Dr. Jeremy Sharp (00:01)
Hey everybody. Welcome back to a clinical episode of the testing psychologist podcast. Today we are talking all about trauma. I’ve got two of the giants in this field with me today for the conversation. I’m super grateful. I have Dr. John Breyer and Dr. Erin Eady. ⁓ Erin is a clinical and health psychologist in Toronto, Ontario, Canada. She’s staff psychologist at the Southeast Toronto family health team, an adjunct adjunct lecturer at the university of Toronto’s
of 8 Faculty of Medicine, and she’s head of child and adolescent care at Fairmark Psychology Center. She conducts and publishes research on the impact of interpersonal trauma on mental and physical health with a specific interest in post-traumatic stress, attachment, dissociation, and emotional dysregulation. Her clinical work and consultation focus on evidence-based assessment and treatment of trauma survivors across the lifespan.
And John Breyer is Professor Emeritus of Psychiatry and the Behavioral Sciences at the University of Southern California, Keck School of Medicine. He’s a past president of the International Society for Traumatic Stress Studies. He’s a recipient of the award for outstanding contributions to the science of trauma psychology from the APA. The William N. Friedrich Lecturer, outstanding contribution to the field of child psychology from the Mayo Clinic.
and the Presidential Award for contribution to methods from the Association for Scientific Advancement in Psychological Injury and Law. He is author or co-author of over 140 articles and chapters, 18 books, and nine trauma-related psychological tests, which you have probably used in your practice. This is a fantastic conversation. So we talk about…
Lots of different things. We talk about the evolution of trauma conceptualization over the past 20 years. We talk about differences between trauma exposure and response and diagnosis. ⁓ Big question, why some individuals develop PTSD and others don’t, even after similar events. We dig into the assessment side of things and what constitutes an appropriate and solid assessment. We do talk about specific measures here and there. We talk about complex PTSD.
We talk about cultural humility and trauma and how it shows up for oppressed and marginalized populations. This was ⁓ just a packed conversation with a lot of different topic areas. And my hope is, as always, you will find it useful in your practice. So please join me for this conversation with Dr. Aaron Eady and Dr. John Breyer.
Dr. Jeremy Sharp (02:43)
Erin John, hey, welcome to the podcast.
John Briere (02:46)
Greetings.
Erin Eadie (02:46)
Hi.
Dr. Jeremy Sharp (02:47)
Yeah, I’m so glad to have y’all. feel like this is like a major get for the testing psychologists, you know, y’all are big players in the trauma world and I’m honored to have you here. So thanks for being willing to spend some time with me.
Erin Eadie (03:00)
Yeah, we’re happy to be here.
Dr. Jeremy Sharp (03:02)
Yeah. So I think folks can probably tell pretty easily who’s who, but I’ll have you do just like a brief intro so folks can orient to your voices a bit. Erin, do you want to go first?
Erin Eadie (03:13)
Sure, I’m Dr. Erin Eadie. I’m a clinical and a health psychologist. I’m based in Toronto in Canada and I do quite a bit of work with trauma-focused assessment as well as with treatment and consultation. And I work in a couple different settings in private practice as well as in more of a primary care setting within a team of physicians. Yeah.
I’m going to pass it to John.
John Briere (03:38)
She’s also done a lot of research. We’ve done research together. of our work with self-injurious behaviors is of interest to a lot of people. she’s actually, I would say she’s a research clinician or clinical research practitioner. I don’t know what she is, but with psychologists, we do so many things. What do we call ourselves?
Erin Eadie (03:54)
Thank you. Yes, I do.
Dr. Jeremy Sharp (03:54)
Great. Yes.
Yeah. Great point. A little bit of everything.
John Briere (04:03)
All right, so
I’m John Breyer, and at the university level, I’m an emeritus faculty emeritus professor of psychiatry and behavioral sciences at USC School of Medicine. And I’ve been working in trauma for a long time, done a fair amount of research written stuff.
Been working with Erin for a lot of years, and absolutely one of my favorite people to work with. So excited we could do, it’s true, that we can do this book together, especially because she’s young and vigorous and I’m not, so a book like that.
Dr. Jeremy Sharp (04:37)
Sounds like Well, maybe we start there. You know, my first question is always why,
why this? and I guess in this case, the, the, this is the book, maybe the updated version of the book. So, you know, I’m, curious why now, why this, like why spend your time and energy, doing an update at this point in time.
Erin Eadie (04:53)
Yeah, so this is the third edition of the book that we’ve put out in the past year in the spring. And it was the second edition publication date, I think was 2004. it was certainly, you know, a lot has happened in the field of trauma in those 20 years and needed that update to kind of keep up with the times and also be sort of a…
reference text for both clinicians and researchers on the current state of things. So really that kind of quite fulsome update based on all the developments in the testing and the assessment, but also in our research and conceptualization and understanding of how trauma kind of can play itself out across the lifespan.
John Briere (05:40)
You know, I think it’s funny, what’s up with the psychology and the psychology of the trauma world that there hasn’t been another assessment book since those books, really. I mean, I’m familiar with all of them and contributed to some of them, but basically this book was so necessary because so much has been figured out or understood or expanded on since the last version of that book, which was a while ago.
I think it was sort of, we wanted to get it out there to be a signpost to where we are right now. So sort of a, because if we just rely on books that were written 15, 20 years ago in this field especially, we’d be missing an awful lot of material.
Dr. Jeremy Sharp (06:22)
Yeah, that’s fair. mean, like everything it’s, it’s evolving and we understand more and more, I think as time goes on, but I don’t know, or we’re going to talk about this, but it seems like trauma has, become a real hot topic over the last, I don’t know, five, six, eight years. and it’s a, you know, our field kind of goes through cycles, I think, and things get hot and trauma is one of those things right now. So it’s, it’s just super timely. And I’m, so glad to have y’all on to, to,
John Briere (06:27)
you
Dr. Jeremy Sharp (06:49)
Just get your thoughts on some big questions about Trump.
John Briere (06:53)
You know, I would just push back a little bit on this notion that trauma is the mode of day. It’s the thing that we’re into now, or it’s really hard. And I don’t view it that way. I’m not being absurd here,
Dr. Jeremy Sharp (07:00)
Please, yeah, yeah.
John Briere (07:05)
I think that trauma is a critical etiology in the psychological and physical functioning of humans at all stages of lifespan. And it’s taken a while for us to understand that, but as researchers, Erin and I could tell you that any time you add trauma to any analysis, it’s going to start predicting variants and showing things that people had not known before. And also a lot of non-trauma syndromes are now understood to have major trauma.
Erin Eadie (07:10)
you
John Briere (07:29)
contributions. So I could be silly here, but I think you’re just seeing what had to come out at some point. What now that this is out, just like some of our stuff on social marginalization, you can’t really, some people try to put it back in the boxes as you know, we, you know, we’re figuring stuff out and I just think it’ll keep on going. I think in five years, the dip. So my experience at USC was when I first was there and I was there for like 30 years or something, nobody knew anything about trauma. made fun of me when I brought up in case conferences that something might be
sexual abuse. I had a chair tell me, John, you seem very interested in sex. I said, well, no, actually, Dr. Stone, I’m interested in sexual abuse, which is not sex. And you can imagine how that started. This was an analyst of the old school. You know, things have just changed. Now, I’ve residency at USC has got a trauma clinic, they’ve got training, they require textbooks.
People like Erin are setting a new standard about how can you actually be a really good clinician and integrate all this stuff, not because it’s cool, because it’s actually sad. What can you do with it? So you see these huge articles down in the major medical things. Wow, trauma is related to everything and it gets a lot of publication, but it’s true. Did I overstate that, Erin? Do you think I overdid that?
Dr. Jeremy Sharp (08:38)
Right, right, yeah, you’re like, we know, we know.
Erin Eadie (08:43)
No, I don’t think you did. And I do, I think it’s sometimes hard when there is sort of a wave of interest in something to know, like, is it a wave? Is it gonna come up and then sort of die back down and go by the wayside? I don’t know if that’s not what you were suggesting, I don’t think, Jeremy, but I agree, John, that the sort of gradual increase in recognition, not just interest, but recognition and the ability
Dr. Jeremy Sharp (08:55)
Mm-hmm.
Erin Eadie (09:12)
probably from an assessment standpoint to be able to identify and to some extent pinpoint the contribution of different effects, right? Whether it’s kind of pre-existing trauma exposure or something more recent and how that has likely complicated the picture. You know, thinking back to a time when there just was no recognition that that could possibly be a contributing factor to now trying to come to terms with
Dr. Jeremy Sharp (09:26)
Hmm.
Erin Eadie (09:38)
maybe it’s in everything, right? Which can feel like it’s taking up all the space.
Dr. Jeremy Sharp (09:40)
Mm-hmm.
Hmm. Yeah. Yeah. I think that’s a good way to put it. You know, it was a very eloquent way to kind of restate what I was saying that it’s not that it was ever not important, but it’s people have more recognition maybe and it’s more integrated into clinical practice, at least, you know, in our practice, right? Like when I went through grad school 20 plus years ago, it was not a thing that we really talked about a lot, you know, but now it’s a, you know, we’re always asking about trauma and different.
types of trauma and experiences in our clinical interviews and the conceptualization in our assessments and so forth. yeah, maybe it’s just better recognition.
Erin Eadie (10:23)
I also see, more recently I’ve been doing some teaching and training with primary care family medicine residents and seeing the expansion outside of the scope of psychology or sort of the purview of psychology and psychiatry to this broader range of healthcare.
Dr. Jeremy Sharp (10:29)
Hmm.
Erin Eadie (10:40)
and recognizing, and I think all the ACEs studies, the adverse childhood experiences research and studies have done, have gone a long way with that and seeing the physical health implications that that has sort of necessitated this recognition that, these things are related in some way and there’s a broad effect of at least attending to it and possibly trying to treat or prevent these trauma effects and trauma exposures.
Dr. Jeremy Sharp (10:43)
Mm-hmm.
Hmm. It’s a great point. It’s a great point. So I wonder if we might start kind of big picture and just continue some of this discussion. I would love to hear from y’all because you’re, you’re in it, you know, how the conceptualization of trauma has shifted over the last 20 years or so.
Erin Eadie (11:23)
I can, do you want to start John and then I’ll add to it?
John Briere (11:26)
Well, you hardly know what that much time has gone past and I’m jealous. So I think that, you know, like the comprehensive textbook psychiatry in the 19.
Well, do you know when they said that incest quote? I think it was in the 50s or 60s, maybe 70s. They estimated the rate of incest in our culture. This is a major training textbook for psychiatrists. They estimated that the prevalence of sexual abuse in American culture was one in one million people, incest.
Dr. Jeremy Sharp (11:58)
Okay.
John Briere (11:59)
And so that tells you sort of what we were up against. Because sex abuse is involved in all kinds of power dynamics and social inequality and age differences and power differentials and stuff, it’s always been political. So the people who hold the strings of power, don’t want to get all weird here, but the people who decide these things are usually older white males who have their own training and background.
systems and was very you know some of those wonderful people and analysts that were friends by my own analyst I was in analysis for a long time he was a great guy around this but there was a lot of pushback and pathologizing so if you had a sexual abuse history hey maybe you didn’t because we knew from the edible analysis that most men women make up stuff like that because they secretly want to have sex with their fathers I’m not saying that you guys that’s what they say to most of you and
Erin Eadie (12:45)
Hehehehe
Dr. Jeremy Sharp (12:46)
Right.
John Briere (12:47)
So A, it didn’t happen, or B, if it happened, was because you inadequately resolved the edipus complex. But then also, if you did have it, you were a dirty, bad little girl, and it was girls at that point, although, Freud originally supposed that boys would have lots of such news experiences. And so.
I just, as a trauma survivor myself, I survivor, not sexual abuse, but a lot of abuse. I just have a lot of appreciation for the fact that you can get double or triple whammy in our culture where you people hurt you and then they blame you for it and they say it didn’t happen. And then they say that if it did happen, you now are pathological. And the minute you’re pathological, you’re no longer a good reporter.
experience and you’re just trying to get attention on you right now I won’t get into it right now there’s some media around did this woman actually experience sexual abuse or not it’s the same old story we heard many years ago just a little more sophisticated so I don’t know what Erin thinks about this although she’s nodding a lot
Dr. Jeremy Sharp (13:37)
Mm-hmm.
John Briere (13:42)
I think that, thank God, one of the big changes is hopefully we’ve de-pathologized this a lot, we’ve de-stigmatized it a lot, but it’s still horribly, it would be just when someone hurts you, why do you want anyone else to know your business? And you’re gonna have a tendency to blame yourself, that’s just human dynamics. So I don’t know, what do you think? It just feels like, I don’t wanna say it’s all great right now, but it feels like this is the time when books and therapies and young clinicians and.
clinicians are reconsidering what they thought before that we’re coming to a really pretty good time. I’m much more happy about the state of our treatment of survivors now than, I don’t what, even five years ago Erin, would you say? 10?
Erin Eadie (14:23)
Probably, yeah.
Yeah. I mean, that’s a helpful kind of way to anchor, you know, if you say, let’s say 50 years ago, whatever the date was that you were referencing that, that evolution of, of just our thought process and our understanding, right? And response and conceptualization around how early experiences, how different even
Dr. Jeremy Sharp (14:32)
Mm-hmm.
Erin Eadie (14:48)
acute traumas or more specific traumas are going to affect a person in the moment and across their lifespan. So yeah, I think there’s massive changes that we see occurring over the course of some of those decades. And then more recently, I can think of, say at the start of my time in graduate school to now, which is maybe similar to you, Jeremy, about 20 years, that the shift
from the conceptualizing trauma as single incidents, the sort of acute, discreet experience that happens to an individual. then, of course, of course you’re traumatized and maybe you have PTSD or something that looks like that. The evolving understanding of integrating that more specific incident within the context of.
cumulative and developmental experiences, some of which would be very abusive and very traumatic, but not all of which. But thinking of it more along those lines of developmental trauma that starts very young and accumulates over the course of childhood and adolescence and then potentially. And I think we talk about this or reference this in our book, the idea that adult traumas that occur in adulthood.
are existing within the context of that individual’s life history, which may have all these pre-existing traumatic experiences as well, right? So understanding that evolution from these like single isolated time points to this more complex, you know, kind of development of longitudinal accumulation of trauma and how that shapes an individual’s life.
That I think is something we’re still appreciating and trying to get our heads wrapped around and fully understand. But we’re in that murkiness of it a little bit more now, which is much more real and authentic to what people’s actual experiences are.
Dr. Jeremy Sharp (16:28)
Mm-hmm.
John Briere (16:35)
Right, we’re in a weird time where the more we know, the less we know and the more complicated we realize it is. know, also if you look at the modern stuff, the last five years stuff.
look at lot of acts of non-physical commission. So things like neglect, disengaged parenting, and people have always said, well, you know, that’s not as bad as actual physical harm. And obviously, sexual abuse is a horrible, horrible thing. Nobody’s arguing that, but for physical abuse. But when our research, including with Erin’s and mine, has been, we’re discovering that disengaged parenting produced symptoms that are actually, in some cases, more extreme than acts of commission like sexual or physical abuse. Now, what’s the problem
trauma
therapists or trauma clinician researchers are studying something that no longer lines up with the notion of trauma, which is that it’s a threat to physical integrity and you’re going to die and you think you’re going be badly hurt. And you’re talking about mommy didn’t love you, you know.
Actually, mommy not loving you or daddy not loving you is, we can’t make, this isn’t a horse race, but it’s really, really bad. So then what we’re doing more and more is realizing that even though we’re trauma is starting to need a little bit of work because it was originally developed in American worlds to explain returning Vietnam veterans when there wasn’t any PTSD diagnosis. So it’s a very specific thing and it was supposed to happen, know, 22 year old males in a foreign country when most of those guys
Dr. Jeremy Sharp (17:43)
Hmm.
John Briere (17:58)
because I was on the Navy recruit stand for 15 years. Most of those guys came from, or many of them came from abusive environments. Just like 9-11, we thought that was an acute trauma due to the terrorist attacks, but you know, because I’m very involved.
A lot of clinicians and certainly clients saying, actually this stuff, which was a non interpersonal trauma, they didn’t know me, it wasn’t my fault, et cetera, exacerbated when my father beat me up or my principal section just been done with a much, much larger issues start to emerge. So it’s fun, right? It’s fun to.
on, funn’s a funny word, but as a researcher who’s fascinated by these things, I think it’s fun to just say this is such a complicated thing. And if you were to look at someone and say, why are they hurting so much right now? while they were sexually abused or physically abused, they were also invalidated because their skin color was not the one that people wanted. They didn’t love the right people according to some people, or they whatever. And those things may be larger. And so how do you do that? And then do you call that trauma? And I don’t know if you want to get into this later, but we just
recently published a paper showing that growing up in a racist, sexist, or homophobic environment was actually massively impactful on modern psychological functioning, including PTSD. So we created a measure and we basically found that the PTSD was highest among people who had been racially or sexist treatment or
treatment to response to LGBTQ stuff. But that was actually, you know, like what’s what it’s all in the Venn diagram is very messy, right? But if we’re really far from the old, you know, DSM 3D, you know what it was? Find a trauma, not enough. Does it have these 17 symptoms? Got PTSD. That was it. That was the dichotomy. Now we know that’s actually the minority of trauma sufferers, the people that fit those slots.
Dr. Jeremy Sharp (19:30)
Sure.
Erin Eadie (19:47)
Yeah.
Dr. Jeremy Sharp (19:47)
Yeah.
So that’s super interesting. I mean, I think at the risk of oversimplifying, we’re talking a lot about like this concept maybe of like complex PTSD, like the ongoing, you know, little T trauma, you know, these experiences that people have throughout their life. And, you know, we don’t have a great way to capture that diagnostically, I don’t think. And that’s where I really get stuck as a clinician primarily. You know, it’s like, I don’t know what to do with these individuals, you know, and how to capture that and kind of honor.
that experience. But you’re starting to touch on too, you know, I really wanted to ask this question of like why in y’all’s experience, like the risk factors involved in like developing sort of a traumatic response or PTSD versus not like, you know, we see a lot of individuals who experience quote unquote identical events and some develop PTSD, some don’t like what are y’all finding in that realm now currently?
Erin Eadie (20:42)
So there’s great, we could probably do the whole podcast just on that question, Jeremy. So we’ll probably, we’ll keep it as concise as we can. I think just to, let’s build on this, but to go off of what we were just saying in terms of like how traumatic experiences can accumulate over the course of a lifetime or just even in a.
Dr. Jeremy Sharp (20:44)
I’m sure. know. know. These are hard questions. know. Yeah.
Erin Eadie (21:02)
discrete period, that one of the big differences is, is this the first time a person has experienced a traumatic event that has threatened their safety or threatened their physical integrity versus is this the last, the most recent time on a long line of experiences that touched on that exactly or something similar to it, right? So what happened before? I just was actually
going over some literature about this in regards to what at least we call here is occupational stress injuries, so like first responders or police or firefighters and the idea of you know for their higher-ups, for their administrators within their organizations helping them to understand why would two people say on the same call
Dr. Jeremy Sharp (21:35)
Hmm. ⁓
Erin Eadie (21:49)
having essentially very similar, the same exposures to a discrete trauma, have very, very different psychological reactions to it. And part of that is what is the meaning of that experience for them. And to know what is the meaning of that experience, you to some extent have to know what came before.
Dr. Jeremy Sharp (22:05)
That’s wonderful way to put it. I think that leads. Yeah, go ahead, John.
John Briere (22:07)
So,
I used to do lot of forensic work and including the Menendez case, for example, which was a good example, that was the kids who killed their parents.
You know, what does an identical trauma mean? Because as Erin’s saying, you might have had the quote, identical trauma, but nobody experienced the world the same way. We all have different expectations and sensitivities and reactivities. And then although they have the same trauma, we can’t go back there and look with a microphone, magnifying glass to see, it in fact the same exact trauma? Like in 9-11, which floor are you on really made a difference? I mean, so, you know, these things are really important, but the other thing is they may have had an identical trauma, maybe one
Dr. Jeremy Sharp (22:28)
Mm-hmm.
John Briere (22:49)
One
was neglected like crazy and the other one wasn’t. And that doesn’t show up on any tests or interview if you don’t ask it. People don’t. They’ll say, no, I had a good childhood. But what was it like? And when they tell you what it was like, you hear a cold, distant, unloving father who was rejecting and a mother who maybe for whatever reason was checked out due to her own suffering or the way the father was treating the mother or whatever. Those are all in there too. And then the biology of the whole thing. The three of us right now in this little podcast are completely different.
I mean, we managed to accomplish some of the same functions. We’re talking, we both, we all got dressed this morning and things like that. But our neurobiologies are massively different. For instance, mine is rapidly decaying because I’m older than you guys. That’s real. Well, that’s real. And early brains, right? 14 year old brains are not pre-friendly developed enough to down that myelination of tissue. I mean, we’re all on some continuum there. I find that fascinating, but it does, it does fly in the face. And I think Jeremy, you were getting at this. It flies in the face of easy,
categorization. Well, what are you after all? Are a trauma survivor? Well, if you use the definition of bad things happen to you and you still suffer from them, almost everybody’s a trauma survivor. But it sounds like when you have a hammer, the world is filled with nails, right? It sounds like you’re just doing what you’ve always done. Yeah, that’s trauma too. But if there is all that adversity out there.
How do we delineate that and how important is it to delineate it, which of course is something. But as long as we clinicians are being asked to make binary decisions about how people are doing.
We have to pay attention to these things and figure out what’s what. I’ve had the experience that I know Erin has, of listening to someone blame in a therapy session, most of this stuff on a discrete sexual abuse incident that happened when childhood, when they’ve got lots of stuff about relational distress and identity confusion and emotional regulation problems that don’t actually probably arise from a single event like that, especially maybe at the age they’re saying. But that’s our official tag, right? So you can say they’re a sexual abuse survivor.
whatever, and not just counting that at all. As a survivor of childhood abuse, I know it’s not great, but it’s way complicated. Who knows what we’re actually looking at? And that’s something that I think Erin and I make a point in the book of is when you’re trying to do trauma specification, don’t get too married to it because it may not be that.
Because there’s something we call event comorbidity. If you were physically abused in childhood, you were probably way more. Can you imagine being physically abused without being psychologically abused? I mean, there going to be all these overlaps.
Dr. Jeremy Sharp (25:07)
Yeah.
Sure. That’s
such a good point. Yeah. Yeah. Yeah. think there’s something in this discussion around, you know, lot of clinicians wrestle with, gosh, how to, I always, I will not be eloquent or tactful in this. So I’ll just put it out there, but, and we’ll wade through it. But you know, there is this question I think of like, is everyone, does everyone have PTSD? Like, my understanding is like,
Pretty much everyone has experienced a traumatic event, quote unquote, at some point in their life that they would say, you know. But then diagnostically, there is some concern, I guess, I guess, the threshold for diagnosis. And is it getting lower and lower and lower? And if it is, does that matter? This is messy, but maybe hopefully y’all are maybe picking up on what I’m getting at. Like, does everyone have trauma, I guess? And is it diagnosable?
in everyone at this point? Are we being too inclusive? Are we not being inclusive enough? That’s all these questions.
Erin Eadie (26:15)
Yeah, so I mean, I think there’s two pretty distinct questions there, right? That we have really good research to show that a really significant portion of the population is exposed over the course of their lifetime to one or more traumatic events. That doesn’t mean everyone’s traumatized by those events, right? So there’s exposure to the event, exposure to more than one event, exposure to more than one really bad event, right? And we can…
Dr. Jeremy Sharp (26:34)
Right.
Erin Eadie (26:43)
talk about the different types, like factors like, is it an interpersonal trauma, as John had mentioned earlier, that that is more likely to lead to negative psychological effects than a non-interpersonal trauma, we’ll say. If it’s a trauma that’s occurred in the context of other risk factors versus in the context of other protective factors. So the actual experience of the trauma is different.
then you move into the sort of middle phase where you say, is this person affected in a psychological way by this trauma? And I think this is actually where I’ll pull from, you know, the creators of cognitive processing.
therapy and the way they present the model, especially when they’re teaching clinicians and it’s encouraged to present this to clients as well, that to think of in some ways, some trauma effects as to some extent a non-recovery following like a normal recovery path. So if we think of most people do and should develop some of the symptoms on a list of
PTSD or in that first sort of month, it’s acute stress disorder, that symptom list, right? It is normal and natural as our brain is coming to terms with unexpected, very stressful, jarring, traumatic event to try to understand it by replaying it, by being more on edge and alert to safety risks, all the different, by having difficulty concentrating, because we’re constantly distracted by things that are going on internally. And when that,
sort of processing is effective and helps us work our way through the experience with a really bad, hard experience that we’ve had, that’s kind of a, that’s a natural sort of recovery process. When something interrupts that or interferes with that, or the trauma itself totally overwhelmed the system, or the trauma itself is, as we talked about before, the last in a long line of them, or the things that help you recover, you know, the supports and
the things that stabilize and structure your life just aren’t there, then you can often lead to this like now we’re in the realm of we have a diagnosable condition potentially of a traumatic effect. And sometimes it looks like PTSD, sometimes it looks like this sort of, you know, more multifaceted complex PTSD that we’ll talk about. And sometimes it’s not either of those. Sometimes it’s something that might be more just in the dissociative realm of having dissociation symptoms.
Sometimes it’s more like a complicated grief reaction or a depression or something like that. So there can be a broad range of where you end up there, but it’s this multi-step sort of process getting to that result where then we might be coming in as clinicians and saying, okay, now we’re gonna assess this snapshot of a picture and look at what’s going on now and what came before here.
Dr. Jeremy Sharp (29:25)
Yeah.
John Briere (29:26)
That
was really, that was excellent, Erin. That was really good. So we’ve developed an evidence-based program for treating inner city socially marginalized kids. That’s Cheryl Langtry and myself, which is now pretty much out there. These things she’s saying are so, you take a homeless kid off the streets, or a kid who’s living, who’s involved in survival sex on the streets just to keep going, et cetera.
You have to divide it up, but it’s so hard to figure out exactly what’s what and where do things come from? you know, and what, you know, even the notion of resilience is a questionable category. Is resilience the absence of support or is it the presence of support? I mean, is resilience the absence of not being support? You know what I’m saying. It’s a, it’s, is it an individual thing or is it just a stressor intensity issue? So you say, well, kids are resilient. Well, actually if kids were resilient, we wouldn’t.
Dr. Jeremy Sharp (30:10)
Mm-hmm.
Erin Eadie (30:10)
Yeah.
John Briere (30:18)
all have jobs right now. mean, the reality is that people get hurt. They get hurt in lot of ways. Maybe they don’t speak English as first language. Maybe they come from a culture or a racial group that’s devalued by the dominant culture in which they’re being seen. They’re probably living, some of them are living in poverty. They probably got domestic violence or community violence.
Dr. Jeremy Sharp (30:20)
Mm-hmm.
John Briere (30:38)
So you, and the problem, it’s exactly what Erin said. The problem is if you say, what is the trauma? You’re already screwed because you don’t know what the trauma is. They don’t know what the trauma is. You don’t know what the trauma is because brains are very complicated and what’s a trauma? If you didn’t have any love at all, know, kids died of hospitalism in the old days in England from being an orphanage and not being cared for enough psychologically. They were cared for physically, but they actually died. It was called…
Dr. Jeremy Sharp (30:46)
Ha
Mm-hmm.
John Briere (31:07)
hospitalism and it was the belief that if kids were in hospitals they would die. Now it turned out it was something else. That tells you how intense that stuff is. So how do you figure out the trauma phase and then the reactivity phase, right? Erin, I mean with an adult, was this a PTSD or was this borderline? Well, they’re both kind of questionable weirdnesses, know, that we people don’t come neatly packaged like that and there’s a lot of overlap, you know, and doesn’t matter.
Erin Eadie (31:17)
Yeah.
John Briere (31:29)
If you have a package for treating PTSD and your client has a lot of emotional dysregulation, it’s going to be hard for you to treat the PTSD if they can’t regulate their affect. And maybe their affect regulation is due to massive maltreatment or neglect in first three or four years of life, where we know you develop a lot of your relational skills and your capacity to regulate your internal experiences. I hope I’m not sounding…
Dr. Jeremy Sharp (31:30)
Yeah.
John Briere (31:54)
pessimistic or I’ll throw your hands up. It’s just that now, you know, we’re PhDs. Well, except maybe in Ontario, we’re PhDs, I don’t know if they don’t know what we’re talking about, right? Ontario is considering allowing master’s level people in for their psychologist degrees.
We have lots of brains and now we know what to work on, right? There’s a lot of stuff here to do, but the danger is if we get what in Buddhism we call delusional. It doesn’t mean delusional like you have a psychotic disorder. It’s when you become attached to an idea that’s stupid or outdated or limited or false. And we have so much of that. So not only are we growing like the fastest tree in the universe, we’re having to break through all kinds of concrete and dirt and beer cans and stuff to get there.
Dr. Jeremy Sharp (32:36)
Yeah
John Briere (32:37)
that led to a weird place.
Erin Eadie (32:38)
Yes!
Dr. Jeremy Sharp (32:40)
Hey, I’ll take it. I’ll take it. I’m right with you. I’m right with you. Well, the thing is funny. The thing that jumped out is when you said, I’m
paraphrasing, but if you ask what was the trauma, you’re already screwed. That’s super interesting. Because the example that comes up for me is like, and this is just a generic, pulled from a bunch of different clinical cases, and not saying any judgment about one thing or another. But we get a lot of young adults or adults who report
you know, significant trauma quote unquote from like a what seems to be an isolated, say, incidents of bullying in childhood, like an elementary school. And I think a lot of clinicians, myself included, I’ll full disclosure, you know, there’s a part of me that’s like, really? I don’t, okay, like what’s happening there? Like, but if I’m reading and understanding what y’all are saying, it’s essentially like, that’s just the tip of the iceberg. We can’t even
start to make those judgments without understanding the full context of this person’s experience and like, what was their home life like for the five years before it happened? And then, you know, how did they get supported when it did happen? And then in the months and years beyond that, and it’s just like, it’s all kind of wrapped up and contributes to the picture.
John Briere (33:52)
The interesting thing is that even though when you point to bullying, could say, well, bullying doesn’t seem like enough of a reason to have these problems. Bullying, for instance, the LGBTQ adolescent communities are supposed to be suicide at distressingly higher rates. So no, I’m not, I’m not even disagreeing. I’m just saying we don’t know that. People say sexual abuse, you were just fondled, quote unquote. hear that in the courts. Just fondled? Your father who served you pancakes yesterday is grabbing your breasts when you’re five? You know, like.
Dr. Jeremy Sharp (34:04)
Sure.
Erin Eadie (34:07)
Yeah.
John Briere (34:18)
So to someone else, so one of the problems we have is unless we’ve walked in those shoes, we don’t really know just how bad a lot of that is. And we’re in very untenable situations because we’re working with very distressed people from very difficult environments.
And how are we supposed, as clinicians, how are we supposed to get it? We can’t. But what we can do is we can be curious and non-arrogant, which I find myself doing that I go, well, that’s not so important. Well, who am I to say that? And I wasn’t there. And it probably wasn’t said just the way it really happened and all those kinds of things. We need to be humble and excited and open. But we also need to know we’re really at the very beginning of, I think, of understanding this stuff.
Dr. Jeremy Sharp (34:59)
Hmm. Yeah, that’s validating.
John Briere (35:00)
Doesn’t mean though, thank
God we can’t make good psychometric tests. Because part of the way out of some of this is that if you do testing, you’re least you’re dealing with the pseudo objectivity of those kinds of instruments.
You got normative data. If it’s a good test, it’s going to ask you enough information for you to get enough information for you to say, well, there was sexual abuse. There was also early neglect. We know both of those are associated with somatization later. And she is complaining or he’s complaining that he’s got massive psychological physical symptoms that have no physical basis. You know, what does this do to? But we have a lot of data now. know that early.
can do some of that stuff, and we know that abuse can do that. And they can talk to us. But the test can allow us, wouldn’t you agree?
Erin, the test can allow us to talk to them better because you get some idea of what’s going on. I don’t mean the old tests, the Rorschach, the old things like that. They have, they obviously can be helpful, but we’re having to talk now about specific items and ask specific questions about specific problems so that we can get a lay of the land, I guess.
Erin Eadie (35:43)
Yeah.
Yeah, so one of the principles, like if we’re thinking about assessment of trauma events or different types of exposure, you know, one of the evolutions in the field and one of the principles behind how to assess for this and kind of thinking back to your bullying example, Jeremy, that we might ask about or look for specific, you know, has this happened to you? Has this happened to you? Has this happened to you?
Dr. Jeremy Sharp (36:04)
Yeah, yeah.
Erin Eadie (36:28)
But we try to do it in a behaviorally anchored way, right? So like, has this experience ever happened to you? There’s lots of literature on this about sexual abuse in particular, because if you look at the studies that say, ask were you ever sexually abused or were you ever raped or were you ever sexually assaulted, the endorsement of that can end up being very, very low. Whereas if you ask the actual behavioral question of,
did this specific act happen to you at what age, by whom? And it’s like, well, that is the definition of one of these categories, right? Similar things for other types of trauma. So having them be more specific and behavioral anchored rather than kind of experientially anchored in a sense, rather than, you know, were you ever bullied, for example.
Dr. Jeremy Sharp (37:05)
Right.
Erin Eadie (37:19)
that gives us both a truer understanding of the actual experience, but also then creates this higher endorsement of, yeah, that has actually happened to quite a number of people. Now, what else happened? What did that happen in the mean it or what was the meaning of that experience for you? So looking at, say listeners, to assessing clinicians, looking at broader inventories, which do sometimes take a longer time.
to go through, but that are more comprehensive, that are covering more of a basis of did these types of experiences happen at some point in your lifetime and trying to then follow up on the ones that are endorsed. Like it’s easy enough if it’s a no, no, no, no, no, and then only one or two things happened and you can gather what was the context behind this. And then if you get someone endorsing five, 10, 15 things on an inventory like that,
That is a pretty strong message in and of itself, right? You have a really clear understanding that there’s an accumulation of trauma here, no matter the murky picture it’s creating, right?
Dr. Jeremy Sharp (38:27)
Hmm.
Well said. I think that’s a great bridge. We’re dipping into the actual assessment component and I know my audience is really curious how you approach that. we’re talking about assessing trauma, right? What you would consider to be kind of core components. Now, obviously you’ve developed a lot of instruments in this realm, you know, like we use your instruments, I’d say daily, you know, so.
Erin Eadie (38:33)
Yeah.
Dr. Jeremy Sharp (38:54)
I’m excited to have this conversation. What y’all think now at this point in the game and this point in time would constitute kind of a core like good trauma assessment, quote on.
Erin Eadie (39:03)
So I can speak to kind of the structure of the assessment if that sounds good. And I’ll let John speak to the nitty gritty of the tools he’s developed. ⁓ And the third edition of our book does a really nice job of kind of laying out the different components and the process potentially that you can follow. And of course it’s based on the same types of assessment standards in terms of using.
Dr. Jeremy Sharp (39:11)
Okay. Okay.
Erin Eadie (39:29)
standardized tools and with good psychometrics, along with a really strong clinical interview. that having those two combined together ends up being really, really important. And we’ve pulled out, so there’s sort of the assessment that we spoke to just before this about to the actual exposure, the events that you’ve been exposed to. But then once we’re getting into what are the effects of this, how is this?
playing out in your life, how is this affecting you and changing your psychological coping or makeup, what types of symptoms are developing in the face of this. We pulled out into two different chapters, both the sort of generic, like broadband measures and how they can be used to identify trauma effects. And then what most people are probably most familiar with from a sort of trauma relevant assessment is we kind of a pretty solid inventory of the trauma specific.
tests of effects essentially. And some of those are broader, like the trauma symptom inventory covering a number of different symptom categories. And some are more specific and narrow. So like a PTSD checklist or a dissociation measure or something else that might be useful in treatment, like a trauma related cognitions measure. And so those are all contained within one chapter, which is really nice. And you can kind of skim through and look through what would be most helpful or relevant.
for my specific client or for the population that I’m working with. So that doesn’t necessarily give you a like, please always use these three to five tests because we know that that’s not really how it works within a clinically sort of like customized and comprehensive assessment plan. But do you wanna be looking at, are you capturing the full picture of the trauma exposure?
Are you doing a broad enough capture of what types of symptoms could present? And are you looking at that both in a clinical interview as well as in a more standardized objective testing method? And then is there anything more after that? Are there more specific areas that might be if someone’s presenting with?
somatic symptoms versus if somebody is presenting with a lot of anxiety. I’ll have you kind of dug into what those specific pieces may be about.
Dr. Jeremy Sharp (41:38)
Yeah. Can I ask a really specific question just about the interview component? Given that we’re talking about the importance, I think, of individual experiences and behaviors and context of some of these events, I’m curious how y’all maybe recommend approaching just like broaching the topic. For the first time, we’re in a clinical interview. It seems like too broad, like you said.
Erin to say, tell me about any trauma you’ve experienced. But then it also feels like a lot to just dive deep into very specific behavior or incidents or experiences. I’m just curious how you all kind of navigate that balance.
John Briere (42:20)
It’s not simple. I had a job the last, say, five to 10 years. I was in patient emergency services at USC. My only job was to sit down with people who were hurt and interview them in front of a large group of staff and students and residents. I’d rep.
Dr. Jeremy Sharp (42:22)
Yeah, well, thank you. That’s valid.
Erin Eadie (42:24)
Yeah.
John Briere (42:39)
I did what you’re talking about over and over again, day in and day out forever. They were more severely hurt. it’s easier to psychologically injure, it’s easier to make a bridge to bad things because people are not really seriously hurt unless they have bad things. So the logic of that is pretty good. But if you’re working at a counseling center, for example, and your kid’s coming in with diffuse anxiety and depressive symptoms and authority issues and it started to think maybe they should use a little bit heavier duty drugs, what are you going to
actually
do there. I don’t actually think we should treat ourselves as Inspector Clusso’s. I don’t think that our job is to blood hand out trauma. And we’re not even looking for it per se. know I said what I said sounds like, you know, that’s the background, but it may not. A lot of very traumatized people are coming in for problems that don’t relate to the trauma. We need to make sure we don’t make false identifications of that.
So I don’t know, Erin, what would you say to something like asking to talk about what’s going on with it in enough detail that the interpersonal, relational, historic aspects are clear to them because it had a history even from their view. And then maybe not to say ever were you traumatized with sexual abuse because I agree that creates problems, but to say, so when did that start? Do you have any idea why that might be? And a lot of people will be like, it’s fine. I’m great at everything. And even very seriously, psychotic people I’ve talked to said,
everything’s great but when you ask them to actually talk about their childhood and they start to cry or something you haven’t said anything to locate it but they’ve sort of located it. We’re trying to find out together. Again this arrogance issue I brought up before which I would relate to myself is the arrogance that I’ve always had in my life is that I knew something about what was going on and I was special by virtue of my gender, skin, training.
entitlements in my profession. We’re all bozos on the same friggin bus here. We’re all doing the best we can, giving the hand we’ve been dealt. And we need to be humble like that. And that means that we don’t, do you agree, Erin, you don’t walk into a session, I believe, as a trauma specialist, you walk in as a caring, empathic person with a skill set that might be able to help you. Let’s see if we can tiptoe through these tulips, wind our way through these issues, and see if we can find out what’s actually what it means to you. And probably I won’t have to talk you into anything, nor would I.
And we directly say in the book, don’t do that. And false memories and all those things. Those are all relevant to some of these issues. Just going at the client’s pace, giving them an opportunity to explore themselves. It made me one out very 20 times I’ve done an interview. People said, you’re barking up the wrong tree. I had a childhood. Everything’s great. Then I said, well, yeah, yeah, we don’t know everything. I wonder what it could be due to. Do any other ideas? I had people say it wasn’t a news or anything. Well, my father was an asshole.
You know, like, well, there’s an interesting diagnosis. But if you come from a system that says parents are in charge, they know what’s going on, authority figures are right, you’re not going to grab onto a lot of explanations because you’re going to, so many kids in our early work with physical abuse would say no to, were you physically abused, but they would say that they were spanked or hit to the point of bleeding.
Erin Eadie (45:15)
Right.
Dr. Jeremy Sharp (45:16)
sure.
Right? Right. What does that
John Briere (45:40)
But they thought that was because they were bad because as Anna Salter said, breathe in the vapors of your perpetrator’s attributional system and understand, especially when they’re in power. So of course you would say, I mean, in my history of physical abuse, I thought I was a bad boy. I don’t think I realized that someone was actually doing something wrong independent of my functioning until I was probably, you know, 58, no, until I was an older person because I had to shake off so much.
Dr. Jeremy Sharp (45:50)
Mm.
Mm-hmm. Mm-hmm. That’s reasonable. Yeah.
Erin Eadie (46:10)
and the survival function that that serves, right? To make sense of a situation when it’s actually happening.
Dr. Jeremy Sharp (46:16)
Yeah, that’s a major cognitive dissonance to work through.
Erin Eadie (46:19)
Yeah, so probably to circle back, Jeremy, to what you were asking, think, you know, taking, there’s sort of a skill set we have when we’re assessing of connecting.
with the client themselves and creating a space, you and the principles from trauma informed assessments that come in there of, you know, creating a safe of space, safety, sorry, and openness that can allow them to speak of their own experiences. The skills of doing a kind of comprehensive.
without meandering developmental interview, right? Like talk to me about the course of your childhood and adolescence, but also, you you can think of to, when John mentioned somebody coming in and saying like, I had a great childhood, I don’t think this has anything to do with that. You know, in general, I would say, okay, like that’s your understanding and your experience, I’m gonna believe that, but I might wanna continue that developmental interview understanding to what happened in adolescence, what happened in young adulthood, you know.
When did other relational factors maybe come in if we think that there’s something relational or interpersonally traumatic going on? So that might be part of the puzzle. Sometimes it is one or more non-interpersonal traumas come up, right? I can think of a specific person I assessed where he came in and didn’t think that there was anything really relating to a trauma history from a childhood family environment perspective, but
but then eventually did proceed to say like his house burned down and you know they they were kind of like in an insecure housing situation for quite a long time. They’re you know in a different situation there they there was a burglary there was you know there was a number of sort of witnessed assaults or violence in the community so we can identify like great like caring supportive protective parents.
Dr. Jeremy Sharp (48:00)
Hmm.
Erin Eadie (48:09)
But maybe there just actually was too much, say, community violence or bad things that happened around them that overwhelmed their system, right? And probably their parent system in that particular situation. So then you can’t very effectively or ideally parent your child when your own system is being overwhelmed, right?
John Briere (48:27)
And it’s an interesting thing, a huge variable that’s very hard for us to control except through further training exploration, maybe our own psychotherapy
Dr. Jeremy Sharp (48:28)
Hmm.
Erin Eadie (48:35)
you
John Briere (48:36)
and Cheryl Lankrey makes this point a lot in interviewing little kids is your demeanor and how you respond makes a big difference in what they’re going to say. So if you’re a white straight male talking to someone who doesn’t fit in any of those categories, are they going to tell you about how it feels to be maltreated and oppressed and marginalized? Probably not because they don’t think you know about it or that you care about it or you know we have a forensic evaluator in LA, any LA people who are really
Erin Eadie (48:40)
you
John Briere (49:02)
trauma me and recognized, I won’t say who he was, but he always got cases where his kids recanted that they’d been abused. So pretty soon, everybody was bringing him in, not to be a psychologist to figure out what’s going on, but ultimately to debunk these kids’ things. So they go, well, we have a licensed psychologist here. But you know, the guy’s interview style, those kids just shut down. So then they would say, no, nothing happened. Then he would write, patient says nothing happened. And this was…
Dr. Jeremy Sharp (49:23)
Mm-hmm.
John Briere (49:28)
So it really makes a big, but that’s the I vow of therapy and assessment. How can you be boundary specific? How can you be, you know, non-intrusive? How can you be caring and kind? But how can you also communicate? I get this, you know, we’re all in the same jam in a way. And, you know, not that I’m going to disclose about myself, but I get you or I understand you or I’m trying to, makes a huge difference. I’ve seen like almost completely different historical renditions as a function of whether the therapist was
or not or whether they were bossy or not or whether they told the patient or client what was right instead of having the client tell them. Now this isn’t the technical part, right? But Erin and I spent some time on it because if you don’t have that relationship, we, Cheryl and found in the inner city young kid world, they wouldn’t even talk to us. They were looking for police.
They wouldn’t reveal anything. It’s like they wanted to bring a lawyer if they could trust a lawyer. And they would threaten us and threaten violence, really a lot of it. But they’re just trying to survive that scenario. And they’re not going to give us data when we’re not. So what do you do? mean, on the other hand, in 9-11, I was president of ICSS then, so we were pretty much involved daily in that. In 9-11, there was
Dr. Jeremy Sharp (50:24)
Mm-hmm.
John Briere (50:42)
there was a huge amount of wonderful clinical activity, but we did notice there was a theme sometimes of this, the reversal, what I’m saying in a way, which is clinicians who were too emotionally reactive to the trauma of their people who were exposed to trauma. you, you know, it actually made the people feel bad about themselves, made them feel traumatized when they were, but maybe not that version of trauma.
And then really what clinicians need to do was to be kind and supportive. And then people wanted to talk, but I’ve been in a lot of mass casualty events. The classic response of mass casualty survivors either to be talking a lot and be really laid back or just to be shut down in space. But both of those things are internal attempts to try to deal with overwhelming distress. And it really is going to matter, do we make eye contact but not too much? In some cultures, eye contact is insulting and dangerous.
Is our seat too close to the other person? Are we just so far away from it? I used to work a lot in sex trafficking and prostitution. We can talk about why I don’t call it.
sex work if you want later, but in prostitution. And you know, I quit because you know, I did it for 10 years. I wrote about it. I researched it. I testified in court. But my stimulus value is too negative for a lot of those people. That’s just too much they would have to get passed even to just be able to relate to me. Just like I think those sexually violated people who were sexually abused by a man should probably do better with a female therapist. That doesn’t mean that all female therapists wouldn’t be better and that all
Dr. Jeremy Sharp (52:01)
Hmm.
John Briere (52:12)
men can’t be carrying empathic, but there’s something there, right? There’s that reactivity. The reactivity is accessible. often ignore it, especially once it turns into a report, then we have the official representation of what’s going on. Not all the stuff that was going on that the assessor was trying to do the test while worried about their kid having colic and that somebody pissed someone off 20 minutes later or I don’t know, I’m going on here, but I do think that
What it means is that assessment has to be technically accurate, but it also has to be relationally. If it’s not relationally good, it’s not going to work.
Dr. Jeremy Sharp (52:49)
I love that we spend so much time on this because the measures are important. They are important. The connection and the rapport and the interview goes a long way and does a lot of the heavy lifting, I think. All this just points in that direction.
Erin Eadie (53:06)
Yeah, it creates the context too, right? I think like I remember learning pretty early on and have carried this through my practice and when I’m teaching and supervising that say the way you present, know, if you’re giving like a, even a, like a PTSD checklist, right? If you’re giving that tool, which is only going to take a few minutes for an individual to complete the way you present that specific assessment tool and…
Dr. Jeremy Sharp (53:08)
Yeah.
Erin Eadie (53:32)
and talk to the client about it, and then potentially the way you receive the information and share it back with them in some form of a feedback session, that’s the relational sort of like buffer context or sandwich that you’re putting this specific tool that’s been well-researched and has good psychometrics and can tell us lots of important things. And a broader tool, a more sort of even quite lengthy tool like the MMPI or something like the TSI2 that
the relationship and the rapport that you’ve built with the client and then offering that up as this is gonna collect some more information that’s really useful to us, that also factors into the validity of their completion of that tool and the information you’re getting out of it. So it really does need to be this combination and this attention to the different elements of the actual assessment, probably for…
Dr. Jeremy Sharp (54:16)
Mm-hmm.
Erin Eadie (54:20)
for all kinds of clients, but we’re more attuned to it when we’re looking at, you know, is there a trauma component here?
Dr. Jeremy Sharp (54:27)
Right, right. You know, I want to make sure that we have some time to talk about, more of the kind of marginalization, you know, different populations that, know, we’ve kind of hinted at, but before we totally wrap the clinical side, and I’m going to veer away from specific measures. I feel like the book does a great job with that. So I won’t dive deep into like specific measures. you know, just encourage people to go check it out and you know, there’s plenty of info there.
I do maybe want to touch on just the feedback component, you know, since you mentioned that Erin and how you approach, I guess I’m primarily curious about like talking about trauma with folks who are more resistant to that idea or maybe less aware or willing to acknowledge, almost like that person you described earlier, John, you know, of whatever getting spanked to the point of bleeding, you know, it’s like, that was just normal or that’s
I deserved it or whatever. So could we talk about that just a bit and how you weave that in for folks or introduce the idea that, this may have been a more significant experience than you’re giving a credit for.
John Briere (55:33)
I’d like Erin to answer that. I would though say that it’s not our job to let them know whether it’s bad or worse and we’re not doing therapy when we’re doing assessment. So, and you can actually screw up assessment by doing therapy during assessment because then you get all kinds of transferential or so-called transferential kind of transferential dynamics start to play out. So, you know, that’s all.
Dr. Jeremy Sharp (55:51)
Mm-hmm.
Erin Eadie (55:55)
Yeah, I mean, I think going off what John just said there, I like doing a feedback session in a sort of like checking it out kind of, you know, process, which so like our therapeutic skills come into play in, you know, a well sort of thought out and engaged assessment and both the sort of interview component as well as the feedback session, but to sort of be, to have some tentativeness in,
presenting a conceptualization and a hypothesis and to have those useful phrases like, is this fitting for you? Or does that make sense for you? Does that speak to your experiences? Is there anything that doesn’t really work or fit for you about this? And then being curious about that. I’ve had that come up where it’s, know, if I say, let’s say somebody has like really classic PTSD, but maybe it’s, you know, it’s connected to an experience that they didn’t necessarily see as a trauma.
and I might be making that connection or hypothesizing that connection to them in a feedback session. And if I check that out and they say, you know, I don’t think that’s why. I actually think what you’re saying is true, but it might be more related to this other thing. And then it’s like, this other thing might’ve been a thing that they didn’t disclose, say, in the trauma inventory or that sort of didn’t register as like a trauma event, but actually was something that landed and was much more meaningful and impactful for them.
And then that, the end feedback still ends up with the same kind of communication of really valuable information, but it’s integrating what I’m bringing in or what any clinician’s bringing in from an area of sort of expertise and knowledge with their true actual experience of those memories and that content and that information. So I think that checking out process can be really, really helpful.
And I think the openness, having feedback be a relatively open process rather than a closed, you know, this is what we have determined is wrong with you and be on your way now. Right?
John Briere (57:54)
So Erin,
Dr. Jeremy Sharp (57:55)
Mmm.
John Briere (57:55)
I’m curious, sometimes we just do assessment, we’re not the clinician, we’re not the therapist, we’re the assessing clinician. Sometimes it’s in the context of psychotherapy. I would imagine, I mean, I have some ideas too, but I think you know more about this. I’m wondering.
What would be the differential there? Do you relate to feedback sessions differently when you’re just an assessor? This is their last session with you or when? I think with the work with the MMPI, actually integrating it into the therapeutic process, and actually talking about it more is an interesting idea. What do you think about that?
Erin Eadie (58:27)
I mean, I would say my therapy training and experience makes me a better assessing psychologist in all the different ways that we’re talking about. I think especially with trauma survivors, if that’s the specific client population that we’re thinking about doing an assessment with, there is a component to the feedback session where you want to be attentive to containment.
And that might be something different than if I’m assessing at the beginning of a therapeutic relationship, let’s say. mean, within therapy, we’re always maybe thinking about what’s within the sort of window of tolerance, to use that phrase, or what are we going to delve into in this specific hour or session, whatever the case is. But if I’m thinking to John’s question of this is my feedback session for an assessment-only client, and I probably won’t see them after this,
then I’m not going into an uncovering or sort of psychological, emotional processing process or pathway in that feedback session. I might be naming and attending to things and saying, does that connection make sense for you? Or do you want to sit with that for some time and possibly, you
call back if you have questions, that type of thing. Is it OK if I include this information with a recommendation to your future treating clinician that this might be an important thing to explore further or pay attention to? And so it’s sort of offering them that information, but in the structure and the containment of the actual feedback session. I’m not in the position where I actually don’t know if I’ve ever assessed somebody.
where I haven’t at least had the opportunity to do that sort of closing feedback session. I use sometimes, there are individuals who are potentially in that situation. And I think that’s really tricky with this population, right? That if you’re writing a report and sending off a report to say the referring physician and then never meeting or speaking with the client again, there’s something that’s like left.
I’m resolved there from a relational standpoint that can be really tricky.
John Briere (1:00:28)
So,
you know, it’s sometimes said that assessment is treatment and treatment is assessment. Do you, do you, I mean.
One function of the feedback session would be, did I get it right? But the other seems like I can’t cite the authors anymore. Maybe you know them in the MMPI, et cetera. It’s literally finding out stuff about yourself that’s valid can actually be therapeutic, even though this is only one time shot, but that you start to really appreciate these things. How do you weigh those two in your mind? I’m sorry, Jeremy, I’m taking over your job. can’t help it.
Erin Eadie (1:00:57)
He’s
just interviewing me now. How do you weigh? Yeah, but if there’s sort of new information, you’re thinking, John, like new insights that are coming from the assessment.
Dr. Jeremy Sharp (1:00:58)
You’re doing great. Yeah. Yeah, these are important questions.
John Briere (1:01:03)
Ha ha ha.
Or a way to
incorporate them.
Erin Eadie (1:01:10)
Yeah. Yeah. Did you want to jump in, Jeremy?
Dr. Jeremy Sharp (1:01:10)
Yeah.
This might be a place, you
know, the therapeutic assessment community, I think, has talked a lot about this kind of thing. You know, they frame it like level one, level two, level three feedback, like things that are ⁓ more to less familiar and acceptable to folks. So that may be a lens to look through and conceptualize as we think through this question. I’m curious if you have other thoughts here.
John Briere (1:01:23)
Really?
Erin Eadie (1:01:33)
Yeah.
Yeah. I mean, I think having the, like to, if I’m developing an assessment plan, I like to think ahead to when I get the results from this particular information or this particular test, how am I going to share that with the client? ⁓ And so something like if there are useful insights from
Dr. Jeremy Sharp (1:01:53)
Hmm.
Erin Eadie (1:01:58)
you know, a broad personality inventory, let’s say. And maybe even if that’s indicative of a personality disorder, if it’s really in the context of gathering a lot more information about that, whether it is or isn’t, you know, you want to be, that’s part of picking the tools, right? What’s the implication of measuring this thing and then the ethical responsibility to communicate the results of it. So I think I’m both thinking that through from the outset.
And then also once integrating and pulling together all the information and thinking about how to kind of concisely and in a sort of meaningful way share this information with a client and thinking about how to sort of place that. So often I’ll do in a feedback session, I don’t know if other people do this, but I’ll do something like, remember that test, remember that really, really long test, right? Or remember that test that asked about this or this.
that was measuring these different things. And what we know from that is these types of outcomes, let’s say, does that kind of fit for you? So it’s being able to take kind of maybe that, I don’t know if this is necessarily answering John’s question, but take that information that might be kind of an add-on or an additional sort of insight or a richness to the say, core assessment question.
Dr. Jeremy Sharp (1:02:55)
Mm-hmm.
Erin Eadie (1:03:17)
and kind of placing it in their own experience of the assessment. And then I might say, you could carry this forward and use this, say, in your future therapy, or how might this make a difference for you in your life, right? And kind of get them thinking about some of those questions. I think that can sometimes just help to carry that through.
Dr. Jeremy Sharp (1:03:29)
No.
Certainly. Yeah. These are great thoughts. Gosh. Like so many things we could do multiple episodes on many of these topics, right? I know, I know it’s hard to, it’s hard to stop. just, I do want to make sure and kind of talk about what y’all are finding and where we’re headed with research on trauma and marginalized and oppressed populations. You know, this is huge. It’s crucial. And it’s been under the radar, I think for many years. And so,
Erin Eadie (1:03:42)
this type of stuff.
Dr. Jeremy Sharp (1:04:01)
Yeah, I’m curious what y’all are finding. This is a big general question, but again, I trust that we can find our way to something meaningful.
John Briere (1:04:07)
If you wanna
just see what we’ve done, you might wanna just Google probably my name and then racial marginalization, because we have a number of papers out now. But I think that if I can just speak for myself, because I can’t.
as a street-wide male, aged guy, academic, I’m a pretty narrow category. There many people in our condition, but I’m a pretty narrow category. And this isn’t about me. It’s about what people like me have done to other people. So you have to be very, very careful about this stuff. And I see my job as I enter my waning years to, was there anything I really wanted to do in my career that I didn’t do that was really important? I mean, I’m not going to die tomorrow or anything.
Although I tell Erin every once in I’m going to die tomorrow.
What would the right thing be right now to maybe move the field? I’m not so airy to think I can move the field, but add to the sounds that lead the field in a certain direction. One of the biggest ones has to be is the biggest trauma probably out there is how we treat each other based on our characteristics. That humans tend to, we have biological and psychological reasons for wanting to make assumptions about people that’s efficient when we’re in emergency situations, et cetera. But.
The racism, sexism, homophobia, cis heterosexism that’s out there right now is huge. And actually, unfortunately, I don’t know if you agree, but I think it’s increasing pretty dramatically in Western culture. This is a big source of trauma.
A lot of people like me, worked in public psychiatry, so we worked and do work with people of color who are marginalized or impoverished, who don’t have secure housing, who are drug addicts, who are engaging in socially devalued ways to get money and food, like engaging sex or whatever, or stealing or robbing or whatever those things.
That’s the actual tip, maybe not for you guys, but in that world, that’s the typical client. And I’ve always wondered, I walk into a room, there’s a room full of black faces and other faces of people that are ultimately like me, but quite different in the circumstances they’ve had to endure.
Can I just now do an MMPI? Can I do a TSI too? I mean, I can, and we need to. They shouldn’t be deprived of not having good assessment, but that’s not a real big piece of this is that if you live in a, here’s the keywords that.
get called woken stuff, but if you’re living in a marginalized, rejecting, devaluing, oppressive community, how can you come out a happy camper? You know, and that’s not to devalue them or make them be less than which is the old solution to hurt people. Let’s pathologize and marginalize and say there’s something wrong with them that caused them to be hurt. But a bigger issue, what’s the error that many of our citizens of breathing or non-citizens of breathing on a daily basis is producing serious psychological outcome. Then the next
Yeah. So what do we do about it? Well, you know.
I don’t think I really should be doing that therapy so much. mean, maybe certainly with women sometimes, obviously, but for a lot of marginalized communities, probably someone closer to who they trust should do it. Probably someone who hasn’t hurt them as much as my combination of attributes have hurt people. So then what we have to do, you know, it’s already out there. Here I thought, it’s a typical thing. I’m introducing all these neat ideas. There’s lots of books out there on how to do racially responsive, gender responsive.
Dr. Jeremy Sharp (1:07:11)
Hmm.
John Briere (1:07:23)
therapies that I didn’t even know anything about because I was busy doing mainstream statistics research psychological stuff but you know I had to be really kind of stupid to not think about that stuff for a long time in a way because that person sitting in front of me the phenomenologic gap between me and them must be so severe in some cases how are we even talking and are we agreeing on terms like power connection and love those things are is it really different so
Erin Eadie (1:07:48)
you
John Briere (1:07:50)
I mean, we could go on and on about the
basic take home finding was that we found was that being marginalized on a new instrument we’ve developed, which you can have for free if you want that.
high scores on sexism, racism, or cisheterosexism, associated with more PTSD than being traumatized in a classic DSM-5 trauma situation. Now remember that trauma might’ve been one trauma where this you were abused from the age of two to 14 in racist ways or whatever. So it’s not a very fair comparison, but what it certainly does say is that if we treat the consultation rooms a vacuum where we’re just trying to look at someone and figure out what’s going on with them, we don’t look at the world they came from.
to get it. I even tell residents and interns and stuff and work with me try to learn the language, try to learn the culture, go to a couple other restaurants and eat the food because we have people in LA, it’s not just LA, I love LA, but we have people who can’t, who’ve been working with Hispanic populations for 30 years, they learn like five words. How can we know more about those people and how would it help? And ultimately though I think for my role, my narrow little role is more to point to that than
Erin Eadie (1:08:49)
All right.
John Briere (1:08:59)
So I have another book that came out this year, Principles of Trauma Therapy, the third edition. a textbook. And I was, I’ve written a whole bunch on how to work with people of color. And then some point I thought, well, that’s really pretty arrogant. I mean, maybe you don’t say it that way, but I just detected that little bit of arrogance in there somewhere and realized what I needed to do was cite what other people have said, typically people from those communities.
I’m sorry I cut you out of that, Erin. Do you have any ideas about that? I know we share all the same views in that, but you’re in Ontario where, well, no, you have a pretty multicultural environment in Toronto, right? Could you comment on this at all? Yeah, yeah.
Dr. Jeremy Sharp (1:09:24)
soon.
Erin Eadie (1:09:36)
In Toronto it is certainly, yeah. Yeah,
I mean, I think there is this like cultural humility, right? That we really need to integrate kind of into how we’re approaching our work. And when I listened to what you’re saying there, John, this sort of role that I think you feel you have and that many of us can.
can possibly take on of kind of shining the light in a particular direction, right? But not necessarily assuming we’re the experts on experiences that we have not ourselves had or been subjected to in our own experiences that we can be curious and open and understanding and learn how to ask the right questions and learn how to kind of empower and facilitate the people who do know more than us.
but not to also kind of stand back and ignore the issue entirely, right? Yeah, exactly. Like the part of having kind of the privilege and the influence to be able to direct attention or direct light in a particular way. So I really like the direction that this is going in terms of just…
John Briere (1:10:28)
have to take responsibility.
Erin Eadie (1:10:47)
bringing, being able to measure in some way, even though it’s never gonna be perfect and it’s not perfect, right? Like what might be the component in a research study or in a clinical assessment of different forms of social oppression. And so, yeah, so to what John had mentioned, just so to be more specific of where people can find things in our book itself, there’s two measures at the end of the book that are just printed in the book. And I think they both…
Dr. Jeremy Sharp (1:11:05)
Mm-hmm.
Erin Eadie (1:11:13)
can be found elsewhere online. One is, let me give you the actual title, because I have it right here. It’s quite short. It’s John’s measure that he was talking about doing research called the social discrimination and maltreatment scale. And he’s actually researched it to the extent that it’s shortened to just six items that each have three components to them. And so that’s a really useful.
very short measure to just be able to kind of gather a bit more information about like, has this experience happened to you because of your sex, because of your race, because of your sexual orientation or gender identity? And then the other measure that I think pertains to this as well as other stuff we’ve talked about is quite a comprehensive, it’s called the Broadband Trauma Adversity and Adversity Review. And it covers, you know, lots of classic trauma exposures, you know,
the types of experiences we see in the ACEs measures, but it also kind of gets at a few additional ones that I think John’s mind had gone to in terms of experiences that we don’t often account for, whether that be being unhoused for a period of time or feeling oppressed or persecuted by an authority or a government. That might not be as common for the latter one, but certainly if that’s happened in your life, it’s gonna affect you in particular ways.
and it’s more likely in certain marginalized populations, right? So trying to both capture how these types of things happen to you and then in what ways have they affected you and then seeing maybe there is a specific trauma in the context of that entire landscape that shows up as sort of the like index trauma, we’ll sometimes say, for something like a PTSD diagnosis, but that
Dr. Jeremy Sharp (1:12:50)
Mmm.
Erin Eadie (1:12:53)
Contextual information then does lead us back to that question you asked earlier of how is it that one person, maybe from a number of privileged categories or protected or non-oppressed categories of identity, how is it that they experienced this trauma and did okay with it and this other person from this other background or this other series of experiences really struggle and suffer in the face of that?
and that it’s not a failing of that particular person, but it’s actually more a representation of that cumulative trauma when we start looking at those forms of oppression as types of trauma that can accumulate over time.
Dr. Jeremy Sharp (1:13:30)
Yeah, well said. Well said. I appreciate both of you trying to capture a huge topic in a few minutes and we’ll take that. We’ll take that. know that, I mean, there’s so many things that we could just talk at length about and create many, many episodes on, you know, from our conversation today. But I know I want to be respectful of y’all’s time and just, you know, start to rap and say thanks for coming on and talking with me about all.
these things. I will definitely put the link to the book and any other resources in the show notes so that folks can go check it out. I was lucky enough, you know, to get the coffee and it’s fantastic and highly recommend that folks dig in and get some more detail on these areas. But it was fantastic to chat with y’all. Thank you so much for being here.
John Briere (1:14:17)
Great, wonderful talking to you.
Erin Eadie (1:14:19)
Yeah, thank you very much.
Click here to listen instead!