The Rivendell Inpatient Therapy Program

Trauma Recovery Program

The program’s clinical framework draws on various evidence-based psychological therapies, including Cognitive-Behavioural Therapy (CBT), Acceptance & Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT) and Schema Therapy. It also incorporates the understanding that trauma is to a large degree in the body and that successful trauma therapy needs to include the body and body-focused therapy and approaches.

The program balances, providing knowledge and education to improve understanding (top-down approaches) with various other therapeutic modes aimed to process and connect with the content in a more experiential, practical and body-focused way (bottom-up approach). This includes art and music therapy, as well as body-focused therapies and therapeutic breathwork.

The program follows a four-week rotating therapy cycle, which can be completed in any order, delivered by highly experienced practitioners in their respective discipline.

During your stay you will also have individual sessions with the psychiatrist and a clinical psychologist as well as 24/7 support from trauma informed nursing staff.

Therapy Modalities

ACT - Acceptance and Commitment Therapy

Acceptance & Commitment Therapy (ACT) is based on the principle of accepting what is out of your personal control while committing to taking action to enrich your life and make it more meaningful. It has a specific focus on increasing acceptance of emotions.

ACT is evidence based for a range of conditions, including depression, bipolar disorder, anxiety, adjustment disorder, substance misuse, acute or chronic stress, personality disorders, post-traumatic stress disorder and complex trauma.

The aim of the group is for individuals to learn to handle painful thoughts and feelings in such a way that they have less impact and influence on their life. It also helps to clarify what is truly important and meaningful to them and use that knowledge to guide, inspire and motivate them to set goals and take action that enriches their life.

(For more information about the ACT model please visit https://www.actmindfully.com.au/about-act/).

Breathwork

There are many forms of breath work and the place of breathing techniques in personal growth has rich traditions that goes back centuries in the east.

Breathwork in this context is a gentler variant of the original Holotropic Breathwork developed by Stanislav Grof1, It combines with elements of mindfulness, cognitive behaviour therapy to create an experiential, body-based intervention intended to facilitate emotional expression in a safe way.

1 Grof. S. & Grof, C. (2010). Holotropic Breathwork. State University of New York Press.

There is a growing understanding of the involvement of the body in holding trauma, depression and anxiety. Many therapeutic approaches focus solely on the mind to be treated without consideration that the contents of the mind are embodied.

The breathwork component is an active over-breathing technique done lying down with music that creates physiological changes in the body including increased serotonin and oxytocin. Individuals commonly experience strong expression of emotion during this process, with high levels of serotonin and oxytocin present, it is experienced with a sense of safety and wellbeing.

The stages of breathwork can be summarised as follows –

Intention setting

In this first stage the individual shares their experience and their intention for the process, usually in a group setting. This has both cognitive and behavioural benefits.

The process allows for clarification of experience and intent in a dialogue with the facilitator and allows opportunity for psychoeducation. For example, an individual might say ‘I want to be free of anxiety’ which can then allow a discussion about avoidance and exposure and clarify an intention ‘to encounter my fear.’

There is also a behavioural exposure benefit in sharing in a group setting and often this is the first time the person has spoken openly about their painful emotions or vulnerabilities in front of others.

Breathwork component

This typically lasts about 60 minutes. The individual is guided through regular breathing to build coherent heart rate variability and increase parasympathetic arousal. The person is then guided to breathe more deeply as music builds, which causes a safe level of respiratory alkalosis. When charging music stops and breathing is allowed to slow the individual typically experiences a sense of wellbeing and emotional release.

In this stage the individual is instructed to observe their experience with mindful awareness and curiosity. Relaxing music allows for safe recovery and grounding.

The process is fully supervised and supported for participants by a certified and experienced practitioner.

Sharing

The third stage of the process encourages individuals to share their experience, often in a dialogue with the facilitator in a group setting and allows for assimilation of the experience and reconsolidation of the memory with the addition of the positive experience. Again, the sharing dialogue allows for education and re-framing, and has cognitive and behavioural benefits.

DBT - Dialectical Behavioural Therapy

Dialectical Behavioural Therapy (DBT) is a skills training group based on a dialectical and biosocial theory of psychological disorder that emphasizes the role of difficulties in regulating emotions, both under and over control, and behaviour. The group program provides skills required to manage and regulate emotions. The overall goal of DBT skills training is to help individuals’ change behavioural, emotional, thinking, and interpersonal patterns associated with problems in living.

DBT is evidence-based for a range of conditions including depression, bipolar disorder, anxiety, adjustment disorder, substance misuse, acute or chronic stress, and personality disorders and Post Traumatic Stress Disorder.

The program introduces participants to four groups of skills:

● Mindfulness- The ability to be aware and reflect on your thoughts, emotions and behaviours without getting caught up in them.

● Distress Tolerance- Managing intense emotions and painful realities in skilful ways.

● Interpersonal Effectiveness- Communicating your needs to others, supporting yourself through difficult conversations and maintaining boundaries.

● Emotion Regulation- Understanding the reasons for emotion and learning the ways to shape and change them

ART - Art Therapy

Art therapy is an explorative journey using art as a medium of expression and discovery. We use the materials and processes as guides into the deeper aspects of ourselves. We create, we share, we explore connection and therapeutic community together.

We use a wide range of art mediums to inform your work, including, paint, printmaking, drawing materials and sculptural elements.

Art Therapy is an evidence-based therapy for a range of non-psychotic mental health disorders.

Art Therapy provides a wonderful way to connect deeper with our emotions and ourselves. Within the safety of the group and aims to open up possibilities for reconnecting with ourselves, with nature, our own true nature and of course with each other.

EMDR - Eye Movement Desensitisation and Reprocessing

EMDR is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.

More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognised as an effective form of treatment for trauma and other disturbing experiences by organisations such as the American Psychiatric Association, the World Health Organisation and the Department of Defence. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 33 years.