Last week I was fortunate enough to interview Dr Janina Fisher who has devoted her career to working with clients and therapists in the complex field of trauma recovery. I hope you enjoy the insightful information she provides in our conversation together.
Tell me a bit about your practice – where it is, who you work with and the services you offer?
At this time in my career, I have a small practice just outside of San Francisco but spend most of my time teaching and training therapists around the world in the newer approaches to psychotherapy, especially the treatment of trauma. Throughout my 33 years of private practice, my clients have always spanned the extremes: half of them therapists, doctors, lawyers, professors and half what I call “clients of last resort,” those whose severe or mystifying symptoms have befuddled good therapists for years without much relief or progress. Having gone from my initial psychodynamic training and practice to trauma-focused talking therapy to hypnosis to EMDR to Sensorimotor Psychotherapy, I have now come to integrate the best mixture of these ingredients for each given client. In a world replete with wonderful new methods, I find there is not one ‘right’ method but an opportunity to combine them.
How did you become interested in Sensorimotor Psychotherapy?
I first heard Pat Ogden, the founder of Sensorimotor Psychotherapy, in 1999 at a conference. At that time, I’d been a specialist in the treatment of trauma for 10 years beginning with a postdoctoral fellowship in the clinic of Judith Herman, author of “Trauma and Recovery,” then appointment as a supervisor at Bessel van der Kolk’s clinic, The Trauma Center, then training in EMDR, becoming an Approved Consultant or Supervisor in EMDR treatment. When even EMDR did not work for some clients, I began to wonder what else could be done to help those more severely affected by their traumatic experiences. Pat Ogden seemed to have the answers: we had to be able to treat the feeling and body memories of trauma, not just the events, and her model provides a way to do that.
What do you consider is a trauma experience and how would someone know if they had one?
I use the following definition of trauma:
A single event, a series of events or a set of enduring conditions that exceed the individual’s capacity to tolerate or integrate and/or that are experienced as a threat to life, bodily integrity or sanity.
The key is that the event has to feel (not be) life-threatening and exceed one’s capacity to stay present, remember what happened, or assimilate the experience. The difficult aspect of this is that, if it’s more than we can assimilate, then we may not have taken in that we’ve been traumatized. The key indicators are: an overly active (anxious, reactive, jumpy, impulsive) or inactive (numb, disconnected, hopeless, ashamed) nervous system, feelings of overwhelm, intrusive feelings and thoughts, tendencies to fight (get angry and self-destructive), flee (run literally or figuratively), freeze (fear, terror), submit (become depressed, hopeless, ashamed, overly compliant), or cry for help (fears of abandonment, can’t tolerate being alone).
How do you believe people overcome trauma?
Brain scan research has shown that the effects of trauma are the result of emotional and body memories without words. Because of the lack of words and pictures, most traumatized individuals don’t know that they are remembering trauma. They know they feel depressed, anxious, angry, jumpy, afraid of people and places, or want to hide, but they don’t know why. The first priority is to help clients identify these states and change their relationship to them. As I said to a woman today: “The events are over—what you’re feeling now are the memories. It feels as if your body is saying, ‘Danger, danger—red alert,’ but it’s a memory of what already happened.’” We used to think that the answer to overcoming trauma was for clients to tell what they remembered to a trustworthy witness. Now we know that remembering doesn’t bring closure. What brings closure is having a life in the here and now and changing the relationship to the feelings and bodily reactions that remain from the past.
Tell us about your approach and why you believe the way you work is effective in helping people with trauma?
Right now, I’m combining Sensorimotor Psychotherapy with a model called Structural Dissociation Theory, mindfulness-based techniques, and the Internal Family Systems model. I’m calling this approach Trauma-Informed Stabilization Treatment or TIST. The combination of models is particularly helpful in treating clients with complex PTSD, borderline personality, treatment-resistant depression and anxiety, as well as dissociative disorders. Each of the contributing approaches changes the client’s relationship to the symptoms: Sensorimotor by noticing them as somatic phenomena, structural dissociation by observing them as manifestations of child parts holding implicit memories, and mindfulness-based techniques by creating curiosity and dual awareness. Each of these calms the traumatized nervous system and helps the client to ‘be here now.’
What services do you offer to psychotherapists who are hoping to develop their skills in working with trauma?
These days, I do less psychotherapy and take advantage of the opportunity to teach therapists about the newest research and treatment models at conferences, workshops, and over the internet via my internal webinar program entitled, “Working with the Neurobiological Legacy of Trauma.” Marg, you know as a webinar graduate how many clients are helped by educating just one therapist about the potential of these new models to help their clients. It means a great deal to me to be part of this international community of therapists devoted to the treatment of trauma and to help them expand their capacity to relieve suffering.
On a personal note, tell us something that you’re passionate about or love to do in your spare time?
Spend time with my grandchildren! When I’m not passionately planning my next workshop or speaking tour! As you know, I’m coming to Australia later this year: to Brisbane at the end of October and then Melbourne and Sydney the first two weeks of November. For information about either the workshop or webinar programme, go to my website: www.janinafisher.com.
More about Dr Janina Fisher:
Dr Janina Fisher is a licensed Clinical Psychologist and Instructor at the Trauma Center, an outpatient clinic and research center founded by Bessel van der Kolk.
Known for her expertise as both a therapist and consultant, she is also past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, a faculty member of the Sensorimotor Psychotherapy Institute, and a former Instructor, Harvard Medical School.
Dr. Fisher has been an invited speaker at the Cape Cod Institute, Harvard Medical School Conference Series, the EMDR International Association Annual Conference, University of Wisconsin, University of Westminster in London, the Psychotraumatology Institute of Europe, and the Esalen Institute. Dr. Fisher lectures and teaches nationally and internationally on topics related to the integration of research and treatment and how to introduce these newer trauma treatment paradigms in traditional therapeutic approaches.