2-Day: Healing from Toxic Relationships: Help Your Clients Recover from Gaslighting, Narcissism, and Emotional Abuse

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All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Speaker

Stephanie Sarkis, PhD, NCC, DCMHS, LMHC Related seminars and products

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Stephanie Moulton Sarkis, PhD, NCC, DCMHS, LMHC, is a psychotherapist specializing in anxiety, gaslighting, narcissistic abuse, and ADHD. She is the author of eight books and two workbooks, including Healing from Toxic Relationships and Gaslighting. Dr. Sarkis is a national certified counselor, licensed mental health counselor, American Mental Health Counselors Association Diplomate (clinical mental health specialist in child and adolescent counseling), and Florida Supreme Court Certified Family and Circuit Mediator. She has been in private practice for over 20 years. Dr. Sarkis is also a senior contributor for Forbes online and a contributor to Psychology Today. She hosts the Talking Brains podcast and is based in Tampa, Florida. Visit her at www.stephaniesarkis.com.

Speaker Disclosures:
Financial: Dr. Stephanie Moulton Sarkis maintains a private practice. She serves as a contributor to Forbes, The Huffington Post, and Psychology Today and is an advisory panel member for Evergreen Certifications. Dr. Sarkis is a facilitator for Collaborative Divorce. She receives royalties as a published author. She receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Stephanie Moulton Sarkis is a professional expert for Understood.org, part of the National Center for Learning Disabilities. She is a member of the Attention Deficit Disorder Association, American Mental Health Counselors Association, Children and Adults with Attention Deficit Disorder, and the National Board for Certified Counselors.

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Objectives

1. Employ evidence-based practice from trauma-informed therapy, dialectical behavior therapy, solution-focused therapy, acceptance and commitment therapy, and cognitive-behavioral therapy to assist clients in rebuilding their lives.
2. Assess suicidality effectively and treat it through integrative psychodynamic psychotherapy and dialectical behavior therapy.  
3. Determine a diagnosis of complex PTSD through trauma-informed interviewing skills. 
4. Evaluate the research-based benefits of altruism through volunteering in increasing self-esteem and self-efficacy.
5. Analyze how parental alienation further traumatizes clients and their children.
6. Build 10 tools to help clients reestablish healthy boundaries via research-based activities.
7. Utilize clinical strategies to uncover and heal client’s family-of-origin trauma.
8. Minimize symptoms of post-traumatic stress disorder through trauma-informed therapeutic techniques.
9. Prescribe individualized therapeutic care to improve client engagement when discussing experience of abuse.
10. Determine level of family-of-origin pathology in order to inform choice of treatment interventions.
11. Demonstrate knowledge of vicarious trauma for purposes of reducing clinician burnout.
12. Diagnose complex post-traumatic stress disorder in a clinical setting.

Outline

Neurochemical Cycle of Abuse: Every Day is a Recovery

• Harder to leave when trauma bonding has occurred
• Abuse = cortisol levels and adrenaline increases
• Reconciliation = dopamine and oxytocin increase
• Client’s brain can get addicted to this cycle
• Withdrawal and/or reframing grief after the relationship (i.e., drug withdrawal)

Phases of Toxic Relationships – Cycle of Abuse

• Attachment Style – Predictor of abuse vulnerability
• Idealizing - Relationship begins - seems too good to be true, pressured commitment
• Devaluing - Toxic person starts emotional abuse, eventually ramps up into physical abuse
• Discarding - Client discovers toxic person’s infidelity, “financial cheating” or toxic person leaves

Results of Toxic Relationships

• Complicated grief
• Questioning what was “real” in the Relationship
• Complex PTSD
• Dissociative episodes
• Brief psychotic episode
• Dissociative identity disorder
• Suicidality
• Case study: Sarah, a 52-year-old female who is experiencing complex grief as a result of an abusive family of origin and abusive relationship

Returning to the Toxic Relationship

• Leave toxic relationships at least three times before they leave for good or are killed
• Abusers “hoover” victims to get their “narcissistic supply”
• Therapists may start “fixing” rather than supporting client – codependent behavior

Solution-Focused Therapy to Relearn Self-Care

• Creating future plans
• Emotional and physical safety
• ADL’s – in extreme cases
• Reconnecting with healthcare (infidelity, etc)
• Seeking injunction – restraining order
• Reframing self-care as a necessity rather than a luxury
• Case study: James, a 53-year-old male relearning basic life skills that were lost as a result of severe abuse and depression

Trauma-Informed Therapy to Break Free from Codependence

• Multicultural therapy’s view that codependence is a culture-bound term
• Multi-cultural implication – divorce, religious, traditional gender roles/abuse
• Determining clients “secondary gain” from codependent behavior

Toxic Family of Origin

• Abuse can be intergenerational
• Family of origin substance abuse
• “Splitting” - golden child and a scapegoat child
• Siblings may maintain dysfunctional roles into adulthood
• Using genograms to identify client’s familial behavior patterns
• Transgenerational family therapy
• Caregiving and elderly toxic parents

Existential Therapy Tools to Manage Suicidality

• Best way to assess for suicidality according to research
• Myths about suicidal behavior
• Hidden signs of suicidality
• Evidence-based treatment of suicidality resulting from abuse
• Case study: Emma, a 17-year-old who has ended an abusive relationship

Coparenting with a Toxic Personality

• Parental alienation
• Using detailed parenting plan
• Resources available - parent coordinator, family law attorney (some do pro bono work)
• Communicate via a coparenting app
• Case study: Ian, a 48-year-old who is learning how to coparent with their ex-partner who has been diagnosed with narcissistic personality disorder.

DBT & Grief Therapy Techniques to Redefine Closure

• Toxic person will not give closure
• Toxic people keep exes and friends “in rotation”
• Helping clients find their own closure
• Forgiveness is not necessary for closure
• Dangers of pushing an agenda of forgiveness on clients
• Sometimes closure is not possible
• Clients can have fulfilling lives without closure or forgiveness

Reconnecting with Trusted Friends and Family

• Reassessing emotional health of client’s loved ones
• Client’s level of disclosure about the abuse to friends and family – how much is too much
• Case study: Jimmy, a 28-year-old male reconnecting with family after going no-contact with his mother

ACT & Trauma-Focused Techniques to Help Client Forgive Themselves

• Forgiving can be a continual process
• Empty chair and writing techniques
• CBT – changing inner dialogue (to non-violent communication)
• Altruism as pathway to healing volunteerism – increase self-esteem and self-concept

The Power of Language in Session

• When to refer to a relationship as “abusive”
• Go at same pace of your client
• Ask client what words they prefer
• Some words can be triggers
• Case Study: Sheila, a 38-year-old mother of two who feels she is the cause of the difficulties in her marriage

Trauma-Informed and Solution Focused Therapy - Prepare for Life After a Toxic Relationship

• Helping clients identify signs of a healthy person
• Addressing client’s concerns about a healthy relationship feeling “boring”
• Addiction to the excitement of a toxic relationship
• Reviewing client’s progress

TIPS for Therapists

• Attend regular therapy sessions and clinical supervision
• Beware of client’s experiences triggering your trauma
• Expect to be contacted by abuser
• You may be involved in litigation
• Protecting yourself and your practice
• Look for signs of burnout
• Practice proactive self-care

Target Audience

• Addiction Counselors
• Counselors
• Marriage and Family Therapists
• Physicians
• Psychologists
• Social Workers