Published in Dramascope-the newsletter of the NADT
Fall 2002



Experiential Treatment for PTSD: The Therapeutic Spiral Model

Author:M. Katherine Hudgins, Ph.D., TEP
Publisher:Springer Publishing Company, New York, N.Y., 2002
springer@springerpub.com

Reviewed by Karen Carnabucci

Creative arts therapists will be pleased to know that the veritable "bible" of psychologists, "The Handbook of Psychotherapy and Behavior Change," has recognized experiential psychotherapy as the treatment of choice for survivors of trauma. With new research in the neurobiology of trauma showing that flashbacks and similar Post Traumatic Stress Disorder symptoms activate the emotional side of the brain rather than the cognitive side, there is growing evidence about the efficacy of these sorts of therapies.

Those of us who have been working with psychodrama, drama therapy, music therapy, art therapy and similar modalities have argued for years that verbally based therapies have limitations in resolving issues of trauma. In "Experiential Treatment for PTSD," Hudgins makes a strong case for experiential treatment as the treatment of choice for trauma survivors, citing not only client and therapist testimonials but also the growing body of research about the effectiveness of experiential psychotherapy.

Hudgins, a Ph.D. clinical psychologist, psychodramatist and internationally recognized and presenter on innovative trauma treatment, has been slowly developing the Therapeutic Spiral Model for the past 15-plus years with the support, interest and input of trainees and colleagues. Although she has published articles in various journals and on her Web site, this 272-page paperback book outlines in detail current research on trauma, theoretical foundations of her model and how its action interventions are applied.

The model is a systemic modification of classic psychodrama combined with object relations theory and current advances in trauma studies. The image of the "spiral" refers to the balancing an awareness of the debilitating and chaotic truth of violent experience with a reasoned approach to integrating that experience in ways that re-establish social ties and reassert non-violent values. Survivors often speak of "spiraling down" into memories of violence and pain and losing the ability to act intelligently. The model suggests that one must learn to spiral "out" as well as "in," taking steps to think and communicate rationally to counter the whirlpool tendencies of traumatic memory. The action techniques - which include dramatic vignettes, the generous use of props such as scarves and cards, sociometric exercises and art projects - support the building of conscious awareness and strong cognitive functioning.

The centerpiece is the Trauma Survivor's Intrapsychic Role
Atom (TSIRA), which expands the role atom concept as devised by Dr. Jacob L. Moreno, the developer of psychodrama. The TSIRA shows the internalization of traumatic experience as defined by role theory; it is a clinical map of the essential internal roles in the self-organization and personality structure of a trauma survivor. The atom is divided into three sets of roles: prescriptive roles, trauma-based roles and transformative roles. Initial focus in treatment focuses on the prescriptive roles, which are the strength-building roles that support safety, cognitive awareness and containment. As the protagonist integrates the roles of observing ego, containing double, manager of defenses and personal and transpersonal strengths, he or she is able to address the trauma with greater consciousness and clarity. For further safety, Hudgins discusses various levels of conscious re-experiencing dramas that are determined by the clinical needs for safety.

Each chapter contains action vignettes and case examples of four diverse clients to demonstrate the model's process with six clinical action structures and 14 intervention modules. The clients - with details modified to protect confidentiality - are typical of the people who have attended Dr. Hudgins'workshops through the years:

·Tricia, a successful professional woman who finds that a simple dinner with her husband is ruined by a casual comment that reminds her of her abusive father,
sending her into a rage.
·Vladamir, a political refugee who fled the former Yugoslavia due to civil war and struggles to adjust to a new culture while feeling haunted by the memory of his mother being brutally dragged from their home by soldiers.
·Jim, a man who became addicted to alcohol and drugs to blunt the emotional pain and flashbacks relating to childhood abuse from his alcoholic father; after nine years of sobriety, he still has difficulty sleeping through the night.
·Andrea, a once-happy young woman who developed life-threatening anorexia to feel a sense of control after she was sexually assaulted by a group of men.

Following their progress within the TSIRA constellation, Dr. Hudgins shows how each is able to come to terms with his or her history of trauma, sometimes fairly quickly.

Drama therapists will find compatible philosophy and ideas, particularly the "dreams and metaphors" category of the conscious re-experiencing dramas. In the model, dreams, myths, symbols and metaphors can be enacted to explore the richness of the unconscious representations of trauma while addressing it indirectly. It is also a useful in community settings to share about common trauma without a great deal of personal disclosure.

The book is geared to professionals who work with trauma in some way. It advocates global activism toward the treatment of trauma to address community violence and generations of family pain. At the conclusion of the book, Hudgins discusses briefly how the model is being adapted by clinicians throughout the world with various populations, including adolescents, sexual offenders and people with eating disorders and addictions. Knowledge of the classical psychodrama and drama therapy is helpful, though not necessary as the writing is kept simple and clear.

Dr. Hudgins is the founder of Therapeutic Spiral International, a non-profit organization based in Charlottesville, Va., that provides training to helping professionals in the model and services to survivors. For more information, see www.therapeuticspiral.org.

Karen Carnabucci is a clinical social worker and trainer, educator and practioner in psychodrama, sociometry and group psychotherapy. She is based in Racine, Wis.