Sustainable Trauma Integration
About Expressive Trauma Integration™
Expressive Trauma Integration™ (ETI) is an integrative therapy approach that draws on recent research and practice from the fields of neuroscience, attachment and developmental psychology, expressive therapies, experiential and body-oriented therapies, cognitive reframing, behavioral modifications, mindfulness, and nutritional psychology.
Mental Health from a Trauma Therapy Lens
Personal reflections by Odelya
I was first introduced to trauma therapy as a student and client trying to live with my own struggles as a trauma survivor. My journey continues as a clinician, scholar, and teacher of sustainable trauma integration therapy. From many years of observing and working on my own dynamics and working with clients on four continents, I've come to see how important it is to view mental health symptoms in the context of underlying root causes.
Trauma, caused by emotional injury or cognitive, physical, spiritual or social harm, is a root cause of problems for a surprisingly large percentage of clients with mental health symptoms.
Clinicians may be technically correct in diagnosing such clients as having Depression, Anxiety, Bipolar disorder, personality disorders, RAD, Addictions, Eating Disorders and so forth. But when trauma lies at the core of symptoms, such a diagnosis can harm more than it helps. Trauma integration is a complex journey with emotional, cognitive, physical, spiritual and social aspects. A single strategy approach doesn't go very far in this journey.
Diagnostic labels can be deeply misleading to both survivors and clinicians, by riveting attention to a narrow set of issues that deserve consideration but only in the context of a much larger journey.
My core training and the primary tools that I use for interaction with clients come from attachment-based psychotherapy, neuroscience and expressive therapies. Responding to the insights above, for the past decade I've also invested a great deal of effort and time in wellness and integrative health, including nutritional psychology, to augment my core training. Goals that I ponder constantly in work with clients and in my writing are sustainability and attaining total wellness.
Trauma integration takes time, and requires in-depth investigation of all root causes. Some trauma survivors suffer from lingering underlying infections that show up in the form of autoimmune and inflammation disorders, psychological conditions such as depression, anxiety, OCD, self-regulation problems, attention or sensory difficulties, or chronic ill health. Unless we address these, no trauma treatment will help for long. In this case the mental health symptoms will not improve without addressing underlying root causes.
We also know that trauma affects the body and can be an instigator of chronic fatigue, IBS and IBD, chronic nerve and muscle pain, and other conditions. In this case, such conditions will not improve without addressing the underlying trauma.
By the time they come to me, many clients have tried a variety of modalities with several therapists. Typically they report temporary good results with one modality or another, that eventually proved unsustainable. For such clients, targeting all aspects of wellness is essential. Working in a linear way, one modality after another is unlikely to assist them. A comprehensive perspective is essential for progress.
That doesn't mean we have to deal with everything at once. But we do need to plan strategy in a way that considers all-aspects of wellness. These include:
(1) Emotional – dealing with first-line emotions such as fear and anger and second-line emotions such as shame, guilt, and pain. An important goal is to expand ability to endure pain and enhance joy;
(2) Cognitive – the way we process thoughts, how we focus attention and retention of information;
(3) Physical – the way we manage nutrition and nourishment, sleep, movement and exercise;
(4) Spiritual – our worldview - the framework we use to find meaning and purpose in life;
(5) Social – relationships with spouses, family, friends, colleagues, and strangers.
Expressive Trauma Integration™ (ETI) approach is based on over a decade of research and clinical work with traumatized populations in the Middle East, United States, Africa, and Asia by Dr. Odelya Gertel Kraybill, an integrative trauma psychotherapist, and consultant. A modular approach suitable for both psychosocial and trauma therapy interventions, ETI is an integrative framework that draws on recent research and practice from the fields of neuroscience, attachment and developmental psychology, expressive therapies, experiential and body-oriented therapies, cognitive processing, behavioral modifications, mindfulness, and nutritional psychology.
ETI has been field-tested and revised in trainings provided to social and community workers, therapists, first responders, and students, in Lesotho, S. Africa, S. Korea, Philippines, US, Canada, Israel, Japan and China. The ETI training model was formally accepted by the Philippines Department of Health in 2014 as one of their key modules of response to communal trauma after crisis.
Psychoeducation about trauma is education about the cognitive, physical, emotional, spiritual and social effects of trauma on survivors and families (individual trauma) and communities (communal trauma).
The Six Stage Trauma Integration Roadmap provides a clear conceptual framework for understanding and responding to trauma. The ETI approach helps survivors describe their experience in stages of: 1-Routine, 2-Event, 3-Withdrawal, 4-Awareness, 5-Action, 6-Integration. Survivors locate what they are experiencing on this map and in the safety of a therapeutic setting, use it to guide exploration of further steps towards trauma integration.
Attunement Based Psychotherapy. Attunement is a nonverbal process of being with another person in a way that attends fully and responsively to that person. A key aspect of attunement is that it is a joint activity, experienced in interaction with a caregiver. In therapy, the therapist attunes to the client with a goal to become a “co-regulator” with the client's responses. Over time, the client is able to transfer the sense of being co-regulated, to self-regulation outside of the therapy room, in everyday life. Through attuned relationship, clients lean to expand their capacity to endure the pain and loss of trauma and its aftermath.
Self-Regulation refers to the ability to maintain control over one's sensory reactions and expand one's capacity to respond emotionally and cognitively. Studies show that traumatic memories are stored in locations in the brain that can’t be accessed by cognitive approaches. Engagement with these memories must come via lower parts of the brain.
Whereas talk-based and cognitive approaches work top-down and enlist higher parts of the brain in calming the more primordial functions of the lower brain, nonverbal approaches work bottom-upwards. They engage directly with the lower parts of the brain and expand from there until the client is ready to engage in top-down narrative processing and trauma integration.
In the ETI approach, we use tools and techniques that facilitate body-awareness (grounding and embodiment), improve sensory and bilateral integration, strengthen the vagal tone, and promote neuroplasticity (reorganization and formation of brain responses).
Individualized Sustainability Plan (ISP). Setbacks are common for trauma survivors, often after encouraging progress. An ISP is an individual plan for self-care designed to assist continuity of progress. It contains techniques and practices tailored to a client's unique situation and preferences and addresses all aspects of wellness, including emotional, cognitive, physical, spiritual and social aspects.
ISPs draw from various practices demonstrated to be effective in mitigating trauma symptoms and enhancing the capacity to experience joy. These include mindfulness and self-compassion practices, sensory and bilateral integration, sport and movement, (top-down) cognitive reframing and behavioral modifications, expressive arts, brain-training, neurofeedback, diet, and nutrition.
I really appreciate how much you put into each training. Having been a trainer I know it takes an enormous amount of presence to hold a group our size and to keep us engaged like you do.
I feel like I have a new and much more expanded understanding of trauma and now have some tools to help to hold the people I work with much more tenderly and with more knowledge. I thank you for sharing the depth of your wisdom and the exquisite care you hold those with you are working.
ETI Series I workshop participant
The workshop was amazing. The experiential activities keep things engaging. I used the Squared Breathing technique to assist clients in a mindfulness activity and even used some of the grounding exercises. It was an extremely useful workshop. I am definitely going to take some more to build on the techniques and understanding until I have integrated them into everyday practice.
Leah Reed LCPC Participant in ETI Series I workshop