Multi-sensory Trauma Processing is a treatment technique created by Dr. Davis to treat post traumatic stress disorder (PTSD), partial PTSD, job-related trauma, complicated PTSD and vicarious trauma/compassion fatigue. MTP helps to process traumatic memories and flashbacks (move a traumatic memory which is stuck in present memory to past memory) and to reduce or eliminate symptoms, such as problems in sleeping and concentrating. MTP can be used as a stand-alone technique or included as part of short-term or long-term therapy. MTP is designed with protocols that can be used by therapists of varying experience and skills.
"The psychotherapist can help a client "in the mastery of trauma through putting the experience into symbolic communicable form, such as words, thoughts and feelings" (van der Kolk, 1995).
MTP has six protocols to treat varying populations:
Level One: For single-incident, job-related traumas employing structured questions that can be used with and taught to employees who routinely experience job-related trauma.
Level Two: For single-incident, traumatic incidents employing structured questions. Can be used by a less experienced therapist than required for Levels Three and Four.
Level Three: For single-incident traumas. Uses extensive interview questions asked by a therapist in the same session in which treatment is administered. Appropriate for single-incident traumas that took place over short or long periods of time. Requires a therapist with experience in interviewing traumatized clients and in treating PTSD.
Level Four: For a client who has experienced a number of traumatic incidents leading him/her to develop acute PTSD and/or "complicated PTSD." Requires a therapist experienced in treating PTSD. The initial treatment session is based on extensive interview questions that cover a lifetime of traumatic incidents. Treatment and interview often take place in the same initial session, and address multiple traumatic incidents. This session can last as long as four hours. Two therapists may be a part of the initial interview and treatment session.
MTP for Vicarious Traumatization/Compassion Fatigue: For therapists, chaplains, counselors, victim witness advocates and other helpers who become traumatized by listening to the trauma experiences of those they seek to help.
MTP for Traumatized Young Children: Taught by a therapist to a parent or primary caregiver of a child with documented trauma in his/her life often associated with child abuse that has led to PTSD symptoms.
MTP includes the following elements:
Review of symptoms: Treatment begins with a careful review of the symptoms exhibited by the client using a Symptom Review Checklist. Symptoms resulting in sleep difficulties are specifically targeted, since they especially interfere with overall life functioning as well as job performance (Neylan, et al., 2002).
Psychological education: a) Providing information to the client as to how exposure to traumatic experiences can lead to biological changes and b) An explanation of treatment. Education is also interwoven throughout all treatment sessions. Research has shown that in order for a traumatic memory to be processed, it must be restructured by providing information that is inconsistent or different from the way in which the client/patient remembers and views his or her traumatic experience. Education is, therefore, an important part of restructuring the client or patient’s trauma memories.
Alternating stimulation: Uses alternating stimulation, in the form of computer generated drum sounds, tapping (usually on the shoulders) and, in some instances, eye movement. Alternating stimulation is an important element used in all levels of MTP treatment. Alternating stimulation seems to dramatically accelerate the processing of traumatic memories. In MTP, two or three types of alternating stimulation are used simultaneously (except with young children, where only tapping is used). In conjunction with this alternating stimulation, the therapist(s) may summarize the client’s traumatic history and/or ask questions of the client or patient to which he or she responds. In this way, the client reviews his or her traumatic memories, a necessary condition for them to process the memory. Typically, the client listens to alternating drum sounds on headphones from an MP3 or CD player as the therapist, standing behind the seated client, alternately taps their shoulders. Research and experience has shown that having a client review a traumatic memory without the addition of techniques that help the memory to process, such as alternating stimulation or exposure therapy, generally causes an increase in their symptoms and/or distress and increased efforts to avoid the trauma memory. However, by combining alternating stimulation with memory review, the traumatic memory is often processed, moving appropriately into memories associated with past events. Traumatic memories seem to be stuck in present memory. We are not certain of how and why ??????? Alternative stimulation may distract the attention of the client in a way that integrates the trauma memory and/or it may work in a more biological fashion, perhaps by stimulating both hemispheres of the brain to integrate these traumatic memories.
Review of the trauma memory: All levels of MTP, except for the protocol with young children, require that the client review his or her memory of events.
Questions: MTP uses structured questions so that the client can recall and talk about as many traumatic incidents from their past as possible. Questions are used for the following reasons:
- Questions seem to assist in retrieval of memories that have been diluted by amnesia or dissociation.
- It is typical for a client to be disorganized in the manner in which traumatic memories are related (van der Kolk, 1995). The use of questions helps the client organize his or her memories related to their trauma.
- Questions are used to determine the impact that each of the following factors could have played on the client's traumatic symptoms: intensity, duration, proximity, support system, family history, childhood abuse and trauma, sex, physical factors, religion, negative emotions such as guilt, shame, humiliation, anger and fear, helplessness, sense of control and prior emotional functioning. By covering many risk factors in the questions asked of the client, he or she often remembers and provides important details related to their traumatic experiences that might otherwise be neglected.
- Structured questions aid therapists inexperienced in structuring appropriate inquiries as well as providing a vehicle to increase his or her understanding of the way in which traumatic experiences can impact a client.
Interview questions were developed from the author's experience in treating hundreds of traumatized clients. This led to a recognition that few of her clients were able to articulate the details of their traumatic incidents and that many were not consciously aware of the event or specific aspect of a traumatic incident that had been most traumatizing to them. Specific questions have been created for law enforcement officers, fire fighters, and soldiers serving in combat in Iraq or Vietnam. Grief questions were created using trauma narratives of hundreds of individuals who had lost a loved one and the dissertation and professional experience of Marcella Marcey, Ph. D. The domestic violence questions, which include an extensive review of traumas occurring to victims traumatized by a sexual sadist, are drawn from a number of sources: Roy Hazelwood, a retired FBI agent and internationally recognized expert on criminal sexual behavior; Sharon Smith, a former Special Agent and instructor in the Behavioral Science Unit of the FBI Academy; and interviews of "compliant victims of sexual sadists" (a term coined by Roy Hazelwood which refers to a wife or girlfriend of a sexual sadist regularly tortured in this relationship) seen in treatment or evaluated by the author. Questions directed to children or rape victims were designed from the author’s experience.
The following are some typical comments of patients regarding the use of questions:
“I liked going to my therapist, but I just couldn’t talk about Granddad (who sexually and sadistically abused her from a young age to age 15). It was too painful and my therapist was too frustrated. She never asked me questions like you did. I probably would have answered them if she had asked them. No one and I mean no one, ever asked me the questions you did that day. That was the key. She wanted me to talk but I just couldn’t put it into words. She didn’t know the right questions to ask.”
"The difference was the questions you asked me. No one ever said to me, 'You thought you were going to die?' and I never thought to say that on my own. And no one ever re-stated what I said in the matter-of-fact way you did. No one! That made a big difference.”
“Do you want to know the one thing that I remember most that you said to me? I had said something about being a weird or odd little kid and you corrected me and said, ‘You were an abused little kid.’ That nearly blew me away. Something so small like that and it validated my feelings so greatly. I think I told you at the time, that I had never told one person everything.”
(Adult describing the interview questions used in MTP treatment.)
Links: MTP recognizes that traumatic incidents are often linked through similarity of events, themes or irrational beliefs (negative self-talk). Traumatic events become linked when the feelings and emotions triggered by one trauma reach back through time and connect with the feelings and emotions of an earlier trauma. The linking of two or more traumatic incidents can dramatically increase the impact of traumatic incidents and the resulting symptoms.
Challenging of cognitive distortions: Although challenging distortions is an important part of all MTP treatment levels, Levels Three and Four, in particular, emphasize the challenging of distortions in thinking, judgment, reasoning and belief systems. Distortions involving shame, guilt and humiliation are particularly targeted, because these emotions have been found to be important elements in the development of symptoms following exposure to traumatic incidents. Although fear has been postulated as being the primary emotion which leads to PTSD (Foa, et al., 1998), this may not be the case for law enforcement officers, fire fighters and paramedics/EMTS. For these professionals, their experience of horror at the most vile of crimes, viewing body parts, homicide victims, drunk driver accidents and trauma to children play a very significant role in their job-related trauma.
In vivo or on-scene review of traumatic incidents: The processing of a traumatic memory seems to increase in direct proportion with the client's ability to accurately recall the experience. Therefore, as a way of improving recall, it is useful to expose some clients to reminders of their trauma, through the use of audio and/or tapes, videos or pictures as well as other mementos, reminders, or even the actual scene of the trauma (Gersons, Carlier, Lamberts & van der Kolk, 2000; Hembree and Foa, 2000).
Therapist: The approach of the therapist in MTP, as in all treatment techniques, is important. Therapists should provide a sense of safety, validation, support, empathy, present a non-judgmental demeanor. They should emphasize self-worth and self-esteem, relationships, self-respect and self-care. In treating complicated PTSD (Level Four), two therapists may be used.
Visual imagery: Visual imagery, metaphor and therapeutic stories are used in Levels Three and Four as additional techniques that help in restructuring the client's trauma memory.
Emphasis on strengths: Particularly in Levels Three and Four, the therapist emphasizes the positive aspects of a client's life, including those who loved him or her, accomplishments, survival strengths, relationships and job successes. Having the client imagine him or herself having processed the traumatic memories and moving on to positive behavior in the future is also a part of Level Three and Four and can be used with all levels (Hobfoll et al., 1991; Van der Kolk, 1995, 2002a).