must have to maximize the chances for a successful outcome?
Eboni Webb: I think absolutely you have to have a very solid psychoeducational base. Helping the client understand how the brain works when it comes to trauma and a language in a way that they really can take it in. I think that is an essential tool, to have something even visually for them to understand. I think also, to be successful, when there is a breakdown in the session, what resources even do you have in your room to bring them back online, and to be able to kind of move forward. So, it’s really critical to have that psychoeducation, but also in the moment resources for when the process kind of goes astray.
Lane Pederson: So, a lot of it is back to that setting the foundation. Does the client actually have an understanding, a real understanding of what happened, how that’s affecting them now, even in this moment, and how that informs what you’re doing as a therapist.
Eboni Webb: Yes.
Lane Pederson: And then of course, it can be at times, really unsettling and sometimes clients can become dysregulated as you’re doing the work. And as a therapist, you need to have the skills to be able to manage those situations when they come up, so the client can leave put together, rather than …
Eboni Webb: Mm-hmm (affirmative). And you have to be very patient because it is a slow process depending on the nature of the trauma. Especially if it’s developmental, it is going to be a slow course.
Lane Pederson: Right.
Eboni Webb: Very, very slow course. So, yeah.
Lane Pederson: Yeah. When you’re thinking about that, the course of treatment, of course there have been times when I’ve thought therapists jump in too soon, too fast with trauma. How as a therapist do you gauge what is an appropriate course of treatment for an individual client?
Eboni Webb: In terms of course of treatment, it’s really determined by the severity of the trauma and the frequency. So, single incident trauma can be cleared pretty quickly and you can go straight to that. But with developmental trauma, you’re going to have to take some time. You really have to work with the client alone, just to be able to tolerate our relationship, right? The relationship between the client and the therapist. And to make sure that they are safe in this moment. So, it can take time to go back to actually the core event. And it’s often not necessary because the brain doesn’t need the original players per se, to be able to work through the trauma.
Lane Pederson: Sure, sure. Well, I know that we’ve really just scratched the surface of what’s going to be covered in the training. I can tell you I’m really looking forward to it. Having worked with people with a lot of trauma in their history for a long time, I know that there’s going to be a lot of new stuff that I’m going to get from this, too. So, thank you for taking a few minutes to talk with me about this.
Eboni Webb: Absolutely. Thank you.