Tag Archive for: affect regulation

I ran Level Two A.R.T. training in Townsville, Australia this April, after being invited by four practitioners who had completed Level One in November 2011.  They were actively using the Level One A.R.T. techniques in their practice with clients and were getting good results, so they were keen to master the Level Two skills as well.

After clients have completed the short term therapy phase of 6 to 15 sessions, and released most acute stress, they generally need to do more in depth work on their social and emotional developmental phases and this is taught in Level Two.  The practitioners found that they now needed these skills in order to move forward with their long term clients.

The group consisted of three psychologists Dr Martha Landman, Dr Alana Bowen and Dr Evelyn Graham and a clinical social worker. Kylie Osborne. Dr Landman, Dr Bowen and Kylie Osborne had also each previously submitted three case studies and received supervision and are now listed as A.R.T. practitioners on the A.R.T. website.

The trainees found the protocols and tools for working with the social, emotional and sensori-motor developmental stages and the integration of these into therapy in a practical way to be valuable and immediately useful in practice with their own clients. Dr Martha Landman immediately used the protocols and information on the second stage of social emotional development with a long term client during the training and could report a successful outcome with the client to the group.

Whereas Level One training teaches how to use A.R.T. as a brief intervention, of up to 15 sessions, Level Two training gives the psychologist a deeper understanding of the growth processes their client goes through in long term therapy. It also teaches more varied skills, allowing the psychologist to work more in depth with long term clients who have more chronic or complicated conditions.

The trainees mentioned that they found the information about physiological signs of emotional processing very valuable. In practice, they observe their clients frequently reporting body sensations that seem related to emotion processing and they found it helpful knowing where emotions are expressed in the body, as well as the significance of certain sensations.

For example, one psychologist reported that her client had experienced a tingling sensation in and around the lips and she found it helpful to learn that this sensation can be linked with an infant fear reflex, the Moro reflex. This would indicate that her client was both releasing early infancy fears and also learning better controls over his anxiety responses. She could report that her client had made significant gains with stress control and an improvement in mood since she had been working with him.

The group had already learnt many physical signs of emotion processing in Level One training, but could now add a new library of knowledge in this area and they found that it gave them more insight into what they had been observing in their clinical practice.

Another of the reasons trainees had for attending Level Two was they wanted to learn more about using sensory integration in psychotherapy. They had been incorporating the sensory exercises into therapy for clients “when they are not into talking”.  They find that clients often do not want to talk about their past or about trauma and that it is helpful to have another medium to access the client’s emotional or mental state. As a participant said, ‘My type of client doesn’t talk, so it’s very helpful.’

They had also observed that when their clients practice the sensory integration exercises at home they respond better in therapy sessions. I concur on this, as I have seen in my practice that those clients who practice the exercises at home on a regular basis make faster progress in therapy sessions.

They had also found, to their surprise, that many of their clients spontaneously used the exercises at home for self calming, without being instructed to do so. It was mentioned that clients find the stretch exercises particularly valuable.

Another valued aspect of A.R.T. that practitioners mentioned was the instantaneous positive effects of A.R.T. For example, a client goal was ‘To have a clear head’, (a very common therapy goal for stressed clients) and the client’s feedback at the end of the session was, ‘I feel so sharp’. Practitioners find this immediate result makes it a positive intervention. I find that in the case studies that practitioners submit this is a very common outcome.

Dr Graham said that she finds that clients come into sessions stressed and tense and at the very least this state can be altered immediately. That is worthwhile in itself and it can also be a way of preparing the client for therapy as well. She gets referrals of clients for whom other therapy methods have not delivered results and she then uses  A.R.T. as  an alternative approach.

Practitioners also discussed how to prepare clients for A.R.T. Each practitioner has developed their own way of introducing the therapy to clients. Dr Graham has given clients the DVD on the book “The brain that changes itself” by Norman Doidge, as this explains concepts like neuroplasticity. This is an area psychologists often discuss. In my practice I explain the technique as being a method for improving the left and right brain connection and that this calms emotions. I suggest each practitioner find their own rationale, based on their own understanding of the therapeutic ingredients.

Apart from discussing cases and clinical applications for various disorders and learning how to use the techniques, we also practiced the techniques with one another, which meant that each participant had a few sessions to personally experience the therapy. Observing one another and experiencing the physical and emotional changes firsthand was a valuable learning tool. And we also get the benefits personally, which is a great plus to doing the training. I regularly get feedback from my students about how well they are doing in their personal lives after completing a training course.

One practitioner said she had had the happiest time of her life since the Level One training.  Another said A.R.T. had helped her cope significantly better with a personal loss. The group also noticed that some trainees looked refreshed and younger after a session.

This improvement in appearance is a common observation after one or several sessions and can be attributed to an improved toning of the facial muscles after stress release and a better left right brain integration, which gives the face a more symmetrical appearance, which is more pleasing to the eye of the beholder. And dullness in the iris of the eyes is replaced by a shiny brightness and better colour. This result raised the comment, “Oh, so it is also a beauty therapy”. Well, that is just an added bonus to solid results on improved mental health!

Affect Regulation Therapy can be used to support the initial delicate phases in psychotherapy of rapport building and contracting for treatment with the client, because it is consistently effective at immediately lowering stress levels and raising mood in a client-friendly way. Here is how it can support you, the clinician, in your practice.

When clients present for psychotherapy they are propelled by a state of psychological discomfort, which may have a variety of causes, commonly difficulties with relationships and latent immaturities.

At time of presentation, the client’s stress levels are usually high. In a general clinical psychology practice, clients may commonly present for treatment with symptoms of stress, depression and anxiety that can range from mild, moderate to severe. Without this type of psychological discomfort, clients wouldn’t arrive for help.

Clients expect assistance from the psychologist to relieve their pain and, at this point, the client wants to know “Can you help me?” “Do you understand what my problem is?”  and “How long will it take to fix it?”

The psychologist is immediately faced with a number of urgent tasks at the first interview. He or she must form a working alliance and positive rapport, or positive transference, with the client and establish a relationship of trust with the client, a goodness of fit to work together. The psychologist must also communicate how therapy works, what goals can be worked on, the context or interpretation of the client’s problem and approximately within what time frame the client can expect what type of result.

This is known to be a delicate period when the contract can easily be derailed and the working relationship lost. However once these tasks are under the belt, both client and psychologist can be more confident, comfortable and relaxed about their joint project, because they have established a mutual trust relationship with a mutual positive expectation of a good result. They have made a commitment to work together, hopefully based on mutually realistic expectations.

A.R.T. can be used by the experienced clinician to support this initial, delicate phase of rapport building, introducing, and contracting, and then starting a psychotherapy process, because it is a client-friendly model that supports your relationship with your client in many ways, the most important of which is that the clinician can use A.R.T. to help the client right away.

It is important that the client feels that he or she got help in the first session. A.R.T. can support this goal by being used as a very brief 5 to 15 minute intervention in the first, second or third interview, to immediately and observably lower the client’s stress level. Generally this will elicit a comment by the client such as ‘Now I feel really relaxed’. This observable shift or change in tension level raises client confidence in the likelihood of future positive therapy outcomes.

This brief intervention, together with the supportive interview and debriefing nature of the first and second interview, will often result in an immediate, significantly reduced score on depression, anxiety and stress scales. This positive result obviously elevates client commitment and can lower overall dropout rates in a practice.

Feedback by a psychologist after she attended a recent training course in A.R.T. illustrates the value of immediate stress relief in a first session.  She had been in psychotherapy for several years to resolve early childhood attachment issues, which had resulted in chronic elevated stress levels for her.

She was surprised that after one session of A.R.T., in a demonstration setting during training, she had significant relief from chronic stress. Her long term psychotherapy had been enormously helpful and she had made progress, but she had reached a point in her therapy where she felt  ’stuck’ and was not making enough ongoing progress and her therapist had concurred with her on this.

She made the following comment after the A.R.T. training,   ‘I am still feeling very good and even feel more sociable. I went to an outdoor boxing class last night that I have felt cynical about due to my perceived clique-iness of the local women! It was fine and I felt normal and great that I went! Thank you.’

Such a reduction in stress and positive change in emotional status can be observed by the client within minutes in a session or within a 24 hour period after a session. I find that even  young children can comment on their change in mood and well being after the intervention.

This elevation of positive emotion translates directly into the client’s enthusiasm
and motivation to set up a treatment contract with the therapist, which fulfills one of the aims of the first three psychotherapy sessions.