Leaving behind a sweltering late-May Toronto (and my warm clothes as well), I arrived yesterday to cold, wind and drizzle on the northeastern American seaboard.
I'm at the 25th Annual International Trauma Conference, hosted by the world-renowned Boston Trauma Center and co-sponsored by The Meadows and the National Child Traumatic Stress Network. It portends to be somewhat of a Woodstock for the trauma world, with many of the world's most famous trauma clinicians and researchers coming together to celebrate a quarter century of growth and struggle
Today was a pre-conference day and I attended a full day workshop on IMPACT, a discipline founded in 1971, with a mission to promote safety and realistic self-defence skills, without the need to master a martial art.
A ways back in my trauma training, I came across the term "Sitting Duck Syndrome", coined by Richard Kluft, a psychiatrist and pioneer in the diagnosis and treatment of dissociative identity disorder. Kluft described victims of childhood trauma who went on to be re-victimized in adult life, not only by family members and perpetrating strangers, but also by people in the mental health care field.
Those of us who practice full-time psychotherapy see this frequently in our patient population - in fact, the tendency to re-victimization is one of the ways we start to suspect a history of attachment failure and subsequent traumatization. And over the years, I've found the whole issue of safety to be more and more central to the care I provide. Often, during intake, I am already asking myself: Is this patient safe? What is his or her posture saying? Do I see evidence of immobilizing responses (freeze or feigned death/dissociation) or of truncated mobilizing defences (like an inability to fully extend the wrist in making a boundary motion while relating a time when a boundary would have been adaptive)? In the long term, I find it hard to accept sending a patient back into the world without the ability to defend themselves; this certainly seems as important as any number of other treatment goals.
Today was mostly spent practicing self-defence. That meant some time with PowerPoint, and a lot of time on the mat (or hotel carpeting in this case). Only one of the attendees had previous martial arts training, which was in no way necessary for the workshop.
Martial arts and self-defence are one of the least studied aspects in medical research, despite the fact that we live in an increasingly dangerous world. And there are many myths abounding about how to best protect ourselves. We tend not to think about this until it is a loved one or a patient, or even ourselves that is victimized.
The IMPACT work provides realistic simulations and a chance to react to them. A core set of verbal de-escalation and boundary skills are taught, as well as effective self-defence tactics that can be employed during an assault. These maneuvers are taught in a way that encourages encoding in muscle memory, so that they may be employed long after they were taught. The training also covers "adrenaline-management skills", which are certainly necessary for all our trauma and highly stressed patients, and also extremely useful for ourselves.
Meg Stone, the main instructor today, noted that trauma victims often come to the work feeling they are unworthy of safety and of fighting for themselves. By learning to defend themselves they often come to re-evaluate these traumatic beliefs and learn that they are worthy struggling for dignity, healing and the desire for a better life, away from those who abuse and exploit them.
They often also learn new postures and responses that, without any further thought involved, remove the somatic cues that are attractive to perpetrators. While learning how to respond to attempted rape (an interesting exercise for me to engage in), I liked the fact that the process was termed a Reversal rather than as something cold and dry like a tactic to oppose a sexual assault.
Meg was assisted by Alex, who works in both childhood education and in security services. Alex, a man whose demeanor offered a fascinating alchemy of tenderness and street toughness, was already much larger than Meg. Once he suited up in protective body armour, including a large headpiece that left him looking a little like a Judoon soldier from Doctor Who, the size mismatch appeared even greater. Though small in body, Meg was large in presence and taught us through example to meet our attacker with the intensity and speed that would be necessary for a real-life assault.
It's nice to come across knowledge that is as much based on "street-based research" as on collected data. IMPACT work has been shown to decrease hyperarousal/hypervigilance and shame in trauma survivors, while helping to build confidence. Who knew that self-defence can be healing? And on so many levels.
IMPACT Boston teaches clients from age 7 to age 80 and teaches across a wide range of populations. They do a lot of teaching with special needs students, including skills to help them set healthy boundaries with caregivers and custodial staff.
Meg will travel to teach, and Alex has taught as far away as South Africa. Check out their website at http://www.impactboston.com/index.html. There are some videos on the website; a good chance to see Meg in action and to see the kind of encouragement and mutual support she brings to her classes . If you are involved in any kind of mental health program, ask yourself if it is worth bringing the IMPACT team to your clinic or organization for a day or weekend long workshop for staff or for patients.
One side benefit for me today is that I feel more in my body as the main conference approaches, but - more importantly - I also feel safer in the ever-changing world. I will continue to practice the skills I learned today some, but most of the laying down of new pathways and consciousness has already been done.
Now is a good time to ask yourself what you as a physician or mental health clinician are doing to provide skills to keep your patients safe and to create healthy boundaries. What can you possibly add to the mix, after reading this entry and reflecting on the topic of self-defence and mindbody health?
Keep in touch with our teaching programs which aim to be trauma-informed, and to provide the kind of programming that relies as much on street cred and embodied awareness as they do on new advances in the field of psychotherapy.
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